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A trauma-informed approach (TIA) is more than a set of practices; it's a fundamental shift in how organizations and systems engage with those they serve.
April 24, 2024
A trauma-informed approach (TIA) is more than a set of practices; it's a fundamental shift in how organizations and systems engage with those they serve. Recognizing trauma's widespread impact, a trauma-informed organization appreciates various experiences of recovery. It is vigilant in identifying the signs of trauma in clients and among families, staff, and other stakeholders. Importantly, this approach integrates an authentic sense of trauma into all aspects of the operation—from policy and procedures to daily interactions, thereby ensuring a supportive environment that avoids re-traumatization.
This widespread impact is reflected in global statistics, which reveal that over 70 percent of people around the world will experience at least one traumatic event during their lifetime, with almost 31 percent experiencing four or more traumatic events. In the United States, the prevalence of trauma is similarly high, with 90 percent of adults reporting exposure to at least one traumatic event.
The concept of safety is central to the trauma-informed approach. It encompasses physical and emotional realms, necessitating a deliberate effort to promote an environment where everyone feels secure. This means reevaluating and reshaping organizational structures and service deliveries to uphold these principles. For instance, common medical or behavioral health practices such as the use of restraints or seclusion may trigger traumatic memories and exacerbate a person's condition. Therefore, adopting TIA involves critically examining current practices and consciously removing or redesigning any that could potentially cause harm.
Creating a trauma-informed culture within an organization is not just about avoiding harmful practices. It's about actively promoting practices that facilitate recovery and build resilience. This involves training staff thoroughly in trauma awareness, adjusting treatment models to emphasize empowerment and collaboration, and continuously evaluating the impact of these changes on all involved. By embracing a trauma-informed approach, organizations contribute to more effective healing and recovery for individuals affected by trauma, enhancing overall health outcomes.
The importance of a trauma-informed approach (TIA) extends far beyond the confines of behavioral health services, touching various facets of society, including child welfare, law enforcement, the judicial system, education, victim services, physical healthcare, housing support, and services for veterans and military personnel. By incorporating TIA across these diverse systems, organizations can enhance the effectiveness of their services, leading to better recovery outcomes for those affected by trauma.
Key objectives to further strengthen a trauma-informed approach to care include:
Disparities exist in the nature of trauma experienced, with women more likely to report experiences of direct interpersonal violence, including sexual and physical assault. The consequences of unaddressed trauma are severe, extending beyond the immediate emotional and psychological distress to include a higher risk of developing mental illnesses and substance use disorders. Chronic physical conditions such as cardiovascular diseases and cancer are also more prevalent among those with unresolved trauma, demonstrating the critical need for comprehensive approaches to trauma identification, treatment, and prevention that are attuned to the physical, emotional, and social dimensions of health.
Traumatic events can vary widely in nature, ranging from single incidents to long-term chronic patterns, and are often categorized based on their origins as either natural or human-caused. Examples of traumatic events include physical, sexual, and emotional abuse; living with a family member who has physical or mental health conditions or substance use disorders; experiences of domestic violence or sexual assault; enduring chronic poverty, racism, discrimination, or oppression; exposure to community violence, war, or terrorism; and surviving a natural disaster or other periods of significant distress.
The way traumatic events are experienced can be individual or collective, and the context in which they occur significantly influences how individuals react and the types of support or services needed for recovery. Trauma operates on multiple levels: micro (affecting individuals and families), mezzo (impacting groups), and macro (involving organizations and communities). These levels are interconnected, clarifying trauma's comprehensive and collective impact on society. At the community level, systemic causes such as longstanding inequality or historical injustices can perpetuate trauma and its effects. Historical trauma, which is the collective complex trauma inflicted on a group of people who share a specific identity or affiliation, illustrates how deeply trauma can be woven into the fabric of a community, affecting generations.
The impact of trauma is highly individualized, and individuals may process traumatic events in vastly different ways. Not everyone who experiences a traumatic event will suffer from lasting negative effects. Several factors influence an individual’s response to trauma, including their previous life experiences, available social supports, personal coping skills, early relational health, and the reactions of their community. These factors can either mitigate or exacerbate the effects of trauma, affecting the severity and duration of its impact. In some cultural groups, there are strong taboos against overt demonstrations of trauma, which can make it difficult to recognize when individuals are suffering. As a result, these individuals might not appear traumatized to outsiders, necessitating alternative methods to understand and address their experiences. This aspect highlights the need for a sensitive and culturally informed approach to identifying and treating trauma.
Structural discrimination against specific groups can intensify the effects of trauma. Historical and intergenerational trauma, along with negative experiences related to beliefs and actions can lead to complex trauma when these individuals face subsequent traumatic events. This complexity is compounded by the social devaluation experienced by these groups, making their journey towards recovery uniquely challenging. Addressing trauma effectively requires not only an understanding of the individual’s direct experiences but also a deep appreciation of the broader societal and cultural contexts that shape their response to trauma. Individuals who experience trauma are significantly more likely to develop a range of mental health conditions, including anxiety disorders, depression, posttraumatic stress disorder (PTSD), and more severe mental illnesses such as schizophrenia and other forms of psychosis. The link between trauma and subsequent mental health challenges is particularly strong among youth; childhood exposure to trauma increases the likelihood of poor psychiatric and functional outcomes in adulthood, even when accounting for other childhood risk factors.
In coping with trauma, some individuals may turn to maladaptive behaviors such as unhealthy eating or self-harm. A particularly concerning aspect is the strong association between trauma and substance use, which includes a high risk of alcohol abuse, drug use, overdoses, and suicide. Among those diagnosed with PTSD, the prevalence of comorbid substance use disorder (SUD) is notably high, ranging from 19% to 35% for substance use and 36% to 52% for alcohol abuse. Almost half of the individuals with PTSD may also struggle with a comorbid SUD. This relationship often creates a self-perpetuating cycle, where individuals with SUD are more likely to experience traumatic events, which in turn exacerbate the substance use and the underlying trauma, highlighting the complex interplay between trauma and addiction. This cycle tells us of the need for integrated treatment approaches that address both trauma and substance use concurrently to break the cycle and support recovery.
