Elements of trauma-informed care The Office for Victims of Crime Training and Technical Assistance Center (OVC TTAC, n.d.) and SAMHSA (2014) divide trauma- informed care into four elements: 1. Realizing the prevalence of trauma : Trauma is currently widespread, with increasing reports of shootings in schools, terrorism, and other violent events occurring worldwide. 2. Recognizing how trauma affects all individuals (including those working to end the trauma): Trauma events and experience of the trauma can have vastly different effects on individuals. Throughout their lifetimes, individuals who have experienced trauma may suffer from the repercussions of those events (SAMHSA, 2014). They may not disclose the trauma to their healthcare providers, but those who do may continue be affected by trauma that happened in the distant past. transparency; collaboration and mutuality; empowerment, voice, and choice; peer support; and cultural, historical, and gender issues (SAMHSA, 2014). Collaboration is at the core of trauma- informed care. Involving survivors of the trauma in meaningful and real decisions and empowering them to tell their stories, creates survivor-based practices that improve quality of care. The survivor’s well-being, wishes, and safety are a priority. An assessment of a trafficked person’s safety and well-being may lead healthcare providers to realize that the person is not currently able to leave the situation of exploitation. The trafficked person might be in need of shelter, food, water, clothing, and so on. Concepts of trauma-informed care Trauma-informed concepts include safety; trust and Rather than forcing an individual into something he or she is not prepared for, the clinician should provide information, resources, and emotional support. Evidence has demonstrated that trafficking can be a cyclical process (Zimmerman et al., 2011), with periods of being free from trafficking followed by re-entry into similar circumstances. This is not a reflection of the services provided for survivors, but a reminder of the complexities surrounding this crime. Safety The concept of safety encompasses the physical and psychological safety of the potential trafficked person, as well as the staff and is a primary concern (SAMHSA, 2014). Patients need to be certain that they are not in danger, either from their trafficker or from the authorities. Many patients are hesitant to volunteer information or cooperate with authorities, because their trafficking experience has left them without control of their lives or bodies and without a sense of safety (IOM, 2009). Healthcare professionals should be aware of the safety protocols specific for their facility and who to call in case of physical violence. How healthcare providers conduct themselves is also important, especially in the early stages of obtaining information from a potentially trafficked individual. Clinicians should be nonjudgmental and allow the patient to process and convey his or her history in a safe and contained way (Clawson et al., 2008). Trust and transparency Trafficked persons are often fearful that they are in danger, from both their traffickers and the authorities, and this fear ties into their trust of clinicians. They are typically concerned about confidentiality. Key principles of building and maintaining trust are to discuss these issues forthrightly and honestly. Healthcare professionals Systematic use of trauma-informed care Every member of a healthcare organization can use trauma- informed care, even those without a distinct medical or health- related position. It is commonly believed that trauma-informed care refers to the organization and actions of a larger system (Heffernan & Blythe, 2014). Individuals can apply a trauma-
3. Responding by putting this awareness of the prevalence and effect of trauma into practice: Healthcare providers, once aware of the potential trauma that a patient may have experienced, must change their practice to protect the patient from re-experiencing trauma while in the office or while receiving care (SAMHSA, 2014). 4. Resisting retraumatization: Retraumatization occurs when an individual experiences something that triggers painful memories and represents an element of the past trauma (SAMHSA, 2014). By practicing trauma-informed care, healthcare providers aim to avoid placing patients in situations that retraumatize them. Training is needed in all areas of the healthcare system to recognize the potential for retraumatization and the need to provide patient-centered care (IOM, 2009; SAMHSA, 2014). are required to keep patient information private and confidential; sharing this fact with potential trafficking patients is vital (IOM, 2009). Transparency, or openly sharing all parts of any procedure before and while they occur, is equally vital for maintaining trust (OVC TTAC, 2015; SAMHSA, 2014). There are instances when state law requires that authorities be contacted. Informing patients about this process before they reveal sensitive information can build trust. It may affect how much the patient reveals, but ultimately it will build a relationship with the patient and likely make him or her feel more comfortable returning if given the chance. Healthcare providers who gain the trust of their patients must ensure that they keep that trust (SAMHSA, 2014). Collaboration and mutuality Collaboration involves multiple different parties, including the trafficked person and other staff members across various disciplines. Developing a plan of care or protocol, even if it does not include the patient immediately leaving the trafficker, is vital. Survivor-based practices, such as working with the patient to make this plan, promote the success of these plans. Empowerment, voice, and choice The closely related concepts of empowering trafficked individuals and teaching them that they have both a voice and a choice are some of the most important concepts of trauma- informed care. Empowering is giving an individual or group the ability to make choices and turn these decisions into actions and outcomes (World Bank Group, 2011). By embodying these concepts, a trafficked person may be able to escape the exploitation. Directing patients to materials and resources that can support them is one way to help empower them and build on their strengths (Jorge-Birol, 2010). Peer support Sharing experiences with fellow trafficking survivors is powerful for recovery and healing; it helps establish mutual self-help, collaboration, and safety (SAMHSA, 2014). If there is a strong, trusting relationship between trafficking patients and providers, the trafficked individuals may be able to provide immediate support to trafficked peers and possibly bring these peers to healthcare facilities. Cultural, historical, and gender issues Collectively, healthcare organizations should offer patients gender-responsive services and respect cultural and traditional practices when possible (SAMHSA, 2014). Individual healthcare professionals should be aware of personal biases.
informed lens to specific situations to maximize the potential of this intervention and to evaluate existing practices. Trafficked individuals need trauma-informed care and symptom-specific interventions.
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