What does it mean to follow a trauma-informed approach?

It is difficult to define trauma-informed care. Providers whose services are described as ‘trauma-informed’ have different views about exactly what it entails. That said, the academic literature suggests some consistent principles which often underpin trauma-informed approaches. These principles do not define trauma-informed care, but they do help us to understand what it looks like.

Here we explore five principles for providing care in a trauma-informed way.

1. Recognise and respond to trauma:

It is vital that you understand the prevalence of trauma among the people you work with, and the impact this trauma may have had on them. Knowing this is the first step to tailoring your policies and procedures to better meet the needs of traumatised individuals, and to ensure your service does not inadvertently re-traumatise someone.

For instance, requiring someone to continually repeat their life story to multiple practitioners could be distressing and a painful reminder of the past. You should think about how someone who has been traumatised experiences your services, and consider how to improve your processes to provide more sensitive care.

2. Provide safe environments:

People who have experienced trauma need to access services in an environment which does not exacerbate their trauma. You can help foster and sustain safe environments in your service by putting collaboration, choice and empowerment for service users at the heart.

For instance, people who have been victims of abuse—where they have been placed in a powerless position—must be aware of the choices they have over their care, and should be supported to make informed choices. Trauma-informed care purposefully avoids putting people in situations which remind them of previous trauma.

3. Take a strengths-based view:

The most successful services for people with experience of trauma build on what people are capable of doing to create positive possibilities, rather than ‘doing things for them’. People who have experienced trauma are often asked by services ‘what is wrong with you?’ rather than ‘what happened to you?’. This view fails to empower people to support their own recovery.

Everyone working in a trauma-informed service should understand the connection between someone’s experiences and the difficulties they face, and apply this to how they perceive people they support.

4. Build empowering relationships:

Many traumatic experiences involve ‘power over’ abuses (i.e. where someone is abused by another person who is in a position of power over them). This can make it difficult for survivors of trauma to engage with services that are built on the professional having power over the service user (such as many mental health services). Power-based relationships between the professional and service user can trigger distress responses in survivors of trauma which undermines their recovery from abuse.

You can alleviate this risk by giving service users a say over how services are delivered, and focusing on building respectful, compassionate and trusting relationships between professionals and service users, so that the user is not in a position of powerlessness.

5. Promote equality of access:

At the heart of trauma-informed care is a recognition of the needs of each individual. People facing multiple disadvantage are not a uniform group; they are individuals with unique and diverse experiences.

Everyone deserves equal access to good quality treatment which takes account of the unique context of their life. Trauma-informed services do not exclude specific people because of things that have happened to them.