Who are trauma-informed services for?

A recent publication on creating trauma-informed programs for sexual assault programs (available for download on the resources page), quoted the National Center for Trauma-Informed Care, “Trauma-informed care is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.”

This is a key definition to our understanding of trauma-informed care as it relates to service provision. For too long and with dire consequences, mental health, substance abuse, domestic violence, child abuse intervention, hospitals, and schools – among others – simply saw challenging and unproductive behavior as a reflection of the person’s character or lack there of. By becoming trauma-informed, we can understand the context of the behavior in order to see some of the historical and interactive but less visible aspects of the behavior.

For example, if I steal to get the money I need to buy the substance I use, traditionally I am punished for the crimes I committed with the idea that by punishing me, I won’t do those crimes anymore. Unfortunately, the punishment only fuels my need for the substance and the need to get the money to buy it. In fact, few people (although some might) quit after arrest and a sentence (whether fine, suspended sentence, probation or confinement) alone.

In a trauma-informed approach, not only am I held accountable for my actions but I am also given information about how trauma, drug use and crime are inter-related. In a trauma-informed program, I am allowed an opportunity to put my own experiences in the context of that information to better understand my behavior and myself. Perhaps I might see that had the trauma not happened, maybe my drug problem and my stealing might not have happened either. If that is the case, addressing the root problem (trauma) might be a way for me to address my current issues (drug use and stealing). As my trauma symptoms reduce, usually my use of substances reduces too. With support, I may be able to abstain.

The recent transformation toward trauma-informed care can be seen as revolutionary. Not only does it allow service provision to be more humane but it also makes it more effective. With trauma-informed care, we have the fortunate combination of compassion and cost-effectiveness. A win-win!

But what about people who have not been traumatized? Given the definition above, trauma-informed services engage people with histories of trauma. Does this mean we have to exclude people who have not been traumatized? Does this therefore mean that we have to get a disclosure of trauma in order to provide trauma-informed care?

These are important questions. We can easily see that if we are providing care only to people with trauma then it becomes imperative that we ask and that people answer questions about trauma. As a result, we also have to define traumatic experiences and determine if the event is truly traumatic. If a person states that he or she definitely never had a trauma, then we would need to ask politely that the person leave. Soon we would be forcing people to disclose, segregating the traumatized and giving them services, like it or not. If you are not traumatized but want services, too bad for you. Rather than creating a trustworthy, collaborative, safe, choice-driven, and empowered program, we would have suspicious, controlling, damaging, prescriptive, and judging services.

Luckily, this is not the case. Trauma-informed services are safety-oriented and all people, regardless of histories, ethnicities, families or geographies, need safety. In fact, people without histories of trauma often understand their need for safety even more clearly than people with histories of trauma.

While some programs that work with people outside social services might hesitate to use the word trauma, all programs can become trauma-informed. Becoming trauma-informed promotes emotional and physical safety first. It provides a framework within which programs can assess themselves for safety and be held accountable for the public funding they receive to promote and increase safety in the lives and communities they serve.

Let’s look at a school. What is the mission of a school? A well-known private school franchise states, “We prepare an environment that is engaging and responsive to each child at each stage of development.”

It’s easy to see that putting trauma-informed in the mission statement might (or might not) provoke some controversy, but what about the word safe? Can we insert safety and make the mission of this school clearer, stronger, and more accountable to the people who fund it?

“We prepare an environment that is safe, engaging and responsive to each child at each stage of development.”

It’s clear that adding the word safe or safety to the mission statement makes it stronger, since if the school is engaging and responsive but unsafe, those other qualities do not count for much at all. If a service wants to ensure it is safe, becoming trauma-informed can assess how safe it actually is and create a plan to increase and measure safety.

Trauma-informed services are a safety-increase orientation to service provision, whatever those services might be. This means that by understanding the impact of trauma universally and acknowledging the impact of trauma individually, we can create safe spaces for everyone, which in turn reduces the effects of trauma when present and also reduces the chances of more trauma happening to both the traumatized and the un-traumatized.

Hello world!

It makes sense to use this first article to introduce the California Center of Excellence for Trauma Informed Care. Founded in 2009, CCE-TIC is an organization dedicated to helping publicly funded agencies understand the impact of trauma on their clients, both individually and as a group, and to then use that understanding to design programs (interventions, policies, training) to work more effectively with their clients. Using the Fallot and Harris (2001) framework from “Using Trauma Theory to Design Service Systems” as the foundation from which to then build and strengthen the entire publicly funded social service system. Fallot identifies key values from which a trauma-informed program can develop: safety, trustworthiness, choice, collaboration, and empowerment.

Thus we begin with safety. For many “uninformed” agencies, safety is the word they tend to use to make clients or staff do or not do something. For example, a domestic violence shelter might have a rule against using your cell phone “for your safety.” In many ways a cell phone is a safety device; I can call 911, a friend, a hotline. But now that I am in a DV shelter, I am not allowed to have a cell phone “for my safety.” How can one type of safety conflict with another type? When an agency creates rules that require compliance “for your safety” but do not proceed to explain how the rules are actually for my safety, I become more confused about what safety is.

Instead, a trauma-informed organization has safety at its core. If something you are doing for safety conflicts with a larger definition of safety, it is up to the agency (not the client) to understand how this conflict can be resolved in order for safety to be achieved.

A first step might be to assess rules from a safety perspective. Why does a shelter have a “no cell phone” rule? Generally, it is so that the resident does not disclose the location to the abusive partner from whom she is leaving or to stop the abusive partner from tracking her to the shelter. These are both issues related to her safety.

Could a modified rule allow for safety to be achieved?

“Turning off your cell phone when in the shelter prevents your location from becoming known.”

Essential in this scenario is the level of threat this person is facing. The Danger Assessment (www.dangerassessment.org) is a validated tool to assess for level of lethality threat within a specific violent or controlling relationship. It allows any agency working with clients exposed to domestic violence to better assess risk and a more effective safety plan for specific clients. If a woman scores high and uses her phone in the shelter, that would necessitate a different response than a woman who has a low score.

Women in DV shelters often have to travel and attend appointments during the day. If they are not allowed to have their cell phones, how can they communicate? If in danger, how can they call for help? If running late, how can they alert the shelter?

Another safety rule might be useful:

“When using your phone, turning off GPS tracking and turning off your phone for periods of time prevents your whereabouts from being identified.”

In fact, the “no cell phone” rule, which merely tells the resident what to do, could become a “safe cell phone” rule, which promotes empowerment of the woman to make safe decisions for herself, given her specific situation.

The goal of trauma-informed transformation is to be able to negotiate potentially dangerous and unsafe situations in a collaborative process that promotes safety and allows for choice. Through these approaches, trustworthiness is also achieved.  If we insist on rules that tell clients what do to, we neither facilitate safety, trustworthiness, choice, collaboration or empowerment. In fact we re-enact once again the negative dynamic that the client is trying to change by coming for services.