Six Principles of Trauma Informed Care

Exploring how we support others who have had traumatic experiences is critical in promoting resiliency and recovery. The simple shift from asking “What is wrong with you?” to “What happened to you?” can have significant benefits in promoting a trauma-informed treatment milieu.

The following six principles of Grafton’s trauma-informed care model were presented at a recent poster session of the 57th annual American Association of Children’s Residential Centers (AACRC) conference:

1.       Evaluate the function and intent of behaviors—Generally speaking, all individuals (and those we support are no exception), want to do well. As treatment professionals, we need to focus more on the front end assessment process to ensure individuals receive the right interventions to help them. This involves completing an assessment to determine the function of a behavior, identifying antecedents and consequences of this behavior, and utilizing data to test and frequently retest hypotheses to help understand why individuals are doing what they do and improve their care.

 2.       Promote a culture of comfort—For years at Grafton, we tried to implement positive behavioral supports and interventions without paying attention to the broader organizational culture. Although we had the very best of intentions, we had numerous practices and systems in place across the organization that fueled a culture of control, rather than comfort. Rules were plentiful, and many existed “just because.” This proved contraindicative to better outcomes and promoting a trauma-informed environment. Moving towards a culture of comfort works and as treatment professionals; we have a responsibility to be at our best when those we support are at their worst. 

3.       Recognize practices that are re-traumatizing—Now think about the number of times a child we support is displaced from a family, school, community or treatment center. Consider the number of times a child has to repeat his/her history and relive emotional, physical and/or sexual trauma. Some practices like having a stranger help with hygiene activities or being in the dark at night could serve as triggers. The very placement of a child within a facility, no matter how great the facility, is traumatic.

 4.       Reinforce training for all employees—We expect a lot from direct support professionals, and we have high standards for them. Compassion, dedication and commitment at the very least are necessary to promote resiliency and recovery in children and youth, but these qualities alone are not sufficient. We need to remind our employees how prevalent traumatic experiences are for those we serve and accept that every individual in our care most likely has had a traumatic experience. Training and retraining employees on the impact of trauma becomes a strong component in the individual’s therapeutic healing process.

 5.       Transform the language used—“Attention-seeking.”“Manipulative.” “Enforcer of rules.” “Compliance.” All of these are examples of non-trauma-informed language. In a true trauma-informed environment, we serve as “caregivers,”“supporters,” and “partners in care.” We use language that is respectful, courteous and compassionate.

Behaviors that we consider as maladaptive could very well be adaptive in a situation related to trauma.In these situations, our role is to help staff reframe how they are evaluating individuals’ behaviors and determine the right type of support that would be beneficial to the individual at that time.

6.       Recognize the role of the caregiver as an opportunity to heal—We have the opportunity as treatment professionals to reverse the effects and impact of trauma, heal individuals and create a treatment environment that is safe, comforting and trustworthy. Creating such an environment requires us, as professionals, to put ourselves in the position of someone experiencing distress and let go of any perceived “upper hand.” It ultimately requires professionals to be kind, courteous, and respectful and to do whatever is needed to ensure that a person is valued and honored.

Integrating these six principles of trauma informed practice can and will lead to positive sustainable outcomes for clients, employees and the organization as a whole.

For those readers of our blog outside of Grafton, what do you think are important components of a trauma-informed milieu? What tools do you think are critical to provide to employees in moving towards a trauma informed culture? We look forward to hearing from you.