Trauma Informed Care – The Absolute Basics
This post aims at providing a very basic introduction to Trauma Informed Care. Advanced versions of this information are available from the author. So what is Trauma Informed Care (hereafter TIC)? Below I have listed rationales of need and core characteristics of TIC in organizations.
Why We Need Trauma Informed Care?
The 2012 (revised 2016) National Survey of Children’s Health (Vermont Sample) documented significant levels of Adverse Childhood Experiences (ages 1 to 17) and Adverse Family Experiences. This data is supported by ongoing assessment of ACEs in Vermont and in the nation. Some information paints a picture of serious psychological and physical needs in Vermont. Such data include a 25% divorce/separation rate; a 25% family financial hardship rate; 10 to 15% rate of children living in a family of substance use or mental health disorders; 43% of children experiencing depression and/or anxiety; and, 33% experiencing behavioral/conduct problems. Vermont has a significant percentage of its children suffering from three-four or more ACEs. Add all this to the out-of-control substance abuse/dependence problems in Vermont and the nation. The final picture is a very sad one. Trauma Informed Care, better training of clinical and medical personnel, required documentation of better clinical outcomes are all part of an improving picture of better biopsychosocial-spiritual development for children and youth.
Some Core Principles and Practices of Trauma Informed Care:
- Personal healing, resilience, and happiness are all possible over time.
- Staff must recognize and respond effectively to personal trauma histories and various, complex developmental consequences.
- Powerful self-safety in the environment and relationships is an absolute requirement of care.
- Trust and transparency go hand-in-hand with systemic trauma recovery.
- Advanced, effective trauma therapy requires more than conducive constructivist and systemic variables. Trauma therapy requires an expanded skills set within the same trusting relationship.
- All parties and their unique contributions are valued and respected in TIC.
- Strong compassion skills and processes work together with improved executive and limbic brain functioning. Concrete skills practice is part of the healing process.
- The science of prevention and the science of treatment are integrated in TIC.
- Assessment is continuous and includes both primary and secondary trauma realities.
- On-going staff training and an emphasis on staff self-care are necessary for TIC to work well. Typical “burn-out” practices are not part of this picture.
- Protective factors are enhanced, and health promotion and risk reduction are always implemented.
- Within relational interactions object constancy, the realities of nature and nurture, and powerful alliance patterns all exist.
- Mindfulness practices, breathing retraining, and trauma-informed yoga may be added interventions. Much trauma treatment is moving into the body, beyond simply talking and thinking.
- Awareness of and responsiveness to ACEs (Adverse Childhood Experiences) and AFE (Adverse Family Experiences) are on-going.
- Ultimately, TIC is part of psychosocial and clinical process that hopes to repair the dearth of healthy early life attachment. Improved object relations goes a long way toward healing.
- Healthy power-sharing reduces marginalization and hopelessness. Hope and empowerment are “musts” for client/consumer populations in recovery.
- In some cases, my premise that “we all are in recovery from something” may be part of this process. This reality make us more like our clients/consumers – not “above” them.
- Needs are projected; needs are met; arousal is reduced; and, relaxed relationships continue.
- In the best outcomes safety, security, trust, self-regulation, hope, and healing will occur over time.
- In some ways D.W. Winnicott, the famous British pediatrician turned psychoanalyst, would be very, very happy with the core “intersubjective” holding environment of TIC.
For more information refer to Quintiliani, A. R. (February, 2016). Trauma Informed Care…Monkton, VT: Self-Published. See also Kasehagen, L. (2012, 2016). National Survey of Children’s Health – Vermont Sample. Vt. Department of Health/CDC.
By Anthony R. Quintiliani, PhD., LADC
Author of Mindful Happiness