Trauma and Violence-Informed Care

Information

What is Trauma?

Trauma is defined by the three Es:

Trauma results from an Event, series of events, or set of circumstances that is Experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse Effects on the individual’s functioning and physical, social, emotional, or spiritual wellbeing.

https://www.samhsa.gov/sites/default/files/trauma-informed-care-operating-plan.pdf

Effects of Trauma: In the Moment and Over the Long Term

At the time of a traumatic event, an autonomic neurobiological reaction is sometimes ignited, referred to as a fight, flight, or freeze reaction. People tend to experience a sense of fear, vulnerability, or helplessness as a first response to a traumatic event. This in-the-moment response may be re-ignited in interactions with service providers when topics or environmental factors bring the trauma memory to the forefront.
Long-term effects of trauma are experienced in many domains of health and functioning (physical, emotional, cognitive, spiritual, or behavioural) when people are unable to make meaning of the trauma and use skills to self regulate, find safety, heal, and grow. It is important for service providers to recognize the range of responses people can have and how these responses affect people’s ability to develop trusting relationships with service providers and benefit from service access.

Types of Trauma

There are a number of types of trauma:

Personal and Developmental Trauma: Trauma can be experienced early in life, arising from interpersonal acts such child abuse, neglect, witnessing violence, and school shootings. This is referred to a developmental trauma. In later life, harmful experiences caused by people, such as domestic and sexual violence, home invasion, and exposure to war, can result in trauma.
Environmental Trauma: Exposure to natural disasters (e.g., wildfires, floods, earthquakes, and tornados), sudden unexpected loss, and other life events that are out of one’s control can also be traumatic.
Intergenerational Trauma: People can be affected by the emotional and behavioural reactions of ancestors or older relatives who have experienced significant trauma. This is called intergenerational trauma.
Socio-Cultural and Historical Trauma: Trauma has been described in socio-cultural terms. Experiences involving disruption in trusted relationships because of violence or abuse, forced uprooting and dislocation from one’s family, community, heritage, or culture are examples of this sort of socio-cultural trauma. Historical trauma is multigenerational trauma experienced by a specific cultural, racial, or ethnic group. It results from highly violent and oppressive events, such as slavery, the Holocaust, forced migration, and the colonization experienced by Indigenous People in Canada.

Note that:

Trauma can be individual, group, community, or mass in nature.
A similar event or experience might be experienced as traumatic for one person but not for another.
Trauma can involve a reaction to, or the lasting effects of, a single event or multiple and cumulative experiences.
Re-experiencing of the fight, flight, freeze response can happen during interactions with health and social service providers, requiring providers to recognize and attend to the situation, and support the service user.

Understanding Trauma and Violence-Informed Care

What we Mean by Trauma and Violence-Informed Care

Trauma-informed approaches are familiar to many organizations and service providers, and this term has been expanded to include violence which underscores the connections between trauma and violence.

Trauma and violence-informed approaches are policies and practices that recognize the connections between violence, trauma, negative health outcomes and behaviours. These approaches increase safety, control and resilience for people who are seeking services in relation to experiences of violence and/or have a history of experiencing violence.

The goal of trauma and violence-informed services and systems is to avoid re-traumatizing individuals, to support safety, choice, and patient strength, and to promote learning, health, and healing.

Trauma and violence-informed care requires a universal application. When working in a trauma and violence-informed way, health care providers are looking to reinforce and amplify resilience, strength, and positive coping within those for whom they provide care.

Trauma-informed specific services seek disclosure of trauma and provide therapeutic/healing-oriented support, whereas trauma and violence-informed services do not require disclosure of trauma and are thus important in the provision of care to those who might benefit from trauma-specific services but be reluctant to access them. When people have been exposed to neglect, danger, problematic substance use, violence and/or trauma, trauma and violence-informed support navigating consent for all levels of services is important.

Enacting the Principles of Trauma and Violence-Informed Care

Trauma and violence-informed care is a principle-based approach to practice. Four principles guide these approaches:

Understand Trauma and Violence, and Their Impacts on Peoples' Lives and Behaviours

Awareness of the high prevalence of trauma, and the breadth of its effects and responses, is the foundation for trauma-informed practice. This foundational awareness is what guides trauma and violence-informed practitioners in all interactions, particularly because being trauma and violence-informed is not about seeking disclosure of trauma nor is it about treating trauma. Awareness is critical.
Create Emotionally and Physically Safe Environments

Safety is a necessary first step for building trustworthy relationships, engagement, and healing. Physical, emotional, spiritual, and cultural safety are keys to trauma and violence-informed practice. This aspect of a relational approach is often not given the centrality it deserves.
Foster Opportunities for Choice, Collaboration, and Connection

The creation of agency in these three ways is reparative of the overwhelming, power-over experience of trauma and violence. Making space for as much collaboration as possible is a shift from directive and expert-driven models.
Provide a Strengths-Based and Capacity-Building Approach to Support Client Coping and Resilience

In trauma and violence-informed approaches, practitioners look for strengths, resiliencies, and skills that have helped people survive, and discuss how these can be built upon. While not necessarily therapists, trauma and violence-informed practitioners are prepared to teach basic self-regulation skills.

These principles can be enacted by all professionals, paraprofessionals, and peer-support personnel. Importantly, they are intended to be universally applied, providing affirming and compassionate care in the face of the high prevalence of adversity experienced by patients.

Trauma and violence-informed approaches align well with evidence-based communication approaches such as “motivational interviewing”, which also emphasizes partnership, acceptance, compassion, and empowerment. These approaches are aligned in how they use “power with” rather than “power over” relational approaches.

Approaches that are culturally safe, that are oriented around harm reduction and equity, and that draw on lived experience/expertise are also aligned with trauma and violence-informed approaches.

Practical Ways of Being Trauma and Violence-Informed

Enacting the Principles

To be trauma and violence-informed, practitioners should ask themselves basic questions about enacting the trauma and violence-informed principles, such as the following:

Awareness Principle: What do I know about trauma and violence that can help me understand what might be happening for the patient in this situation? If the client discloses trauma or violence, am I ready to normalize the experience and share information?
Safety and Trustworthiness Principle: How might I create trust and safety? Are there potential traumatic issues for the patient and how can I handle a trauma response if there is one?
Choice Collaboration and Connection Principle: How can I work with the patient to build on their skills and practices used to manage difficult emotions? How will I integrate patient choice within the parameters possible and provide space for patient agency?
Strengths and Skills Principle: How will I acknowledge patient strengths? And am I prepared to teach basic breathing or other grounding skills should the need for patient self-regulation arise?

Key Strategies

Trauma and violence-informed practice is both simple and profound in its impact. It makes it possible for patients who have experienced trauma or violence, who may find it difficult to manage relationships, to access the care they need and deserve. Beyond in-the-moment trauma responses, you may notice that people with trauma or violence histories may be easily frustrated, act impatiently, appear to over-react, be oversensitive, or have difficulties managing feelings in general. Trauma and violence-informed approaches offer practitioners guidance in the face of these relational challenges including:

building trust and predictability;
anticipating triggers and creating safety;
supporting client control and collaboration;
deciding as to the helpfulness of talking about trauma or not, and being ready to share information;
being flexible in the face of challenges by paying attention, making decisions, and processing information;
teaching basic skills in grounding, breathing, and mindfulness; and
considering how diversity such as gender, race, housing and income security, age, and migration status may affect the experience of trauma, and how processes such as ageism, ableism, racism, sexism, homophobia. and transphobia may be in operation.

Resources for Health Care Providers

Here are some resources that may be helpful for your practice, including those specific to African, Caribbean, and Black patients, Indigenous patients and gender-diverse patients. Information and resources for patients are also included below.