Trauma-Informed Engagement, Part 1: Understanding Trauma
By Carolyn Shimmin
In previous blog posts we’ve discussed the importance of incorporating a trauma-informed intersectional analysis in public and patient engagement in health research. In the next few posts, we’re going to delve deeper into what the practice of trauma-informed engagement might look like. Typically, trauma-informed practice has four main principles: 1) trauma awareness; 2) emphasis on safety and trustworthiness; 3) opportunity for choice, collaboration, and connection; and 4) strengths-based approaches and skills building. In this post we begin to look at the first principle, trauma awareness.
Trauma Awareness
Trauma is defined as one or more experiences that overwhelm an individual’s capacity to cope. Trauma is a widespread, harmful and costly public health issue. Yet oftentimes, in the development of a public and patient engagement strategy, health researchers overlook the fact that the experiential knowledge being sought out to inform research decisions may also be intertwined with experiences of trauma. Evidence shows that many patients in primary care settings have significant trauma histories, which can have an impact on (a) their physical and mental health; (b) their responsiveness to health interventions; and (c) their ability to access appropriate healthcare services (and hence even identify as a “patient”). Therefore, it is important to make sure that any engagement practice and approach is trauma-informed from the very beginning (i.e. from identifying who to involve and choosing the right participatory approach).
Trauma-informed practice begins with building awareness among health researchers and public and patient partners about the following:
- Trauma is a common experience;
- The impact of trauma can be central to one’s development;
- There is a wide range of adaptations people make in order to cope with and survive trauma; and
- There is a relationship between trauma and substance use, as well as mental and physical health concerns.
What is Trauma?
First and foremost, it’s important for health researchers who want to do active and meaningful public and patient engagement to understand what trauma is and why it is important to be aware. Trauma can be experienced early in life, including child abuse (i.e. physical, emotional, psychological and sexual), neglect, witnessing violence, and disrupted attachment. Trauma can also occur later in life through experiences such as violence, accidents, natural disasters, war, sudden unexpected loss, and other life events that are out of ones’ control.
The intricacies cannot be overstated and there are a myriad of dimensions to trauma ― including its magnitude, complexity, frequency, duration, at what age trauma occurs, and whether it happens from an interpersonal or external source. There are five types of trauma:
Single incident trauma
This is when an unexpected and overwhelming event occurs such as an accident, natural disaster, a single episode of abuse or assault, sudden loss, or witnessing violence. For example, when thinking about health care, evidence shows that women who experience a pregnancy loss may struggle with profound trauma responses.
Complex or repetitive trauma
This is when abuse is ongoing, such as domestic violence, war, or ongoing betrayal, and it often involves feeling trapped both emotionally and physically. For example, when thinking of health care, recent evidence shows that survivors of cancer can experience post-traumatic stress disorder (PTSD).
Developmental trauma
This results from exposure to early ongoing or repetitive trauma (as infants, children and youth) such as neglect, abandonment, physical, sexual or emotional abuse or assault, witnessing violence or death, and/or coercion or betrayal. These types of trauma often occur within a child’s caregiving sphere and interfere with healthy attachment and development.
Intergenerational trauma
This describes the psychological or emotional effects that can be experienced by people who live with trauma survivors. What is often seen as coping and adaptation patterns developed in response to trauma (including alcohol and substance use) can be passed from one generation to the next.
Historical trauma
This is the cumulative emotional and psychological wounding over a lifetime and across generations, emanating from massive group trauma. These collective traumas are inflicted by oppressive and dominant systems of power. Examples of historical trauma include genocide, colonialism, slavery, and war. In Canada, it is important for trauma-informed engagement to include an examination of the role of colonization, both past and present, in violence against Indigenous peoples. This includes consideration of the legacy of the residential schooling system. From the 1800s until 1996, approximately 150,000 First Nation, Inuit and Metis children were removed from their families and communities by the government and forced to attend residential schools, where they were subjected to physical, spiritual, emotional, psychological and sexual abuse. Additionally, the 60s scoop (from 1960–1980) involved thousands of Indigenous children being taken from their families, often without their parent’s knowledge or consent, and fostered or adopted out to primarily white, middle-class families within Canada, the USA, and Western Europe via the child welfare system.
Adding a trauma-informed approach would also mean recognizing that the over-representation of Indigenous children in the child welfare system is not a remnant of the past, but rather a fact that remains an urgent and ongoing challenge facing Indigenous communities across Canada. It is important to note that intergenerational trauma is an aspect of historical trauma.
There also needs to be an understanding that healthcare systems that are intended to provide services and supports to individuals may themselves be trauma-inducing. For example, the use of coercive practices, such as seclusion or restraints in the behavioural health system, or the use of invasive procedures in the medical health system, can be re-traumatizing to individuals who may have already experienced significant histories of trauma before entering the system.
Continue Reading: Part 2: The Effects of Trauma
Need Help?
- Please refer to the Canadian Association for Suicide Prevention’s list of crisis centres across Canada.
- First Nations and Inuit Hope for Wellness Help Line: 1–855–242–3310. It is toll-free and open 24 hours a day, 7 days a week.
About the Author
Carolyn Shimmin (@CarolynShimmin) is the Public and Patient Engagement Lead at the George & Fay Yee Centre for Healthcare Innovation (CHI). Her experience includes stakeholder engagement, research, writing and reporting on various health policy issues including mental health, addictions, trauma and the sexual exploitation of children and youth. Areas of interest include patient engagement, lived experience research, knowledge translation, trauma-informed approaches, intersectional analysis, and post-structuralist queer theory.
