Trauma-informed Care is a model of care that has long been promoted in many healthcare and social service settings. Despite years of evidence showing the positive impact of organizations adopting a trauma-informed model, there are still many providers who struggle to implement it. Organizations who traditionally don’t treat trauma symptoms may especially have difficulty understanding what trauma is and its impact.
Trauma is all around us, and it can affect any individual you come into contact with. Current events like the coronavirus pandemic, public images of police brutality, and an economic downturn all contribute to increased stress and traumatic experiences. For this reason, it is crucial that every health and human service provider have a basic understanding of trauma-informed care. First, you must know what trauma involves, and how it can affect the individuals and communities you serve.
What Counts as Trauma?
Stress itself is a normal part of our lives – in some instances, it can be considered beneficial or adaptive. But stress that induces intense and long-lasting physical and emotional responses is considered traumatic stress. This type of stress is what causes the flight, fight or freeze response in our bodies and can contribute to the development of post-traumatic stress disorder.
The DSM-5’s diagnostic criteria for post-traumatic stress disorder considers trauma to be exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event
- Witnessing, in person, the event as it occurred to others
- Learning that the traumatic event occurred to a close family member or friend
- Experiencing repeated or extreme exposure to aversive details of the traumatic event (i.e. law enforcement officers repeatedly exposed to details of child abuse)
Regardless of the type or duration of an event, the most important thing to remember is that the event itself is not nearly as important as what the trauma means to the individual. Two individuals could experience the exact same traumatic event and respond in vastly different ways. Because of this, it’s important that those working with trauma survivors take the time to understand how the individual has perceived and adapted to the event.
There are many other ways to categorize and describe traumatic events. The following are just a few examples of different types of trauma:
- Complex Trauma – this is the pervasive impact of being exposed to multiple, simultaneous, or prolonged traumatic stress. Examples can include repeat incidences of abuse or multiple deployments of military personnel to a war zone.
- Secondary or Vicarious Trauma – this trauma appears when an individual experiences trauma-related symptoms in response to helping or emphasizing with others who have experienced traumatic events. This is common among helping professions who may repeatedly hear about or witness traumatic events happening to clients.
- Historical Trauma – also known as generational trauma, this refers to traumatic events experienced by specific cultural or ethnic groups. Historical trauma can have an effect on populations throughout generations, resulting in individuals being hesitant to enter systems of care that have historically oppressed these populations. Examples include the forced migration and colonization of Native Americans, the internment of Japanese individuals during WWII, and the enslavement and oppression of African Americans.
- Racial/Ethnic Trauma – this type of trauma results from race- or ethnicity-related experiences that involve discrimination, prejudice, or racism. Examples of racial/ethnic trauma can range from interpersonal interactions (e.g. microaggressions, hate speech) to systemic oppression (e.g. workplace discrimination, community violence).
- Minority Stress – similar to racial/ethnic trauma, minority stress involves chronic levels of stress faced by members of stigmatized minority groups. One example of minority stress includes members of the LGBTQ+ community experiencing discrimination or violence in response to their sexual orientation, gender identity, or gender expression.
How Does Trauma Affect Individuals and Communities?
Individuals who experience traumatic stress are at an increased risk of developing maladaptive stress responses. Emotional dysregulation (difficulty managing anger, anxiety, or sadness), numbing or feeling detached from one’s environment, and experiencing flashbacks to the traumatic event are just some of the psychological symptoms trauma can cause. These psychological effects can be short-term, or in the case of post-traumatic stress disorder, can last up to 3 months or longer.
Besides the psychological effects trauma can cause, it can also have a deep impact on the physical well-being of an individual. One of the first major studies to find a correlation between traumatic experiences and physical health was the Adverse Childhood Experiences (ACEs) Study. This study found that an increase in the number of certain childhood traumatic experiences (such as physical abuse or neglect) led to an increased risk of developing chronic illness and other poor outcomes later in life.
While the ACEs study focused on a specific sample of traumatic events, experiencing any type of trauma at any point in development can profoundly affect the brain’s structure and makeup. Trauma can also affect the body’s autonomic nervous system, which regulates survival responses like the flight, fight or freeze response. When this system is adversely impacted, individuals may become overresponsive to stressful stimuli (such as becoming hypervigilant or having an easy startle response) or under responsive (such as feeling depression, fatigue, and disassociation).
Communities can also collectively experience trauma. Certain experiences, such as a natural disaster or community violence, can cause traumatic stress to a large group of individuals. Some scenarios, such as the terrorist attacks of 9/11 or the meltdown of a nuclear reactor in Fukushima, Japan, can cause mass trauma, where communities who weren’t in close proximity to the traumatic event can still be significantly impacted by it.
Remembering the Importance of Resilience
More than anything, one of the most important aspects of trauma-informed care providers and organizations can remember is that of resiliency. No matter the type or severity of the trauma, individuals can, and do, recover from it. Holding a strengths-based perspective and being person-centered in your practice is one of the best ways to help build resilience in individuals who have a history of trauma.