Trauma-informed care training shifts the focus from “What’s wrong with you?” to “What happened to you?” A trauma-informed approach to care acknowledges that health care organizations and care teams need to have a complete picture of a patient’s life situation — past and present — in order to provide effective health care services with a healing orientation. Adopting trauma-informed practices can potentially improve patient engagement, treatment adherence, and health outcomes, as well as provider and staff wellness. It can also help reduce avoidable care and excess costs for both the health care and social service sectors including educational settings like schools.
When children are exposed to trauma, the effects can be widespread and long-lasting, not only on behavioral and social skills, but also in the classroom.
Trauma in childhood and adolescence can include abuse, neglect, disadvantage and other adverse family circumstances. The terms developmental trauma, complex trauma and toxic stress are often used to describe child and adolescent traumatic events that occur in the family home.
Children and adolescents exposed to childhood trauma are more likely to experience poor academic performance, have difficulty forming friendships and have challenging classroom behaviors. They are also at risk of developing post-traumatic stress disorder, depression, anxiety disorders and conduct problems.
Psychological disorders following childhood trauma are characterized by heightened arousal of the fight-or-flight stress response, including running away or becoming physically or emotionally aggressive
intrusive and distracting thoughts related to the trauma, leading to difficulties with attention and concentration -avoiding reminders, people and events related or perceived to be related to the traumatic experience. Increased sadness, low self-esteem and reduced trust or increased anger towards others. Psychological distress following trauma in childhood and adolescence is associated with disrupted attachments and connectedness in schools anti-social and withdrawn child and adolescent behavior challenges controlling emotions and behavior in the learning environment suspensions and expulsions from school.
The development of children and adolescents who have been exposed to trauma compared to those who haven’t is different.
Children and adolescents without traumatic exposure can achieve survival and emotional and behavioral control, allowing them to flourish and succeed socially, emotionally, and cognitively.
However, children and adolescents exposed to trauma find it challenging to achieve at school due to their heightened state of arousal and real or perceived concerns about their safety and security.
Trauma-based educational practices have gained ground over the past 10 years. These practices:
improve realization and recognition among educators of trauma and its impacts on children and adolescents
improve educator responses to children and adolescents experiencing trauma
limit re-traumatization of children and adolescents by increasing support and reducing punishments in education settings
limit secondary/vicarious trauma among educators by increasing support and professional learning of educators concerning child and adolescent trauma.
Trauma-informed models in schools and early learning settings have been shown to reduce stress, anxiety and depression among children and adolescents. They can also reduce stress and feelings of helplessness in educators when responding to trauma exposed students.
Let us take a look at Five principles of trauma-informed care
Number 1: Family belonging, engagement and attachment
Models of trauma-informed practice show the importance of educators, family members/care givers and health professionals collaborating to support children and adolescents who have experienced trauma.
Collaboration between educators and family members/care givers can increase consistency and routines across home and educational settings. This improves a child’s sense of safety and security, and limits triggers associated with the fight-or-flight stress response.
Common triggers for trauma-exposed children and adolescents include:
- a perceived loss of control
- anxiety around changes in routine
- fear of disappointing or upsetting others
- unexpected events, sounds, sights and activities.
Family belonging, engagement and attachment, as well as other approaches of trauma-informed care, can help reduce these triggers. It also helps to identify triggers specific to the individual child or adolescent. This can occur through observation in the learning setting, and through consultation and collaboration between educators, family members/ care givers and health professionals.
- School belonging, engagement and attachment
Behavior-specific praise using the child’s name, naming the correct behavior and prompting the child to behave in that way in the future, as well as the principles of unconditional positive regard, consistency and empathy between learners and educators are used to improve a child’s sense of safety and security in the school setting, and to limit triggers associated with the fight-or-flight stress response.
All of the principles detailed here are also used to increase the learner’s sense of belonging, connectedness and engagement in education services.
- Emotion identification, regulation and expression
The approach of emotional awareness and regulation targets the capacity of children and youth to identify and regulate their own emotions, and also their capacity to identify and notice the impact of their emotions and behavior on others.
Learners who have been exposed to trauma require more neutral and less punitive prompts to help them to identify their own emotions and the emotions of others, and to identify and use specific strategies that will help them to regulate their emotions in learning settings.
- Predictable routines, rhythm and consistency
Creating routines, rhythm and consistency in the educational setting is achieved through:
using visual schedules and verbal reminders around these visual schedules, instructing and prompting learners during transitions
using reward charts and token systems
allowing repetitive activities and self-regulation through movement.
Modelling, practice and behavior-specific praise around routines are also important.
- Development of strengths, identity and choice
Children and young people who have been exposed to trauma are more likely to have impaired self-esteem and negative views about themselves and the safety of the world and those around them.
The principle of collaboration and choice provides these children and adolescents with the opportunity to have some control of their environment and to develop their identity and sense of achievement.
Collaboration involves developing well-defined and achievable short-term and longer-term goals which the child or adolescent can approach one by one and step by step. These goals are typically incremental and consider the delayed cognitive, social and emotional development, and psychological concerns of children and adolescents who have been exposed to trauma.
Creating a physically and emotionally safe environment, establishing trust and boundaries, supporting autonomy and choice, creating collaborative relationships and participation opportunities, and using a strengths and empowerment-focused perspective to promote resilience are ways in which the principles of Trauma-Informed Care work to reduce re-traumatization and promote healing.
A Trauma-Informed approach also considers and modifies policies, procedures and treatment strategies from the top-down in order to ensure they are not likely to mirror the common characteristics of traumatic experiences.
The Substance Abuse and Mental Health Services Administration recommends that when organizations and systems create a trauma-informed environment the following ten implementation domains be considered: Governance and Leadership; Policy; Physical Environment; Engagement and Involvement; Cross-Sector Collaboration; Screening; Assessment; Treatment Services; Training and Workforce Development; Progress Monitoring and Quality Assurance; Financing; and Evaluation.
The manner in which a system or organization views and responds to individual trauma sets the stage for the degree of severity of the impact of trauma as well as the facilitation of the healing and recovery process.