Trauma-informed Care

What is Trauma?

Trauma refers to an event that threatens the life or integrity of the individual or a loved one, such as physical abuse, death of a parent, witnessing domestic violence, abandonment, natural disasters, war, community violence, or medical issues. Types of trauma include: single, complex, developmental, historical and intergenerational.

Trauma affects brain development, causing structural and hormonal changes that manifest in adverse physical and mental outcomes. If exposure to stress and trauma is unrelenting, the brain adapts in ways that can make learning and socialization difficult. Persistent exposure to toxic stress during childhood can have serious developmental consequences that may last well past the time of stress exposure. [1]

What is Trauma Informed Care?

At its core, the trauma-informed model replaces the labelling of clients or patients as being “sick,” resistant or uncooperative with that of being affected by an “injury.” Viewing trauma as an injury shifts the conversation from asking “What is wrong with you?” to “What has happened to you?” [2]

Utilizing a trauma-informed approach does not necessarily require disclosure of trauma. Rather, services are provided in ways that recognize the need for physical and emotional safety, as well as choice and control in decisions affecting one’s treatment. Trauma-informed practice is more about the overall essence of the approach, or way of being in the relationship, than a specific treatment strategy or method.

A key aspect of trauma- informed services is to create an environment where service users do not experience further traumatization or re-traumatization (events that reflect earlier experiences of powerlessness and loss of control) and where they can make decisions about their treatment needs at a pace that feels safe to them. [3]

Facts and Stats

• 76% of Canadian adults report some form of trauma exposure in their lifetime, 9.2% meet the criteria for PTSD
• An estimated 50% of all Canadian women and 33% of Canadian men have survived at least one incidence of sexual or physical violence
• Among Canadians with mental health and substance use concerns:
• 90% of women in treatment for alcohol problems at 5 Canadian treatment centres indicated abuse-related trauma as a child or adult; 60% indicated other forms of trauma
• 90% of females and 62% of male youths in co-occurring disorders treatment in one treatment centre endorsed concerns with traumatic distress [4]

Why is it Important?

Psychological trauma is a major public health issue affecting the health of people, families and communities across Canada. Trauma places an enormous burden on every health care and human service system. Trauma is not only a mental health issue, but it also belongs to every health sector, including primary/ physical, mental and spiritual health. Given the enormous influence that trauma has on health outcomes, it is important that every health care and human services provider has a basic understanding of trauma, can recognize the symptoms of trauma, and appreciates the role they play in supporting recovery. Health care, human services and, most importantly, the people who receive these services benefit from trauma- informed approaches. [5]

What Does it Look Like?

Reactions to trauma vary from person to person, from minor disruptions in an individual’s life, to debilitating responses. Across the continuum, people may experience anxiety, terror, shock, shame, emotional numbness, disconnection, intrusive thoughts, helplessness and powerlessness . Trauma responses can interfere with an individual’s sense of safety, self, and self-efficacy, as well as the ability to regulate emotions and navigate relationships.

Physiological adaptations can create an underlying state of dysregulation – difficulty controlling or regulating emotional reactions or behaviours, and/or an imbalance in the body, which often results in hyperarousal and hypervigilance (in which an individual seems to overreact to every situation) or listlessness and dissociation (in which an individual seems numb and disconnected in stressful or dangerous situations). This dysregulation of the brain and body systems perpetuates mental, emotional, and physical distress. [6]

See Trauma-Informed Care in the Mental Health Training Framework document

References

1. Trauma Informed Perspectives and Resources. Understanding the Impact of Trauma.  Retrieved from https://gucchdtacenter.georgetown.edu/TraumaInformedCare/issueBrief1_UnderstandingImpactTrauma.pdf 
2. Klinic Community Health Centre. (2013). The Trauma-Informed Toolkit. Retrieved from https://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf
3.  4. BC Centre of Excellence for Women’s Health. (2013). Trauma Informed Practice Guide. Retrieved from http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf
4.     Klinic Community Health Centre. (2013). The Trauma-Informed Toolkit. Retrieved from https://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf