(i) As per Good Therapy (2017), all the events that affect the physiological, emotional or physical well-being of a person is termed as trauma. These are the events that severely life-threatening and have a long-lasting effect on the person's mental, social, emotional and spiritual well-being. There are various types of trauma such as interpersonal trauma, non-interpersonal trauma, mass trauma and many more.
(ii) The trauma which is caused due to multiple traumatic events is termed as complex trauma. This type of trauma is generally interpersonal and often has more severe effects on the person than other forms of trauma. These types of trauma are damaging, and they are results of past experiences of child abuses, family violence, sexual abuse, and trafficking (Blue Knot Foundation, 2017).
(iii) The trauma that affects different generations of a family is termed as intergenerational trauma. For example, the Indigenous children who were removed out from their communities by the Australian Government experienced intergenerational trauma. These children are known as members of the Stolen Generation, and many of the generations of these children suffered from traumatic events (Healing Foundation, 2019).
(iv) The care in which the caregiver tries to understand the causes and effects of trauma is termed as trauma-informed care. In this type of caregiving approach, the focus is on the identification of the past experiences that have to lead to trauma. Trauma-informed care approach is based upon screening of trauma exposure along with its symptoms. It ensures that a safe environment is built around the patient suffering from trauma to minimize secondary traumatic stresses.
(a) A huge population of Australia suffers from trauma, and it has been observed that the prevalence of trauma in Australian Society is around 65 per cent. Around two-thirds of the Australian population experiences some form of the traumatic event in their lifetime. The rate of interpersonal trauma in Australians is 50 per cent (Australian Family Physician, 2014).
(b) Children are more vulnerable to traumatic events as they face sexual, physical abuses and have adverse childhood experiences. Various community services are built for children suffering from traumas. As per Kundal, Debnath and Sen (2017), the prevalence of trauma in children is very high. Every year, around 5 million children face death due to traumatic experiences. Some of the common impacts of trauma on children include depression, anxiety, fear, impaired thinking and panic attacks.
(a) Evidence-based practice is defined as the clinical decision-making approach in which the medical professionals used evidence-based treatments to treat trauma in patients. The evidence-based practise aims to provide optimal patient outcomes (National Child Traumatic Stress Network, 2017). The evidence-based practise of trauma-informed care that is implemented on a national level is termed as evidence-based practices at the national level. However, the evidence-based practices that are implemented internationally or are accepted worldwide for providing trauma-informed care are termed as evidence-based practices at the international level.
(b) The example of evidence-based practice at the national level is the National Child Traumatic Stress Network (NCTSN) in the United States. This organization works for proving trauma-informed care to the American children who experience trauma in their childhood. However, the evidence-based practice, which is implemented internationally for providing trauma-informed care is Adverse Childhood Experience or ACE (Bunting et al. 2019).
(a) As per Good Therapy (2016), the five strengths that can be observed in an individual coping with trauma are as follows:
(b) The strength-based approaches and resilience are effective in supporting positive recovery outcomes of the patients. This is because these approaches help the patients in understanding their strengths and weakness while dealing with trauma. These approaches help the person in understanding their emotional states and the ways in which their strengths can be useful in their recovery.
(a) The process of experiencing any traumatic event is termed as traumatization. However, re-traumatization is defined as the process in which the patient experiences threats due to past traumatic events (Shock et al., 2016). Some of the trauma assessment tools and the policies that are related to trauma-informed care can lead to dramatization and retraumatization because these tools and policies make the patient remember the traumatic events and their negative impacts.
(b) The process of trauma screening can lead to re-traumatization in some patients. The practice of building an unsafe environment around a trauma-suffering patient can also abuse re-retraumatization (Menscher & Maul, 2016). Time-out practices that are used for treating trauma can also lead to retraumatization. The immigration policies that involve raids and detention harm children and cause retraumatization. However, all these policies and assessment tools should be used effectively to prevent retraumatization. A safe environment, effective screening and reduced use of time-out traumatization practices can help in reducing the chances of re-traumatization. Moreover, the children that suffer from immigration policies should be provided with better trauma-informed care to prevent re-traumatization (NCCP, 2017).
(a) According to Menscher and Maul (2016), the use of review practices to document and record patient's participation in the trauma-informed care services could help the caregiver in ensuring that the process of documentation is collaborative with the client. The review practices are used by the caregivers in community services to achieve and improve the health outcomes of their clients. The review practices involve continuous reviewing of documentation and patient's records that can lead to re-traumatization.
(b) The feedback related to review practices can be gathered by taking regular feedbacks from the consumers. The caregivers can implement regular feedback questionnaires for trauma patients and their families. They can gather feedback from analyzing the patient's responses to the feedback questionnaires (Menscher & Maul, 2016).
The people who have past experiences of trauma play an important role in improving the trauma-informed care services. This is because their experiences help caregivers in understanding the different aspects of trauma. These people have meaningful involvement in all areas of trauma-informed care functioning such as program designs, quality assurance, service delivery and others. The caregivers can have a clear understanding of trauma and its effect on the patients when they interact with trauma survivors. The trauma survivors also help caregivers in identifying the practices and policies that can lead to re-traumatization. They help in developing new and improved trauma-informed care practices. Thus, in this way, the collaboration of caregivers with the patients of trauma help the caregivers in developing new strategies to strengthen their trauma-informed practices and services (SAMHSA, 2014).
It is important to review all the plans, services and strategies of trauma-informed care because these can lead to re-traumatization. There are high chances that some of the plans, services and strategies that help treat some trauma patients are not effective in others. Moreover, these plans, services and strategies are causing re-traumatization in the patient that decrease patient outcomes. The continuous review of these trauma care tools helps caregivers in developing new and improved trauma-informed care plans. The caregivers can also identify the loopholes in the plans and strategies of trauma-informed cares by reviewing them continuously.
As per the CDC (2018), trauma-informed care has the following five key principles:
(i) Safety - The trauma-informed care practices should be safe for the patients; they must build a safe environment around the patient.
(ii) Trustworthiness and Transparency - Trauma-informed care provided by the organizations must be transparent to build trust with the clients.
(iii) Peer support -The trauma-informed care must-have experiences of trauma survivors. This makes the care more effective in treating traumatized patients.
(iv) Collaboration - All healthcare professionals and other organizational staff should collaborate to make effective decisions while treating patients suffering from trauma.
(v) Empowerment and Voice - The trauma-informed care services must focus on empowering the patients. These services should help the patient in evaluating their strengths and experiences while recovering from traumatic events.
The trauma that is caused due to continuous exposure to traumatic stores of other individuals is termed as vicarious trauma. This type of trauma is generally faced by counsellors who treat trauma-suffering patients. The five strategies that can be used to minimize and respond to such trauma are as follows (Sexual Violence Research Initiative, 2015):
(i) Effective planning to manage workload and taking time in between handling traumatized patients.
(ii) Lightening the situation while interacting with traumatic patients through humour can prevent the stress developed due to traumatic stories.
(iii) Reflecting on their own experiences and sharing it with the patient can be effective in reducing vicarious trauma.
(iv) Ensuring flexibility while interacting with patients is also useful in preventing or reducing vicarious trauma.
(v) Physical fitness enhances mental fitness which helps in reducing the stress caused by traumatic stories.
As per Menscher and Maul (2016), the four strategies that can be used to promote trauma-informed practices in the workplace are as follows:
(i) The workplace must have a safe and open environment with minimal communication gap as this helps people to speak about traumatic events faced by them openly. This also reduces the chances of traumatic events that can occur in workplaces, such as physical and verbal abuses.
(ii) Engaging the people in organization planning so that they can implement trauma-informed practices in the workplace.
(iii) The organization must take steps to train its staff about the use of trauma-informed practices. For example, adequate training sessions related to trauma-informed care must be conducted by the organization.
(iv) Workplaces should take several steps to prevent secondary traumatic stress in their staff members. They should conduct feedback sessions where staff members can express their opinions on traumatic events.
(a) The following ways can be used to provide information to colleagues for promoting trauma-informed practices:
(i) Health discussions related to trauma-informed practices help promote such practices.
(ii) Informing about own's beliefs about trauma-informed care and listening to the colleague's viewpoints on the same is also beneficial in promoting trauma-informed practices.
(iii) Conducting small training sessions for colleagues is also helpful in promoting trauma-informed practices.
(iv) Discussing with colleagues about the early work of other leaders in the community services and the approaches taken by them in implementing trauma-informed practices.
(b) The five things or practices that are expected in a trauma-informed supervision session are as follows:
(i) The sessions should discuss the fundamental principles of trauma-informed care.
(ii) The sessions include detailed information of trauma, its prevalence and impacts on various age groups.
(iii) The session would include supervisee's experiences with traumatized patients.
(iv) The session would discuss the successful trauma-informed practices and the ways in which these practices can be implemented effectively to reduce the prevalence of trauma.
(c) The following policies and procedures can be used to reduce vicarious trauma in community service workplace (Trauma Recovery Centre, 2017):
(i) Building a safe environment for staff members and developing a supportive culture.
(ii) Promoting the concept of self-care in the members can prevent vicarious traumatic events in the workplace.
(iii) Training staff members about preventing vicarious trauma is also beneficial.
(iv) Staff meetings must be conducted regularly, and in these meetings; the supervisors should promote optimization in sat
(v) Policies that explicit the discussion of self-care must be implemented in the workplace.
(d) A person can promote self-care by sharing their own experiences related to vicarious trauma. It helps reduce the vicarious trauma faced by the colleagues. Moreover, an individual should try to guide their colleagues in the community service work about the role of humour, space, workload management and stress management.
(a) Vicarious Trauma has several adverse effects such as loss of sense, altered sensory experiences and others. However, effective management of vicarious trauma is also possible. The counsellors working in community services should manage their workload pressure and should not make emotional bonding with their patients. In this way, the counsellors working in community services can prevent vicarious event and can also ensure their safety.
(b) The five self-care strategies to prevent vicarious trauma are as follows (Sexual Violence Research Initiative, 2015):
(i) Plan the work to avoid workload stress and take regular break time while interacting with traumatized patients.
(ii) Build a lightning environment while interacting with patients in community services. Use of humour while such interactions help reduce vicarious trauma.
(iii) Use personal experiences to motivate the patient as this will reduce the involvement in their traumatic stories.
(iv) Develop self-care strategies as per experiences of past interactions with traumatized patients.
(v) Take support from colleagues working in community services, and avoid social isolation.
(c) The other strategies that can be implemented to avoid vicarious trauma are as follows:
(i) Adopting a healthy lifestyle improves both physical and mental well-being; mental stability reduces the chances of suffering from vicarious trauma.
(ii) Identification of early signs of vicarious trauma is also useful in reducing such trauma.
(iii) Learn own personal attitude towards traumatized patients. This will help in reducing or preventing vicarious trauma.
Australian Family Physician. (2014). PTSD – an update for general practitioners. Retrieved from https://www.racgp.org.au/afp/2014/november/ptsd-%E2%80%93-an-update-for-general-practitioners/#:~:text=Approximately%20two%2Dthirds%20of%20the,and%207.2%25%20(lifetime).
Blue Knot Foundation. (2017). What is complex trauma. Retrieved from https://www.blueknot.org.au/Resources/Information/Understanding-abuse-and-trauma/What-is-complex-trauma
Bunting, L., Montgomery, L., Mooney, S., MacDonald, M., Coutler, S., Hayes, D. & Davidson, G. (2019). Trauma-informed child welfare systems-A rapid evidence review. International Journal of Environmental Research and Public Health, 16(13), n.d. doi: 10.3390/ijerph16132365
Centres for Diseases Control and Prevention (CDC). 2018. Infographic: 6 guiding principles to a trauma-informed approach. Retrieved from https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm
Good Therapy. (2016). 7 Personality Characteristics That Help in Managing Trauma. Retrieved from https://www.goodtherapy.org/blog/7-personality-characteristics-that-help-in-managing-trauma-0622165 Good Therapy. (2017). Trauma. Retrieved from https://healingfoundation.org.au/resources/who-are-the-stolen-generations/
Healing Foundation. (2019). What are the stolen generations? Retrieved from https://healingfoundation.org.au/resources/who-are-the-stolen-generations/
Kundal, K. V., Debnath, R. P. & Sen, A. (2017). Epidemiology of Pediatric Trauma and its Pattern in Urban India: A Tertiary Care Hospital-Based Experience. Journal of Indian Association of Pediatric Surgeons, 22(1), 33-37. doi: 10.4103/0971-9261.194618
Menschner, C. & Maul, A. (2016). Key Ingredients for Successful Trauma-Informed Care Implementation. Retrieved from https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf
National Centre for Children in Poverty (NCCP). (2017). Facts about trauma for policymakers. Retrieved from http://www.nccp.org/publications/pub_746.html
National Child Traumatic Stress Network. (2017). National child traumatic stress network position statement: Evidence-based practice. Retrieved from https://www.nctsn.org/sites/default/files/resources/position-statement/position-statement-evidence-based-practice.pdf
Sexual Violence Research Initiative. (2015). Guidelines for the prevention and management of vicarious trauma among researchers of sexual and intimate partner violence. Retrieved from https://www.svri.org/sites/default/files/attachments/2016-06-02/SVRIVTguidelines.pdf
Shock, K., Böttche, M., Rosner, R., Wenk-Anshon, M. & Knaevelsrud, C. (2016). Impact of new traumatic or stressful life events on pre-existing PTSD in traumatized refugees: results of a longitudinal study. European Journal of Psychotraumatology, 7(10), n.d. doi: 10.3402/ejpt.v7.32106
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Retrieved from https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
Trauma Recovery Centre. (2017). Vicarious trauma and staff support. Retrieved from http://traumarecoverycenter.org/wp-content/uploads/2017/05/11-Vicarious-Trauma-and-Staff-Support-v1.pdf
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