Trauma-Informed Care

by | Apr 1, 2024 | Mental Health, Trauma Series

Trauma-Informed Approach

 The last time I ran a team was six years ago. This year, I have the once-in-a-lifetime opportunity to produce and direct the Storytelling Theater for Healing and Social Justice and work with a team of eight amazing individuals. They consist of six actors, one playwright, and a coordinator. The mission of the Storytelling Theater is to normalize mental health conversations within Asian American communities by incorporating theatrical methods as part of mental health workshops. Additionally, the goal is to honor and celebrate Asian American identities and immigrant experiences. We are slated to deliver fifteen performances/workshops in the fall

Now, I am working with a new team using theater to advocate for mental health awareness. I have been asking myself how I can run a team efficiently while fulfilling the contractual obligations and, at the same time, honoring my teammates’ mental health. In other words, how can I do better this time around as the team leader? Looking back, I was an okay manager and leader. This prompted and inspired me to retake and recertify trauma-informed approach (TIA) training so I can better work with my new team.

Why is talking about trauma so important, not only in clinical settings but also in our daily lives? Data have shown that trauma is a risk factor for nearly all mental health and substance use challenges. [i]  People can experience trauma through a single incident or a long-term chronic pattern that is either naturally or human-caused. [ii] Examples of traumatic events include:

      • Physical, sexual, and emotional abuse
      • Living with a family member with physical or mental health conditions or substance use disorders
      • Domestic violence or sexual assault
      • Chronic poverty, racism, discrimination, or oppression
      • Violence in the community, war, or terrorism
      • Living through a natural disaster or other period of distress

It’s estimated that 90% of US adults report exposure to at least one traumatic event. American women experience a higher rate of direct interpersonal violence, sexual assault, and physical assault than men. [iii]  Thus, not addressing trauma can lead to various mental health and substance use challenges, as well as chronic physical health conditions, including cardiovascular disease and cancer. [iv]

When people experience depressive episodes, uncontrolled anger, or other emotional/mental challenges, it can often be traced back to unaddressed trauma. Trauma is like a wildfire burning through one town after another, spreading throughout generations and affecting the people around them. So, as individuals and as a society, how can we stop the fire from continuing to burn and harm people in its path?

What is a Trauma-Informed Approach?

TIA is a system and tool that creates a safe and courageous space for people around you, including in professional work settings and personal life. There are different variations of definitions for TIA. My favorite one is from SAMHSA. Below is an excerpt from SAMHSA’s Practical Guide for Implementing a Trauma-Informed Approach.

“Incorporating a TIA involves understanding the widespread impact of trauma, recognizing trauma symptoms in both staff and care recipients, avoiding re-traumatization, and supporting paths to recovery. For a program, organization, or system to be trauma-informed, it is not enough to provide trauma-specific interventions. An organization or agency must incorporate trauma-informed principles in its culture, policies, procedures, and practices.

A TIA requires all personnel of an agency, including, but not limited to, administrators, providers, staff, and board members, to recognize that a care recipient’s history of trauma can affect their:

          • Experience, engagement, and receptiveness to the organization’s services and supports
          • Functioning in the community
          • Interactions with staff and other clients
          • Sensitivity to guidelines and interventions

In addition, organizations need to implement TIA holistically by recognizing that trauma is not unidirectional and that the micro, mezzo, and macro levels of trauma are intricately connected. Finally, organizations need to acknowledge the trauma staff and providers themselves experience, either as part of their own personal lives or secondary to working with clients who share firsthand details about their trauma.”

Here are the principles of TIA:

“Assumptions: 1. Realize the widespread impact of trauma and understand potential paths for recovery. 2. Recognize the signs and reactions of trauma in clients, families, staff, and others involved with the organization. 3. Respond by fully integrating knowledge about trauma into policies, procedures, and practices. 4. Resist re-traumatization

Principles: 1. Safety. 2. Trustworthiness and transparency. 3. Peer support. 4. Collaboration and mutuality. 5. Empowerment, voice, and choice. 6. Cultural, historical, and gender issues.”

          • Domains of Implementation
          • Governance and Leadership
          • Training and Workforce Development
          • Cross-Sector Collaboration
          • Financing
          • Physical Environment
          • Engagement and Involvement
          • Screening, Assessment, and Treatment Services
          • Progress Monitoring and Quality Assurance
          • Policy
          • Evaluation

Insights and Takeaways

This time around, after relearning TIA, here are some of my key insights and takeaways.

    • First of all, you do not need to be a clinician or psychologist to teach, practice, and implement TIA in your workplace or personal life. All you need is empathy and TIA training. There are great courses and training programs available on trauma-informed approaches, some of which are even free. (See the end of the blog for a list of free online courses available)

    • TIA contains a wealth of information, making it crucial to continue learning about it. One of the instructors from the TIA course I took said this (paraphrasing), “You can never get bored learning TIA because there is always new data and research. People’s lived experiences with mental health and trauma are so diverse that you can’t learn it all. I’ve been teaching TIA for over a decade, and every time, I am still learning new information about TIA.” Therefore, I’ve been encouraging myself to continue reading and learning more about TIA. Just like what the instructor said, every time I take a class or read about TIA, I gain new insights

    • Due to a lack of understanding, denial, and political reasons, it’s unfortunate that DEI is receiving this unwarranted negative perception. Once you start learning more about TIA, the connection between hate, discrimination, and mental health trauma becomes more prevalent, evident, and obvious. Once you see the connection, it’s hard to unsee it. For example, people of color who experience hate and discrimination from racism are three times more likely to develop severe depressive and anxiety disorders.

    Because of this, I am doubling down on my DEI work. My DEI efforts are not about fostering an ‘us vs. them’ mentality or dictating what people can or cannot say. Instead, I focus on inner growth and healing, which I refer to as ‘Starting from Within.’ Another major component of my DEI work involves supporting individuals who have experienced adversity such as hate and discrimination and providing practical mental health support.

    • TIA requires a high level of time commitment. This can be counterintuitive to the fast-paced working culture and the short-term gratification mentality that prevails in our society. We often seek quick solutions, chase after the next exciting and shiny thing, become addicted to the short bursts of endorphin rush from social media, and expect quick fixes or results.

    What I am trying to do differently this time around is learn to slow down and be more patient with myself and the people around me. Due to deadlines, scheduling, and my personal anxiety, I often get stuck in the zone of checking off my to-do list and chasing after results. While this is important, I’ve realized that I sometimes prioritize tasks and my job over people’s well-being. So, the questions that I often reflect upon are: “How can I put humans first?” “How can I be more patient?” “How can I take the time to listen to the people around me and the folks that I work with?” “How can I shut up and listen?” “How can I be less judgmental?” and “How can I fulfill my contractual obligations while also honoring my team’s mental health?”

    • Self-accountability – I’ve been learning to hold myself accountable to a higher standard. Why is this important? Even though I have been talking and teaching about mental health and DEI for over a decade, I still catch myself making mistakes. Partly it’s because old habits die hard, and secondly, I don’t know everything. Thus, it’s important to continue learning and holding myself accountable. For example, during the process of interviewing actors for the Storytelling Theater, I accidentally said something disrespectful to a candidate. Even though my intention was to make a point while being funny, I offended the candidate. The candidate called me out. Instead of trying to defend myself, I apologized. Did it bruise my ego? Yes! Did I feel ashamed and embarrassed? Of course. I had to remind myself, ‘human-first’.

    • This brings us to self-compassion. Oftentimes, we treat ourselves worse than we treat the people around us. It’s a natural human tendency to be hard on ourselves or to feel guilty. We know that constant harsh self-criticism and self-loathing can have a detrimental negative impact on our mental health. In other words, we are re-traumatizing ourselves. It’s going to be very challenging to practice TIA when we are not applying TIA within ourselves. So, the reflections that I have are, “How can I be kinder to myself?” “How can I transform the energy that I put into self-loathing into self-compassion?” and “Who are the people in my life that can give me a positive boost?”

    • Lastly, the foundation of building and sustaining self-accountability and self-compassion is a gratitude practice. The power of gratitude lies in its ability to shift our focus away from negative loops in our minds. A simple daily gratitude practice that we can all adopt is to identify three things, people, or experiences and express gratitude towards them. These things can be as trivial as the running water in our homes or as significant as the loved ones in our lives.

    In conclusion, embracing a trauma-informed approach (TIA) is not merely a professional endeavor but a personal journey toward empathy, understanding, and healing. As we navigate the complexities of mental health and diversity, it becomes increasingly vital to prioritize human connection, self-awareness, and accountability. By committing to continual learning, practicing self-compassion, and cultivating gratitude, we lay the groundwork for creating supportive environments that foster growth and resilience. Let us remember that our efforts ripple outwards, shaping the collective landscape of compassion and well-being for ourselves and those around us. Together, we can nurture a culture of empathy and empowerment, where every voice is heard, and every person is valued.

    TIA Resources

    Citations

    • [i] Mental Health First Aid
    • [ii] Trauma-Informed Care Implementation Resource Center. (2021). What is trauma? Center for Health Care
    • Strategies. https://www.traumainformedcare.chcs.org/what-is-trauma/
    • [iii] Substance Abuse and Mental Health Services Administration: Practical Guide for Implementing a Trauma-Informed Approach. SAMHSA Publication No. PEP23-06-05-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2023.
    • [iv] Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and
    • guidance for a trauma-informed approach (HHS Publication No. (SMA) 14-4884). https://store.samhsa.
    • gov/sites/default/files/d7/priv/sma14-4884.pdf
    •  [v] https://www.cdc.gov/minorityhealth/racism-disparities/index.html

    Photo by Gordon Johnson from Pixabay