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Toolkit: Trauma Informed Care

What is Trauma?

Trauma results from an event, series of events, or a set of circumstances that someone experiences in which they go through physical or emotional harm, or threats, that have lasting negative effects on their functioning and physical, social, emotional, or spiritual wellbeing.

There are “3 E’s” to trauma:

  1. The Event(s): Events can happen once, happen many times, or be chronic conditions such as poverty. People may experience an event directly, witness an event, or feel threatened by an event that affects someone they know. Examples might include, violence, abuse, death of a loved one, a natural disaster, and more.
  2. The Experience(s): A person’s experience of trauma will be affected by when, how, where, and how often it occurs. Not every person experiences the same events as traumatic. Experiences that produce trauma include bullying and humiliation, dysfunctional household or living situation, constant feeling of powerlessness, and feeling different or not feeling accepted.
  3. The Effect(s): Trauma often has long-term and negative effects on a person’s functioning, as well as their mental, physical, social, and emotional well-being. Trauma can result in confusion, sadness, anxiety, agitation, long-term and recurring physical pain, difficulty developing healthy relationships, difficulty expressing and managing emotions, harm to the brain and nervous system development, a weaker immune system, and engagement in risky behaviors such as smoking, substance abuse, self-harm, unsafe sexual practices, and diet and exercise habits that lead to obesity.

Trauma and People with Disabilities

People with developmental disabilities experience significantly higher rates of trauma than the general population. Many are considered vulnerable, meaning they are more susceptible to physical, emotional, or financial injury from other people. Many have been teased or bullied at some point in their lives. They are called the “R” word and other offensive names or have been made to feel left out or ignored. They are also more likely to be physically or sexually abused.

Other common factors that can expose people with developmental disabilities to higher rates of trauma include

  • they may have been taught to comply with authority figures and do as they are told without question,
  • they are dependent on caregivers for a longer time,
  • they are sometimes impaired in their ability to communicate or in their mobility,
  • those with intellectual delays may not understand what is happening in abusive or exploitive situations,
  • or the signs of abuse or trauma are attributed to the person’s disability and ignored

How Does Trauma Effects Families?

Trauma causes stress in family members which has consequences that flow through family relationships, sometimes limiting family functioning. Oftentimes families living in unsafe or traumatic conditions experience many traumas and do not have the resources needed for recovery. All families experience trauma differently, just as each person within the family might experience trauma in different ways too.

What is Trauma Informed Care?

Trauma-Informed Care (TIC) is a caring approach that believes a person may have a history of trauma. TIC identifies trauma symptoms and recognizes the role trauma may play in a person’s life. The overarching question shifts from what is ‘wrong’ with someone to what has happened to someone. There is a change in thinking and in how the provider helps people they are working with:

  • “What is your diagnosis?”  becomes “What is your story? What has brought you here?”
  • “What are your symptoms?”  becomes “How have you coped & adapted?”
  • “How can I best treat you becomes “How can we work together to figure out what helps?”
  • “Here is what you need to work on.” Becomes “How can I support changes in your behavior that will benefit you?”

When using a TIC approach, providers focus on providing safety, trustworthiness and transparency, peer support, collaboration, empathy, empowerment, and take into consideration cultural, historical, and gender issues.

The focus of TIC is not to treat symptoms or issues related to trauma but to provide services in a way that are appropriate to those who have experienced trauma. Sometimes when TIC is not provided it is possible to create or worsen trauma within somebody’s life.

Why Do Families Need TIC?

By using a TIC approach in receiving supports and services, people experience an improved quality of care, improved safety for patients and staff, decreased use of seclusion and restraint, and improved engagement and satisfaction. Overall, there are better outcomes when TIC is used.