Trauma-Informed Care

Trauma-Organized Systems of Care

Many individuals seeking help for trauma are further harmed by care systems that unintentionally re-traumatize rather than heal (Taylor, 2011). Neurological, psychological, and somatic research increasingly links early childhood trauma to chronic physical and medical conditions, substance use disorders, mental health issues, relational difficulties, employment instability, higher rates of incarceration, homelessness, intimate partner violence, and reduced life expectancy (National Child Traumatic Stress Network, n.d.). People living with severe and persistent mental illness—most with significant trauma histories—average a 20-year shorter lifespan than those without such histories (National Center for Trauma-Informed Care). Historically, trauma’s prevalence and impact have been minimized or ignored, resulting in inadequate prevention and intervention efforts (National Center for Trauma-Informed Care). Recent societal crises—including the COVID-19 pandemic, political unrest, racial violence, climate disasters, and the Russian invasion of Ukraine—have exacerbated the mental health crisis, further highlighting the need for trauma-informed approaches (National Child Traumatic Stress Network, n.d.). The annual cost of child abuse and neglect is estimated at $103.8 billion (National Child Traumatic Stress Network, n.d.). Effective prevention and treatment require recognition of trauma’s impact on individuals, families, organizations, and communities.

Impact on Caregivers and Organizations
Caregivers often work in chaotic, understaffed, and unsupported environments, leading to organizational stress and collective trauma. Organizations and staff may begin to exhibit trauma symptoms such as fight, flight, or shutdown responses, which impair rational decision-making and service delivery (Taylor, 2011). This collective trauma affects both caregivers and clients, resulting in burnout, secondary traumatic stress, attrition, and ineffective or harmful practices (National Center for Trauma-Informed Care).

Trauma-Informed Care
Trauma-informed care recognizes the presence and impact of trauma, aiming to restore control and autonomy to survivors and foster healing environments (National Center for Trauma-Informed Care). It is a system-wide framework that emphasizes understanding, recognizing, and responding to all types of trauma (National Trauma-Informed Care Project, 2017). Trauma-informed care draws on person-centered theory, empowerment theory, and the strengths perspective, emphasizing physical, psychological, and emotional safety for clients and caregivers (National Trauma-Informed Care Project, 2017). True trauma-informed care requires systemic change, not just superficial adoption of terminology. Problematic practices include unrealistic expectations, inadequate compensation, and lack of support for front-line workers (National Center for Trauma-Informed Care). Ethical concerns are raised regarding underpayment, excessive workload, and promotion based on administrative tasks rather than clinical competence (National Center for Trauma-Informed Care). Advocacy is needed for proper support, competitive wages, and work-life balance for trauma workers.

Clinical Perspective
Trauma-informed care incorporates trauma-specific interventions to reduce symptoms and compassion fatigue (National Center for Trauma-Informed Care). Effective trauma-informed practice requires advocacy, client empowerment, and addressing systemic barriers within treatment systems. Trauma-informed care is essential for effective, ethical treatment of individuals with trauma histories. It requires comprehensive, system-wide changes that prioritize safety, support, and empowerment for both clients and caregivers. Prevention, recognition, and treatment of trauma must be integrated into organizational practices to avoid perpetuating harm and to promote recovery and well-being (National Child Traumatic Stress Network, n.d.; National Trauma-Informed Care Project, 2017; Taylor, 2011).

‍ ‍Resources

Bloom, S.L., & Farragher, B. (2011). Destroying sanctuary: The crisis in human services. New York, NY: Oxford University Press.

Bloom, S.L., & Yanosy-Sreedhar, S. (2008). The sanctuary model of trauma-informed organizational change. Reclaiming Children and Youth, 17(3), 48-53.

Cooper, J.L., Masi, R., Dababnah, S., Aratani, Y., & Knitzer, J. (2007).Strengthening policies to support children, youth, and families who experience trauma. The National Center for Children in Poverty (NCCP). Unclaimed Children Revisited Working Paper No. 2. Retrieved from http://www.nccp.org/publications/pub_940.html

Dana, D. (2020). Polyvagal exercises for safety and connection: 50 client-centered practices (Norton Series on Interpersonal Neurobiology). New York, NY: Norton.

Guarino, K., Soares, P., Konnath, K., Clervil, R., & Bassuk, E. (2009).Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Harris, M., & Fallot, R.D. (2001). Using trauma theory to design service systems. San Francisco, CA: Jossey-Bass.

Mathieu, F. (2012). The compassion fatigue workbook: Creative tools for transforming compassion fatigue and vicarious traumatization. New York, NY: Taylor & Francis.

Pimputkar, T. (2017). The importance of relational support in healing from trauma. Goodtherapy.org. Retrieved from http://www.goodtherapy.org/blog/importance-of-relational-support-in-healing-from-trauma-0214174

Saakvitne, K.W., Gamble, S., Pearlman, L.A., & Tabor, L.B. (2000).Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran Institute.

Saakvitne, K.W., & Pearlman, L.A. (1996). Transforming the pain: A workbook on vicarious traumatization for helping professionals who work with traumatized clients. New York, NY: W.W. Norton & Company.

Sapolsky, R.M. (1998). Why zebras don’t get ulcers: The acclaimed guide to stress, stress-related diseases, and coping (3rd ed.). New York, NY: Henry Holt and Company.

Substance Abuse and Mental Health Services Administration. (2014).Trauma-Informed Care in Behavioral Health Services (Treatment Improvement Protocol [TIP] Series 57; HHS Publication No. SMA 13-4801). Rockville, MD: Author.

Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin.

Yellow Bird, M. (2021). Neurodecolonization using the medicine wheel: An indigenous approach to healing the traumas of colonialism. 3rd Biennial Brad Sheafor Lecture in Social Work [Video File]. Retrieved from https://www.youtube.com/watch?v=XLFZkgumKxAe‍ ‍