Updated: Oct 25, 2018
The National Partnership to End Interpersonal Violence (NPEIV) advocates for the adoption of a trauma-informed approach in all sectors and systems that affect people across the life span. These include schools, colleges, primary health care, hospitals, child welfare, human services, mental health services, civil and family courts as well as the criminal justice system (e.g. law enforcement, prosecutors, courts and adult corrections and juvenile facilities). These systems and sectors need to fully acknowledge the trauma caused by current or past victimization and the impact on the victims and their families so that they can respond in a manner that is fully supportive, whole person-centered and avoids re-traumatization.
Trauma-informed care is a universal-precautions approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives and in the lives of their families and the professionals who work with them. Trauma may result from an event, series of events and/or circumstances that an individual can experience as threatening or as physically or emotionally harmful. Such events can have an adverse effect on an individual’s functioning and physical, emotional and/or spiritual well-being. Although many people who experience trauma will go on with their lives without lasting negative effects, others will have difficulties and experience traumatic stress reactions. There may be a reluctance to trust others including service providers. Worse, systems as currently designed may actually cause or exacerbate trauma.
Trauma-informed care is grounded in an understanding of the neurological, biological, psychological, and social impact of trauma on the person as well as the heavy burden those effects can have on individuals, families, and communities. A trauma-informed approach can be implemented in any type of service setting or organization. It is distinct from trauma-specific interventions or treatments that are designed specifically to address the consequences of trauma and to facilitate healing.
Impact of Trauma
For some people, reactions to a traumatic event are temporary, whereas others have enduring physical and mental health consequences (e.g., complex post-traumatic stress disorder, life functioning issues, biopsychosocial impairment, and medical problems). Others may not meet established criteria for specific disorders but can still experience trauma-related symptoms. In addition, individuals in relationship with the survivor may experience vicarious trauma and/or compassion fatigue. For that reason, even if an individual does not meet diagnostic criteria for trauma-related disorders, it is important to recognize that trauma may affect him or her in significant ways.
A program, organization, or system that is trauma-informed is one that creates a contextual milieu and a culture of delivering care and services to people impacted by trauma in a way that:
Realizes the impacts of trauma and understands potential paths for recovery;
Recognizes the signs and symptoms of trauma and vicarious trauma in clients, families, staff, and others involved with the system;
Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and,
Seeks to actively mitigate re-traumatization and encourage self-care.
A trauma-informed approach reflects adherence to key principles that set forth a methodology and terminology rather than a prescribed set of practices or procedures. These principles can be implemented across all types of settings although terminology and application may be setting or sector specific:
Safety – Ensuring physical and emotional safety, through better communication,
Trustworthiness and Transparency – Making tasks clear, maintaining boundaries,
Choice – Prioritizing consumer choice and control,
Collaboration and Mutuality – Sharing power with consumers, and,
Empowerment -- Skill-building, acknowledging and strengthening resilience.
Culture and Trauma
It is critical to understand that the way in which people perceive or react to trauma can be influenced by their culture (e.g. gender, age, ability, ethnicity, race, religion, sexual orientation, geographical location, socio-economic status, family group, immigration status) or the historic, systemic or intergenerational transmission of trauma as well as the intersectionality of these factors.
Rates of traumatic stress are disproportionately high among diverse and vulnerable populations and cultures.
Some traumas may have greater impact on particular populations because those traumas represent a significant disruption to their cultural practices or ways of life.
Culture can influence which events are perceived as traumatic, how an individual interprets and assigns meaning to the trauma.
Culture influences how people convey traumatic stress through behavior, emotions, and thinking. It can also provide a source of strength, unique coping strategies, and specific resources.
Studies have revealed trauma-informed service settings have better outcomes including a demonstrated improvement in daily functioning and a decrease in trauma reaction, substance use, and mental health symptoms. Trauma-informed services for children lead to higher self-esteem, improved relationships and increased safety.
Trauma-informed services may have a positive effect on housing stability and can lead to decreased utilization of crisis-based services.
Trauma-informed, integrated services are cost-effective; providing improved outcomes without substantial increases in costs.
Providers report positive outcomes in their organizations, noting more collaboration within and outside their agencies, improved staff morale, fewer negative events, and more effective services.
Consumers respond well to trauma-informed services reporting an increased sense of safety, better collaboration with staff, and allowing them a more significant “voice.”