Trauma-informed practice - why it is important for service providers 

article by VSS staff member Darren Hincks

Trauma-informed care and practice –why it is important for service providers

In the previous article we looked at how trauma-informed care can support those whose lives have been shaped by trauma. This article will explore why implementing trauma-informed practice is important for service providers.

For a service provider, the importance of trauma-informed practice should not be overlooked. Being sensitive to a survivor’s history of trauma can assist service providers in developing a tailored approach when engaging with clients that may have a history of trauma. Often, an individual’s trauma may not be immediately obvious   For example, coping mechanisms such as self-medication and substance misuse can be better understood once contextualised within a survivor’s history of abuse and trauma (DeCandia & Guarino 2015).

Many survivors will experience complex trauma and will continue to struggle with their health and wellbeing, relationships and sense of self and identity throughout their life (Kezelman 2014).  

Complex Trauma can be defined as ‘a full range of psychological trauma that has as its unique trademark a compromise of the individual’s self-development’ (Ford & Courtois 2009). For example, a child experiencing complex interpersonal trauma, such as repetitive physical abuse, sexual abuse or neglect, may have their normative stages of development severely disrupted. A complex trauma therefore is not only related to the traumatic event itself, but also to how neurobiological and physiological systems will adapt to the traumatic situation. So, complex trauma is often synonymous with developmental trauma.

The level of influence complex trauma can have on a child’s brain development and functioning can be significant. Over time, a child becomes unable to experience nurturing relationships that are essential to the development of self-regulation (beliefs, thoughts, and actions) and self-integrity. The potential long-term impact will depend on the child’s level of vulnerability, and the severity, duration and frequency of the traumatic event. Development becomes a state of helplessness and hyperarousal which results in ‘malignant memories’ (Schwartz & Perry 1994). As such, the child is predisposed to re-experiencing the traumatic event - such as intrusive thoughts and dreams, and other symptoms of PTSD.

The needs of such survivors will change over their lifespan and will often go beyond the scope of traditional mental health services.  They may need to access a wide variety of services, such as those relating to substance misuse, homelessness and employment. However, when seeking various services, survivors are met with a system that is fragmented in approach and inconsistent with follow-up. These inconsistencies can lead to feelings of re-traumatisation, or secondary victimisation.

The traditional medical model, using non-trauma-informed practice, tends to address symptoms but overlooks the underlying trauma that a survivor has experienced. For example, complex trauma is not an official diagnostic classification (Wall & Quadara 2014). Traditional diagnostic criteria of trauma are based on the classification of posttraumatic stress disorder (PTSD).  PTSD is generally considered to be experienced after a single-event, such as a random assault. In actuality, when an individual presents for trauma it may well be triggered by earlier, undisclosed experiences of childhood trauma. Addressing a client’s needs based only on a diagnosis of PTSD can inadvertently overlook undisclosed complex trauma. It has been estimated that 5 million adults living in Australia have been impacted by various forms of trauma and therefore complex trauma is a major issue facing the public health system in Australia. For example, the Royal Commission into Institutional Responses to Child Sexual Abuse has revealed the alarming extent to which children were, or are still, vulnerable to abuse and repeated trauma, stretching back decades. Despite the number affected, the effects of complex trauma are often unrecognised and go unaddressed within the Australian public health system. 

Survivors of complex-trauma have complex needs and they often face barriers when negotiating with a variety of service providers.  In addition, engaging with services that are not trauma-informed may be triggering for them. For example, a survivor may receive an empathetic understanding response from one trauma-informed service - only to have their experience minimised by another service which is not trauma-informed. Moreover, services intended to support those experiencing trauma can unintentionally provide an environment that is triggering and re-traumatising if they are not trauma-informed (Kezelman 2014).  

Fortunately, survivors have shown positive outcomes after engaging with services that adopt trauma-informed practice (Kezelman 2012, Fallot & Harris 2011).  "Recovery cannot occur in isolation. It can take place only within the context of relationships characterized by belief in persuasion rather than coercion, ideas rather than force, and mutuality rather than authoritarian control – precisely the beliefs that were shattered by the original traumatic experiences." (Herman, 1992).

Service providers who decide to adopt trauma-informed practice have a variety of resources available to them. The Blue Knot Foundation's Practice Guidelines for Treatment of complex trauma and trauma informed care and service delivery provide a useful blueprint. Fallot and Harris (2011) provide an overview of how organisations can ‘self-assess’ from the top-down (administrative) and bottom-up (service level) to align their operation with the principles of being trauma-informed.  

 Complex trauma affects not only its victims but those with whom they are in contact, as well as the children they go on to have (Kezelman 2014). Service providers who adopt trauma-informed practice, can better support survivors of complex trauma in their healing process and reduce the likelihood of intergenerational transmission of trauma.  

  

   

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