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Trauma-Informed Care: The Basics

July 30, 2020
All Points North Lodge

What Is Trauma-Informed Care?

At its most basic, trauma-informed care is the practice of providing health care or human services in a way that intentionally acknowledges that trauma is prevalent in the world, and many (if not most) clients and patients have experienced some sort of trauma in their lifetimes.

Trauma-informed care does not mean that the services being offered to a person are services to help heal past trauma. Instead, trauma-informed care is a philosophy that emphasizes that all patients and clients have a past that may impact the way they receive or respond to any health or human service.

Facilities and providers implementing trauma-informed care seek to understand the whole person and avoid practices and policies that could trigger past trauma.

What Is The Definition of Trauma?

In the most recent version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) exposure to trauma is the first essential criterion of a PTSD diagnosis. In this DSM-5, qualifying trauma is articulated as "exposure to actual or threatened death, serious injury or sexual violation."

The DSM-5 goes on to add:
"The exposure must result from one or more of the following scenarios, in which the individual:

  • directly experiences the traumatic event;
  • witnesses the traumatic event in person;
  • learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or
  • experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related)."

Though PTSD was previously considered an anxiety disorder, it is now categorized as a stressor-related or trauma-related disorder. Other trauma-related disorders addressed in the DSM-5 include adjustment disorders, acute stress disorder, reactive attachment disorder, and disinhibited social engagement disorder.

When we think about trauma, our minds often jump to what we would call "Big T" traumas. These would fit into the DSM-5 definition of traumas above. These may include events like natural disasters, war, terminal illness, car accidents, abuse, etc.

However, a second and more informal category of trauma is what our clinicians call "little t" traumas. These types of trauma are more inconspicuous and much more common. They don't count as qualifying events for trauma-related conditions in the DSM-5, but they can still leave lasting impacts on our behavior. In fact, "little t" traumas often seem normal until later in life when something helps us realize that what we experienced was not the norm. These more unassuming traumas are still essential to consider in trauma-informed care.

"Little t" traumas can include nearly anything negative (intentional or unintentional) throughout the lifetime like:

  • Your childhood role in your family-of-origin
  • Difficult words from others that stuck with you
  • Bullying
  • Family fights
  • Divorce
  • Breakups
  • Job loss

Ryan Soave, Director of Program Development at APN Lodge, often says, "The question isn't if you have experienced trauma. The question is, what trauma have you experienced."

What Are the Statistics on Common Traumas?

The statistics on trauma (even "Big T" trauma alone) can be staggering. Below are some statistics on common traumas. Again, the goal here when learning about trauma is never to increase fear or anxiety. Instead, it is to realize that the majority of people have been impacted by significant trauma during their lives.

  • In 2015, an average of 9.2 out of every 1000 children were victims of child abuse and neglect. - SAMHSA
  • "Each year, the number of youth requiring hospital treatment for physical assault-related injuries would fill every seat in 9 stadiums." - SAMHSA
  • Disaster has impacted 54% of families living in America. - SAMHSA
  • One in six women has been a victim of rape or attempted rape during their lifetime. - RAINN
  • Around 5% of children experience the death of one or both parents by the time they turn 15 years old. - VICE
  • Around 40,000 people die in vehicle-related accidents each year. - NSC

The Four Assumptions of Trauma-Informed Care

The Substance Abuse and Mental Health Services Administration (SAMHSA) developed and published a comprehensive explanation and guide to trauma-informed care in 2014. In that guide, SAMSHA established that four main assumptions are essential to trauma-informed care. Those assumptions are:

  1. Realization: All staff in a trauma-informed organization (no matter their level or role) must realize the prevalence of trauma in the world and how trauma can have deep and wide effects on clients, families, and communities.
  2. Recognize: All staff must know and be able to recognize signs of trauma in the people they encounter.
  3. Respond: Basic awareness is not enough. Trauma-informed organizations go beyond awareness to implement trauma-informed care using the six principles listed below.
  4. Resist Retraumatization: Some policies and practices can be triggering for staff and clients. Trauma-informed organizations fight to foster well-being, health, and a safe environment.

The Six Principles of Trauma-Informed Care

In order to put assumptions three and four into action, SAMHSA outlines six principles of implementation for trauma-informed care in any organization.

  1. Safety: Both clients and staff must feel physically and psychologically safe while in the building and working with the staff.
  2. Trustworthiness and Transparency: Trust should be developed continuously through transparency and rapport-building. Operations and decisions should not feel shady or deceitful.
  3. Peer Support: Foster hope and safety by encouraging people to share with and support each other as they navigate difficult experiences.
  4. Collaboration and Mutuality: Discourage staff silos, and encourage every level and role of staff that they are an important piece of the collaborative team effort to make the organization safe and trustworthy.
  5. Empowerment, Voice, and Choice: Empower both staff and clients to voice their opinions, contribute to the conversation, collaborate in choices, and speak up. Recognize strengths and allow trauma to unite and empower rather than isolate and silence.
  6. Cultural, Historical, and Gender: Reject stereotypes. Teach and practice cultural competency. Recognize historical traumas. Offer services to empower and increase accessibility to care.

How Does Trauma-Informed Care Work at All Points North Lodge?

All Points North Lodge works to foster safety, trust, empowerment, and voice from the first touch with our brand to the alumni program. Beginning with a website click or a call to the Contact Center, our team views every prospective client or family through the lens of trauma. But that is just the start.

At All Points North Lodge, we offer what we have termed "trauma-integrated care" to take trauma-informed care to the next level. In addition to incorporating the pillars of trauma-informed care, APN Lodge views addiction, mental health, and trauma through the lens of trauma. While our entire staff practices trauma-informed care, our clinicians work with clients and their families to dig deep into both "Big T" and "little t" traumas.

Research and anecdotal evidence have shown that dysfunction in adulthood is frequently the result of unresolved trauma. We believe that lasting recovery from addiction, mental health issues, and trauma is much more possible when the work of healing does not center merely on symptom reduction, but on the wounding that caused the symptoms to begin with. By implementing a trauma-integrated approach on top of trauma-informed care, our goal is not just to avoid triggers and foster safety, but to actually resolve and heal the trauma. When healing comes for the heart of the issue, clients are able to begin to reduce symptoms and re-learn how to function without resorting to old, dysfunctional trauma responses.

For more information on our take on trauma or how we can help you, a loved one, or a client who is suffering with the effects of unresolved trauma, give us a call today.

References & Resources

  1. https://images.app.goo.gl/Gw4zKNPp7dY2sDH89
  2. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
  3. https://www.samhsa.gov/child-trauma/understanding-child-trauma
  4. https://www.rainn.org/statistics/victims-sexual-violence
  5. https://www.vice.com/en_us/article/a3y9g4/how-the-death-of-a-parent-affects-a-child
  6. https://www.nsc.org/road-safety/safety-topics/fatality-estimates

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