Book Review - Becoming Trauma Informed

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Publication Date: 
Fri, 2013-04-26

Many of the chapters in this book confirm that while there is considerable evidence that most people attending mental health and substance abuse treatment facilities are survivors of abuse, often service providers ignore their clients' trauma histories. In fact, one author noted that 90 per cent of people with mental health problems have been exposed to trauma and that this connection was particularly prevalent in people who experience psychosis. If this important trauma lens remains unacknowledged it can result in key neurobiological, psychological and psychosocial adaptations to trauma being misdiagnosed. This failure to acknowledge the need for trauma-informed care has meant that services fail to acknowledge that they themselves can traumatize clients. As a result client rights are sometimes compromised. One author explains that the overemphasis on a medical model approach to treatment can diminish the relevance of people's lived experiences, and the needs identified by clients themselves are then eclipsed by expectations to comply with medical instructions.

Throughout the book there is an emphasis on trauma-informed principles. Primary care providers in Saskatoon have articulated nine principles of sensitive practice that are attentive to the need to feel safe. The principles include respect (to be sensitive to how diminished survivors may feel), taking time (to address feelings of depersonalization and devaluing), rapport (to increase people's sense of safety), sharing information (to decrease anxiety and support involvement), respecting boundaries (to avoid retraumatization), fostering mutual learning, understanding non-linear healing and demonstrating awareness and knowledge of interpersonal violence.

The United States Women Co-occurring Disorders and Violence Study presented 10 principles of trauma-informed services for women, beginning with a principle related to recognition of the impact of violence and victimization on development and coping strategies. Chapters that focus on the evolution of services at the Centre for Addiction and Mental Health (CAMH) suggest that trauma-informed principles rest on a foundation of client empowerment. One outcome of this belief is the effort to define the CAMH Bill of Rights and other initiatives to reduce the use of restraints and seclusion in mental health settings. As with harm reduction, it is critical to solicit consumer input and involve consumers in designing and evaluating services as a core principle of trauma-informed practice.

Applying a trauma lens switches the focus from what is wrong with this person to what has happened to them as a key characteristic of trauma-informed service. The chapter written specifically about working with men who have experienced trauma noted that one of the first lessons in a trauma-informed, gender-responsive culture is that service providers need to ask men about their history of exposure to violence.

In trauma-informed services, professionals are not required to treat trauma; rather, they approach their work with the understanding of how common trauma is among those they serve, how challenging it may be to establish a therapeutic connection and how critical pacing may be. In this way, trauma-informed approaches are similar to harm reduction-oriented approaches and imply a universal precautions philosophy intentionally operating "as if" anyone who comes into our care is likely to be a trauma survivor. In a trauma-informed system, trauma is viewed as a defining and organizing experience for the survivor. All staff at human service agencies, including receptionists, security personnel and kitchen staff can benefit from general training in trauma to help them understand that trauma is the expectation not the exception. It is not necessary to disclose or be diagnosed with trauma to experience and benefit from trauma-informed services.

I highly recommend this book to anyone interested in learning more about trauma-informed approaches. Becoming Trauma Informed is inspired by a broad systems approach that builds on assumptions that trauma, whether diagnosed or not, recognized or not, can determine life course and engagement with and outcome of health services. As the editors of this book conclude, "given the scope of the adaptations needed across settings and populations, the structures for learning about trauma and its implications need to be innovative and multiple." Reading this book is a great start!

Nancy Ross's employment in addiction and mental health settings has resulted in a commitment to work towards a reduction in the rates of violence and sexual assault. Her enrolment in a research PhD in Peace Studies, Bradford University, UK incorporates a social justice and trauma-informed approach.