by Laura Hindley
Trauma-informed support is a healthcare practice that prioritises recognising and responding to the impact of trauma on individuals’ lives. Following this approach involves understanding the complex impact of trauma on the service user and on their ability to trust support providers and feel safe (Muskett, 2014). It also involves integrating that understanding into every aspect of support, working in collaboration with service users to empower them to make choices regarding their wellbeing. In challenging situations, trauma-informed support providers adopt a mindset of "What does this person need?" rather than "What is wrong with this person?", allowing for a comprehensive understanding of their behaviour.
We are committed to implementing a set of key trauma-informed support principles when providing support to our service users:
Safety is a paramount consideration in trauma-informed support, as trauma can profoundly disrupt an individual's sense of feeling safe, often persisting long after the traumatic event has occurred. Establishing an environment of physical, psychological, and emotional safety for both service users and staff members is critical. This is achieved by cultivating trust, maintaining clear boundaries, and promoting collaboration (Herman, 2015).
Trustworthiness and transparency are essential aspects of supporting individuals who have experienced trauma, as they may have endured such trauma from people who were previously entrusted with their care. To establish a solid foundation of trust, it is crucial to exhibit trustworthiness and transparency. This involves effective communication, consistency, and mutual respect. Additionally, having clear, well-informed policies that are readily visible and easily accessible to both service users and staff members further promotes trust and transparency.
Collaboration and mutuality are principles that aim to address power dynamics commonly present in the provision of care services. This principle emphasises treating the service user as an equal and as an expert in their own experiences. It involves actively engaging with the service user, working together to make decisions about their support plans and processes. Encouraging service users to take an active role in the decision-making process empowers them and ensures their perspectives are valued and respected.
Empowerment, voice, and choice are also fundamental elements in trauma-informed support. Trauma survivors often experience a sense of disempowerment, having experienced a loss of control and autonomy over their lives. Therefore, it is crucial to empower them by encouraging their autonomy and enabling them to make informed choices that align with their individual needs. Additionally, creating a space where service users can freely provide feedback and be genuinely listened to ensures that the support evolves and adapts to their changing needs over time. This dynamic process allows for a personalised and responsive support approach.
Respecting social differences is another vital component of trauma-informed support, particularly when addressing collective trauma arising from discrimination based on social categories and identities. Adopting a comprehensive trauma-informed approach involves acknowledging the profound influence of cultural backgrounds, historical context, gender, age, race, religion, and sexuality. It is essential to integrate this understanding into our support services, ensuring that each individual's unique experiences and identities are considered. By valuing and embracing these social differences, we create an inclusive environment that promotes well-being for all.
Trauma-informed practices play a vital role in providing holistic and compassionate support, fostering empowerment, independence, and recovery. By creating a safe environment and recognizing the long-term impact of trauma on individuals' lives, these practices address the far-reaching effects of trauma. These practices are so important in mental health support practices due to the widespread prevalence of trauma. Results from several studies, including the Adverse Childhood Experience (ACE) study, suggest a link between childhood trauma and long-term negative health consequences. Research conducted by Felitti (2004), Hennessey et al. (2004), Scaer (2005), Stein & Kendall (2006), and Talbot et al. (2011), provide evidence that 90% of individuals seeking treatment for severe and persistent personality disorders, substance abuse problems, eating disorders, anxiety, and depression, as well as those involved with the criminal justice system, have experienced significant emotional, physical, and/or sexual abuse during their childhood.
In our daily support practices, we embrace and apply all of these key principles. We actively seek to understand the profound impact of trauma and recognize its wide-ranging effects on an individual's physical, psychological, and emotional well-being. We focus on highlighting individuals’ strengths, resilience and abilities rather than solely focusing on their challenges or weaknesses. Furthermore, we are committed to preventing retraumatisation by ensuring that our support practices and policies are thoughtfully designed to avoid inadvertently triggering or exacerbating trauma symptoms.
Ceiba Community Support Case Study: Supporting a Trauma Survivor in Community Living
Our client is a young adult who is a trauma survivor and had experienced abuse in the past. They currently reside in the community and receive 24-hour support to assist them in navigating the challenges stemming from their mental health difficulties and traumatic experiences.
Key Support Principles in Action:
Safety: Our first concern is ensuring their safety. We have created an environment where they feel physically, psychologically, and emotionally secure. We have a female-only team in place who they feel comfortable around, and our small, familiar team cultivates trust by maintaining clear boundaries, actively listening to their concerns, and fostering a collaborative relationship.
Trustworthiness and transparency: Recognizing the trust they lost in the past, we prioritise building trust by consistently demonstrating trustworthiness and transparency. Our team maintains consistency in their behaviour and responses through regular team meetings, ensuring that everyone is aligned in their approach. We foster honesty in our interactions with them, providing a safe space for open discussions and feedback through regular check-ins with their support manager. We make sure that our policies are easily accessible and clearly understood by them. Additionally, we emphasise that they can reach out to upper management at any time should the need arise. By fostering trustworthiness, transparency, and open communication, we create an environment where they feel heard, valued, and respected.
Collaboration and Mutuality: We prioritise collaboration and mutuality by maintaining a small, dedicated team, allowing for strong, meaningful relationships. This fosters their comfort and ease in collaborating with us. We highly value their expertise, treating them as an equal partner in decision-making. When the client moved into the community, they worked closely with their support manager from the very beginning to design a personalised support plan, addressing their needs, goals, and interests. As well as determining the most effective ways we can support their journey towards independence. We regularly check in with them to adapt to their evolving needs and circumstances, updating support plans and keeping the entire team informed. By maintaining open communication and involving them in decisions, we ensure ongoing collaboration and mutuality.
Empowerment, Voice, and Choice: We empower them by promoting autonomy and encouraging informed decision-making, recognizing the impact of trauma-induced disempowerment. Throughout their support journey, we consistently highlight their strengths, resilience, and abilities to foster growth and recovery. One way we facilitate empowerment is by equipping the client with practical resources and information, such as managing bill payments. With our guidance, they develop the skills and confidence to handle these tasks independently, receiving reassurance and encouragement when needed. This fosters a sense of accomplishment and capability, empowering them to tackle future challenges with confidence.
Respecting social differences: We recognize and respect the influence of cultural backgrounds, gender, age, and other social factors in their life. Our support is specifically tailored to honour their unique experiences and identities, guided by the information they share regarding their background and preferences. We are committed to maintaining a respectful and inclusive approach, actively avoiding any form of discrimination or marginalisation. By valuing and embracing their social differences, we create an environment that fosters dignity, understanding, and acceptance.
Impact of Trauma-Informed Practices:
Implementing trauma-informed practices has profoundly influenced their well-being. The client has experienced a restored sense of safety and trust, finding solace in their new home as a secure and empowering space. Our trauma-informed support has fostered stronger connections with our support team and facilitated the development of their own external support network. Through active empowerment and inclusion in decision-making, they have gained a remarkable sense of control over their life. By emphasising their strengths and abilities, we have witnessed their resilience grow, resulting in notable progress in their journey to independence.
Felitti, V. (2004). The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study. [Cited 12 October 2011]. Available from: URL: http://www.acestudy.org/files/OriginsofAddiction.pdf
Hennessey, M., Ford, J., Mahoney, K., Ko, S. & Siegfried, C. (2004). Trauma amongst Girls in the Juvenile Justice System. [Cited 9 October 2011]. Available from: URL: http://www.nctsnet.org/sites/default/files/assets/pdfs/trauma_among_girls_in_jjsys.pdf
Scaer, R. (2005). The Trauma Spectrum: Hidden Wounds and Human Resilience. New York: W.W. Norton &Company
Stein, P. & Kendall, J. (2006). Psychological Trauma and the Developing Brain. New York: Hawthorn Press
Talbot, N., Chaudron, L., Ward, E.et al. (2011). A randomised effectiveness trial of interpersonal psychotherapy for depressed women with sexual abuse histories.PsychiatricServices,62(4), 374–380
Muskett, C., 2014. Trauma‐informed care in inpatient mental health settings: A review of the literature. International journal of mental health nursing, 23(1), pp.51-59.
Herman, J.L., 2015. Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. Hachette UK.