TRAUMA-INFORMED CARE
The Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) defines individual trauma as follows: An event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. (p. 7) What is trauma-informed care? Trauma-informed care is a broad approach to treating all patients, many of whom have experienced trauma and its physical, emotional, and social repercussions. It is a lens to view all people encountered in the healthcare setting, because any individual may have experienced a trauma that is affecting his or her actions and decisions (National Technical Assistance Center for Children’s Mental Health, n.d.a.). As stated by the team at Georgetown University Center for Child and Table 3: Human Trafficking Health Risks and Consequences Definition
Trauma-informed care encompasses more than just trafficked individuals and is not limited to those who have diagnoses that are typically associated with trauma, such as PTSD. The healthcare professional must keep trauma-informed care in mind when deciding on appropriate interventions for a trafficking patient. Trauma-informed care is imperative for providing the best treatment of patients who have been trafficked and those who have other violence-related health concerns. Human Development, trauma-informed care is changing the fundamental question from “What is wrong with you?” to “What happened to you?” (National Technical Assistance Center for Children’s Mental Health & JBS International, n.d.b.). SAMHSA (2014) dissects trauma into the three E’s: event, experience of the event, and effect. Identifying these elements of trauma helps deepen the healthcare provider’s understanding of how trauma differs among individuals (see Table 3).
Example
Event
Either single or recurring circumstances of actual or extreme threat of physical or psychological harm or neglect. The individual’s perceptions of the event(s); how he or she labels, assigns meaning to, and is affected physically and psychologically. The results and repercussions of the events, most frequently described as adverse effects, which negatively affect the individual who experienced the traumatic event.
Witnessing violence against others, being sexually violated, verbal abuse and/or threats, etc. Two siblings living in a toxic and abusive environment, one may view the experience as negative, and the other may not. Decreased ability to cope with normal stresses, developing a stress disorder such as posttraumatic stress disorder, etc.
Experience
Effect
Note . Adapted from Substance Abuse and Mental Health Services Administration. SAMHSA’s concept of trauma and guidance for a trauma- informed approach . (HHS Publication No. [SMA] 14-4884). Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Elements of trauma-informed care
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). 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.
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),
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