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What is Trauma Informed Care (TIC)?

Trauma-informed care (TIC) is an approach to service provision in settings such as child welfare, substance abuse, mental health, educational and criminal justice institutions.
A person holding a child's hand.
© University of Glasgow

Trauma-informed care (TIC) is an approach to service provision in settings such as child welfare, substance abuse, mental health, educational and criminal justice institutions.

According to Bransford and Cole (2019), TIC represents “a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma that emphasises physical, psychological, and emotional safety for both providers and survivors and that creates opportunities for survivors to rebuild a sense of control and empowerment”.

The Principles of Trauma Informed Care (TIC)

TIC is underpinned by several core principles:

  • physical and emotional safety for service-users
  • service-providers’ trustworthiness and transparency
  • empowerment
  • voice and choice
  • peer support; collaboration
  • the understanding that cultural background influences help-seeking behaviours

According to the U.S. Substance Use and Mental Health Services Administration, the following assumptions should be the cornerstone of TIC.

"The Three Es" - In three boxes, the words "events", "experience", and "effects" are shown. "The Four Rs" - In four boxes, the words "realisation", "recognise", "respond", and "retraumatisation" are shown.

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual wellbeing.
A program, organisation, or system that is trauma-informed realises the widespread impact of trauma and understands potential paths for recovery; recognises the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatisation.

Challenges to TIC

There exist multiple challenges to effectively delivering TIC in different service settings. Working with clients who have experienced trauma can negatively impact the wellbeing of service-providers. Several constructs have been used to describe this impact. These include vicarious trauma, secondary traumatic stress and compassion fatigue.

Vicarious Trauma Compassion Fatigue
This is also known as secondary exposure to trauma, this concept refers to the indirect experience of trauma as retold by another person, which can lead to secondary traumatic stress. This is especially common in healthcare and social care staff working with trauma survivors in settings such as accident and emergency units, homeless shelters, refuges for victims of domestic violence, hospice care and orphanages. This concept refers to the reduced ability to feel compassion and empathy towards service users. Certain client behaviours may be interpreted as unwillingness to engage with treatment, but may actually reflect efforts to cope with effects of trauma. For example, a service-user seemingly failing to engage in therapy sessions may be exhibiting dissociation and avoidance, both of which are common PTSD symptoms. This requires that service providers be well-trained in trauma awareness. Furthermore, services often use a one-size-fits-all approach and may fail to meet the unique needs of clients.

Take some time to think about what some of the essential ingredients of TIC are in practice? Make some notes on your understanding of ‘trauma-informed culture’ in service settings? What do you think are the main challenges of delivering a truly trauma-sensitive service?

References

Bransford C., Cole M. (2019). Trauma-Informed Care in Homelessness Service Settings: Challenges and Opportunities. In: Larkin H., Aykanian A., Streeter C. (eds) Homelessness Prevention and Intervention in Social Work. (pp. 255-277). Springer, Cham. https://doi.org/10.1007/978-3-030-03727-7_13

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma informed approach. HHS Publication No. (SMA) 14-4884. MD Rockville: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.nasmhpd.org/sites/default/files/SAMHSA_Concept_of_Trauma_and_Guidance.pdf

© University of Glasgow
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Post-Traumatic Stress Disorder (PTSD) in the Global Context

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