Trauma-Informed Care: What It Means and How It Can Be Implemented in Behavioral Health
“Trauma leaves ‘fingerprints’ on the victim. These don’t fade when the bruises do.” — Dr. Ellen Taliaferro, physician and author specializing in domestic violence and abuse
Violent events—whether they occur on purpose or by accident, and whether they are physically or emotionally violent—leave a mark on a person’s psyche. Long after an event has passed, its memory can cause psychological suffering for those who experienced it. In some cases, this prolonged suffering may be diagnosed as post-traumatic stress disorder, but the event and its emotional consequences are also referred to more generally as trauma.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma “results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” Statistics from SAMHSA show that 61% of men and 51% of women are exposed to a traumatic event sometime in their lives, and 90% of clients in public behavioral health care settings have experienced trauma.
We’ve previously explained how interventions like yoga can help to reduce symptoms of post-traumatic stress, but most of the time, trauma is so deep-seated that it must be addressed by professional therapy or counseling. However, it’s crucial that behavioral health care is delivered in a way that’s attentive to the needs of trauma victims. The last thing that’s wanted is for treatment to trigger residual feelings of stress and anxiety, which is why all care must be trauma-informed.
Trauma-informed care is a framework for treatment that helps clients feel safe, respected and in control while minimizing any risk of re-traumatization. Here at Cummins Behavioral Health, we strive to integrate the principles of trauma-informed care into every interaction between care providers and consumers. We spoke with Rebecca Bradford, Team Lead at our Marion County outpatient office, to learn more about trauma-informed care and how it can be effectively implemented in behavioral health care.
The Six Principles of Trauma-Informed Care, Explained
As Team Lead at Cummins' Marion County outpatient office, Rebecca Bradford, LCSW, supervises therapists and clinicians as well as peer service providers.
As mentioned above, trauma affects more than half of all adults in the U.S., and the percentages are even higher among people who seek out behavioral health services. Interestingly enough, a higher than average number of behavioral health workers may have also experienced some form of trauma in the past. As a result, a trauma-informed approach to care is important for the well-being of consumers as well as employees within an organization.
“Trauma-informed care is important because there are so many people who have experienced trauma,” Rebecca says. “Whether they have a diagnosable condition like PTSD or not, it is likely that at some point in their life, a large majority of the population we serve has experienced some sort of trauma in their life. It even affects a lot of our providers, because we know that people sometimes go into the helping fields because they’ve experienced things in their own life that make them want to help others.”
But what does a trauma-informed approach to care mean, exactly? According to SAMHSA, trauma-informed care is treatment that adheres to six guiding principles:
- Safety: throughout the organization, both staff and the people they serve feel physically and psychologically safe. As Rebecca explains, this is one of the first things that a person who has experienced trauma considers when entering a treatment environment. “If I’m talking to someone who has trauma, their safety has likely been threatened or taken away from them at some point in their life, so that’s going to keep them guarded. We need to make sure the physical space is presented as safe as well as the emotional space, which is often done through rapport-building with consumers,” she says.
- Trustworthiness and transparency: organizational operations are conducted with transparency in order to build trust among staff, consumers, and consumers’ family members. This can be achieved with consumers through open communication about everything that happens during treatment. “We use collaborative documentation so consumers know what’s being written about them and what the provider is documenting,” Rebecca says. “Being transparent about the parameters of the therapeutic relationship is very important, as well, and those boundaries get established up-front.”
- Peer support: consumers have access to peer recovery specialists who have experienced trauma in their own lives and can provide additional emotional support. Due to their unique position in the organization, peer specialists can often engage with consumers in ways that might be inappropriate for a therapist or counselor. “With trauma, people often feel isolated, so sometimes they feel more comfortable opening up to somebody that has had that experience versus a therapist who may not disclose, even if they have had that experience, just to keep those therapeutic boundaries,” Rebecca explains.
- Collaboration and mutuality: consumers act as partners with staff in their own treatment, and the balance of power remains equal between consumer and provider as well as among staff. According to Rebecca, one part of collaboration means that consumers take equal responsibility for their recovery. “A huge part of treatment is that we’re always giving it back to the consumer and not just doing things for them. We teach them how to do things themselves, or we do it with them if they can’t do it themselves just yet,” she says.
- Empowerment, voice and choice: consumers are encouraged to take control of their treatment and freely express their concerns and desires. Care providers are facilitators of recovery rather than controllers of recovery, and they strive to support consumers in shared goal-setting and decision-making. “We let the consumer know that they can control the pace of treatment. That’s a big part of Empowerment as well as Safety and Collaboration,” Rebecca says.
- Cultural, historical and gender issues: the organization ignores cultural and gender stereotypes and is responsive to the racial, ethnic, cultural and gender-specific needs of consumers. At Cummins, this is partially achieved through the Cultural Competency Committee, which researches and disseminates best practices for treating people from diverse populations. “It’s a matter of continuing to educate our providers on diversity and gender issues and making sure that we’re not imposing our own belief systems on any other person,” Rebecca explains.
Putting Trauma-Informed Care into Practice
Once the core principles of trauma-informed care are understood, the real challenge lies in implementing these principles throughout the organization. In its guidelines for trauma-informed care, SAMHSA lists ten domains for implementation: governance and leadership; policy; physical environment; engagement and involvement; cross-sector collaboration; screening, assessment and treatment services; training and workforce development; progress monitoring and quality assurance; financing; and evaluation.
In Rebecca’s experience, workforce training is among the most crucial of these domains. In order for trauma-informed care to truly make a difference, its principles must be upheld at every point of consumer contact within the organization. “From that first person a consumer meets when scheduling an appointment all the way up to the CEO, everyone should know about these things,” Rebecca says.
Trauma-informed care is typically implemented from the “top” of an organization by means of policy choices, but employees at all levels of the organization should be encouraged to offer input. This helps to ensure that policies remain as current and effective as possible, as Rebecca illustrates:
“At Cummins, leadership is always open to hearing what providers have to say about treatment environments and treatment modalities. For example, my providers were recently discussing needs with the Chief Clinical Officer and identified a book that had some protocols to address poverty, which often goes hand-in-hand with trauma. The Chief Clinical Officer took that input and came back to us two months later, presented his interpretation of the basic ideas, and changed the way we do our onboarding system as a result of reading this book that was suggested by my providers.”
Finally, behavioral health care providers must be careful to avoid common stumbling blocks like burnout and compassion fatigue, which can undermine their ability to administer effective trauma-informed care. For this reason, regular self-care is important for everyone in the organization. “Something we talk about a lot is good supervision and open communication with the provider, with me being able to say, ‘I think you need to take a step back,’ and them also being able to come and say that to me,” Rebecca explains.
Due to the high prevalence of trauma among behavioral health care consumers, it’s imperative that treatment recognizes the challenges faced by trauma survivors and empowers them to improve their own lives. We continually strive for this goal at Cummins Behavioral Health as we work toward our mission of inspiring the hope of recovery in every person we serve.
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