Trauma
Informed
Care
By Navjeet Lehal
In-Service Presentation
Definition of Trauma
The Substance Abuse and Mental Health Services
Administration (SAMHSA) defines individual trauma
as: “Individual trauma results from an event, series
of events, or set of circumstances that is
experienced by an individual as physically or
emotionally harmful or threatening and that has
lasting adverse effects on the individual’s
functioning and physical, social, emotional, or
spiritual well-being.” (SAMHSA)
Examples: Adverse Childhood Experiences (ACEs),
PTSD, abuse, neglect, violence, etc.
(SAMHSA, 2024)
Adverse Childhood Experiences (ACEs)
ACE Study (1995-1997) highlighted the high prevalence of
several types of trauma occurring during childhood (ACES)
including childhood emotional, sexual, and physical abuse,
neglect, and family dysfunction
Predominantly white middle class study pop. 63.9%
experienced at least 1 ACE category, 12.5% experienced 4 or
more
Devastating health effects and adverse social outcomes
associated with ACEs
Fortunately, protective factors like supportive relationships
and resilience factors can mitigate the behavioral and
health outcomes of ACEs
Always available adult (AAA) can mitigate impacts of
childhood adversity
Vicarious trauma can affect anyone who deals with (Kimberg & Wheeler, 2019)
trauma
Prevalence
Three quarters (74.9%) of Australian men and women
had experienced at least one PTE (potentially
traumatic event)
Men and women were equally likely to have
experienced a PTE (76% versus 73.8%).
The most commonly experienced event among men
was having seen someone being badly injured or killed,
or having unexpectedly seen a dead body (36.7%).
Among women, the most commonly experienced
event was having had someone close die
unexpectedly (35.4%)
(Mills et al., 2011)
Impact of Trauma
Numbing is a biological process whereby
emotions are detached from thoughts,
behaviors, and memories.
Some trauma survivors have difficulty
regulating emotions such as anger,
anxiety, sadness, and shame—this is more
so when the trauma occurred at a young
age
Common physical disorders and
symptoms include sleep disturbances;
gastrointestinal, cardiovascular,
neurological, musculoskeletal, respiratory,
and dermatological disorders; and
substance use disorders
(Center for Substance Abuse
Treatment (US), 2014)
(Kimberg & Wheeler, 2019)
What is Trauma Informed Care?
Trauma-informed care shifts the 6 Principles
focus from “What’s wrong with Safety
you?” to “What happened to you?” Trustworthiness/
Seeks to: Transparency
Realize the widespread impact Peer support
of trauma and understand Collaboration
paths for recovery Empowerment
Recognize the signs and Humility/
symptoms of trauma in Responsiveness
patients, families, and staff
Integrate knowledge about
trauma into policies,
procedures, and practices
Actively avoid re-traumatization.
(Texas Health and Human Services, 2024)
Safety
People are at their best and most productive when they feel
emotionally and physically safe.
Physical safety — or the sense of your body not being
threatened in any way — must be established first. We can
only form healthy attachment or connection when physical
safety is present.
Psychological safety means being able to express yourself
and be genuine without the threat of humiliation or
judgment.
Trustworthiness/Transparency
A clear, consistent and predictable environment
creates stability and builds trust.
• Acknowledge that they don’t have answers to all
questions but will find the answers they know in a
timely manner.
• Provide appropriate, timely, consistent and
reliable service, and ask about any urgent needs.
• Remain accountable and responsible in
interactions and maintain confidentiality as is
legally and ethically appropriate.
• Individualize interactions and services based on
the needs of each person.
Peer support
Peer support builds healing relationships, providing
individuals the opportunity to process and learn from their
own lived experiences and the experiences of others.
• Work with others to develop and honor community
agreements or rules for participants to safely engage in
peer support.
• Actively listen without judgment and remaining curious
about the content, emotion, subtext, culturally specific
meaning, and emerging themes.
Collaboration
Collaboration is creating an environment of “doing
with” someone rather than “doing to or for”
someone.
• Making decisions with colleagues related to day-
to-day activities.
• Engaging in advocacy on behalf of those served,
when appropriate.
Empowerment
Empowerment means:
-Recognizing and building on individual strengths and skills.
Coaching individuals or families to identify strengths,
coping resources, and protective factors and creating
goals around those protective factors.
Providing space for others to express thoughts, emotions
and opinions, and confirming that they have been heard.
Humility/Responsiveness
Enables individuals and organizations to respond
respectfully and effectively to people of all backgrounds in a
manner that recognizes, affirms and values their worth. It
involves critical self-reflection, lifelong learning and growth,
a commitment to recognizing and sharing power, and a
desire to work toward institutional accountability.
• Invite or encourage those with lived experience to lead
conversations on challenging topics if they feel comfortable
doing so, and use person-first language (unless directed
otherwise by the individual).
• Ask open-ended questions to better understand how
impactful experiences are interpreted by individuals from
different cultural groups
Trauma-Informed Approaches in Practice
Avoiding re-traumatization
Active listening and validation
Creating safe spaces and supportive environments
Physical
Making sure clients have a clear path to the
exit
Monitor who is coming in and out of the
building
Social-Emotional
Make clients feel respected and supported
Communication that is open, respectful, and
compassionate
Involve client in the treatment process
Screen for trauma
Upfront vs. later screening (Menschner & Maul, 2016)
Thank You! Trauma informed
care hopes to acknowledge
people’s pasts and be mindful
of it now!
References
Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health
Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014.
(Treatment Improvement Protocol (TIP) Series, No. 57.) https://www-ncbi-nlm-nih-
gov.proxy.pnwu.org/books/NBK207201/
Kimberg, L., & Wheeler, M. (2019). Trauma and trauma-informed care. Trauma-informed
healthcare approaches: A guide for primary care, 25-56. https://
doi.org/10.1007/978-3-030-04342-1_2
Menschner, C., & Maul, A. (2016). Key ingredients for successful trauma-informed care
implementation [Issue brief]. Center for Health Care Strategies; Robert Wood Johnson
Foundation. https://www.fredla.org/wp-content/uploads/2016/04/Trauma-informed-care-
implementation-1.pdf
References
Mills, K. L., McFarlane, A. C., Slade, T., Creamer, M., Silove, D., Teesson, M., & Bryant, R. (2011). Assessing the
prevalence of trauma exposure in epidemiological surveys. The Australian and New Zealand journal
of psychiatry, 45(5), 407–415. https://doi-org.proxy.pnwu.org/10.3109/00048674.2010.543654
National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC).
Substance Abuse and Mental Health Services Administration. About NCTIC 2017, September
15 (Updated). Accessed 30 June 2018. Available from: https://www.samhsa.gov/nctic.
SAMHSA. (2024, November 8). Trauma and violence. https://www.samhsa.gov/mental-health/
trauma-violence
Texas Health and Human Services. (2024). The six principles of trauma-informed care. https://
www.hhs.texas.gov/sites/default/files/documents/six-principles-trauma-informed-care.pdf
