What is Trauma-Informed Care and Why Does it Matter?
By Angela Boring LMSW, MHA, CPHQ, CPHRM, Vice President, Clinical Services Quality & Risk Management
What is trauma-informed care?
The University of Buffalo Center for Social Research defines Trauma-informed care (TIC) as “an approach in the human service field that assumes that an individual is more likely than not to have a history of trauma.” This philosophy of care recognizes that trauma has a significant impact on people’s lives and a lot of people continue to exhibit symptoms of trauma even if the series of events leading to the trauma has passed. Thus, it is the responsibility of healthcare professionals to recognize the symptoms of trauma and create a friendly environment for healing and recovery.
Trauma is more prevalent than you think
The prevalence of trauma in the United States is sobering. According to the CDC:
- 25% of American children experience some sort of abuse
- 1 in 4 women and 1 in 6 men has experienced one form of sexual violence
- 1 in 71 men and 1 in 5 women have been raped at some point in their lives
These statistics highlight the prevalence of trauma and unfortunately, the statistics are likely even more harrowing as it is well known that sexual abuse is grossly underreported across all populations. And experts agree that the incidence of sexual abuse, especially in children and adult male populations is far greater than what is reported to the authorities. Some sources report that as many as 570 people experience sexual violence every day in the United States.
Both children and adults are exposed to various forms of abuse and trauma and the devastating effects of such experiences could remain for years. Health facilities and professionals need to set up their practice with the under- standing that a random patient is more likely to have experienced trauma than not.
Before the advent of trauma-informed care, the important question to ask as a healthcare professional is ‘what is wrong with this person?’. However, TIC seeks to ask ‘what has happened to this person?’ Although TIC does not intend to directly address the symptoms of abuse or other forms of trauma, the philosophy encourages healthcare.
What is re-traumatization?
Re-traumatization refers to environments or situations that are exactly or symbolically similar to a person’s traumatic experience and can lead to a re-enactment of the original trauma. Although the potential for re-traumatization exists in a wide variety of settings, certain features of healthcare facilities make them easier triggers.
First, there is a perceived power differential between health professionals and patients; they ask a wide range of invasive questions and expect full disclosure, even while they are yet unfamiliar with the patient.Furthermore, they may need to carry out invasive tests that occasionally require removal of patients clothing and exams of their body that can make people uncomfortable - especially those that have been victim to sexual or physical abuse. Additionally, patients also often have to undergo certain painful treatments and procedures that could easily trigger re-traumatization.
If these situations are not properly managed, some patients may become flooded with memories of their abuse or trauma and suffer a breakdown. In extreme cases, they may exhibit violent tendencies as a defensive mechanism. Too many times, healthcare providers fail to discern the cause of the patient’s behavior and may easily misinterpret it as defiant. TIC as a philosophy of care aims to prevent this from happening or properly manage such situations when they occur.
The Principles of Trauma-Informed Care
Five principles govern how health systems are set up and how healthcare professionals go about their services under TIC. They are:
The first step to providing TIC is creating an environment that guarantees the physical and emotional safety of the patient.
Patients need to know they are the ultimate decision-makers when it comes to their health. The provider lets them know their options and educates them so they can make an informed decision. When patients feel in control, they feel safer and have better faith in healthcare.
Accessing healthcare should be a collaborative effort between the providers and the patient. When patients feel involved in the decision-making process, the power differential is greatly reduced, and they are better encouraged to participate in healthcare services.
TIC advocates that health institutions and service providers must create an atmosphere of complete trust. This can be achieved by establishing clear boundaries and letting patients know what is expected of them.
Service providers need to discover their patients’ strengths and build on them while helping them develop better coping skills to mask their weaknesses. When patients are empowered, they are better equipped to deal with certain situations on their own when they stop receiving services.
The ultimate aim of these guiding principles is to ensure the healthcare environment is friendly enough to reduce the risk of re-traumatization or effectively manage a re-traumatization episode if it eventually occurs. Thus, there are no fixed rules or procedures guiding the