Trauma-Informed Care (TIC)
What is a trauma-informed care approach?
“A trauma-informed care approach is a system-wide approach to addressing adversity that underlies much suffering and its impact on relationships” (Kennedy, 2020). It involves “a service model guided by knowledge of what is needed for healing from emotional and psychological wounds.” (Kennedy, 2020). It is committed to creating a culture of thoughtfulness and communication, with people continuously doing their best to learn about, and adapt to, the different and changing needs of the individuals the work with.
A TIC philosophy applies to all our work within the integrated care systems. Everybody has a responsibility for helping people to heal from adversity they have experienced in their lives.
What is viewed as “trauma” in a trauma-informed care approach?
This is any level of adversity in life which has detrimentally impacted upon the person. (NB. It is important to note that the impact of adversity is not deterministic of suffering. People who experience adversity should not be automatically thought to experience suffering – this would be anti-TIC. Some people experience psychological growth after adversity.)
What does trauma-informed care look like?
Everybody in the Integrated Care System (ICS) is able to recognise:
- the signs and symptoms of trauma and adversity,
- understand the impact of trauma and adversity,
- understand what is needed to heal adversity,
- understand what is within the scope of their practice to assist in healing the psychological wounds, and what requires referral to other services.
An understanding of the person’s difficulties based on “what has happened to you?”, rather than “what is wrong with you?”. Difficulties are understood as an understandable response to what has happened (“survival strategy”).
Pathways within the integrated care system based on knowledge of what is needed for healing from emotional and psychological wounds. This needs to include:
- Psychologically-informed care and access to psychological therapies (trauma-informed, and trauma-specific, interventions). (NB. Not everybody who has experienced adverse experiences requires psychological therapy. Many psychosocial interventions delivered by a host of services can assist in overcoming the legacy of adversity. Sometimes we can assume that all people who have experienced adversity require trauma therapy, which can be undermining for the person).
- Collaborative working across sectors with divides between these removed.
An approach within integrated care systems (ICS) based on:
- Offering Validation – recognising and communicating that the person’s experiences/behaviours are understandable/meaningful/adaptive responses to adversity in their lives (“survival strategies”)*. The person would not be here if they had not developed them.
- Offering compassion
- Working in a collaborative way, acknowledging that – “people who deliver the service and people who access services” together have wisdom in knowing how to meet the person’s needs.
- Using everyday language to discuss mental health. Avoiding labelling and stigmatising.
- Empowering people and developing their self-efficacy (“doing with” not “doing to”).
- Recognising and building on the persons strengths.
- Offering support for creating conditions where healing can begin (help with housing, income and getting out of an abusive relationship).
- Offering choice over treatment, care, and approach.
- Being truly diverse and inclusive, reflected in the ICS values, the staff/people offering support so that that people for whom the service is provided can feel they can identify and be understood.
- Ensuring a sense of physical and psychological safety for the people we work with (sense of worth, having a valid place, free from physical harm, trust, dignity, privacy).
- Engaging people in proactive safety planning. Addressing the issues causing risk behaviours which place people at risk. Advocating for sharing the plan throughout the system and learn from each episode of crisis within the system.
Integrated Care Systems which recognise the potential for causing harm (re-traumatising people). Trauma can be caused and perpetrated by services and institutions. Thus, Integrated Care Systems need mechanisms in place to avoid this including:
- A staged model of care adopted across Integrated Care Systems which focus on stabilisation before processing adversity.
- Not encouraging re-telling of trauma stories unnecessarily as this is re-traumatising.
- Acknowledgement of harm that can be caused by services in the management of risk. A commitment to positive risk-taking and collaboration with the person and other services around risk. Remembering “People need to come before protocols”.
- Clinical supervision and reflective practice focussing on the relationship with “service users” so that traumatic patterns are not re-created and that compassionate practice is enabled.
- Enabling “staff” to engage in reflection in their day-to-day work to notice and address re-traumatising relationships occurring with “service users” and to enable compassionate practice.
- Mitigating power imbalances between “service users” and “staff”.
- Focussing on organisational processes which can be re-traumatising (e.g., being turned away from services, removing the persons control to manage risk).
- Having services available to meet the persons needs at the right time. A commitment to fitting the service to the person and recognising the harm caused when people cannot fit into what a service dictates.
- Including knowledge about trauma into policies, procedures, and practices.
- Co-production in service development with people with lived experience.
ecognition that organisations and teams are traumatised and develop survival strategies. Emotional and psychological safety needs to be offered to all service providers and practitioners. (NB. This needs to take account of the current context of the Covid-19 pandemic).
Commitment to evidencing the process and value of TIC via evaluation/research.