CONVENTIONAL APPROACH
Trauma Informed Approaches (TIAs)
‘Trauma-informed’
‘Trauma-informed’ has become a term commonly used among mental health professionals, service providers and the general public over the past 20 years (Goodman, 2015). This term is used to describe the way in which service providers are trained to respond to situations and offer services, with an embedded understanding of the "complex and ongoing role of traumatic events in an individual’s life” (Harris & Fallot 2001; Goodman, 2015, p.57). Trauma Informed Approaches (TIAs) are grounded in principles of “neuroscience, psychology and
social science as well as attachment and trauma theories” (Sweeney, et al., 2016, p. 177). TIA models seek to establish a complete understanding of the lasting impacts of traumatic event can have on the "neurological, biological, psychological and social development” of a service user and to further interrogate the repercussions this bares on an individual’s guiding perspectives and relationships (Sweeney, et al., 2016, p.177). However, it is important to keep in mind that the discourse around trauma and trauma-informed practice is extensive, and for this reason, it is difficult to establish a comprehensive and unified definition within this short overview.
What is Trauma?
The common use of the term ‘trauma’ demonstrates that there is a pervasive acknowledgement and acceptance that “traumatic experiences can have negative and lasting effects on individuals” (Goodman, 2016, p. 55). Trauma is recognized by the American Psychiatric Association and described in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as the following:
The person has been exposed to a traumatic event in which . . (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or other; (2) the person’s response involved intense fear, helplessness, or horror. (p.428; quoted Bustow, 2003, p. 1296)
The significance of the DSM, will be further discussed when evaluating ways in which mental health professionals assess and diagnose service user trauma. What is also important to note here are the dissimilar ways in which individuals may respond to the same traumatic event. Symptoms of trauma include, but are not limited to: fear, nightmares, hopelessness, helplessness, worthlessness, flashbacks, avoidance, depression, anxiety, despair, distrust, rage, guilt, dissociation, self-harm, emotional numbness (American Psychological Association, 2013; Goodman, 2015; Burstow, 2003).
Of significance here is the variance in which individuals identify with the term trauma. For instance, Yuen (2007) raises that there are “individuals and groups who are determined to not be defined by stories of trauma” ( p.4), whereas others posit that trauma is “[a]rguably, […] a conceptualization that psychologically injured people claim for themselves” (Burstow, 2013, p. 1301). Therefore, although trauma is defined concretely by the DSM, as demonstrated above there are countless ways in which it is understood and embodied by survivors of trauma.
Key Principles
"Trauma-informed mental health services are strengths based: they reframe complex behaviour in terms of its function in helping survival and as a response to situational or relational triggers” (Sweeney, 2016, p. 179).
According to Sweeney et al. (2016), frontline mental health professionals should be trained in methods that foster a safe environment, prevent the retraumatization of service users and provide further referrals to trauma-specific resources. A consolidated list of TIAs’ key principles includes: recognizing the signs of trauma, building trust, maintaining transparency and practicing an attuned awareness of power differentials. Ultimately, the goal is for service providers to work with service users to collectively establish a care plan that involves peer-support and appropriate service referrals. The table below, borrowed from Sweeney et al. (2016), defines the nine key principles of TIA in more detail.
Assessing Trauma
“[T]rauma-informed services can engender more comprehensive and effective mental health services by ensuring that practitioners conduct in-depth assessments of trauma service” (Goodman, 2016. p. 57). Through this process, service providers “screen for a history of trauma and assess for trauma symptoms, including the ways in which trauma coping might manifest '' (Fallot & Harris 2001, as sited in Goodman, 2016, p. 57).
A tool commonly used to diagnose trauma is the DSM. According to Burstow, the “DSM is the key text that mediates the application of diagnoses” (2003, p. 1299). It defines mental disorders and provides a guideline for further assessing trauma and diagnosing Post Traumatic Stress Disorder (PTSD). For example, the PTSD Checklist
for DSM-5 is a 20 question survey that can be completed individually by a service user, or together with a service provider to assess symptom severity. Answers are to fall within the 5- point Likert scale, which ranges from zero (‘Not at all’) to four (‘Extremely’) and, according to the International Society for Traumatic Stress Studies (ISTSS), the survey results should only be interpreted by a professional or clinician (National Center for PTSD, 2013). Results are used to determine appropriate treatment plan, allows service provider to track service user progress, and if necessary, prompts service provider to address the lack of improvement (National Center for PTSD, 2020). The image below showcases a section of the PTSD Checklist for DSM-5 (National Center for PTSD, 2020).
Trauma Informed Care in Social Work
The short video on the right discusses the practical application of TIAs within the social work profession.
Benefits
Goodman (2015) acknowledges that through the creation of TIAs and the acknowledgement of the complex, multifaceted and long-lasting impacts of trauma on an individual, we have made significant progress in counselling and psychology. Goodman identifies two key benefits that TIAs bring to the mental health sector:
1) By integrating the use of assessments to identify the root and the severity of trauma symptoms, especially within settings that are not typically focused on mental health where trauma-specific needs might be overlooked (such as schools), we can avoid misunderstanding of cause of behaviour, and can provide appropriate referrals rather than discipline.
2) Trauma-informed practitioners and scholars advocate for a deeper understanding of the “underlying and interconnected concerns’ of trauma rather than only “treating symptoms or seeing life events and concerns as separate and unrelated” (p.57) and a recognition that “traumatic events have ongoing impacts” on trauma survivors (p.58).
3) The strength-based approach employs the construct of ‘empowerment’ when working with service users who have experienced trauma. This is significant because “trauma survivors [..] are often disempowered by traumatic events and/or by post-trauma symptoms that continue to affect their lives” (p. 58).
However, Goodman (2015) also identifies that in order for TIAs to be effective they need to be integrated within all social service programs.