The Roots of Trauma-Informed Care

In 2005, the United States founded the National Center for Trauma Informed Care. The center exists to recognize the incredible prevalence of adverse childhood experiences (ACEs) among the United States population. The primary theory behind trauma-informed care is that the presence of ACEs and toxic stress has a massive effect on our current emotional and mental well-being. 

The concept first emerged to me while reading, ‘The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma,’ by Bessel Van Der Kolk, M.D. After 30 years of experience working with individuals who had survived severe trauma, Bessel Van Der Kolk summed up his findings and theories in this New York Times bestseller. 

While reading the book, several things stood out to me. The first is that trauma, especially ACEs, physically alters the brain. It affects our ability to focus, adapt, and harness control over our emotions. Trauma triggers our stress response, which affects the amygdala, hippocampus, and prefrontal cortex. Opening the floodgates for these stress hormones accompanying ACEs causes lifelong changes in these brain regions.  

These alterations affect the amygdala, hippocampus, and prefrontal cortex, which results in a ‘touchy’ alarm system. This alarm system triggers our stress responses, reduces our ability to regulate emotions, and leads to lifelong sleep difficulties. Trauma often coexists with other mental health conditions, such as; anxiety, depression, borderline personality disorder, or post-traumatic stress disorder. 

What Is Trauma?

SAMHSA defines trauma as; “A result from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.” 

Trauma forces us to fight, run, or freeze up at the moment of its impact and floods individuals with fear and helplessness. We experience things differently, so an event that traumatizes one individual may not trouble another. Our reactions to the events vary as well. Our response to trauma includes; substance abuse disorders, mood disorders, anxiety, post-traumatic stress, frequent headaches, and stomach aches.

What Is An ACE?

ACEs, or adverse childhood experiences, pertain to adversity in childhood. The experiences could be neglect, abuse, or instability. ACEs are common. In fact, two-thirds of the United States population report experiencing at least one ACE. 

The presence of adverse childhood experiences directly correlates to worsened adult lives. Individuals affected by ACEs are more likely to have heart problems, depression, obesity, and early death. These outcomes are due to the association between ACEs and toxic stress. Both ACEs and chronic stress cause trauma. 

Approaching Trauma-Informed Care

Trauma often leads an individual to a limited sense of self and an inability to trust or believe others. These outcomes reduce the likelihood of an individual suffering from trauma seeking and participating in care. Because the commitment to care is precarious, retraumatizing the individual during therapy is possible and should be avoided at all costs. 

This risk leads to the development of trauma-informed care. Trauma-informed care aims to minimize the barriers between a traumatized individual and mental health care. This approach also requires training in recognizing the signs and symptoms of unhealed trauma. Policies, procedures, and practices in a trauma-informed care approach align with the assumption that all individuals may have suffered from trauma.

4 Assumptions in Trauma-Informed Care

A trauma-informed system assumes four ‘R’s.’ Caregivers in a trauma-informed structure acknowledge the impact of trauma and stress on everyone in the system. Children, individuals, and care providers all play a role in trauma-informed care. The four assumptions in trauma-informed care are as follows.  

Realization 

There must be a realization at every level of the trauma-informed system. We must realize the effects trauma has on an individual and their family, caregivers, and health care providers. If we notice the connections between experiences and trauma, it better equips us to identify them. 

Recognize 

Understanding the coping strategies that manifest in behavior and experiences in the past and present can help care providers recognize trauma. Recognizing trauma is necessary to treat the mental and substance abuse disorders that evolve from untreated trauma. 

Response 

Once we recognize the trauma, we must respond to it. We utilize the following five principles of trauma-informed care in our treatment of individuals with past trauma. These basic principles can be self-training, continued education, and research. 

Resists

Understanding the proper way to respond to trauma allows us to resist re-traumatization. Stressful environments and the triggering of trauma can result in further traumatization. Educating yourself on the 4 R’s and 5 Principles of Trauma-Informed Care reduces re-traumatization risk. 

5 Principles of Trauma-Informed Care

The following five general principles guide care providers in reducing re-traumatization risk. These principles are vital in the care of traumatized individuals because mental health may worsen each time the individual is traumatized by a past event. 

Safety

The first guiding principle is safety. The individual must be safe both physically and emotionally. Ensuring the individual’s safety is the provider’s first step in trauma-informed care.

Choice

Once the individual feels safe, they must also choose to seek care. The autonomy of choice and control must be present for therapy to work. Trauma-informed care requires effort from the individual. 

Collaboration

Along with choice, the individual should be responsible for collaborating with the care team and making their own decisions. Including the individual in developing the care plan and assigning responsibility for evaluating their care and services are great ways to encourage collaboration.

Trustworthiness

The willingness to participate and communicate will not come unless the individual determines that the provider is trustworthy. Providers and therapists should be clear and consistent. Establishing and respecting everyone’s boundaries is key to developing trust.

Empowerment

Traumatized individuals often have a diminished sense of self. A large part of their mental health care is assisting them in reestablishing this sense of self. The provider must validate and affirm the thoughts and feelings of the individual to ensure that they feel empowered. Empowerment will allow them to accept their feelings and opinions more readily. 

Shifting Perspective

The primary goal of trauma-informed care is to shift the outlook of the care team. Instead of asking, “What’s wrong?” or “What’s wrong with me?” we ask, “What happened?” Care plans often focus on the individual and their symptoms. Care providers may prescribe medication to manage the undesirable side effects of mental illness. 

Trauma-informed care centers try to uncover the root. Providers realize that every person comes from a different background and experiences things differently. The mental health symptoms we experience today could be an effect of a much earlier event. Instead of treating the symptoms, trauma-informed care cleanses the source.