Trauma-Informed Care is a relatively recent concept that is growing in acceptance. In contrast to other kinds of care, it starts with the assumption that the person receiving care (counseling, therapeutic, medical, etc.) has experienced trauma. Therefore, the care needs to take the trauma into consideration from the start. It’s not a bad assumption as trauma is common, even if it does not become post-traumatic stress disorder.

In this post, we’ll cover what trauma means, what it looks like, and how to support an individual with trauma. The ideas here come from a presentation given by Fiona Wilson from St. Joseph’s Healthcare Hamilton at the 2016 National Conference on Peer Support.

There are many kinds of support for individuals who have faced a traumatic situation. However, before you can understand how to support an individual you must understand what trauma means and what it looks like.

Trauma is defined as a threat to life and limb or body integrity of self or someone else. The experience of trauma is terrifying, individuals can experience sudden and out of the ordinary feelings of helplessness and fear. The causes such as witnessing or directly experiencing an event can lead to extreme stress that can overwhelm an individual and their ability to cope. There are two major types of trauma:

1. Interpersonal Trauma (i.e., childhood abuse, sexual assault, historical trauma, loss due to homicide, torture and forcible confinement, elder abuse)
2. External Trauma (i.e., war-combat, killing, fear of being killed, witnessing death and extreme suffering, dismemberment, victim of crime, sudden death of loved one, suicidal loss, natural disaster, extreme poverty, etc.)

Trauma can be experienced personally or vicariously. For example, many people who work in mental health and or addiction services may have experienced personal trauma. Some individuals can use their personal traumas and use their resilience and strength to support others. The idea of peer support is built upon this premise. Unfortunately, when you work with individuals who are dealing with trauma you are putting yourself at risk of developing vicarious trauma. Vicarious trauma is the experience of “bearing witness to atrocities that are committed human against human. It is the result of absorbing the sight, smell, sound, touch, and feel of the stories told in detail by survivors who are searching for a way to release their own pain.”(Health Canada, 2001)

There are many responses to handling stress and trauma, many know of the fight or flight response. However, there are many options as to how someone could respond to the stress they are feeling.

If individuals are unable to cope appropriately and effectively, there are many health consequences they could face. Some examples are:

• Substance Abuse/Smoking
• Depression and Anxiety
• Eating and Sleep Disorders
• Feelings of Shame and Guilt
• Poor Self-Esteem
• Phobias and Panic Disorders
• Physical Inactivity
• Psychosomatic Disorders
• Post-Traumatic Stress Disorder
• Suicidal and Self-Harm Behaviour

Much research has been conducted on how to help individuals cope with the above mental health consequences of trauma. Trauma-informed care (TIC) includes both individual and organizational responses to the acknowledgement of the link between trauma and the experience of mental illness and/or addictions. TIC acknowledges that some of the mental health conditions acquired after trauma may be adaptive responses instead of a mental illness. The assumption of a trauma experience guides individual’s interactions despite whether the individual understands or remembers the trauma history. Their response to the trauma and the defence they put forward can be reframed as a coping strategy and this is recognized as a strength. The goal of TIC is to help individuals feel empowered and knowledgeable through their use of skills to take care of themselves, have a sense of choice, and internal control and autonomy of their lives.

“Abuse knows no boundaries, no cultural group, ethnic background, lifestyles, educational or socioeconomic background is spared”

Trauma-informed support is guided by the principles of peer support. Having an individual use their personal trauma to support others. There are many strategies that should be used to properly provide TIC.

1. Practicing the principle of “Do No Harm”
   • Pro-actively avoiding re-traumatization
   • Do not lead where you are not prepared or able to follow.
2. Grounding
   • Helping someone be completely in the here and now.
   • Discussing what would make a person feel safe in the moment
   • Use pillow, blankets, warm or cold liquids, etc. to refocus attention on the present & give comfort.
3. Validating
   • Respond to disclosure with belief and validation
   • Disclosure does not require you to do something other than watch for triggers and helping to make efforts to connect with experts in trauma/abuse.
4. Reframing
   • Acknowledging the person’s coping behaviours/actions as ways to survive – supporting an exploration of alternative behaviours and actions as part of the recovery process.
5. Modeling Self- Care
   • Share ways in which you’ve taken care of yourself during difficult or distressing situations.
6. Practicing Self-Care
   • In order to model good self-care, you must first practice good self-care.
   • What are the things you need to do for yourself on a regular basis to feel good and stay healthy.

Ultimately recovery is the core goal for trauma survivors, their families, and their treatment providers. This does not mean complete freedom from post-traumatic issues but it can allow you to move forward. The recovery process allows individuals to regain the understanding, support and practical assistance so that trauma survivors can find within themselves a genuine basis for hope, as well as personal, relational and spiritual renewal.