What is Trauma-Informed Care?

by M.A. Marino, LMHC
Director of Personalized Recovery Oriented Services for people engaged in rehabilitation (PROSper)

We live in an unforgiving world. It’s no secret that acts of unkindness stretch the bounds of the human psyche, often resulting in traumatic stress for those who have experienced emotionally taxing or traumatic situations, and for those providing care.

Mental health practitioners may not be able to change the world in a day; however, they can empower themselves to change the way trauma is viewed and the impact it has on those overcoming traumatic experiences.

Traumatic experiences come in many forms. Emotional, physical, or sexual abuse; domestic violence; traumatic grief or loss; and threats to one’s safety are a few examples. Witnessing an event as it occurs to others, learning about devastating events, or exposure to extreme situations can also fall into the classification of traumatic events. The impact and effects of trauma can be pervasive and long-lasting, while remaining specific to the individual’s unique experience. Effects from exposure to traumatic events can include recurrent or intrusive memories that cause one to re-experience the event as if it’s happening again, sleep disturbances, mood dysregulation, anxiety, memory problems, negative thought patterns, jumpiness, and irritability, to name a few. Symptoms of traumatic stress fluctuate along a vast spectrum and impact either one’s entire life, or certain parts. For example, someone who experiences sexual trauma may have difficulty forming intimate relationships, or a first responder who experienced the fallout from a terror attack may struggle with on-the-job work performance. When working with traumatized individuals, awareness is the first step to treatment.

In addition, the impact of trauma can manifest differently dependent upon on various factors, including but not limited to, one’s age at the time of event, one’s sexual orientation or LGBTQ+ communities, the duration of the traumatic event—was it a one-time event or long-lasting, and was support provided following the event.

Trauma-Informed Care involves recognizing that people experience innumerable types of trauma in their lives, understanding its impact, and responding to its effects. When someone who has experienced trauma enters counseling, safety is at the forefront of treatment for both consumers and providers. A trauma-informed environment promotes physical, psychological, and emotional safety so that survivors can rebuild a sense of empowerment and control over their lives.

It is often asked, “What does a trauma-informed environment look like?” Trauma-informed care begins with an initial assessment of trauma, asking the right questions, and transforming the first experience of treatment for consumers. It begins by crafting a culture that asks, “What happened to you?” rather than assuming a stance of, “What’s wrong with you?” Understanding and acceptance are vital to healing.

When providers recognize that traumatic events make people feel powerless and unsafe in their day-to-day endeavors, a partnership can be formed and individuals can begin to work toward recovery.

A trauma-informed program seeks to create an environment where both clients and staff feel safe and empowered. Providers focus on creating a safe place, helping to regulate emotions, and building coping and self-management skills—all steps that can lead to a positive and effective therapeutic relationship.

The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) identifies six core principles of trauma-informed care: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment/voice and choice, and cultural/historical/gender issues. When working with someone recovering from trauma, all of these principles need to be considered.

So how can practioners best assist those who have experienced trauma?

  • Understand the impact of the trauma. Survivors often heal in the context of relationships experienced during their recovery. This begins from the very first contact with treatment.
  • Develop an understanding that symptoms and behavioral expressions are a survivor’s way of adapting to a world that has been unforgiving and unsafe. Meeting situations with compassion and empathy can change their experience.
  • Create a physical environment that accommodates an array of tastes and needs. Staff can create safe spaces that meet the needs of individuals (i.e. preferences for a quiet space, an open area to move freely, a tidy and visually appealing environment, inclusion of creativity/multimedia practices to reach all types of consumers).
  • Promote a supportive work environment for fellow care providers that endorses self-care, which in turn can reinforce the healing relationship between providers and clients. Recognize that staff’s own trauma responses can impact the relationship with clients and coworkers. Incorporate staff support and self-care practices for caregivers to help mitigate exposure to critical incidents and stories.

Trauma-informed care remains the forerunner of a positive therapeutic practice. With an open and educated mind, crafting services geared toward individuals who have experienced traumatic events creates an inclusive environment that fosters healing and recovery. In turn, clients become empowered to end their cycle of suffering, recognize their worthiness, and begin taking steps to re-engage in affirmative experiences ahead.