Trauma informed practice
Article by Dr Cathy Kezelman
Trauma can arise from single or repeated adverse events that threaten to overwhelm a person’s ability to cope. When it is repeated and extreme, occurs over a long time, or is perpetrated in childhood by care-givers it is called complex trauma.
Two thirds of people presenting to mental health services, inpatient and outpatient, have a lived experience of child physical or sexual abuse. Other causes of complex trauma include emotional abuse, neglect, family violence, living with a parent with a mental illness or who abuses substances, war and refugee trauma, separation and loss. In Australia 5 million adults have been affected by childhood trauma.
Many trauma survivors show remarkable resilience. However many are left struggling day to day with their health, wellbeing, emotions, relationships, and sense of self and identity. Complex trauma affects not only its victims but those with whom they are in contact as well as the children they go on to have.
Research has established that trauma is a major public health problem. Yet within current systems it is frequently unrecognised, unacknowledged, and unaddressed. Many of those affected have been inadvertently re-traumatised in systems of care lacking the requisite knowledge and training around the particular sensitivities, vulnerabilities and triggers of trauma survivors.
Trauma Informed Practice is a strengths-based framework which is founded on five core principles – safety, trustworthiness, choice, collaboration and empowerment as well as respect for diversity. Trauma informed services do no harm i.e. they do not re-traumatise or blame victims for their efforts to manage their traumatic reactions, and they embrace a message of hope and optimism that recovery is possible. In trauma informed services trauma survivors are seen as unique individuals who have experienced extremely abnormal situations and have managed as best they could.
Becoming trauma informed necessitates a cultural and philosophical shift across every part of a service and is applicable to all human and health service systems. Trauma informed systems understand the dynamics of traumatic stress, survivors in the context of their lives and the role of coping strategies. They feature safety from harm and re-traumatisation, emphasise strength building and skill acquisition rather than symptom management, and foster true collaboration and power sharing between workers and those seeking help at all service levels.
Studies have shown that programs that utilise a trauma-informed practice model report a decrease in symptoms, an improvement in consumers’ daily functioning, and decreases in the use of hospitalisation and crisis intervention.
Trauma-informed services do not cost more than standard services and report more successful collaboration with all stakeholders, enhanced skills, and a greater sense of self-efficacy among consumers, improved staff morale, fewer negative events, and more effective services and positive outcomes.
We need to embed trauma informed practice within all health and human service systems to provide appropriate trauma-informed services to those needing them. The provision of trauma informed services must also be supported by trauma specific services, which provide specific interventions to address the consequences of trauma.
For more information see ASCA Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery and ASCA’s Workshops.
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Article contributed to the newsletter Perspectives - June 2014. Please note that this article is from an individual contributor and does not necessarily reflect the views of the Mental Health Council of Australia