Guidelines for a Trauma-Informed Approach to Clinical Work
Our first ideas about trauma-informed practice were significantly influenced by two presentations of concepts. We were first motivated by primary care providers in Saskatoon, Saskatchewan, who developed nine principles of "sensitive practice" based on patient-centered care but deemed "so critical to survivors' feeling of safety" (Schachter et al., 2008).
These include respect (for the diminished survivors' feelings), time (to address depersonalization and devaluation), rapport (to increase people's sense of safety), information sharing (to decrease anxiety and support involvement), boundary respect (to prevent retraumatization), mutual learning (to understand non-linear healing), awareness of interpersonal violence, and knowledge of the topic.
The article "Trauma-informed or trauma-denied" (Elliot et al., 2005) influenced us as well. In it, clinicians and researchers from the U.S. Women, Co-occurring Disorders, and Violence Study presented 10 principles of trauma-informed services for women, the first of which was to acknowledge the influence of trauma and victimization on a woman's psychological and behavioral development.
Whether one is offering trauma-informed or trauma-specific treatments, the second principle emphasizes the need of integrating trauma healing as a key priority in this work, rather than delivering care in a sequential or parallel fashion. The authors elaborate on the ways in which an empowerment framework might help survivors, particularly women, take charge of their own healing. The fifth principle emphasizes the need of placing healing within the framework of collaborative relationships characterized by a shared sense of safety, trust, and (to the extent feasible) the elimination of any underlying power dynamics. The sixth tenet is concerned with adjusting the service environment so that survivors feel secure and welcome. This includes making adjustments to the attitudes, practices, and even physical layout of the personnel.
The authors generalize the concept of "strengths-based" and apply it to the field of trauma studies, arguing that it is crucial to place emphasis on coping mechanisms rather than symptoms and on resilience rather than pathology.
Another concept is reducing the likelihood of re-traumatization, which is highlighted by the authors' discussion of how the services themselves may be traumatic for survivors, particularly if they are pressured to dig up painful memories at a time when they are feeling particularly vulnerable.
Understanding each woman in the context of her life experiences and culture, and providing her with access to the specific cultural resources that may aid in her recovery, are both examples of cultural competency. Finally, the authors highlight the need of including consumers in service design and evaluation as a fundamental premise of trauma-informed practice, much like harm reduction.