Unpacking Trauma-Informed Care: What Does it Really Mean?
The term 'trauma-informed' has gained widespread attention, reflecting a heightened awareness of trauma and a shift towards more compassionate and empathetic practices across various fields. However, as the term becomes more prevalent, its meaning and scope can sometimes become ambiguous. This essay aims to clarify the concept of 'trauma-informed' by exploring its definition, principles, and practical applications.
A Trauma-Informed Approach
Trauma-informed principles focus on creating a safe and supportive environment by recognizing and addressing the impact of trauma. These principles prioritize safety, trustworthiness, empowerment, and collaboration, while also stressing the importance of sensitivity to cultural and historical contexts. Additionally, they focus on actively avoiding re-traumatizing practices. By integrating these principles, individuals and organizations can cultivate environments that more effectively promote well-being.
The Substance Abuse and Mental Health Services Administration defined a trauma-informed approach (SAMHSA, 2014) with the four Rs:
Realize: Understanding the widespread impact of trauma on individuals.
Recognize: Identifying signs and symptoms of trauma in individuals.
Respond: Integrating trauma-informed practices into interactions and services.
Resist Re-traumatization: Avoiding actions or practices that might cause further trauma.
Trauma-informed Scope
Sometimes individuals mistakenly believe that trauma-informed practices are synonymous with trauma treatment, so it’s crucial to differentiate between the two. Trauma-informed practices focus creating an environment that supports individuals and prevents re-traumatization, whereas trauma treatment involves therapeutic interventions provided by licensed professionals. Just as a business might install wheelchair ramps to support those with physical disabilities without offering medical treatment for those disabilities, businesses can implement trauma-informed practices to support individuals with trauma without providing direct therapeutic services.
Trauma-Informed, Trauma-Sensitive, and Trauma-Informed Care
The term “trauma-informed” is sometimes accompanied by other related terms such as “trauma-sensitive,” “trauma-aware,” “trauma-focused,” and “trauma-responsive.” These terms are sometimes used to describe specific aspects of trauma-informed care while at other times used interchangeably with “trauma-informed.” For instance, "trauma-sensitive" might refer specifically to trauma-informed relational practices while not encompassing broader trauma-informed policies. However, this distinction is typically subtle and not always necessary to highlight.
Trauma-Informed Care, on the other hand, refers explicitly to the application of trauma-informed principles within professions that offer support or care, such as healthcare and education. This term emphasizes creating environments where clients, students, or patients receive support that acknowledges their trauma without exacerbating it. Like “trauma-sensitive,” the term “trauma-informed care” is generally used within contexts like healthcare and education, focusing primarily on practical, relational practices rather than broader organizational policies.
Personal and Professional Relevance
A trauma-informed approach holds significant value in both personal and professional contexts. On a personal level, applying trauma-informed principles to relationships with friends, partners, and family can greatly enhance these connections, as trauma often plays a role in the challenges that arise within them. Professionally, integrating a trauma-informed approach within a business can improve dynamics with coworkers, customers, and clients across various fields.
This integration varies depending on the profession and can be understood along two axes: internal/external and policy/practice. The internal/external axis pertains to whether the approach is applied within the workplace setting (internal) or in interactions with clients and customers (external). The policy/practice axis distinguishes between the application of trauma-informed principles to a business’s abstract policies or its concrete practices. For example, a business with multiple employees would have an internal component with policies, whereas a sole proprietor working independently might lack both. The primary aspect that differs most across professions is the focus on external practices, such as engagements with customers and clients.
In professions like healthcare, mental health, social services, and education, where trauma is highly relevant to the care or support services provided and employees work with coworkers, there is often high integration of trauma-informed principles both internally and externally, encompassing both policies and practices. For example, healthcare policies might integrate mental health screenings into routine care, while practices could involve training staff in trauma-sensitive communication and recognizing trauma symptoms to improve patient interactions. In education, policies might mandate respectful communication about procedural changes, while practices could include training educators to interact with students sensitively, ensuring that classroom environments do not inadvertently re-traumatize them.
In professions such as retail or customer service, where trauma is not directly related to the service provided, employees still work with coworkers, and there are frequent face-to-face interactions with customers, internal integration would focus on the workplace setting, while external integration would be less intensive and centered on customer interactions.
In fields like administration, IT, manufacturing, or agriculture, where there is no external-facing component, the integration of trauma-informed principles would be entirely focused on internal policies and practices.
Distinguishing Trauma-Informed from the Norm
Identifying whether a business is genuinely trauma-informed can be challenging, but comparing its practices and policies to those of a trauma-aware organization can be revealing. In healthcare, for example, a non-trauma-informed approach might manifest in staff interactions that lack essential relational skills, such as showing empathy or actively listening to patients' concerns. This can exacerbate feelings of distress or powerlessness among patients. On the other hand, a trauma-informed healthcare provider would prioritize strong relational skills, ensuring compassionate communication, validating patient experiences, and fostering a supportive environment that respects the emotional needs of patients.
In education, a non-trauma-informed school might view a student who is acting out or another who is disengaged as displaying random, poor behavior that needs correction. However, in a trauma-informed classroom, teachers would recognize that these behaviors might be adaptive strategies for coping with success—a success the student may feel unworthy of due to early childhood trauma. Teachers might even anticipate these behaviors following significant successes, thereby removing the perception that they are random occurrences. This approach isn’t about being lenient because of a student's difficult family background; rather, it’s about genuinely understanding why these behaviors exist, acknowledging their adaptive nature, and learning how to respond in a way that avoids re-traumatization, despite the natural tendency to react otherwise.
Trauma-Informed Training
To become trauma-informed, it's essential to have a foundational understanding of trauma's impact—biologically, psychologically, and socially. However, the depth of this understanding varies depending on the professional context. For instance, healthcare providers might need more detailed scientific knowledge than professionals in retail or administration, though both require practical skills. Regardless of the field, effective trauma-informed care demands training that goes beyond theoretical knowledge to include hands-on, practical skills. True trauma-informed care involves consistently applying these skills in daily activities, making experiential learning and practice crucial for effective implementation. A basic level of competence typically requires around 8 to 12 hours of training, with ongoing education and advanced training recommended to further develop understanding and skills.
Conclusion
Trauma-informed care is not just about understanding trauma but also about integrating that understanding into meaningful practices and interactions. Whether in personal relationships, workplace environments, or client-facing roles, applying trauma-informed principles enhances empathy, supports healing, and creates more effective, supportive interactions. For a comprehensive understanding of trauma-informed practices, consider participating in immersive and experiential training that goes beyond factual knowledge to develop practical skills and insights.
References
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.
Author
Dr. Mark Olson holds an M.A. in Education and a Ph.D. in Neuroscience from the University of Illinois, specializing in Cognitive and Behavioral Neuropsychology and Neuroanatomy. His research focused on memory, attention, eye movements, and aesthetic preferences. Dr. Olson is also a NARM® practitioner, aquatic therapist, and published author on chronic pain and trauma-informed care. He offers a variety of courses at Dr-Olson.com that provide neuroscientific insights into the human experience and relational skill training for professionals and curious laypersons.