Trauma-informed care in child/family welfare services
- Trauma terminology
- What is the evidence that a trauma-informed approach is needed?
- What is trauma-informed care?
- Which services should be delivering trauma-informed care?
- Challenges in implementing a trauma-informed approach to care
- Applying trauma-informed care principles
- Moving forward
Applying trauma-informed care principles
To illustrate how trauma-informed care principles can be applied to respond to different trauma issues, we briefly look at service delivery in the context of people affected by the policies that created the Stolen Generation, past adoption practices and humanitarian migration.
The Stolen Generation
In their program logic, the Aboriginal and Torres Strait Islander Healing Foundation (2014, p. 25) explain how a collective healing process for members of the Stolen Generation and their descendants can occur, and the mechanisms that underlie this process. Central to this model is an understanding of an Aboriginal world view and the pervasive trauma of colonisation, and the need for specific strategies to address ongoing, collective trauma. A common element of collective healing projects is that they are based on a trauma-informed or recovery framework. According to the Healing Foundation (2014):
Trauma-informed practice is a strengths-based approach to healing that: is based on an understanding of, and responsiveness to, the impact of trauma; emphasises physical, psychological, and emotional safety for people seeking help and for the helpers; and creates opportunities for people affected by trauma to rebuild a sense of control and empowerment. It recognises the prevalence of trauma and is sensitive to and informed by the impacts of trauma on the wellbeing of individuals and communities. (p. 47)
Forced adoption and past family removal practices
An example of an issue that has only recently received public acknowledgement of its role in traumatising a large number of Australians is the former practice of forced adoption, or separation from family due to past family removal practices. In their exploration of good practice principles for services addressing the needs of people affected by forced adoption and past family removal practices, Kenny, Higgins, and Morley (2015) noted:
There is increasing recognition of the potential for trauma for individuals who have been subjected to forced adoption policies and practices, and the value of a "trauma-informed" or "trauma-aware" approach to service delivery. Good practice suggests that service providers should approach all clients with a forced adoption experience as if they might be trauma survivors (p. 8).
In their overview of good practice principles, Kenny et al. (2015, p. 8) outlined the key elements of trauma-informed service delivery. Being a trauma-informed service ensures the provision of:
- a safe and supportive environment that protects against physical harm and re-traumatisation;
- an understanding of clients and their symptoms in relation to their overall life background, experiences and culture;
- continued collaboration between service provider and client throughout all stages of service delivery and treatment;
- an emphasis on skill building rather than managing symptoms;
- an understanding of the symptoms and survival responses required to cope;
- a view of trauma as a fundamental experience that influences an individual's identity rather than a single discrete event; and
- a focus on what has happened to a person rather than what is wrong with a person.6
Humanitarian migrants surviving torture and trauma
The NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) outline the program logic for their service model as systemic and based on an ecological model of factors that influence and support healing for survivors (see How We Work <www.startts.org.au/about-us/how-we-work>).
They aim to provide a range of services that reflect the bio-psycho-social model, such as:
- complementary therapies or neurofeedback to address biological impacts;
- counselling to address psychological impacts; and
- community development projects to support social changes.
"There is nothing more practical than a good theory": The theoretical basis of trauma-informed models of care
(a) Attachment - developing a secure base
Attachment theory (Bowlby, 1988) has been used by developmental psychologists to explain positive, secure relationships between infants and caregivers, and how this forms the template for secure adult interpersonal relationships. Disruption to the relationship or insecure attachment is seen as a fundamental mechanism by which childhood trauma affects adult self-concept, wellbeing and interpersonal relationships. Trauma-informed care systems provide a safe environment to expose disruption to the attachment relationship, and build new internal models and "scripts" of the self and relationships.
(b) Self-regulation and control
Social cognitive theories of self-regulation help explain how individuals respond to threatening events. Key components of many trauma-specific treatments are to help individuals to improve self-regulation, safety, security, sense of control and mastery of their environment, and modulate their emotional reactions to traumatic stimuli. Trauma-informed systems of care are aware of the ways in which programs and organisations can trigger traumatic reactions - or even inadvertently replicate the dynamics of the traumatic events/relationships - and seek to minimise them, and promote environments that facilitate positive affect regulation or "modulation".
(c) Fundamental attribution error - overestimating the personal characteristics, underestimating situational factors
Theories of social psychology have identified that humans often make what is termed the "fundamental attribution error", whereby we over-emphasise a person's personality, or internal characteristics, in explaining their behaviour, and underestimate the environmental, or situational factors, that are external influences on their behaviours (e.g. see: Jones & Harris, 1967). For clients who have experienced trauma - particularly complex trauma involving multiple injuries in the interpersonal domain - it is likely that those around them, including their families, their work colleagues and even their health/mental health professionals, are likely to attribute their interpersonal difficulties and deficits in functioning and wellbeing to an inherent personality flaw, rather than having been shaped by their environment (i.e. the external traumatic events they have endured). Creating new environments of support, and opportunities for "reprograming" life scripts are important. But practitioners need to be open to seeing the external influences and specifically target intervention strategies to remediate the long-standing negative consequences.
Source: The title is a quote from Lewin (1952, p. 169)