| Trauma | - The emotional response that can result from experiencing a very distressing or scary situation
- Experienced as a threat to the safety of the person
- People may experience a sense of powerlessness during the traumatic event or experience, which can later cause feelings of guilt and shame, threatening a person’s very identity
- Traumatic events/experiences:
- Are unpredictable and unexpected
- Are beyond a person’s control
- Exceed a person’s ability and/or capacity to manage the threat
|
| Types of trauma | - Interpersonal: Childhood abuse, sexual assault, domestic abuse, elder abuse
- External: War, sudden death of loved one, extreme poverty, natural disaster, accidents
- Developmental: Child abuse and neglect, witnessing violence at home
- Historical: Residential schools, Holocaust
|
| Trauma impacts | - Physical: Obesity, diabetes, myocardial infarction, stroke, sleep disturbances
- Mental: Depression, alcohol, and substance use
- Cognitive: Difficulty reading faces and social cues, difficulty with attention and concentration
- Social: Decreased trust, difficulty with relationships
- Physiological: Fight, flight, freeze
|
| Mental health impacts | - PTSI: Mental illness, diagnosable using specific criteria. Symptoms are significant and impact the person’s day-to-day-functioning
- Delayed PTSI: May occur weeks, months, or even years after the event. Symptoms same as PTSI. Can be frightening or confusing as there may not be a clear connection with traumatic event
- Complex/developmental PTSI: Prolonged trauma experience at early age, involving a person close in relationship. Profoundly disruptive, with most severe symptoms
|
| PTSI diagnostic criteria | - T: traumatic event
- R: re-experiencing traumatic event
- A: avoidance and emotional numbing
- U: unable to function
- M: symptoms last for month or more
- A: increased arousal (increased startle reaction, poor concentration, irritable mood, insomnia, hypervigilance)
|
| PTSI: dissociation | - A disconnection between a person’s thoughts, feelings, actions, or sense of who and where they are
- Subtypes:
- Depersonalization: their body may feel unreal
- Derealization: the world may feel unreal
|
| PTSI: Cooccurring disorders | - Mood disorders (e.g., depression)
- Anxiety
- Substance use
- Personality disorders
|
| Trauma exposure response | - Impact of working directly with individuals who have experienced or been affected by trauma
- Can be seen as an occupational hazard for healthcare providers and emergency medical services
|
| Impact of trauma exposure on healthcare provider mental health | - Burnout: Physical, mental, and emotional exhaustion caused by high levels of stress over a prolonged period
- Vicarious trauma: Witnessing neglect, others’ intense and excessive loss and pain
- Secondary trauma: Trauma of patients triggers memories of personal trauma history
- Moral injury: Profound distress arising in the aftermath of situations in which one’s moral or ethical beliefs are violated
|
| Trauma-informed care | - Care adjusted to accommodate the needs of individuals who have experienced trauma
- Based on knowledge of the impact of trauma, and what is required for the patient to feel safe and able to receive care being provided
- A treatment and organizational approach
- Benefits patients, staff, and organizations
- Person-centred care that focuses on overall well-being of the person, rather than simply treating symptoms
|
| Trauma-informed vs. trauma-specific care | - Trauma-informed care: Service delivery approach. Requires changes to practices, policies, and culture of the entire organization
- Trauma-specific care: Clinical treatment designed to address trauma-related symptoms. Usually delivered in specialized programs by clinicians with advanced training
|
| TIC foundational principle: Become trauma aware | - Anticipate the possibility of a history of trauma
- Be sensitive to the impact of trauma
- Explore with your client/trauma survivor the best way to view or define their experience
- Ensure safety, trustworthiness, choice, collaboration, empowerment
|
| TIC foundational principle: Recognize that some health practices can be traumatizing | - Treatment procedures and practices can be triggering for clients with histories of trauma
- Re-traumatization can leave the client feeling as if the past trauma is reoccurring
- Examples: Diagnostic procedures that require the client to wear ill-fitting patient gowns, personal care in hospital or long-term care settings, breast exams, pelvic exams, rectal exams
|
| TIC foundational principle: Create a safe environment | - Consistency in client interactions and treatment processes
- Following through with what has been reviewed and agreed upon
- Honest and compassionate communication
|
| TIC practice tip 1: Routine query about trauma history | - Routinely ask about a client’s trauma history on initial assessment or at any time during the intervention
- Provide brief psychoeducation about the prevalence and consequences of trauma to normalize the experience and open the door for the client to disclose later, if not ready in the moment
|
| TIC practice tip 2: Recognize signs and symptoms of trauma history | - Recognize that client behaviours and symptoms may be potentially linked to a trauma history
- Rather than viewing the client as “noncompliant” (or using other labeling language), recognize that signs and symptoms may be associated with trauma history
|
| TIC practice tip 3: Respond to signs and symptoms of current self-harm | - Self-harm refers to a person harming their body on purpose. The intent is not to kill oneself
- Determine intent and level of risk to determine whether the behaviour was an instance of non-suicidal self-injury or whether it was a genuine suicide attempt
|
| TIC practice tip 4: Recognize when someone is being triggered | - A trigger is any sensory experience that reminds the person of the original traumatic event or experience
- Once triggered, the person is pushed back to the traumatic memory and may lose awareness of the present moment
|
| TIC practice tip 5: Responding to disclosures | - Disclosing a trauma history requires trust on the part of the survivor
- Honour this trust by responding with respect, belief, and compassion
- Expressing shock, pity, or anger at the perpetrator are not helpful
|
| TIC practice tip 6: Risk assessment and referral | - Suicidality is common among those with PTSI
- The presence of major depression further increases the risk of suicidal behaviour
- Determining risk and what action to take is critical for the healthcare provider
|
| Trauma-informed organizations | - Trauma-informed organizations promote:
- Physical safety: Safe physical spaces which are well-lit with signage, minimize environmental triggers, ensure privacy and personal space, provide appropriate interpretation services
- Emotional safety: Trauma-informed policies that promote change in thinking, change the language that is used to describe clients, share power and control
|
