Five things to know about trauma-informed practice

It’s Public Health Week—a time to reflect on the hard work accomplished in public health and a time to look at the approaches currently influencing the field.

This week on Public Health Insider, we are going to explore one key concept that is informing the work of public health today: trauma-informed practices.

What do these terms mean? It sounds like jargon, but when we say that we are using a trauma-informed approach, we are saying that we recognize the impact trauma may have on people’s mental, physical and emotion health. From a public health perspective, it also includes a focus on root causes of trauma such as racism and oppression that cause collective harm in the first place.

But the focus on trauma has its limits. As we will explore this week, a lot about how a trauma-informed approach translates into practice is about tapping into the strengths that individuals and communities use to be resilient in the face of adversity. To better understand this important lens, here are five things to know about trauma-informed approaches.

1. Trauma-informed approaches are a shift in perspective often characterized by a deeper understanding of the impact that trauma can have on physical and psychological health over time, and the power to heal in the context of safe and trusting relationships. The well-known ACEs (Adverse Childhood Experiences) study and many subsequent studies found that adults who have greater exposure to childhood trauma, such as abuse and neglect, are more likely to experience negative health and social impacts later in life.

This deeper understanding has led to a shift in the way providers across many fields work with individuals and communities. For example, without a trauma-informed approach, we might focus narrowly on one health behavior—like smoking. Now, we look at understanding the larger cumulative effects of adversity in someone’s life that may contribute to someone smoking. This shift is often characterized by a change from asking, “What’s wrong with you?” to “What’s happened to you?” or “What’s right with you – what are your strengths?” “How can this relationship contribute to healing?”

2. Trauma is not about one single event. One question that comes up is how to draw the line of what is considered trauma? Trauma, in a public health context, is anything that overwhelms our capacity to cope—experiences or stressors that overtake our physiological or psychological system and lead to a profound sense of loss of control and helplessness. Different people experience trauma differently, and the impacts of trauma on an individual are the result of the complex constellation of life experiences, sources of support, genetics, and societal context.

3. The concepts aren’t new, but the applications have broadened. These ideas are not new, but they are gaining traction and being applied in many different contexts.

For instance, trauma-informed practices are now used in schools to inform the way discipline is handled and among doctors who look to build on a patient’s strengths in addition to their needs. We see the concepts being used to better support staff in health and social service fields who are more likely to be exposed overtime to the difficult experiences of people with higher levels of trauma. These second-hand experiences —a concept known as vicarious trauma — can slowly lead to burnout.

4. A trauma-informed approach is incomplete without a focus on what is protective for individuals and communities.

An important departure from a narrow focus on trauma is widening our lens to include the many ways that people and communities are resilient to adversity. We know that adverse childhood experiences are common—about two-thirds of people in King County have had at least one adverse childhood experience and yet, ACES do not define us. Instead, we are increasingly determined to build on the strengths that lead to well-being.

For example, research has found that supportive relationships with caring adults can prevent or even reverse the impacts of trauma—this research has informed many approaches such as this one within Best Starts for Kids. At the community level, public health draws on the knowledge that healing is experienced collectively and can be strengthened through connections to ones’ community and culture, such as this approach supported through Communities of Opportunity.

5.  Many great resources to explore. This week, we are going to highlight just a few of the many perspectives on the topic. But there are many resources for “Public Health Insiders.”  Here are just a few of our favorite resources:

This great read by Dr. Shawn Ginwright describes the importance of moving from trauma informed care to healing centered engagement.

Excerpt: “ . . The pathway to restoring well-being among young people who experience trauma can be found in culture and identity. Healing centered engagement uses culture as a way to ground young people in a solid sense of meaning, self-perception, and purpose. This process highlights the intersectional nature of identity and highlights the ways in which culture offers a shared experience, community and sense of belonging. Healing is experienced collectively, and is shaped by shared identity such as race, gender, or sexual orientation.”

This 5 minute video primer on Adverse Childhood Experiences provides a helpful foundation on the original ACEs study and its current applications.

The ACES Too High site includes research and reflections like this one including how organizations and communities are implementing practices based on the research.

Originally published April 1, 2019

One thought on “Five things to know about trauma-informed practice

  1. Thank you for writing a post about this; I am really glad the concept of trauma-informed practice is gaining more attention. Another aspect of trauma-informed care that is good to include in the conversation is trauma-informed consequences, especially when interacting with homeless young people or other young people who have experienced trauma.

    The reason I bring this up is because in my experiences volunteering in homeless shelters, I have seen the confusion that ensues when trying to “punish” or set boundaries with youth who have experienced trauma, but may also be behaving in a disruptive or unsafe manner. When interacting with young people, rules and consequences must take into account normal adolescent development, the impact of trauma on development and behavior, the realities of homelessness or an unstable living situation, and the unique histories of each young person. It is useful to clarify the differences between punishment and trauma-informed consequences in order to use the situation at hand in a constructive manner. Typical “punishment” includes things like barring youth from shelters or handing them off to a different staff member without any follow-up from the staff member who witnessed the situation. Trauma-informed consequences, on the other hand, involve responses like asking youth to cool off in a safe place, and asking oneself what in the environment could be triggering that person’s emotions. It involves open communication with youth to find out what their needs are to feel safe, should be individualized, and requires more forethought and creativity by service providers. In the end, trauma-informed consequences can slowly shape behavior and build youths’ ability to manage powerful emotions.

    Again, thank you for engaging in this topic! I am open to hearing any other levels of trauma-informed care that others have had experience with.

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