Trauma Informed World

Making the world a better place through trauma informed care.

6 Essential Ingredients for Trauma Informed Care

1. Safety
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.

Posted 191 weeks ago

Trauma Informed Momentum is Here and NOW

Trauma informed care is gaining momentum as we approach the world with a new lens.  No longer are we able to look the other way when people who have suffered historical trauma and sanctuary trauma are in the news every day.  Our awareness of the need to change is crystal clear in the time of global terrorism and national concerns about how our systems are treating citizens.  The overpopulation of the Earth has led to a global crisis of apathy, us versus them mentality, and inability to be effective at creating change.  We are no longer a global community but in a race to have global dominion over one another no matter how much we convince ourselves that we are doing the right thing for our country, our religion, and our freedom.  

So what is trauma informed care and why do we need it?   The groundbreaking ACE study led by Kaiser Permanente and CDC asked 10 questions about Adverse Childhood Experiences and showed that these experiences are correlated to individuals being in “survival mode”.  This mode of being affects our health and wellbeing.  We have learned from this study that adverse childhood experience affects all of our people from every socioeconomic, cultural, and racial background.  Those who have had historical trauma are even more affected.  This is why we should care…we all experience trauma, we all experience adversity.  We should expect from our governments and our systems a trauma informed approach.  SAMHSA defines trauma as, “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being”.  SAMHSA goes further by stating that we need trauma informed care because of the adverse effects trauma has on individuals.  “Examples of adverse effects include an individual’s inability to cope with the normal stresses and strains of daily living; to trust and benefit from relationships; to manage cognitive processes, such as memory, attention, thinking; to regulate behavior; or to control the expression of emotions. In addition to these more visible effects, there may be an altering of one’s neurobiological make-up and ongoing health and well-being”.  These adverse effects are creating humanity incapable of solving problems as hopelessness and rigidity are on the rise.

There are those of us who can and do shut out adverse experiences of ourselves and others.   We avoid feeling our own pain by numbing with food, alcohol, drugs, technology and we avoid feeling others pain by blaming them, looking at them as different, seeing through them instead of walking with them.  We don’t understand and therefore we judge, we shame, and we push them out the door as fast as we can by stating, “What is wrong with them” rather than asking, “What happened to them”.   We go home from our jobs, our trips, our errands seeing it right in front of us but not wanting to confront the reality that our community members are experiencing pain.  We have the cultural expectation of being independent and handling our problems on our own.  We would be hermits if this were the case!  We are biologically programmed to live in community.  We are biologically programmed to not go it alone.  We have allowed ourselves to be convinced that very young children separate from their parents by going to preschools.  We have allowed ourselves to be convinced that letting your child go means all day 4K, all day K.  We have allowed our middle schools to encourage parents not to be involved as to “encourage independence”.  We fight with our teenagers because we don’t know how to make them feel important and valued unless they are involved in a sport.  Our biological families have been so diminished that they have lost meaning.  In its place are psychological family relationships—the people we meet in school, the friends that come and go, the neighbors we have if we even know who they are.  The friends we make in our hometown that are there to know us help us, encourage us—if we are lucky.  

This blog is to encourage communities to become trauma informed and to share the journey that this community is taking.  This blog is about creating community wide trauma informed systems.  There are communities who have been brave enough to start the process and who are farther along than most. Some of those places include San Diego County in California and Tarpon Springs, FL.  There are ACE groups in many states but their reach is not far enough.  County governments can take action on developing systems and programs for trauma informed care.  Again, quoting SAMHSA, “A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization”.
We can create a trauma informed world!  Please share your journey in creating trauma informed societies.

Next post:  The 6 Essential Ingredients for a Trauma Informed System
Do you know YOUR ACE score?

Posted 191 weeks ago
Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.
Thich Naht Hanh
Posted 191 weeks ago