Trauma Informed Practice: Better Late Than Never
I vividly remember my first ‘real’ job in the helping profession. I was 21 years old, fresh out of University and had taken a position as a Child and Youth Worker at a boys group home. After my first day on the job my roommates were shocked to hear that I had spent the better part of my day protecting myself from being stabbed with a protractor and dodging flying bricks from a wildly out of control 13 year old. I had physically restrained him over a dozen times and at the end of the day I left exhausted and doubtful that I had a future in this field.
The training I had received focused on behavioral management techniques as many group homes at that time operated as token economies. In reality, this meant that a great deal of focus from staff was connected to the behaviors that the children/adolescents exhibited. If you presented with positive, desirable behaviors, you would be rewarded by moving up a level, or receiving some form of token reinforcement. In turn, if you exhibited undesirable or negative behaviors, you would lose tokens, privileges, control and status.
It wasn’t until several years later that I began to understand the shortcomings of this model when used in isolation. I was working in the Yukon in a similar setting but had now been trained in ‘Trauma Informed Care’. The children/adolescents in both settings had many similarities despite ethnic, geographical and social differences. They presented with a pervasive pattern of dysregulation, they all had problems with attention, concentration and impulse control and for the most part, they struggled with getting along with themselves and others. Most importantly, they were all survivors of some form of childhood trauma.
As brain science evolves, we are quickly coming to understand that childhood abuse and neglect is the most costly public health issue to date. One look at the ACE Study (Adverse Childhood Experiences) and you can see that traumatic life experiences such as physical, emotional or sexual abuse during childhood/adolescents leads to an increased likelihood of developing mental health disorders, addictions, learning & behavioral problems as well as coming in contact with the criminal justice system. This study showed that the more adverse traumatic experiences you had as a child, the more likely you would be to use IV drugs, attempt suicide, have unintended pregnancy or have an STD. The study connected early trauma to workplace absenteeism, financial problems, prescription painkiller use and even a higher chance of developing COPD, heart disease, liver disease and cancer due to the ongoing stress in the body.
Despite this study and countless others, we live in a health care system that often ignores trauma and it’s impact on brain and body development. In some cases, the ongoing practices and policies even further traumatize and victimize those who touch foot into the system. For those that have worked in organizations that aren’t ‘trauma informed’, you are not alone, and it is not too late.
As I reflect back on the shift in being ‘trauma-informed’, as a front line worker this meant that the youth’s behaviors were really a unique language that provided a glimpse into how childhood abuse and neglect had impacted their physical, emotional, social and mental well-being. Providing trauma informed care meant that creating safety and trust were the most important aspects of our jobs. As such, building relationships with the youth was paramount and ruptures in relationships such as being attacked with a protractor were opportunities to teach emotional regulation, demonstrate how to repair relationships and develop meaningful connections. As a result, youth felt more empowered, they had more control and predictability in their environment. For staff, this meant less energy was spent on managing behaviors and more focus on creating an environment where youth could heal their broken attachment systems and learn how to calm their physiological responses that were so prone to living in fear and danger.
Trauma informed practice is strengths based. It means trust and safety over obedience. For youth, it means that having a melt down is met by support, comfort and learning rather than less privileges, shame and isolation. As health care professionals we have to focus on attachment and trauma histories. We have to view behaviors as a language and not as the root problem. We have to become trauma informed to truly create a safer, healthier and balanced society for future generations to come.