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Understanding and Implementing Trauma-Informed Care for Clients in Pain: Summary 37
• Adopts a strength-based approach to care • Prioritizes emotional and physical safety of service users • Works in partnership with trauma survivors to design, deliver, and evaluate services A WORLD OF TRAUMA AND PAIN It is important to recognize the prevalence of chronic pain and trauma in our society, and the impacts it might have on us, our clients, and our work. The National Council for Mental Well-Being states that 70% of adults in the United States have experienced some type of traumatic event at least once in their lives . In public behavioral health, over 90% of clients have experienced trauma. Approximately 60% of adults report abuse or other difficult family circumstances during childhood and 26% of children in the United States will witness or experience a traumatic event before the age of 4. More than 60% of children 17 or younger have been exposed to crime, violence, and abuse either directly or indirectly. People who have PTSD are 15 times more likely to attempt suicide. People who have experienced trauma are four times more likely to become an alcoholic, develop a sexually transmitted disease, or inject drugs. Defining Trauma The American Psychological Association states, “A traumatic event is one that threatens injury, death, or the physical integrity of self or others and also causes horror, terror, or helplessness at the time it occurs.” • Acute trauma : Resulting from a single incident like a car accident • Chronic trauma : Repeated and prolonged, such as domestic violence or childhood abuse • Complex trauma : Exposure to multiple traumatic events throughout a lifetime • Trauma occurs when a stimulus, stress, or threat exceeds a system’s capacity to withstand it Trauma can result from: • Sexual assault
INTRODUCTION
A NEW MODEL OF CARE What is Trauma-Informed Care (TIC)? Four Pillars of TIC include: 1. Understand the prevalence and impacts of trauma 2. Acknowledge signs and symptoms of trauma 3. Respond and support in an informed manner 4. Aim to avoid retraumatization What Trauma-Informed Care is NOT 1. Doesn't involve knowing their detailed trauma history 2. Doesn't involve assessing or even assuming trauma 3. Doesn't involve talking about their trauma 4. Doesn't involve treating or "healing" trauma There is a difference between “on” and “with.” To work on trauma is to tell your client what to do about it. To work with trauma is to understand what they are experiencing and navigate it as it comes up. Trauma-Informed Care - 6 Core Principles 1. Safety: Creating a safe physical, physiological, and psychological environment 2. Trustworthiness and transparency: Helping the client become informed and being a consistent safe resource for them 3. Peer support: Being able to recognize what other sources of support a client (or a colleague) may need 4. Collaboration and mutuality: Helping the client become an active participant in their health journey 5. Empowerment, voice, and choice: Encouraging a client’s autonomy and supporting them to set boundaries 6. Cultural issues: Recognizing and eliminating any racial, cultural, or gender bias to appropriately meet that client Researchers and trauma survivors define tic as a system that: • Understands and acknowledges the links between trauma and mental health • Adopts a broad definition of trauma that recognizes social and complex trauma • Undertakes sensitive inquiry into trauma experience • Refers individuals to evidence-based trauma-specific support • Addresses vicarious trauma and re-traumatization • Prioritizes trustworthiness and transparency in communication • Seeks to establish collaborative relationships with service users
• Emotional abuse • Childhood neglect • Serious accident or illness • Natural disaster • War • Terrorism • Domestic violence • Life-threatening medical procedure
A stressor or event will not become traumatic if there was adequate capacity to handle the stimuli or if there was adequate resilience to come back to homeostasis after the threat or stress was removed. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), trauma is not an objectively diagnosable psychological condition. PTSD, which is a formal
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