Managing Trauma-Informed Services

What are trauma-informed services?

The phrase ‘Trauma-Informed’ has become increasingly popular, with many organisations aspiring to become trauma-informed or deliver trauma-informed practice. But what does the phrase ‘trauma-informed’ actually mean?

First, let’s get a few misconceptions out of the way. To be trauma-informed is not to assume that everyone who walks through the doors of your service has a trauma history, or that every difficult behaviour you encounter should be excused as coming from a place of trauma. It is not to assume that the only meaningful events which will have a negative impact on a person’s life are their past traumas. It is also not to assume that there is a concrete destination point that you should be aiming to reach where you will be able to label yourself as a trauma-informed service.

One way to understand what it means to be trauma-informed is to use the analogy of disability legislation. The Disability Discrimination Act of 2005 states that organisations are required to make reasonable adjustments to their services and premises to ensure that disabled people can access them. This might mean adding wheelchair ramps or hearing loops or providing written material in a variety of formats such as Braille. The assumption is not that everyone entering the building will have a disability. It is about recognizing that some people will have disabilities and making sure that the service accessible.

Operating in a trauma-informed way makes an organisation psychologically accessible. We understand how trauma histories can affect people, and we know the difficulties they can cause. So we can use that understanding to make our services more accessible, more usable, and more manageable for any staff and services users who may have trauma histories. By proxy, this also tends to improve the staff and service user experiences of people without trauma histories too. This is done by working towards four key aims: (1) to realise the widespread impact of trauma, (2) to recognise the signs and symptoms of trauma in clients, staff, and others involved with the service, (3) to respond with policies and procedures which integrate a knowledge of trauma, and (4) to resist re-traumatisation.

Why is it important for my staff that we are trauma-informed?

We don’t know people’s histories, but we can be confident that all experiences, good or bad, will shape the way people are today. When past experiences have been traumatic, that shaping can make everyday situations really challenging. Every person’s experience of trauma is unique to them. How they are affected will also be unique and personal. However, it’s important to know how to recognise the common reactions that your staff may be experiencing.

Most commonly, people can start avoiding reminders of their trauma. They can get intrusive, unwanted memories and thoughts, and they can feel a lingering sense of threat. Trauma histories which involve abuse or neglect, or which occur over a prolonged period, commonly erode self-esteem and can bring strong feelings of guilt or shame. They can also lead people to feel like they are somehow defective or at fault for anything which goes wrong around them. Forming trusting relationships, even with colleagues, can be a real challenge, as can accessing social support – something we know is crucial when it comes to maintaining or improving mental wellbeing.

It’s worth bearing in mind that traumatic experiences are very common. It’s estimated that in Scotland more than 1 in 7 adults have experienced four or more traumatic experiences in childhood, such as verbal, sexual, or physical abuse, household domestic violence, household drug or alcohol use, or mental illness within the household. But trauma is not just about childhood trauma with figures suggesting that 70% of adults experience at least one potentially traumatic event.

Indirect experiences of trauma can also have an impact on your staff. Witnessing the trauma experienced by others, or feeling the distress resulting from decisions that may contradict their personal moral code, can be similarly affecting.

How can I make my service more trauma-informed?

There are different ways to make your service more trauma-informed. We recommend you use a model developed by NHS Education for Scotland (NES), which is built on five principles: Safety, Trustworthiness, Choice, Collaboration, and Empowerment. For a fuller overview and concrete examples of how each principle has been put in practice by organisations in Scotland, have a look at Trauma-Informed Practice: a toolkit for Scotland.

Safety refers to both the physical and emotional safety of those using and working in the service. Consider, for example, whether your staff have sufficient equipment to do their jobs safely and have adequate space to decompress when needed. You might also benefit from tuning into aspects of the physical environment which could be retraumatising or feel hazardous or dangerous. NES have produced a Trauma-Informed Lens tool, which will help you evaluate your environment.

Trust is key for developing an effective working relationship – you need to feel you can trust your staff, and likewise, they need to feel they can trust you. This is especially true among trauma survivors where trust in others has been eroded. So it’s important to remember that no matter what position you hold, trust is something that needs to be earnt. It’s also something which is far easier to lose than to gain, so if you want your staff to trust you, you need to be transparent with them. This could be as simple as doing what you say you’re going to do, when you say you’re going to do it; and when you can’t, being upfront about it.

Trust goes hand in hand with the next two principles: choice and collaboration. Providing meaningful choice will help show your staff that they can trust you to put them first. It will also help you learn to trust your staff and their decision-making. As well as providing meaningful choice in their role, it’s important that communication with staff is two-way, with the views and experiences of staff members being taken into consideration when procedures are updated. Continually changing procedures and recommendations can be anxiety-inducing for staff but being transparent regarding the reason for change can be key to mitigating this.

Finally, we have empowerment. This is essentially about knowing the strengths and skills that people possess and providing opportunities for these to flourish. It’s about encouraging self-confidence to overtake self-doubt. This might involve finding ways to minimise perceived power differentials between you and your staff, to show that they and their contribution are genuinely valued. Empowerment isn’t just about work performance though, empowering people to look after themselves and practice good self-care is equally important. This might involve modelling good self-care yourself, by attending reflective practise sessions or group supervision, or even just by showing that you take your annual leave entitlement. How you treat yourself tells your staff how they should treat themselves.