“Trauma-informed organizations, programs, and services
are based on an understanding of the vulnerabilities or
triggers of trauma survivors that traditional service
delivery approaches may exacerbate, so that these
services and programs can be more supportive and avoid
re-traumatization.” (SAMHSA)
Vs.
Trauma Specific Services – intended to reduce trauma
symptoms experienced by survivors. (EMDR, TFCBT,
Seeking Safety, TREM, ATRIUM)
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Calling a client "noncompliant", "treatment-resistant" etc. rather than taking
responsibility for failing to better help him or her, or for not knowing what to do
or how to understand.
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Accusing clients of "splitting" staff rather than staff taking responsibility for
splitting themselves. Most of what passes for "splitting" is simply the person
asking different people for what she/he wants, hoping for an alternative answer
or an ally.
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"Your history follows you no matter what you do in the present. I only got
assaultive one time and that was when they tore the head off my stuffed doll that
I had had for a lifetime. Now providers tell me I'm dangerous and I terrify people.
My history follows me“

I got traumatized because of trusting people, so asking me to make a contract
with you demands I trust you - which I can't.

We know what works for us and what we need, but no one will listen or take us
seriously.
From “In Their Own Words: Trauma survivors and professionals they trust tell what hurts, what helps,
and what is needed for trauma services” (1997) Jennings, A. and Ralph, R.
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Can be single event.

More often multiple events, over time
(complex, prolonged trauma).

Interpersonal violence or violation, especially
at the hands of authority/trust figure, is
especially damaging.

NVAW Survey (NIJ, 1995-96)
 52% of women report lifetime history of physical assault;
66% of men.
 18% of women reported rape or attempted rape at some
time, many before age 18.
 22% of women reported domestic violence; 7% of men.

Adverse Childhood Experiences study (CDC, 1995)
 17,337 Kaiser enrolled adults
 ACE score cumulative based on 10 experiences in
childhood.
 Includes but not limited to violent trauma.
Lack of nurturance and
support (emotional
neglect).
 Hunger, physical
neglect, lack of
protection
(homelessness).
 Divorce in the home.

Alcoholism or drug use
in home.
 Mental illness or
attempted suicide
among household
members.
 Incarceration of
household member.

Two-thirds of sample had a score of 1 or
more.
More than 10% had score of 4 or more.

ACE study (scores 0-10)
 Score of 4 or more:
▪ Twice as likely to smoke
▪ 12 times as likely to have attempted suicide.
▪ Twice as likely to be alcoholic.
▪ 10 times as likely to have injected street drugs.

Score highly correlated with:
 Prostitution, mental health disorders, substance
abuse, early criminal behavior.
 Physical health problems, early death.

Fight, Flight, Freeze
Tend & Befriend (Taylor, et al)

Chronic Trauma, Complex trauma overtime

Fight, Flight……….& Freeze
Tend and Befriend (Taylor,
et al)

Emotional Reactions
 Feelings – emotions, Regulation
 Alteration in consciousness
 Hypervigilence

Psychological and Cognitive Reactions
 Concentration, slowed thinking, difficulty with decisions, blame

Behavioral or physical
 Pain, sleep, illness, substance abuse,

Beliefs
 Changes your sense of self, others, world
 Relational disturbance
**pay attention to how this intersects with getting basic needs
met

Without helpful affect regulation skills people who are
traumatized may have to rely on tension reduction
behaviors -external ways to reduce triggered distress
(Briere, 2004)
▪ Address TRB and/or reduce distress
▪ Has to match…

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Chronic trauma interferes with neurobiological
development and the capacity to integrate sensory,
emotional and cognitive information into a cohesive
whole. Developmental trauma sets the stage for
unfocused responses to subsequent stress.
(Van der Kolk,
http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trauma_Disorder.pdf )

Sue successfully completed her AOD treatment. Part of the safety
plan for her to have her 4 y/o is no contact with her abuser. While
out one day she runs into her ex-partner who was abusive. Her
DHS worker finds out, confronts her about it and she doesn’t tell
the truth saying “it never happened”.

Pat agrees to MH counseling in a team mtg but “no shows” for the
intake. During follow-up she states she is very interested but “no
shows” again.

Jack calls all of his providers, multiples times. The calls are often
about the same thing. He is often asking for tangible goods & can
be verbally aggressive. For example last week he called
requesting bus tickets. One of his providers said “I think I can get
you some” but he kept calling the other providers.

You are meeting with Sophie to complete paperwork to get
services for her children as she requested. She keeps rustling
through her bag while your talking, looking outside your office,
and checking her phone. She can’t seem to settle down and focus.

You are meeting with Yumi after an altercation with another
resident in your program. She quickly says it is not her fault, that
the program is targeting her and the system is unfair.

Tim is completing an intake for your services. Your program has
several rules and protocols that need to be followed to
successfully complete. Tim’s referral states that he has difficulty
with authority and following rules and doesn’t accept help from
others.
1.
What might the NON-Trauma Informed system
say about this person?
2.
What we know about trauma is
because/to
1.
2.
3.
What we know about trauma is that trauma survivors often
started using substances to either prevent feeling greater
pain, to feel something, or because it was forced onto them.

Takes the trauma into
account.

Trauma awareness

Avoid triggering trauma
reactions and/or
traumatizing the individual.

Emphasis on safety

Adjust the behavior of
counselors, other staff and
the organization to support
the individual individual’s
coping capacity.

Opportunities to rebuild
control

Strengths-based
approach

Allow survivors to manage
their trauma symptoms
successfully so that they are
able to access, retain and
benefit from the services.
Harris, M., & Fallot, R. (2001).
Hopper et al, 2010

Trauma Awareness

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
Trauma education and training for all staff;
Hiring, management, and supervision practices;
Policies and procedures for referral, intake, termination;
Recognition of vicarious trauma and the appropriate care of staff;
Universal precaution and/or universal screening;
Knowledge of effective trauma recovery services;
Advocacy within the agency and with partner agencies/systems.
Understanding of the impact of historical trauma and all forms
of oppression
 Ongoing training for all staff
 Ongoing inclusion of consumer voice
 Procedures and practices that promote and sustain accountability
With a foundation of awareness and
understanding, organizations can strive to
reflect three central principles of TIC, by
creating policies, procedures, and practices
that:
1. create safe context,
2. restore power, and
3. value the individual.

Physical Safety

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
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

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What does it look like?
Where and when are services?
Who is there/allowed to come?
Attend to unease.
Signage about what to expect, where to go…
Home visiting plans.
End with “whats next” - predict
Vicarious trauma prevention plans
Is there anything I can do to help you feel more safe?

Emotional Safety
 Clear & consistent boundaries
▪ Be able to state and model
▪ Allowed to speak up re: vicarious trauma
 Transparency
▪ Explain the “why”
▪ Eligibility written out and explained
 Predictability
▪ What next
 Choice
▪ True choice

Empowerment
 Advocate, model
 May need to do for first

Choice
 As much as possible
 3 options

Strengths Perspective (trauma)
 Focus on the future

Skill building
 Every encounter

Respect
 Life experienced valued

Collaboration
 Referrals, teams, meetings

Compassion
 Not an excuse but an explanation
 Self Care

Relationship
 Modeling, boundaries, learning, partnering
 Supervision
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I wonder if…..
I notice….
In times of stress it is difficult for our brains to
retain information so to make sure we are on the
same page can you repeat back ….
Accessing services can sometimes feel
traumatizing
I am getting ready to …..
Is there a way to make this more comfortable,
safe, successful
Is that your understanding….
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Deny
Prioritize
Accountability
“Your kid is doing great”
“Well there is always a chance….”
“Do you want her to be worse off”
“It was your choice to…”

Asking:
 Is trauma at play here?
 Re-frame to a trauma explanation when
appropriate.
 Trauma education statements
 Trauma translators

I think applying TIC principles in practice will:
 Improve our desired outcomes (dependent on
system)
 decrease vicarious trauma or compassion fatigue
 And support trauma recovery by
 Reducing re-traumatization
 Providing “corrective emotional experience”
 Educating others

Identify policies, practices, and/or
experiences in your work that have potential
to re-traumatize those accessing your
services.

What is at least one thing you can do
differently to be more trauma informed?
Awareness, Understanding, Create safety,
restore power, value the individual
http://www.familyhomelessness.org/media/90.pdf
http://www.odvn.org/images/stories/FinalTICManual.pdf
http://www.annafoundation.org/CCTICSELFASSPP.pdf
http://www.socialwork.buffalo.edu/students/self-care/

Prescott, L., Soares, P., Konnath, K., and Bassuk, E. (2008). A Long
Journey Home: A Guide for Creating Trauma-Informed Services for
Mothers and Children Experiencing Homelessness. Rockville, MD:
Center for Mental Health Services, Substance Abuse and Mental
Health Services Administration; and the Daniels Fund; National
Child Traumatic Stress Network; and the W.K. Kellogg Foundation.
Available at www.homeless.samhsa.gov