What is trauma-informed care? And what would that mean in the context of a community that has experienced a traumatic event?
Two weeks ago, NYU’s Silver School of Social Work held a one day conference on the “Core Principles of Trauma-Informed Care: The Essentials” to address these very questions. This post is the first one of a series that will provide you with some key take-aways from this training.
Below is a brief overview of what trauma and trauma-informed care are, according to Cheryl S. Sharp, MSW, ALWF from the National Council for Behavioral Health.
What Is Trauma?
According to SAMHSA, individual trauma results from an:
- Event, series of events, or set of circumstances that is
- Experienced by an individual as physically and/or emotionally harmful or threatening and that has lasting adverse
- Effects on the individual’s functioning and/or physical, social, emotional, or spiritual well-being.
How Prevalent Is Trauma?
- 61% of men and 51% of women report exposure to at least one lifetime traumatic event
- In public behavioral health settings, 90% of clients have experienced trauma
As Hodas (2005) eloquently states: “We need to presume the clients we serve have a history of traumatic stress and exercise “universal precautions” by creating systems of care that are trauma-informed.“
—> We all need to provide trauma-informed care to ensure the best possible health outcomes.
A trauma-informed approach incorporates:
- Realizing the prevalence of trauma
- Recognizing how it affects all individuals involved with the program, organization or system, including its own workforce
- Resisting re-traumatization
- Responding by putting this knowledge into practice
Core Principles of a Trauma-Informed System of Care:
- Safety – ensuring physical and emotional safety
- Trustworthiness – maintaining appropriate boundaries and making tasks clear
- Choice – prioritizing (staff) consumer choice and control (people want choices and options; for people who have had control taken away, having small choices makes a big difference)
- Collaboration – maximizing collaboration
- Empowerment – prioritizing (staff) consumer empowerment and skill-building
7 Domains of Trauma-Informed Care:
- Early screening and comprehensive assessment – If the client isn’t talking, ask: “What’s happened?” (Don’t ask: “What’s wrong with you?”) Not everyone is ready to talk but we give them permission to talk when they are ready.
- Consumer driven care and services – Listen to the people who are coming to us for services. Ask them if you can improve your services. Ask what can we do to help you better?
- Trauma-informed, responsive and educated workforce – Everyone in the system from the receptionist through the doctor matters. Disrespect can be triggering.
- Emerging and evidence-informed best practices – We need to use universal precautions. We need to expect either childhood experience or a current trauma but once we ask what happened, we need to provide EBP assistance.
- Safe and secure environments – It is important for the clinician to make it safe for the client. The organization also needs to make the client feel safe and comfortable (or is the waiting room dingy and dark?).
- Create trauma-informed community partnerships – This is very important to include in our work. Reach out to other organizations such as schools, the juvenile justice system etc. We need to spread this information to our partners in the community.
- Develop a performance monitoring system – Develop a data collection system to demonstrate what are the outcomes that you are seeing.
Moving onto Nelba L. Marquez-Greene, LMFT, she opened this conference on trauma-informed care with a moving keynote presentation. Marquez-Greene embodies the essence of the transformative power of trauma with all the meaningful work she is doing on behalf of trauma survivors since she herself became a trauma survivor.You can listen to her speak in the above video of her TED talk. Briefly, her 6-year old daughter, Ana, was killed during the shooting in the Sandy Hook in December, 2012 and her son survived.
As you listened to her sharing her family’s tragedy and the impact the mass shooting had on her and her community, you could not help but be moved to tears.
While it is true that Marquez-Greene is a mental health professional, the guidance she offered us came from her heart, from her being a trauma survivor.
As Marquez-Greene explains:
- Trauma overwhelms one’s ability to cope
- A trauma survivor is on a continuum from feeling:
Overwhelmed < —————————–> OvercomingWhat Was Most Helpful to Marquez-Greene and Her Family?
- Her parents moved in for 3 months to help care for their son.
- A neighbor brought over her son everyday to play with their son.
- A volunteer social worker assigned to her family to check in everyday, providing practical help.
- Large extended network of college friends banded together to form love and support; they provided a sense of safety, control, community, connection and love in the midst of chaos and loss.
Marquez-Greene’s Suggestions for Mental Health Professionals:
- Educate clients about their bodies’ natural flight, freeze or flight response
- Encourage clients to connect with their friends and family for support
- Be curious without being voyeuristic
- Do not let the story get too big for the client; interrupt client (suggest wiggling toes in shoes or other grounding technique to allow client to self-regulate)
- Offer hope, for ex., “You’re going through the most horrible event in your life but I know you’re going to make it.”
- Try to be available for more than just 50 minutes/per week
- Be helpful with practical needs and still be around six months later
- Help/services are provided/offered for the deceased but nothing is offered for the survivors [living witnesses of the trauma].
The tragedy isn’t only when my daughter died; it’s for my son when my his sister died and his parents fell apart. The statistics for couples who lose a child are very stark.
- Being handed a list of unvetted resources is not helpful. You can’t think straight after trauma and being handed a long list list is too long and/or overwhelming.
Alternatively, receiving a piece of paper with a couple of resources with an explanation as to why you recommend those specific ones would be helpful.
- People think there’s a time limit to grief. You can use their gift certificate for 6 months and/or it is non-transferable.
She would have loved to have been able to honor some of the people who helped her with some of those gifts.
- Some parents did not talk to their children about what had happened to their kids at Sandy Hook school. This mean that they had to come up with a script for their son b/c kids would ask him where is his sister.
It would have been helpful had all parents found a way to speak to their children about what had happened.
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The Memoir You Will Bear Witness is available on Amazon in Kindle and Paperback