Trauma-Informed Care for Individuals with Complex Trauma: Case Study Approach

QUESTION

Kath is a 55-year-old woman. She has recently moved to Adelaide from New South Wales. She has moved here to be near her younger sister and her family. She has2 cats and a dog who she dotes on. She loves gardening, knitting, and taekwondo. She was institutionalized from the age of 25 with a diagnosis of schizophrenia until 1994. With changes to mental health practices, many people were de-institutionalized and came under Community Treatment Orders so they could live in the community.

Kath had many negative experiences in the institution. This included being put in isolation, being given forced showers, receiving beatings from staff, and having food withheld from her if she didn’t take her medication. Kath is very worried about what could happen to her if she becomes unwell as she has no trust in the Mental Health system.

Apply the key principles of trauma-informed care in all work

When welcoming the person who has experienced trauma to your service, you will be required to establish a safe physical and emotional environment where basic needs are met, safety measures are in place, and your communication is consistent, predictable, and respectful, consider your body language and how you can make the person feel comfortable and able to discuss their situation.

You will also be required to identify how implementing these safety practices is also ensuring your own safety.

When working with the person, you will be required to demonstrate safety, trustworthiness, choice, collaboration, and empowerment in all aspects of service delivery.

Develop strong, safe relationships and environments that promote a sense of safety, trust, choice, and control

You will need to build rapport with the person to ensure they feel that you are there to help them and that you will respect their choices in their recovery process. You will provide the person with information about all aspects of the system, outlining clear expectations of the service. Useopencommunication with the person, which involves using active listening skills such as open-ended questions, affirmations, and reflective listening. The techniques are designed to demonstrate respect and empathy for the consumer experience at any given point on the road to recovery. Respectful communication also involves an awareness of the language used to talk to or about consumers. Avoid negative and derogatory labels that foster disrespect (e.g. referring to the consumer as “manipulative” or”lazy”). Provide opportunities for the person to make daily decisions and participate in the creation of personal goals. Maintain awareness and respect for basic human rights and freedoms.

Empathetically and sensitively, acknowledge and respond to disclosures of past and current trauma or abuse

You will be required to engage the person in communication that allows them to provide you with the details of their situation. When communicating with the person, you should ask “What happened to you” instead of”what’sdwaq12wesxde324rwfw3mjnwb 3bqa3z wrong with you” and conduct the intake assessment in a trauma-informed manner which may include conducting the intake in a private space, offering the person options about on where to sit, who is in the room with them, providing them with information on what to expect, asking the person how they are doing throughout the assessment, offering water and breaks, and being aware of body language that may indicate that a consumer is feeling overwhelmed. Using a strengths-based approach also sets a tonne of respect for the consumer and enhances the process of relationship-building between consumer and provider.

Respond to current distress in ways that reflect an understanding of the impact of trauma

You should ensure when communicating with the person, you understand traumatic stress and how it impacts people, and recognize that many behaviors and responses that may seem ineffective and unhealthy in the present, represent adaptive responses to past traumatic experiences. Your responses should demonstrate that you are able to interact with people in distress without telling them what to do or immediately giving consequences. Listen to and validate a wide range of emotions(e.g., grief, sadness, anger, and fear) from the person. You should acknowledge that their responses and feelings are in response to their traumatic experience.

Jointly identify the person’s strengths, resilience, and range of strategies used to cope with and manage the impact of trauma

You will be required to communicate with the person in a way that encourages them to identify their strengths, resilience, and strategies they use to cope with the impact of trauma

You should talk about the whole person and their abilities and capacities, rather than defining them by what has happened to them. Reframe the person’s experiences in such a way that acknowledges the ways they have responded to difficult situations. Many people who have experienced trauma have already engaged in positive strategies that have helped them survive to this point.

Discuss and highlight the positive aspects of their life and personality, this may include but not be limited to:

good intelligence.

secure attachments to family members and individuals outside the family who have a loving, continuous relationship with the person

multiple harmonious relationships

a sense of self-efficacy (a feeling of confidence in one’s own ability to deal with things) a range of social problem-solving skills

a positive social interaction style

a flexible, adaptive approach to new situations

You should communicate to the person that coping mechanisms develop for a reason, serve a purpose, and can be highly effective in the short term. But some methods of coping (eg. Excessive alcohol use) can be risky in themselves. Addictions (to food, sex, drugs), avoidance of contact with others, and compulsive behaviors of various kinds are always people try to cope. Highlight to the person that recovery is possible and develop their individual support plans that include the above information as well as their goals and plans. The individual support plan will be a  document and should be updated throughout the recovery process. You should also document referrals on the support plan.

Communicate information about the impact of trauma to people in a culturally and age-sensitive way

When communicating with the person regarding the impacts of trauma, you will need to take their personal situation into consideration and address them appropriately. This includes recognizing that it may be extremely difficult for trauma survivors to verbalize their thoughts, feelings, and memories related to their trauma. People who have experienced trauma sometimes disconnect from emotions and physical sensations in an attempt to cope. Allowing the person to communicate in body-oriented, non-verbal activities provides an opportunity for them to reconnect to their bodies, manage their feelings, and communicate in non-traditional ways.

You will also need to ensure you understand how cultural context influences one’s perception of and response to traumatic events and the recovery process; respecting diversity within the program, providing opportunities for consumers to engage in cultural rituals, and using interventions respectful of and specific to cultural backgrounds including age, ethnicity, and socio-economic status. Consider some of the valuable resources that are available to assist with this process, that you may be able to provide to the person to help understand their situation.

Work with the person to identify he impact of trauma on the development of mental health issues

You will need to demonstrate your understanding of how people who have experienced trauma(in childhood or not) often experience mental health issues. Sensitively provide information to the person on the types of mental health issues that can result from experiencing trauma and why this may occur. Mental health issues may include anxiety, PTSD, and depression. Discuss any mental health issues the person may be experiencing and reaffirm that this is most likely a result of their trauma experience. You should communicate to the person that recovery is possible.

Collaboratively identify and develop strategies to eliminate, minimize and/or manage potential triggers to traumatization and re-traumatization in relation to service provision

Work with the person to identify current triggers to traumatization and re-traumatization and write down a list of situations that the consumer finds stressful or overwhelming and remind him/her of past traumatic experiences. Identify ways that the consumer shows that he/she is stressed or overwhelmed (e.g. types of behaviors, ways of responding, etc.). Identify staff responses that are helpful when the consumer is feeling upset or overwhelmed as well as staff responses that are not helpful when the consumer is feeling upset or overwhelmed. You should also identify a list of people the person can go to for support.

Collaboratively identify a person’s specific trauma needs

You should be aware of the potential for the person to freeze as it can be quite overwhelming and intimidating when discussing what their needs are. Instead of taking over and speaking for the person, you should encourage and help the person to identify their trauma needs and create their own goals that allow them to take control of their lives and futures. Trauma-informed goal planning should be individualized and address the needs of the person. This may be in relation to housing, employment, education, advocacy, legal assistance, etc.

Determine the capacity of the service and self to respond to people’s trauma issues

Based on the needs the person has identified above, you will need to determine if you and your service can provide the support required or discuss the possibility of specialist trauma services and support through referral options.

Evaluate suitable services and support options that will meet the person’s trauma needs and provide the relevant information to the person in a way that will foster choice and control for the person

Before you provide information to the person on the services and supports available, first

consider:

·          Is this the best possible service provider to refer this person to?

·     Will they be able to adequately meet the needs of this person?

·          Are there specific protocols (cultural and/or otherwise) that must be followed to ensure effective referral processes?

To do this, you need a good understanding of the services and requirements of the agency that you are providing referrals to. This will require you to undertake some research into the available services, programs, and supports. Once you are confident the referral options or supports can meet your person’s needs, you will need to discuss the details with the person and provide all possible information that will allow them to make an informed decision as to the service they would like to be referred to.

Facilitate and support referral for specialist trauma services for the person, with consent

Once the person has made their choice for an appropriate referral, and you have their written consent, you will need to contact the service provider and discuss the referral process. You may need to negotiate on behalf of the person to make sure that the referral is agreed upon and the roles and expectations of the service provider and person are clear.

When liaising with the service provider, you should ensure you only provide them as much personal information about the person as will directly help them to deliver their particular service. It would not be necessary, for instance, to reveal personal details about your consumer’s family history to the worker helping them with job training skills.

Arrange for the referral to occur taking into consideration the appropriate documentation and information to be provided to the service that will ensure the person isn’t impacted and feels supported in the process of accessing a referral. Make sure you obtain the person’s consent to discuss their needs and refer them to the relevant service providers. You should assure them that some information remains confidential.

Collaboratively record and complete required documentation including individual support plans in ways that minimize the likelihood of re-traumatization

When completing the required documentation, you will need to demonstrate your ability in providing trauma-informed care by ensuring the person is comfortable with the information that has been written and feels they have been given a choice in the decisions made, the documentation should be reflective of empowering the person. The information is securely stored away ensuring the person’s confidentiality and privacy.

Follow-up referral to ensure the person’s needs are being met

Once the person has engaged with the referral option, you should follow up with them within 24 hours to gauge their initial response to the service and ensure it is so far meeting their needs. You will need to conduct another follow-up after the person attended for 3 days to ensure the service is continuing to meet their needs and determine if any additional support is required.

Defuse, and de-escalate potential incidents by implementing individual plans or service procedures and communicating effectively and sensitively with the person

One of your consumers has returned from their referral option seemingly quite distressed, you will need to demonstrate your ability to defuse and de-escalate a potential incident occurring by implementing the strategies they have previously identified when displaying this type of behavior. The way in which you deliver these strategies should demonstrate your ability to communicatesensitivelyandeffectively

Identify emergency situations and seek assistance according to the needs of all those involved

If the person is unable to calm down and is displaying violent behavior, you will need to respond appropriately in a trauma-informed way and seek the assistance of a senior staff member in the first instance.

Resolve conflicts using conflict resolution and negotiation skills

Once the person is no longer demonstrating signs of re-traumatization, you will need to discuss the issue with them in a trauma-informed way and implement effective conflict resolution and negotiation skills

Following completion of this assessment and counseling the person, you will be required to write report on a self-reflection on your trauma-informed care approach to your supervisor. The report should that will include:

•         recording personal views, understandings, ideas or observations, and opinions about your practice

•         identify ways in which you could potentially improve next time and

•         identify areas where you feel you could benefit from additional training/support

Once your reflection paper is submitted, you will need to engage with your supervisor to discuss the details of the service delivery and how you feel about the information you have been exposed to.

ANSWER

 Trauma-Informed Care for Individuals with Complex Trauma: Case Study Approach

Introduction

This essay explores the application of trauma-informed care principles in two case studies: John, a 22-year-old man with a history of institutionalization and trauma, and Kath, a 55-year-old woman with a history of schizophrenia and negative experiences in an institution. The aim is to provide an understanding of trauma-informed care and its practical implications in working with individuals who have experienced trauma.

Applying the Key Principles of Trauma-Informed Care

In both case studies, the primary focus is on establishing a safe and supportive environment. This involves ensuring physical and emotional safety, providing consistent and respectful communication, and acknowledging the individual’s autonomy and choices. By creating a sense of safety and trust, professionals can promote healing and recovery while also ensuring their own safety.

Developing Safe Relationships and Environments

Building rapport and trust is crucial in trauma-informed care. Professionals should engage in active listening, use open-ended questions, and respect the individual’s preferences and decisions. Establishing clear expectations and providing comprehensive information about the service can help individuals feel empowered and involved in their recovery process.

Acknowledging and Responding to Trauma Disclosures

When individuals disclose past or current trauma, professionals must respond empathetically and sensitively. Using trauma-informed language and conducting assessments in a private and supportive space are essential. Non-verbal activities can also help individuals express themselves, as trauma survivors may struggle to verbalize their experiences.

Responding to Distress in Trauma-Informed Ways

Professionals should understand the impact of trauma and recognize that individuals’ responses and behaviors may be adaptive coping mechanisms. Validating a wide range of emotions and providing non-judgmental support are essential. By listening, affirming, and providing a safe space, professionals can help individuals navigate their distress.

Identifying Strengths and Coping Strategies

Trauma-informed care emphasizes identifying and reinforcing individuals’ strengths and resilience. Professionals should focus on their clients’ abilities and capacities rather than defining them solely by their traumatic experiences. By reframing their experiences, validating coping strategies, and highlighting positive aspects of their lives, professionals can instill hope and empower individuals.

Culturally and Age-Sensitive Communication

Professionals must communicate information about trauma in a way that respects cultural and age differences. This involves understanding how cultural context influences perceptions of trauma and ensuring interventions are respectful and specific to diverse backgrounds. Non-verbal communication and cultural rituals can facilitate engagement and promote healing.

 Understanding the Impact of Trauma on Mental Health

Professionals should help individuals connect the dots between their traumatic experiences and mental health issues. By providing information on the relationship between trauma and conditions such as anxiety, PTSD, and depression, professionals can assist individuals in understanding their symptoms and instilling hope for recovery.

Managing Triggers and Traumatization

Collaboratively identifying potential triggers and developing strategies to minimize re-traumatization is vital. Professionals should create individualized support plans that consider triggers and responses to distress. By offering choices and maintaining clear communication, professionals can help individuals manage potential triggers and prevent re-traumatization.

Conclusion

Trauma-informed care plays a crucial role in supporting individuals with complex trauma histories. By applying the key principles outlined in the case studies of John and Kath, professionals can create safe environments, build trust, and empower individuals on their journey toward healing and recovery. It is essential to continue developing skills and knowledge in trauma-informed care to provide effective and compassionate support to trauma survivors.