In This Article
- What is trauma-informed care?
- Core principles of trauma-informed care
- Is there a difference between stress and trauma?
- The importance of being trauma-informed in healthcare
- How to build a trauma-informed practice
- Expert insights: how to respond to trauma and sustain your healthcare role
- Enhance your clinical impact with trauma-informed care skills
Around 75 per cent of adults in Australia have experienced a traumatic event during their lifetime.
Given such a high prevalence, it's essential that healthcare systems and professionals therein are equipped to recognise and appropriately respond to patients with a historical experience of trauma. This helps create safer, more supportive healthcare environments, acknowledging a patient’s personal history to promote recovery rather than cause further distress.
This article covers the core principles of trauma-informed care, the relevance and importance in healthcare contexts and how you can build a trauma-informed practice to best support your patients.
What is trauma-informed care?
Trauma-informed care is a framework which recognises that people’s traumatic experiences can profoundly impact their lives, which can be reactivated by engaging with different systems and services. A trauma-informed care framework can be applied to varying contexts, such as healthcare, law, education and on an individual level.
The origins of trauma-informed care started over 20 years ago from the work of trauma researchers who acknowledged that trauma shapes a person’s entire lifescape. Whether from childhood events, experiences in the health system or other personal hardships, trauma can have a lasting impact on a person’s physical, emotional and psychological health. It can also affect interpersonal relationships, daily activities and how they interact with the systems around them.
The primary goal of a trauma-informed care approach is to shift from asking a person what’s wrong with them to instead ask what happened to them. This change in focus toward the person and their experience allows systems, services and people to create an environment that prioritises safety, agency and empowerment for the person receiving that service.
Core principles of trauma-informed care
Trauma-informed care is underpinned by several key principles that guide practice and organisational culture. For a comprehensive overview, here is a breakdown of each of these core principles:
Safety
Safety is a foundational principle of trauma-informed care. This principle involves the cultivation of physical, emotional and psychological safety in every interaction involving a particular service or setting. When people have experienced trauma, they may experience anxiety, hypervigilance and may generally feel as though they are in danger, whether perceived or real.
A trauma-informed approach prioritises creating spaces that feel predictable, calm and secure. It also means the people involved with the delivery of a particular service need to be compassionate, caring and ready to adapt to the person’s unique needs. When people feel safe, they are more likely to engage willingly, co-operate with professionals who are dedicated to supporting them and begin their healing or recovery process.
Trustworthiness
People who’ve experienced trauma may be understandably distrusting, especially if their experience has involved the misuse of power by another person or entity. The principle of trustworthiness is vital in a trauma-informed model, as honest and transparent communication helps to establish trust between a person and the provider.
When processes are explained well and clearly understood, this supports the first principle of cultivating safety and nothing is unknown or a surprise. People can understand what they should expect, how a particular plan will be carried out and whether the intentions or goals of each party are aligned. This helps reassure people they are in good hands with those who have their best interests at heart.
Choice
The feeling of powerlessness is another hallmark feature of trauma. This is likely because people felt they had no control or choice over what happened to them and often were alone in their experience. Affirming the principle of choice in a trauma-informed care approach is about ensuring people understand they have agency in the decision-making process and they can opt in or out of something at any point if it doesn’t feel right for any reason.
Giving people the option of when and how they can receive care or an intervention is a key component of a trauma-informed approach that builds on previously established trust and safety. This principle ultimately puts the decision-making power back into the hands of the individual, with the acknowledgement that they know what will work best for themselves, their health and their wellbeing.
Collaboration
Physical, emotional or psychological healing is optimised through relationships and shared problem-solving. Collaboration is a trauma-informed care principle that helps break down the power dynamic between a service provider, such as a healthcare professional and the person receiving a service, such as a patient.
In this way, implementing effective collaboration strategies helps both parties work together to explore viable options, with the awareness that the person receiving the intervention or care is inherently the expert on their own lives. This encourages the cultivation of mutual respect and fosters a sense of connection, which is essential for rebuilding trust and engagement.
Empowerment
When people feel safe, trust the process, have agency over their care and begin to work collaboratively with their provider, they can begin to naturally feel empowered within their situation and see the positive outcomes. Empowerment is about helping people recognise their own capacity, resources and strengths to move forward with healing or recovery.
A valuable aspect of empowerment as part of a trauma-informed approach is the use of peer support for additional resource-building. Connecting with others, whether within the system directly or externally as an extra source of support who have a similar lived experience can be a meaningful way of receiving validation and encouragement. Seeing others with a similar background who have improved their health and wellbeing helps people see their own innate potential.
Cultural, historical and gender considerations
A contemporary trauma-informed care approach should also be culturally sensitive and acknowledge the role of intergenerational and historical trauma. Similarly, gender considerations must also be taken into account when supporting people’s unique needs. The experiences of specific cultural groups, men, women and communities are all distinct and may impact people to varying degrees.
Racial discrimination and gender-based violence are examples of the unique challenges faced by marginalised or disadvantaged groups. Services need to be inclusive, respectful and tailored to honour people’s unique identities and lived experiences. This typically means adopting a person-centred approach to care for optimal and equitable outcomes.
Is there a difference between stress and trauma?
Stress
Stress is a normal, physiological response to challenging or novel events. It is not always negative and may be triggered by various emotional, physical or stimuli. Examples of physical and emotional stressors include exercise, job loss, taking exams, separation and loss of loved ones. The mechanism of stress in the body initiates the ‘fight or flight’ response, which includes increased heart rate, pupil dilation, sweating and muscle recruitment. Prolonged or chronic stress can cause a range of health problems, including anxiety, depression, sleep and digestive issues.
Trauma
Trauma is an experience of extreme stress or shock that can overwhelm a person’s coping capacity. Trauma can arise from a single event or a series of events perceived by the person as significantly distressing or life-threatening. Examples include natural disasters, car accidents, emotional, psychological or physical abuse and challenging medical or childbirth experiences. It can manifest in many ways and cause long-term negative effects on mental, emotional, physical and social wellbeing.
What is ‘big T’ and ‘little t’ trauma?
Trauma can commonly be categorised in two ways, ‘big T’ and ‘little t’. Both of these terms have major impacts on an individual’s entire health and wellbeing. ‘Big T’ trauma refers to serious, catastrophic or life-threatening events such as an accident, abuse, natural disaster, pandemic or warfare. Experiences such as these are highly correlated with the onset of post-traumatic stress disorder.
‘Little t’ trauma involves events that are less obvious single or major negative events like the examples above. Instead, it is often characterised by the gradual accumulation of stressful and negative experiences, such as workplace bullying, neglect and gaslighting, relationship breakdowns and chronic stress. These experiences can impact people just as profoundly as a major traumatic event, leading to symptoms like hypervigilance, emotional distress, exhaustion or insomnia.
The importance of being trauma-informed in healthcare
Integrating trauma-informed care into individual practice and organisational policies align closely with the fundamental healthcare ethos of first do no harm. Recognising that trauma is common among presenting patients and adjusting care accordingly means that healthcare professionals can uphold their commitment to delivering compassionate, respectful and patient-centred care and protecting their emotional, psychological and physical wellbeing.
There are many reasons why seemingly innocuous experiences in healthcare settings can inadvertently cause a trauma response in susceptible people. These are known as ‘triggers’, which remind people of past trauma and can evoke an intense physical or emotional reaction in the person.
Some environmental triggers also exist in healthcare settings. These can include the lighting, noise or smells in a clinical environment, triggers like undressing, physical examinations or an uncomfortable procedure. Other triggers may be communication issues or a negative tone from authority figures and the disregard for cultural or gender-specific needs such as a requirement for a female practitioner by the patient.
How to build a trauma-informed practice
Upskilling to advance your knowledge of trauma-informed practices can help you better understand the impacts of trauma on your clients and patients. Organisations such as Phoenix Australia offer online courses for healthcare and social care professionals to build awareness of the principles of trauma-informed care.
You can choose to study a postgraduate course as part of your professional development requirements and learn how to incorporate trauma-informed principles into your clinical practice.
Building your trauma-awareness through postgraduate study can help:
- Foster a person-centred approach to treatment
- Improve patient safety and health outcomes
- Promote better communication and transparency
- Strengthen the therapeutic alliance
- Create more inclusive and equitable care
- Reduce the risk of inadvertent re-traumatisation
Edith Cowan University (ECU) Online’s Master of Counselling is highly suitable for people in the helping professions and includes a unit called Trauma-Informed Counselling to equip you to support those with a background of trauma. This course includes a professional placement to help you apply your theory into practice if you wish to pursue a career as a counsellor.
Victoria University (VU) Online’s Master of Mental Health Nursing is accredited by the College of Mental Health Nurses (ACMHN). This course is for registered nurses who are interested in becoming a mental health nurse and includes units relevant to building a trauma-informed practice, including Recovery-Oriented Mental Health, Biopsychosocial and Cultural Perspectives in Mental Health and Effective Trauma-Informed Care.
The University of Technology Sydney (UTS) Online’s Master of Women’s and Children’s Health is a unique course for professionals with qualifications in nursing, midwifery, public health, rehabilitation therapies or other health-related fields. This course allows you to build your own specialisation from various subjects within each major category. If you’re looking to build a trauma-aware practice, consider enrolling in the Trauma-Informed Mental Health Care and Practice elective unit to gain advanced skills to support women and children who’ve experienced trauma.
Victoria University (VU) Online’s Master of Child and Adolescent Mental Health is another unique course catered to people in social work, psychology, medicine, counselling and health science disciplines who want to build important skills to support the mental health of young people. This course includes an Effective Trauma-Informed Care unit to support youth mental health.
Expert insights: how to respond to trauma and sustain your healthcare role
We gathered some helpful insights from experienced health professionals on how to respond and work with people who have a history of trauma.
Advocate for your patients and their wellbeing
Nursing coach, Madeline Kessler, emphasises the value of being present with the patient, listening intently and asking them directly what they need in terms of extra support. “I may want to identify what’s important to them,” she says. Madeline adds that it helps if everyone in the department is informed on the needs of the patient receiving care. “The more you understand, the better equipped you are to support your patient. Reassurance and education is key.”
Nursing career specialist, Michelle Deroubaix, highlights how important it is for nurses to be intuitive and responsive to patients in their care at all times, especially if they suspect there may be a history of trauma. She says that some telltale signs for patients are in their body language and if their behaviour is beyond the situation. Michelle adds that sometimes patients may get upset about small things or react to having a private room, which may signal to her that something about their health history and previous experiences is being triggered by the current situation they’re in.
Michelle says that nurses should always ensure they’re the patient’s advocate, emphasising that promoting a sense of safety is highly important.
“You need to help them trust you to know that you’ll do the right thing by them.”
Keep clients safe and build trust
Luke Lawrence, principal psychologist at Explore Psychology, has vast experience working with people who are recovering from trauma. The field of psychology is inherently trauma-informed, and as Luke says, it’s therefore important to create an environment that is sensitive to trauma. “We’re working to desensitise people with trauma,” and this begins with the very first interaction with clients.
Other than making the space physically safe and welcoming with soft lighting and comfortable chairs, it’s essential to foster psychological safety with the client. This helps them understand the therapist's professional bounds, the benefits and risks involved in seeking therapy and the overall plan to keep them safe. Luke says that having a robust informed consent policy helps ensure these boundaries and the patient’s best interests are upheld.
Luke mentions how important it is to be transparent and to build trust with clients, which is a natural progression from the establishment of safety in a trauma-informed care model. He adds that the “[therapeutic] goals are usually collaborated on early with the client. I don’t say to someone – this is going to take eight sessions and you’ll be right as rain after that.”
Luke says that because everyone exhibits a trauma response differently, it’s important for healthcare professionals to take their time with clients. It helps to understand their presentation using the biopsychosocial model, which is a framework that takes into account the biological, psychological and social facts that impact physical and mental health.
Look after yourself so you can provide effective care
As Luke’s professional role distinctly involves working with people who have a trauma history, he has a unique awareness on the importance of self-care in this context. “It’s important (for psychotherapists in particular, I believe) to feel safe during practice and have strategies to prevent transference, such as maintaining boundaries, practicing self-reflection, being clear with their own therapeutic framework (i.e., to stay within the bounds of therapy), address transference if/when it arises and seek professional support when necessary.”
Another key element to providing effective trauma-informed care as a healthcare professional is recognising how your own history, life experiences or past traumas can impact your role. Luke highlights the importance of doing your own ‘inner work’ through supervision or counselling in order to provide more effective client care and avoid burnout.
“I’ve always advocated for psychologists to have appropriate access to psychotherapy, as the evidence shows we are at significant risk of burnout. When this happens, psychologists cannot provide sufficient care for their clients and may have to take time off work, which puts more pressure on the mental healthcare system.”
Enhance your clinical impact with trauma-informed care skills
Adopting a trauma-informed approach can help you prioritise compassion, understanding and equity in healthcare. When you understand and implement the core principles of trauma-informed care in your healthcare role, you can make a positive impact on the patients or clients you help.
If you’re interested in developing your skill set to become more trauma-informed, there are many courses available that can advance your knowledge. Many postgraduate counselling, mental health and nursing courses can equip you with important trauma-informed skills, giving you the confidence to respond to patients with a history of trauma appropriately and effectively.
GlobalHealth Education’s university partners, as well as other reputable universities, offer postgraduate courses in a range of other healthcare fields. These include social work, psychology, leadership and management and public health. If you’re interested in applying to a course, select one here and enquire to speak with a Student Enrolment Advisor for help with the enrolment process.
Book a free professional development strategy call with our Education Consultant, Catriona, to get started on your study journey.
