Traumatic stress is incredibly prevalent in the general population, with almost 70% of adults in the U.S. having experienced some type of traumatic event in their lifetime. Traumatic stress is also incredibly prevalent among individuals with intellectual and developmental disabilities (IDD), due to the fact that they are at a much higher risk of experiencing traumatic situations like abuse, neglect, and exploitation. These experiences can affect individuals with IDD in the same way trauma affects anyone else, having a tremendous impact on a person’s mental and physical health and well-being.
While behavioral health organizations, school systems, and criminal justice systems have begun adopting a trauma-informed care framework, less so is the case for IDD organizations. However, this framework can be applied to any type of organization, and has promising outcomes for IDD services. Implementing a trauma-informed system of care at your organization not only provides strategies that can reduce staff turnover and improve organizational wellness, it can also positively impact the lives of the people you serve.
Understanding Trauma in Persons Served
The trauma-informed care (TIC) framework involves recognizing, understanding, and responding to the effects of trauma, not only in persons served, but in staff and throughout the entire organization. It also involves shifting one’s mindset surrounding trauma, and seeing it not as a pathological reaction, but rather as an adaptive response to a traumatic event. Its goal is to prevent traumatic situations from occurring and prevent re-traumatization for survivors of trauma.
Unfortunately, despite our best efforts and intentions, many services and systems that are designed to help people with IDD are often traumatizing or re-traumatizing. Traditional approaches to behavioral issues within the IDD population have included interventions designed to encourage individuals to “ask for what they want” in a more productive manner. However, this approach is ineffective for individuals with a trauma history, because their behavior is more often an expression of emotion rather than an effort to communicate what they want. Focusing on behavior and labeling this behavior as “maladaptive” can actually make the traumatic response worse.
Instead, TIC practices shift this understanding away from controlling or “fixing” behavior to becoming aware that the behavior is something that is programmed into our brains and bodies. Traumatic experiences can deeply impact the chemical structure of the brain and re-program the body’s autonomic nervous system, creating reactions that make sense during a traumatic experience but do not positively serve the individual afterwards. Recognizing and understanding how trauma impacts an individual’s brain and body can help lead to more effective and compassionate interventions with persons with IDD.
TIC is well-adapted to fit into many other treatment philosophies and models of care in IDD services. At its core, TIC is person-centered, as it focuses on making sure the individual is empowered and has voice and choice over their treatment interventions. It is also strengths-based, as it seeks to focus on an individual’s positive assets and ways to build upon strengths the individual can use to create healthy coping mechanisms.
Trauma-Informed Care Benefits for Staff
Trauma-informed care is also something that does not solely exist between therapists and clients; paraprofessional staff, including direct support staff (DSPs), can implement and make use of trauma-informed care when working with persons served. Organizations that implement trauma-informed practices with their DSPs see considerable benefits, including increased staff consistency in carrying out person-centered planning activities, decreased use of restraints and seclusion interventions, and an increased ability among staff to support clients with known trauma histories.
DPSs and other staff at your organization can also greatly benefit from trauma-informed practices. Sometimes the work of supporting individuals with IDD itself can be traumatizing; one study found that 25% of DSPs in community settings were exposed to acts of aggression nearly every day. DSPs are also more likely to have a history of trauma—over 75% of DSPs have experienced at least one adverse childhood experience, while 30% have experienced four or more.
TIC places a heavy emphasis on employee health and wellbeing, since reducing burnout and compassion fatigue has a direct impact on the wellbeing of persons served. Promoting strategies to support staff and build resilience can help mitigate some of the poor outcomes of experiencing vicarious trauma while on the job. Ultimately, these strategies also help improve employee’s job satisfaction and have a hand in reducing employee turnover.
The Organizational Benefits of TIC
Implementing a trauma-informed system of care requires organizational buy-in at all levels, including supervisors, organizational leadership, and even your board of directors. In order for trauma-informed systems to be sustainable and impactful, it must include a cultural shift within your organization. It will be incredibly difficult for TIC to take root in your services and supports if it exists solely in one area of your organization.
Thankfully, there are resources available to support the journey to becoming a trauma-informed organization. The National Council on Behavioral Health offers consultative services to help organizations (including IDD organizations) become trauma-informed. ACEs Connection has resources specifically for IDD organizations interested in implementing trauma-informed care. Additionally, Relias has the training and expertise to help your staff better understand how trauma affects individuals, the basics of trauma-informed care, and how staff can practice self-care to mitigate the impacts of vicarious trauma.
It is high time for IDD organizations to begin incorporating TIC into their services. The benefits of a trauma-informed model of care are plentiful, and ultimately lead to the end result we all wish for: that the people we serve can lead healthy, productive, and independent lives free from abuse, exploitation, or trauma.