TRAUMA-INFORMED CARE GUIDE FOR EVERYONE
We are in unprecedented times. A large segment of the population is experiencing increased stress related to an interminable pandemic, racial injustices, and a volatile political climate. There seems to be an ongoing, collective feeling of toxic stress. How do we help those who are struggling right now?
The reality is that in typical times, approximately 20% of Americans meet criteria for a mental health diagnosis (Center for Behavioral Health Statistics and Quality, 2015). With increased demand for help, even if you have the time and money to access mental health services, you may not receive the care due to scarce resources. For years, researchers have reported that there is a serious shortage in the availability of professional mental health workers (Thomas, Ellis, Konrad, Holzer, & Morrissey, 2009). To meet the needs of struggling folks we need to consider universal practices to create communities that mitigate the effects of toxic stress and foster healing.
If you work in the helping profession you are likely familiar with the concepts related to trauma-informed care (TIC). TIC is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma (SAMHSA, 2014). There are countless articles about the value of TIC and potential application to work with individuals who have or are experiencing trauma or toxic stress. This is such a valuable therapeutic approach that its application should not be contingent on the availability of someone from the helping profession. Although thoughtful and researched-based, many of the concepts associated with TIC can be practiced by anyone who is empathic, caring, and kind.
Despite the exhaustive number of writings justifying the value of TIC, there continues to be a need for a simple guide for applying TIC. There are no prescribed set of interventions, which makes practical application challenging at times. In an attempt to communicate the essential aspects of TIC to both the busy professional and the caring non-professional, I have created a simple acronym for implementing TIC.
The letters in the word H*E*A*L capture TIC principles and assist with recall to allow for application when needed. The HEAL acronym removes TIC from the abstract and moves it to the practical. The hope is that synthesizing TIC into a simple guide will empower concerned people to respond thoughtfully and maximize the impact on those in need.
Honor Personal Experiences
Each person’s reality is their own. Your assessment regarding the intensity and significance of a someone’s experiences is secondary to their assessment.
An individual’s collection of life experiences impacts their current functioning. This includes current stressors, effects of abuse/neglect, results of systemic racism, and a litany of other potentially traumatizing events and situations that a person may communicate.
Providing space for individuals to process their adversity is a necessary step along the healing journey.
Put it in practice. How have you been doing in the last month? What are you struggling with? What do you think is the cause for your stress? Is this a new challenge? What is going well?
Explore Calming Activities
Prior to problem-solving with someone, it is necessary for folks to be at a calm state. Often, people move too quickly to cognitive interventions to quickly solve a person’s problem. This is futile when a stressed individual is struggling to manage their physiological responses (increased hear rate and respiration) to life’s stressors. Don’t fight biology — help them calm their body.
There is a continuum of activities from intense whole-body work to quiet restorative practices that can effectively re-wire stressed brains. When someone can successfully manage their stress, they will be more amenable to cognitive interventions.
You can help by presenting opportunities for calming activities and/or help label current activities that are beneficial.
Put it in practice. Tell me a time in your life when you felt calm. What activities make you feel calm? What are the barriers to engaging in calming activities? Are there any activities that you would like to try? Would it be helpful if we did the activities together?
Address Relationship Issues
The nature and quality of an individual’s relationships is critical to their ability to persevere through stressful events and circumstances.
An important step to recovery is helping stressed individuals examine their relationships. Increasing the number of positive supportive people and distancing from individuals that provoke negative emotions is a critical action.
A person’s capacity for healthy relationships is often related to early experiences. Meet them where they are at, because it will take time for them to develop trust and security with others.
The main objective is to strive to be a source of comfort to someone in need, so remain positive or neutral regardless of circumstances.
Put it in practice.
How are things going with spouse/partner/friends/family? What most concerns you about your relationships right now? Tell me about a relationship that you value. How can we increase opportunities to spend time within positive relationships?
Listen to Their Story
There is no monolithic trauma experience. Encourage individuals to share their stories from their perspective in their own words.
It is a powerful process for someone to put words to uncomfortable thoughts and feelings. Sharing one’s story can be liberating and empowering as it is an intentional act of controlling their life.
As individuals increase their time engaged in calming activities and recognize the value of positive relationships, their personal narrative will bend toward hopeful.
Achieving a sense of wellness takes time and your non-judgmental, supportive presence is vital to the process.
Put it in practice. Use encouraging words while they are sharing (e.g., thanks for sharing, that must be difficult, I appreciate you trusting me enough to tell me your story). Summarize their story and check for accuracy. Ask them how they feel to ensure that they have opportunities to label feelings. Provide opportunities for them to repeatedly share their story, while noting changes that suggest growth.
Conclusion
When provided with sufficient supportive resources, people can overcome adversity and develop resiliency. If you are not a professional, it should be noted that this guide does not replace the work of a trained, licensed professional. Ideally, the essence of TIC can be captured by both the professional and non-professional as we collaboratively work to create healing communities.
References
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and
Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14–4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. 2015. HHS Publication No. SMA 15–4927, NSDUH Series H-50. Available from http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm
Thomas, K. C., Ellis, A. R., Konrad, T. R., Holzer, C. E., & Morrissey, J. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60(10), 1323–1328.
