Trauma-Organized Systems of Care

Many individuals with a history of trauma have attempted to access care to help deal with their traumatic pasts, but have instead found danger in the system that were supposed to help. Recent developments are beginning to recognize how the current systems of care have re-traumatized people instead of helping them. Neurological, psychological, and somatic research is starting to identify the link between early childhood trauma and the development of chronic physical and medical problems, substance abuse and mental health issues, difficulty forming healthy relationships, securing and maintaining adequate employment, and living a rich and meaningful life. These problems ultimately lead to higher rates of incarceration, homelessness, intimate partner violence, the greater risk for further traumatization and ultimately a shorter life. Trauma accelerates the aging process and it is estimated that people living with severe and persistent mental illness, most of whom have significant histories of trauma, average a 20-year shorter lifespan than those who have not experienced significant trauma. Historically, the prevalence and impact of trauma has been widely ignored or downplayed by those in power and unfortunately this practice continues in many systems that were originally created to help people heal from the consequences of trauma and stress. The recent pandemic, political unrest, racial violence, climate disasters and the horrific trauma due to the devastation of the Russian invasion in the Ukraine has led us to the worse mental health crisis we have had in decades if not longer. I am hopeful that new developments in neuroscience will allow caregivers to provide effective trauma-informed and trauma-specific interventions that promote balance, well-being, and recovery for those affected by the horrific effects of trauma during these trying times.
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A conservative annual cost of child abuse and neglect is an estimated $103.8 billion, or $284.3 million per day (The National Child Traumatic Stress Network, n.d.). The more we know about trauma and the impact of early childhood trauma on individuals, families, organizations, and communities, the more we can prevent and provide effective treatments for those who have been traumatized. I feel as a nation we are not doing enough to prevent child abuse, neglect, and sexual assault, but I am hopeful that with new organizations and systems shifting towards trauma-informed approaches that more efforts will be put towards preventative efforts.
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Caregivers who provide services to survivors of trauma often work in chaotic, understaffed, and unsupported environments. These resource-strapped organizations can become collectively traumatized and instead of making decisions from a rational perspective, organizations start responding from a position of stress. The people working in these systems start to take on the same symptoms of the clients they serve including the fight, flight, and shutdown response. These stressed systems, and the people working in them, are unable to function effectively because the physiological changes that stress creates in their bodies creates anxiety, panic, anger, or people “shut down”. These normal trauma responses prevent people from approaching things from a rational manner as stress impacts higher brain functioning. This explains why children who are experiencing trauma have higher rates of learning disabilities, or why people with histories of trauma might lash out in violence, aggression, or completely shut down and isolate themselves after experiencing a traumatic event.

A great article that discusses how organizations are at risk of becoming collectively traumatized a concept that I call trauma-organized systems of care is Taylor, A.T. (2011). The Limbic Model of Systemic Trauma. Journal of Social Work Practices: Psychotherapeutic Approaches in Health, Welfare, and the Community, 26(1), 125-138. For more information on this article please click HERE.

Trauma-Informed Care
Trauma-informed care is an 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 (National Center for Trauma-Informed Care). The purpose of a trauma-informed service system of care is to return a sense of control and autonomy to the survivor of trauma and foster an environment that promotes healing and well-being.

Trauma-informed care is a system-wide community, organizational structure, and treatment framework that “involves understanding, recognizing, and responding to the effects of all types of trauma” (National Trauma-Informed Care Project, 2017). Utilizing Carl Roger’s person-centered theory, empowerment theory, and the strengths perspective, Trauma-Informed Care emphasizes the importance of physical, psychological, and emotional safety for both the people accessing services and the caregivers providing the services.

As trauma-informed care gains popularity, I worry that systems will merely say they are trauma-informed without investing the time, resources, and effort to make the system-wide changes that are essential as programs, organizations, and communities implement trauma-informed systems of care. A common example are organizations that say they are trauma-informed in service delivery but continue to place unrealistic expectations on the front-line workers providing the direct services. More specific examples include expecting child protection workers to work over 60 hours a week with minimal training and support and then only paying them for only 40 hours per week. Therapists who hold master’s degrees or a PhD are some of the most underpaid professionals today. Most therapists, doctors, and other clinicians are required to achieve mandatory billing hours each week despite internal systems that prevent these same workers from completing their jobs efficiently. Recent reports revealed that community mental health providers in Colorado were paid only a mere 5% what the organization was paid for providing these services. This is absolutely unethical behavior and should be illegal. Caregivers are expected to do more and more with less and less and often systems promote only those workers who can keep up with the paperwork/administrative side of the job. These systems breed high levels of burnout, secondary-traumatic stress, attrition, and ultimately the delivery of ineffective services and often harmful practices. I advocate that social workers, counselors, nurses, teachers, and all providers those who work in the field of trauma be provided the right support by their organizations, supervisors, and peers so they can thrive at work and can maintain a good work-life balance. Trauma workers should make competitive wages as they often give a big part of themselves through this type of work.
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I specialize in working with people who have experienced trauma, abuse, and/or neglect in the past or are currently going through a stressful or traumatic situation
I incorporate the trauma-informed perspective into all the services that I provide as well as trauma-specific interventions that have shown to be effective in reducing the negative symptoms of trauma and compassion fatigue. For more information on my treatment philosophy and therapeutic approaches please see my “Approaches” page. I am a strong advocate for my clients in helping them access the care they deserve in a treatment system that can often be overwhelming, dismissive, punitive, and ultimately create more problems for those trying to get help.

References

The Adverse Childhood (ACE) Study. (n.d.). Bridging the gap between childhood trauma and negative consequence later in life. Retrieved from http://www.acestudy.org/

Bloom, S. L. (2006). Organizational stress as a barrier to trauma-sensitive change and system transformation. Adapted from: Living Sanctuary: Complex Antidotes to Organizational Stress in a Changing World, Retrieved on May 1, 2010 from www.sanctuaryweb.com

Bloom, S.L., and Farragher, B. (2011). Destroying sanctuary, New York, NY: Oxford Press.

Bloom, S.L., and 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., and 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 on March 5, 2009 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). Norton. 

Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. (2009). Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation. Available at www.homeless.samhsa.gov and www.familyhomelessness.org.

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

National Child traumatic stress network. (n.d.). Effects of complex trauma. Retrieved on March 24, 2017 from http://www.nctsn.org/trauma-types/complex-trauma/effects-of-complex-trauma

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

Pimputkar, T. (2017). The importance of relational support in healing from trauma. Goodtherapy.org Retrieved on March 23, 2017 from http://www.goodtherapy.org/blog/importance-of-relational-support-in-healing-from-trauma-0214174

National Child Traumatic Stress Network. (n.d.). Effects of complex trauma. Retrieved on October 28th, 2017 from http://www.nctsn.org/trauma-types/complex-trauma/effects-of-complex-trauma

Perry, B.C. (2006). The boy who was raised as a dog and other stories from a child psychiatrists’ notebook: What traumatized children can teach us about loss, love, and healing, Philadelphia, PA: Basic Books.

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

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

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 Mental Health Services Administration (SAMHSA). (n.d.). National Center for Trauma Informed Care. Welcome to the National Center for Trauma-Informed Care. Retrieved on November 23, 2010 from http://www.samhsa.gov/nctic/
Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

Van dernoot Lipsky, L., & Burk, C., (2009). Trauma-stewardship: An everyday guide to caring for self while caring for others. San Francisco, CA: Berrett-Koehler, Inc.

Tyler, T.A. (2012). The limbic model of systemic trauma. Journal of Social Work Practice: Psychotherapeutic Approaches in Health, Welfare and the Community, 26(1), 125-138.

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

Winberger, L. and Poole, D. (2022). Rewiring the brain after Trauma. Therapy Mastermind Circle. https://dianepooleheller.com

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=XLFZkgumKxA