I recall referring a woman I worked with who had been sexually abused to counseling and seeing the fear in her face at the thought of calling to schedule an appointment. Part of my routine in my sessions became dedicated to reviewing how to approach this difficult task--practicing what to say, and helping them develop confidence in their ability to do this. I would prepare them for the fact that the person answering the phone might not be a trained clinician, might be busy or stressed, and come across as brusque, rushed, or even uncaring. We would role-play this interaction (phone call) so they could get past this potential roadblock (the person answering the phone) and start on their road to recovery.
Think about it. Something as simple as scheduling the first appointment was as difficult as climbing a mountain.
Flash forward 10-25 years. Now we have a framework to help us improve how we interact with those we serve--trauma informed care. It includes paying attention to language and to every interaction. It also involves all staff at an organization, not just clinical, as all staff members are critical to the recovery process and thus must have skills and sensitivity.
Recently, Relias Learning hosted a webinar on using trauma sensitive language, facilitated by the fantastically knowledgeable, experienced and generous experts at the National Council for Behavioral Health, Karen Johnson and Linda Henderson-Smith. We’ve hosted a handful of webinars on various topics related to Trauma Informed Care in the last year or two and they are always very well-received. The questions and comments during the webinar reveal a population of human services professionals who are invested in learning and committed to improving care.
We were unable to answer all the questions during the webinar so we have posted them here for reference. Thank you to all who attended the webinar and are striving for improved quality of care.
Q: What other words are preferred, such as those mentioned, like triggered or activate?
A: As we indicated, preferred words change often. It is important to speak with clients and staff and ask their preferences.
Q: What are the "Absolutes" in a 'Housing First" shelter for single adults - considering programmatic stays usually do not last for more than 90 days?
A: A Trauma-Informed Care Organization Includes:
- Safe, calm and secure environment with supportive care
- System wide understanding of trauma prevalence, impact and trauma informed care
- Cultural Competence and Humility
- Consumer voice, choice and self-advocacy
- Recovery, consumer-driven and trauma specific services and/or supports
- Healing, hopeful, honest and trusting relationships
Q: Is using the term "survivor" or "victim" or "perpetrator" considered trauma-informed?
A: The terms “survivor” or “victim” in themselves are not bad. However, depending on the individual, they can trigger certain reactions. It is important to understand that depending on where people are in their journey, they may prefer different references to their experiences. As for “perpetrator” it is labeling and would likely not be considered “trauma-informed.” The better way of describing the individual is to describe the behavior not the person.
Q: Should we be saying "people WHO we serve" because "THAT" refers to an object?
A: Yes. Who references people. That references objects.
Q: You mentioned not to use “non-compliant’. What did you use instead? What would be a positive response?
A: A positive reframe is acknowledging that the client is doing the best they can at the moment and then exploring with the client how you can help them better engage in their care.
Q: What might you say instead of "no show"? Do you have some alternative language examples? Thank you!
A: Here are two alternatives:
Example 1- The client was unable to make their appointment.
Example 2 – The client missed his appointment today.
Sometimes we need to use the term “no show” in an EHR, which is ok. The critical change is to move away from using this language in conversation. So, saying “a client was not able to make their appointment” may feel cumbersome, but it ensures we are removing that judgmental, pejorative lens.
Q: Do you have any resources we can share with our co-workers with additional suggestions for more trauma-sensitive language (i.e. what to replace "no-show" "non-compliant" etc. with)
A: We are in the process of developing this resource. We will make sure to provide it once it is finalized.
Q: How can we enforce safety policies without escalating trauma?
A: There are alternative strategies in safety policies that can be used which still promote and ensure safety, but do not require hands-on interventions such as restraints and seclusions. One example is from an inpatient IDD facility in Virginia: they changed their safety policies to include protective gear as a way to avoid staff or clients being hurt while still allowing for the behavioral crisis to de-escalate.
Organizations always need to balance the needs of staff and clients when it comes to safety. This can be done by ensuring the voice of both are included in all discussions around creating safe environments. For example, the client is the best person to tell us if a waiting room feels safe, or if security uniforms are activating.
Q: What happens when someone can’t move on? What do you suggest?
A: I suggest building a relationship with them and allowing them to progress at their own pace. Everyone’s journey is different. People have to heal in their own ways and on their own time.
Q: How can frequent no-shows be interpreted in a positive light?
A: If someone frequently does not attend their appointments, there needs to be some evaluation of whether they feel they need the service or if there are other things (Maslow’s hierarchy) that are prohibiting them from attending. You may also want to consider if there is something in the organization that is causing the individual to not attend their sessions, such as a client’s concern about safety.
Q: Any insight for someone dealing the effects of suicide?
A: Grief counseling or peer support groups may be needed. National Alliance for the Mentally Ill (NAMI) and other organizations similar to NAMI frequently have support groups for family members of those that have died by suicide.
Q: What do you do with a teen who doesn't want to admit that she has some trauma and mental health issues? I'm ok with her not taking any medications right now, but she is not getting better; she is getting worse. How do I present the idea of Trauma counseling?
A: The most important part of working with teens is developing the relationship. Be consistent. Be a listening ear. Build the relationship. When she is ready to discuss it, she will. It is also important to note that not everyone moves to admitting their trauma or unpacking it in therapy. The first stage of healing is safety, and sometimes focusing on how an individual can remain safe is enough. Seeking Safety by Lisa Najavits is an evidence-based intervention focused on this first stage of recovery from trauma. Judith Herman addresses this question in her book Trauma and Recovery.
Q: What is the best approach when a family do not agree in the way the family should approach the trauma of their child?
A: Psychoeducation about trauma, the effects of trauma on the brain and the long-term effects of trauma would be your first step. Sometimes a family struggles to address the child’s trauma if it happened at the hands of a family member. In this case, it is critical to apply the trauma-informed lens to the family, to attempt to mitigate the effects of judgment and stigma that the family likely feels by helping them to understand that it is not what is wrong with them, but it is what happened to them.
If there is disagreement about the treatment plan, that is a discussion should likely involve the full treatment TEAM.
Q: How do you assist someone who is not ready to discuss trauma and what do you tell parents who are frustrated?
A: You assist someone who is not ready by allowing them to not be ready. Many times people are not ready to discuss it because they do not feel safe enough to discuss it (socially, psychologically and sometimes physically). Building a relationship and creating safe environments for the discussion are going to be key. As for the parents, psychoeducation about safety and safe environments will be extremely helpful.
General Questions on Trauma Informed Care:
Q: When you referred to Types of Trauma Events - you talked about a paper that we should be familiar with. What was that?
A: The Substance Abuse and Mental Health Services Administration (SAMHSA) TIP 57 is the paper referenced. You can find it here.
Q: Isn't "Trauma Informed Care" understanding the symptomology that is often identified as a diagnosis as adaptive behavior? (referencing the slide on mental health disorders)
A: Trauma-Informed Care is partially about understanding the symptomology, but is also about ensuring that the core principles are infused into your language, daily work, environment, and relationships.
Q: Can I have more info as to where I can find other webinars/classes that have CEUs? thank you!
A: Relias Learning offers many webinars and online classes on a variety of human services topics (like trauma-informed care, working with children and families, evidence-based practices, leadership and more).
If you are at an organization and want to provide training for all staff, check out the organizational information on our website and additional resources on trauma informed care. If you are an individual looking for more training and CEUs, check out Relias Academy.
We frequently conduct webinars such as these, record them and post them online for free viewing. Occasionally we turn them into courses and add them to our libraries and academy site. Check back to our webinar page for both upcoming live webinars and recordings of previous ones.