Chapter 17: Trauma-Informed Care

INTRODUCTION

Increasingly more individuals, families, and communities experience violence and the devastating aftermath. The experience of violence and trauma alters one’s emotional and physical growth, perceptions, responses, and often behavior. Experiencing childhood trauma places one at risk for mental illnesses such as depression, anxiety, post-traumatic stress disorder, alcohol and drug abuse, and personality disorders and for physical health conditions such as cardiovascular disease, lung and liver disease, hypertension, diabetes, asthma, and obesity (Felitti et al., 1998). A report from a United Kingdom correctional facility revealed that 27% of prisoners experienced abuse as a child and 41% observed violence in the home as a child (Williams, Papadopoulou, & Booth, 2012). Additionally, 90% of individuals seeking public mental healthcare and 75% of substance abuse treatment seekers report trauma exposure (Jennings, 2004). The consequences of trauma increase the likelihood that these individuals will seek healthcare in a variety of settings. A recognition and understanding of trauma and its effects is important for optimal patient care. The purpose of this chapter is to define and describe principles of trauma-informed care. It also includes strategies, barriers, and solutions to implementing trauma-informed care.

Individuals who experience trauma develop strategies and resiliency that enable them to continue to function and to manage the trauma. Many of these behaviors appear dysfunctional in other contexts. For example, substance use can provide respite from the trauma, but it can lead to abuse and addiction. Similarly, hypervigilance and hyperawareness help one remain alert to prevent further abuse; these behaviors can also place strains on interpersonal relationships. Sensitivity to touch and not feeling safe can negatively influence healthcare experiences. Although many of the individuals that nurses routinely encounter in their professional practices have experienced trauma, nurses are often unaware of the cumulative effect of trauma. Trauma and undisclosed history of exposure to violence can complicate nursing care and treatment plans.

Trauma-informed care (TIC) is an overarching framework that emphasizes the effects of trauma and guides the entire organization and behavior of individuals in the system (Hopper, Bassuk, & Olivet, 2010). Individuals include patients and staff that experience that organization. Treatment facilities have to consider how trauma could affect parts of their practice, analyze the effect of the environment on trauma survivors, and move to providing trauma-sensitive ...