6 Essential Ingredients for Trauma Informed Care
2. Trustworthiness and Transparency
3. Peer Support
4. Collaboration and Mutuality
5. Empowerment, Voice, and Choice
6. Cultural, Historical, and Gender Issues
SAMHSA has identified 6 essential ingredients above for implementing trauma informed care. I will break them down into easy to understand examples and definitions.
1. Safety. Safety is defined by Merriam-Webster Dictionary as “a place that is free from harm or danger”. Safety in an organization means that the clients, family members, and staff feel both physically safe and psychologically safe. The stakeholders in the organization (clients, staff, and family) should have input into this. Physical safety measures that I have included in my private psychotherapy practice are increasing the brightness of the lighting for someone who was uncomfortable with a dimly lit room due to previous trauma, giving my clients first choice about seating, and providing directions on getting to my office. Psychological safety measures that I have included are providing an accepting environment, returning phone calls promptly when a client first calls to schedule an appointment, and transparency about my availability. Other physical safety measures for organizations that have staff are: ensuring that the office environment is not over stimulating, ensuring that staff does not have their backs facing each other—no one should have to be approached from behind. This should be adapted in all systems. There are juvenile detention centers who provide a physical space that has an appealing mural painted on the wall. Reducing the use of seclusion and restraint and finding alternatives may be another way to ensure the physical space is safe for people with mental illness or who are incarcerated.
2. Trustworthiness and Transparency. The method of communicating organizational policies and making decisions are clear to staff, clients, and family. Having clear and healthy boundaries are not only comforting to clients but to staff who are not re-traumatized by unclear policies and lack of enforcement of healthy boundaries. I have tried to incorporate trustworthiness and transparency in my work as a therapist by being on time for appointments, letting my clients know that I am human and make mistakes but will take responsibility for them, and outlining confusing fee schedules and payment. Starting on time and ending on time can also be part of the trustworthiness or at least acknowledging that the time may extend beyond the expected end time and allowing a choice.
3. Peer Support. Systems that encourage mutual self help fall under this category of peer support. How does your system, organization, or group encourage peer support? Are there opportunities to meet one on one? Are there opportunities to encourage safety through bringing a friend or trusted person to an appointment with you? Are there opportunities to engage with another who is going through a similar experience or have been through a similar experience? Do the staff have allotted, uninterrupted time for peer support?
4. Collaboration and Mutuality. Role power is minimized through collaboration and mutuality. Collaboration with building owners, maintenance, clients, and other organizational stakeholders is valued and there are processes in place to ensure everyone gets a voice in the therapeutic process. In my practice, I often ask my clients if I missed anything in the session or if there were important items that we did not cover in that session. I also involve clients in goal setting and determination of length of services to the extent that I am able.
5. Empowerment, Voice, and Choice. From SAMHSA, “Throughout the organization and among the clients served, individuals’ strengths and experiences are recognized and built upon. The organization fosters a belief in the primacy of the people served, in resilience, and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. The organization understands that the experience of trauma may be a unifying aspect in the lives of those who run the organization, who provide the services, and/or who come to the organization for assistance and support”. Staff often gets pushed to the side in the interest of cost savings and bottom line expectations of productivity, however, empowerment, voice, and choice apply to the staff as well.
6. Cultural, Historical, and Gender Issues. The agency makes no assumptions about race, culture, or gender expectations and roles. The agency is sensitive to historical trauma and even the likelihood of previous sanctuary trauma. Systems are in place to be culturally sensitive, racially aware, gender informed, and trauma aware. Education is ongoing. In my practice, I don’t pretend to know everything about a culture or way of life. I ask questions; take an interest by reading about culture specific practices and concerns. I am aware of the gender spectrum. I make no assumptions that if I share the same race as my client that we are alike.
These essential ingredients which are listed in SAMHSA’s Concept of Trauma and Guidance for a Trauma Informed Approach and expanded by me in this posting, can be a guidepost for any organization in development, evaluation, and planning. Communities should look within their agencies to ensure that these ingredients are being followed. City and county governments could benefit greatly from posting these ingredients in a widely seen place to guide them as they make decisions that will affect those in the community—both who have and have not been affected by trauma and/or adverse childhood experiences. Promoting resilience takes the upfront effort of planning and coordinating.