Trauma-Informed Practice Matters

Trauma-informed care is an approach that has come to the forefront in recent years. In fact, the National Center for Trauma-Informed Care was only founded in 2005. According to the Ohio Leadership Advisory Council, “as awareness of the many kinds of trauma, and its effects on both the body and the brain developed, trauma-informed care became more widely studied, funded, and folded into the practice of medicine.” The initial event that spurned the implementation of trauma-informed care was made by medical and mental health practitioners working with Vietnam War veterans in the 1970s. Although strides have been made over the last two decades to provide more empathetic and understanding care, it is evident that there is still room for growth in this area. Societal crises such as substance use, violence, severe mental illness, housing instability, poverty, and more could be decreased with proper trauma-informed care.

While all trauma may not be the same, trauma impacts us all. For some it may be a single event, for others, it could be a series of related events or even unrelated events across our lifespan. Trauma changes us, shapes us, and, sometimes, triggers us.

Trauma-informed care approaches shift the question from “what’s wrong with you?” to “what happened to you?”

In working with survivors of sexual trauma, trauma-informed care can make or break a person’s healing. This type of care extends far beyond medical and mental health practitioners, which is what often comes to people's minds when they hear “trauma-informed care”.

Law enforcement officers, title IX coordinators at universities, sexual assault advocates, journalists, librarians, and spiritual leaders are all people who may encounter a survivor and, in some cases, they may be the first point of contact for a survivor. How a person works with the survivor could change the survivor’s life — for better or worse.

Imagine we have two survivors, we’ll call them Jayden and River. Here are their stories:

Jayden
They present at the hospital after being sexually assaulted. The medical examiner provides empathetic, compassionate support. They conduct a forensic exam while checking in with the survivor to ensure they’re as comfortable as possible. The nurse believes the survivors’ account of events. The survivor then talks to law enforcement officers, who also affirm their belief in the survivor’s story. They support the survivor's decision to report or not to report and agree to follow up with the survivor in a couple of days to see how they’re doing. Throughout the survivors’ next several months, they’re referred by their primary care physician to helpful resources. The survivor receives counseling, advocacy, and other support. The survivor feels empowered and is able to heal and return to work, their social life, and even a sense of normalcy.

River
They present at the hospital after being sexually assaulted. The medical examiner has not been trained in trauma-informed care nor how to work with survivors during a forensic exam. The survivor feels frightened and triggered by the various tests conducted, but is afraid to speak up. The survivor then meets with law enforcement officers, who question their version of events because the timeline doesn’t “add up”. The survivor meets with law enforcement officers again, who question the survivor about their alcohol use. When they discover the survivor had been drinking, they make them feel as though it is their fault they were assaulted. The survivor self-isolates and grapples with feelings of shame and guilt over their assault. “Maybe it was my fault,” they think. This survivor utilizes dangerous coping mechanisms to deal with the negative impacts of their assault, rather than the healing resources available.

Jayden and River’s vastly different experiences after their assault will lead to different outcomes in both the short and long term. Rape victims are 5.3 times more likely to abuse prescription drugs, 6.4 times more likely to use cocaine, and 10 times more likely to use other hard drugs. And 90% of alcoholic women were sexually or physically abused as children. The risk for substance abuse increases exponentially when a person has experienced sexual trauma and even more so when the healing process does not begin.

Sexual violence is a public health issue.

Sexual violence can happen to anyone, be perpetuated by anyone, and occur in person or online, via technology. Because sexual violence is so prevalent and the impacts so great, it’s vital that those who work with survivors come from a place of understanding and empathy.

Trauma-informed services incorporate knowledge about trauma — prevalence, impact, and recovery — in all aspects of service delivery, minimize re-victimization, and facilitate recovery and empowerment.
- WCSAP, 2012

Trauma-informed approaches are useful when working with any individual, not just those who’ve experienced trauma. The National Center on Family Homelessness (NCOFH) has developed a trauma-informed organization toolkit, which is designed for those working with homeless individuals, but the information transcends to all individuals in need of trauma-informed care. Through extensive research, the NCOFH developed 8 guiding principles for trauma-informed care:

1. Understand trauma and its impact
2. Promoting safety
3. Ensuring cultural competence
4. Supporting consumer control, choice, and autonomy
5. Sharing power and governance
6. Integrating care
7. Healing happens in relationships
8. Recovery is possible

You can read more details on each principle in the toolkit (linked above). It’s essential to keep in mind that the implementation of trauma-informed services may look different depending on your specific role. However, each of us can use a trauma-informed approach in our everyday lives. The WSCAP lists some basic things we can keep in mind:

• A respectful, collaborative approach is more effective than a traditional provider-client relationship.
• Remember that the survivor is the expert on her or his own life and feelings.
• Do not expect instant trust, but do everything in your power to be trustworthy.
• Normalize and validate feelings that come from the trauma experience.
• Ask! Ask the survivor what will help him or her to feel more comfortable and how you can best work with him or her.
• Realize that behaviors that may seem difficult or obstructive have probably served the survivor well in the past. It is hard to give up a behavior that you believe has kept you safe.
• Maintaining appropriate boundaries is always important, but even more so with survivors, as it contributes to a sense of safety.

Resources

There are extensive resources available on the internet from reputable organizations about becoming a trauma-informed provider.

STAR also offers trauma-informed training for those wanting to bring this important resource to their place of business.

One last thing to keep in mind — providing trauma-informed care can be exhausting! Emotionally, mentally, and physically draining at times, working with survivors of trauma is challenging but necessary work. Remember to take care of yourself, recognize signs of burnout and compassion fatigue, and learn what things help you feel refreshed.