Trauma-informed practice: what it is and why NAPAC supports it

In the twenty or so years of its existence, NAPAC has heard from thousands of abuse survivors who described harrowing, retraumatising experiences in a wide range of health and social services settings – the very organisations that they looked to for support in their recovery or in their efforts to seek justice.

Physical restraint, seclusion and forced treatment are still part of practice in many mental health units, psychiatric hospitals and prisons in the UK.[1]  Disbelief, coercion, manipulation, restriction of movement, shaming, belittling and many other behaviours and dynamics that are reminiscent of the callers’ original abuse are replayed in many service settings and deepen survivors’ physical and emotional distress. It goes without saying that such experiences worsen a person’s chances of lasting recovery, not least because they discourage or altogether stop them from seeking support again in the future.

In the United States and Australia there has been growing recognition in recent years of the high prevalence of trauma and post-traumatic stress in the general population – not only among war veterans[2]. Vast numbers of people have suffered chronic abuse and neglect in childhood, marginalisation, poverty, racism, violence, imprisonment or experienced or witnessed other events that resulted in traumatisation. Moreover, a solid body of research now exists to show that many mental and physical illnesses and general emotional distress are associated with unprocessed traumatic experiences.[3]

Against this backdrop—and propelled by an ever-increasing number of abuse survivors speaking out about their experiences in public—health and social care services in the US and Australia started to develop trauma-informed approaches to their practice and/or systems.

The key goal of trauma-informed practice is to raise awareness among all staff about the wide impact of trauma and to prevent the re-traumatisation of clients in service settings that are meant to support and assist healing.

In addition, it raises awareness of and guards against vicarious trauma, i.e. the health risks that have been identified among staff who regularly engage with traumatised clients.

In other words, a trauma-informed organisation pursues an approach in all areas of its operations to prevent the replication of traumatic experiences or dynamics among clients and staff and avoids adding to the chronic stress people carry.

A programme, organisation or system that is trauma-informed, as defined by the US Government,

  • realises the widespread impact of trauma and understands potential paths for recovery
  • recognises the signs and symptoms of trauma in clients, family, staff and others involved in the system
  • responds by fully integrating knowledge about trauma into policies, procedures and practices
  • seeks to actively resist re-traumatisation.

 

Rather than following a prescribed set of policies and procedures, a trauma-informed approach adheres to six key principles:

  1. Safety

Throughout the organisation, staff and the people they serve feel physically and psychologically safe. The physical setting is safe and interpersonal interactions promote a sense of safety.

  1. Trustworthiness

Organisational operations and decisions are conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members of clients.

  1. Collaboration

There is true partnering and levelling of power differences between staff and clients and among organisational staff, from direct care staff to administrators. There is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making.

  1. Empowerment

Throughout the organisation and among the clients served, individuals’ strengths are recognised, built on, and validated and new skills developed as necessary.

  1. Choice

The organisation aims to strengthen the staff’s, clients’ and their family members’ experience of choice and recognise that every person’s experience is unique and requires an individualised approach. [4]

 

NAPAC strongly supports the growing movement towards trauma-informed practice and has been raising awareness among relevant stakeholders in recent years. Since 2015, NAPAC’s training programme has been spreading best practice in engaging with and supporting abuse survivors in a trauma-informed way among professionals from a range of sectors: health and social care, criminal justice, educational and religious institutions, national and local government, and the media.

For people living with with mental health diagnoses it can be extremely empowering and healing to explore and recognise that many or even all of their symptoms are linked to chronic traumatic experiences in childhood rather than innate ‘defects’ or ‘disorders’

For this reason, trauma-informed approaches encourage trained practitioners to ask their clients, “What happened to you?” – not “What’s wrong with you?”.

It is our hope that the common effects of trauma and the best approaches to engaging with and supporting traumatised people will become part of a much larger conversation and increasingly absorbed into general knowledge and practice. With a recent Word Health Organisation survey suggesting that 70% of the global population has experienced at least one traumatic event—and on average 3.2 traumas over a lifetime—it is clear there is an urgent need to raise awareness and deepen knowledge about the impact of traumatic experiences and how all of us can find a more trauma-informed approach to life.[5]

[1] Care Quality Commission (2017). The State of Care in Mental Health Services 2014-2017.  Retrieved 11/01/2019 from https://www.cqc.org.uk/sites/default/files/20170720_stateofmh_report.pdf

[2] See https://www.acf.hhs.gov/trauma-toolkit and https://aifs.gov.au/cfca/publications/trauma-informed-care-child-family-welfare-services/introduction

[3] Felitti, V. J., & Anda, R. F. (1997). The Adverse Childhood Experiences (ACE) Study. Center for Disease Control and Prevention. Retrieved 2015 from: http://www.cdc.gov/ace/index.htm

[4] Retrieved March 2019 from: https://www.integration.samhsa.gov/clinical-practice/trauma

[5] Kessler, R.C. et al (2017), Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology. Retrieved March 2019 from: https://www.tandfonline.com/doi/full/10.1080/20008198.2017.1353383

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