Trauma- and Violence-Informed Care
“We’re really creating that container to prevent re-traumatization from happening. It’s really more about what we can do as facilitators to create that container for the person to feel really met.”
— Atira Tan, Trauma Specialist, Educator, and Activist (personal communication, 2022)
Trauma and Violence-Informed Care is a practice that promotes trust, safety, empowerment, and healing within a healthcare environment.
Individual behaviours that may otherwise be viewed as challenging personal deficiencies are understood within a Trauma and Violence-Informed Care approach to be expressions of previously adaptive coping strategies that were once useful and resourceful for survival or to ensure stressors were lessened (Gomes, 2014; Johnson, 2014). What was once a survival adaptation commonly becomes the source of future suffering.
One key feature of Trauma and Violence-Informed Care is to shift from a pathologizing perspective that looks for what is ‘wrong’ with someone to a compassionate and informed perspective that considers what may have happened to or be happening with someone. Trauma and Violence-Informed Care is not based on disclosure of traumatic experiences, but rather it sees and acknowledges that how a person thinks and behaves is most often rooted in past or ongoing wounds or traumas: a stance that supports compassion.
Trauma and violence-informed therapists understand the physiological, psychological, and behavioural impacts of trauma as well as different types or categories of trauma, including but not limited to intergenerational trauma, relational-developmental trauma, incident trauma, complex trauma, race-based traumatic stress, structural oppression and systems trauma, vicarious trauma, and medical trauma (Agarwal et al., 2020). Trauma and Violence-Informed Care therapists acknowledge that PTSD represents a specific set of diagnostic criteria and does not capture or represent the full spectrum of how individuals may be negatively impacted by traumatic experiences. Symptomatology may show up through other mental or physical health conditions, such as depression, substance use, eating disorders, or chronic pain.
The Four R's of Trauma-Informed Care
A useful tool to remember the essence of the above principles is the “Four R’s” of trauma-informed care:
References
Agarwal, T. M., Muneer, M., Asim, M., Awad, M., Afzal, Y., Al-Thani, H., . . . El-Menyar, A. (2020). Psychological trauma in different mechanisms of traumatic injury: A hospital-based cross-sectional study. PLOS ONE, 15(11), e0242849.
Butler, L., Critelli, F., & Rinfrette, E. (2011). Trauma-Informed Care and Mental Health. Directions in Psychiatry, 31.
Gomes, S. (2014). Engaging Touch & Movement in Somatic Experiencing® Trauma Resolution Approach, PhD thesis.
Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of psychopharmacology (Oxford, England), 28(11), 983-992.
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. In: HHS Publication.