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What Is Trauma-Informed Care?

by Trevor Norkey

What is trauma-informed Care?

Trauma affects nearly every person at different levels and is a central focus of many social services. Trauma can impact various human services cases, including substance use, employment, and child welfare. Additionally, we are still learning more about trauma's symptoms, origins, and best practices.

Empathetic and effective social workers must be able to answer the question, "What is trauma-informed care?" — including its core principles, responses, and importance.

The Role of Trauma-Informed Care

Trauma-informed care practices help social workers approach clients in a sensitive, mental health-focused manner. Even without a post-traumatic stress disorder (PTSD) diagnosis, trauma-informed responses ask social workers to assume clients have experienced trauma. In doing so, they can more easily identify the effects of trauma and avoid triggering re-traumatization throughout their care plan. 

Trauma-informed approaches aim to increase respect and empathy in social services. Rather than only considering current responses, social workers are now better trained to understand trauma history and how it shows today. 

That said, you should avoid explicit conversations about trauma with most clients unless they're in a safe environment and feel comfortable discussing it.

What Is Re-Traumatization?

Re-traumatization consists of an individual entering a situation or environment that reminds them of their trauma or otherwise impacts their PTSD. These instances may trigger difficult or overwhelming emotions connected to the initial traumatic event. Depending on the instance, re-traumatization can also cause intense trauma responses that are difficult to understand. 

For example, an individual with childhood trauma may experience re-traumatization after stepping into an old home. Alternatively, an abuse survivor may push loved ones away if a situation makes them feel unsafe. 

Mental health professionals take re-traumatization seriously because it poses risks to clients and those around them. Re-opening the trauma can increase its effects and longevity by turning an isolated incident into a perceived series of events. 

Additionally, clients' reactions may cause them to hurt themselves or others, even emotionally. As such, being aware of re-traumatization and each client's triggers is crucial to providing a practical trauma-informed care approach. 

The Long-Term Effects Of Trauma

Trauma can take many forms throughout people's lives with different levels of prevalence. For many people, the effects of trauma may be less noticeable at times, but never go away.

Long-term trauma can impact clients' behavioral and chronic physical health. Without proper recovery from trauma, these effects can lead to mental health conditions, irrational decisions, substance use, and other serious concerns. This can also impair clients' careers, relationships, reputations, and wellbeing. 

Left untreated, trauma such as childhood emotional abuse may be passed onto others, creating a vicious cycle. Trauma-informed care social work aims to help clients break the chains of their trauma, whether it's generational or isolated. With a personalized, empathetic care plan, clients will hopefully identify how their trauma affects them and diminish its long-term effects.

The 6 Principles of Trauma-Informed Care

Trauma-informed care is a multifaceted process that requires social workers to combine various practices and principles.

1. Safety

Safety should be among a social worker's top concerns for any client, which may be especially challenging to prioritize in trauma-informed care. Individuals with PTSD may respond to frightening situations with irrational thoughts, words, or actions, which can endanger them or others. 

Even outside of physical safety, social workers should ensure their clients feel safe. Feeling endangered or unwelcome are natural adverse effects of trauma that can lead to worse conditions, such as anxiety and insomnia. Case managers should ensure clients are in a safe environment, including at home and at work, and be attentive to their comfort needs.

2. Choice

Re-establishing and maintaining a sense of control is critical to helping clients overcome trauma symptoms. Though every incident is different, many traumatic experiences occur when an individual cannot escape, such as a natural disaster. These experiences can limit individuals' fight or flight responses and make them feel stressed in situations they don't have control over. This is especially true for chronic trauma and adverse childhood experiences.

Social workers can help clients overcome their feelings of powerlessness by giving them control over their care plans, such as letting them choose between therapists. Furthermore, giving clients options in their trauma recovery may make them feel more engaged, leading to better retention and results. 

3. Collaboration

Human services organizations give social workers opportunities to share information and resources with one another. Coworkers, colleagues, and others in your network may recommend educational outlets for specific types of trauma. They can also suggest or refer you to service providers that meet your clients' needs. 

Organization-wide collaboration is especially critical when working with complicated trauma cases. Coworkers and others in your network may identify symptoms or solutions you hadn't considered, increasing your perspective for clients. Additionally, other social workers may step in to help with cases as needed, which can be critical for your mental health when working with trauma.  

4. Peer-Support

Information-sharing helps your organization improve by increasing perspectives, resources, and available data. Supporting one another is essential for social services as the industry continues to learn more about mental health and better practices. 

Everyone in your organization should have at least basic knowledge about trauma to aid clients and one another. In doing so, you can ensure you have an open channel of communication and support. Furthermore, leaders should highlight employees' skills, experiences, and training, as some social workers may be more qualified to handle specific trauma. 

5. Trustworthiness

Trustworthiness and transparency are critical to all social services, particularly for sensitive clients with a history of trauma. Your organization's trustworthiness includes its public image, cybersecurity, reliability, and more. Even missing one appointment with a client could impair their trust.

A client losing faith in your services can limit their engagement in their care plan and, in doing so, impair their recovery. Additionally, clients may not feel a reliable sense of control if they can't trust your organization with their schedule or data. 

As such, maintaining a trustworthy brand is critical to giving clients the help they need. 

6. Empowerment

Every client is different. But many victims of trauma find peace after acknowledging their scars and embracing the life they've built despite them. Whatever path your client takes to get there, self-empowerment should be their end goal. 

For example, consider a patient with PTSD related to a physical injury. Everyday tasks they can no longer perform the same way may remind them of the incident and cause re-traumatization. However, regularly attending physical therapy may improve their dexterity and make them feel more empowered and in control. This process will help them decrease the prevalence of trauma in their life. 

Handling Trauma: The 4 R’s of Trauma-Informed Care

In 2014, the Substance Abuse and Mental Health Service Administration (SAMHSA) established four "R's" for trauma-informed approaches

  • Realization
  • Recognition
  • Response
  • Resistance 

These principles have since become the framework for many trauma-informed care models, especially in social services. They help organizations prepare for various services while treating clients respectfully and avoiding re-traumatization. 

Realize the Impact of Trauma

Realization stresses the need for organizations and service providers to understand the effects of trauma. Even if your work isn't directly trauma-focused, everyone within your organization should have basic knowledge about it. Most crucially, you should be aware of how trauma affects a person's life, as it can be prevalent in almost any case. 

Trauma-informed care is still relatively new to mental health. Previously, an individual with undiagnosed trauma may not have received the care they needed. In extreme circumstances, stigmas and prejudices impaired social workers from identifying clients' underlying traumas and responding appropriately.

In order to provide the best possible care, case managers must realize trauma's various impacts and forms. This process requires continuous trauma education to stay updated on new practices and eliminate unconscious biases. 

Recognize the Symptoms of Trauma

"Recognition" focuses on a service provider's ability to identify symptoms of trauma — particularly before incidents of re-traumatization. Most social workers can research specific forms of trauma as they get to know each client. Nevertheless, they should still be able to identify different trauma signs, symptoms, conditions, and risks before taking on each case. 

Identifying trauma can be complicated as its effects look different for each individual and extend beyond PTSD criteria. Trauma-related symptoms may include:

  • Emotional distress
  • Avoidance of responsibilities
  • Lack of focus
  • Intrusive thoughts
  • Outbursts of emotion
  • Irritability
  • Reliving traumatic events or experiencing flashbacks
  • Nightmares and insomnia
  • Depression
  • Anxiety
  • Physical discomfort

Respond Appropriately by Providing Care

Trauma-informed responses are the primary focus of the four R's. Social workers should apply specific trauma-informed care principles to all areas of their case management plans, from their services to implementation. Then, they should update and change their approach as they learn more about clients' situations to meet their needs adequately.

First and foremost, social workers must identify the best specific services for each client, which may require choosing from multiple options. For example, a veteran struggling with PTSD and substance use could benefit from various types of resources and rehab programs. Their best choice likely depends on their specific trauma and needs. 

Beyond services, social workers should also be aware of their language and behavior when working with clients. Certain words, actions, or environments may make individuals with PTSD feel unsafe or unwilling to trust you — which can be challenging to come back from. Awareness of your entire approach, down to your word choice, tone, and non-verbal cues, is crucial for their betterment. 

Finally, human services organizations must also adopt trauma-informed care practices into their policies. As discussed, unconscious biases and unidentified effects of trauma can impair your services and potentially worsen clients' conditions. 

So, individuals at every level of your organization must respect and understand trauma and mental health issues. This ensures social workers have the appropriate space to advocate for their clients' needs.

Resist Re-Traumatization

Finally, re-traumatization and other traumatic experiences can impede clients' recovery and lead to safety concerns. So, social workers must know how to resist re-traumatization, including by helping clients understand their symptoms and risks. 

As discussed in the other R's, the most crucial aspect of resisting re-traumatization is being aware of the trauma itself. Re-traumatization incidents can often be avoided by letting your clients share their thoughts. Simply verbalizing their fears and being heard may help them rationalize their feelings in the moment. In other cases, you may suggest steps for the client to aid or distract themself to regain their sense of control. 

Though discussing overwhelming emotions is often an appropriate approach, you should not push clients to discuss anything they aren't comfortable with. Many people unconsciously repress their traumatic memories because they're not ready to process them. But this doesn't mean they'll never be ready. 

Listen to your client's needs and look for non-verbal cues. However, never put them in a situation that makes them feel unsafe. Otherwise, you may trigger re-traumatization and worsen their symptoms. 

In some cases, re-traumatization may be unavoidable — especially if the client's care plan requires them to unpack their trauma through therapy. So, effective resistance also includes a social worker's ability to diminish the impacts of re-traumatization when it occurs. 

In most cases, re-traumatized clients should not be left alone to ensure they don't hurt themselves or others. Therapists and mental healthcare providers may recommend grounding techniques for trauma, such as focusing on breathing. 

Causes of Nonprofit Employee Retention Problems

In the aftermath of the COVID-19 pandemic and the great resignation, businesses across many industries have experienced an uptick in employee turnover. This trend has been especially prominent in the nonprofit sector, where limited budgets and resources often make it difficult for organizations to retain their top talent.

High turnover can have serious consequences for nonprofits, including reduced productivity, decreased morale, and increased costs — all of which directly affect the quality of services these organizations provide to their constituents.

In this article, we'll discuss why high turnover is a critical issue for nonprofit organizations, the negative impacts of high turnover on nonprofit organizations and the people they serve, the best practices for keeping teams engaged and reducing turnover, and how low-cost nonprofit case management software can help improve engagement and retention in nonprofit teams.

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Trevor Norkey