OTalk

#OTalk – 10th August 2021 – Trauma Informed Care

This #OTalk will be hosted by Deborah Murphy @Murphlemurph

Studies suggest that up to half of all adults living in the UK have experienced adversity or trauma as a child.   Not all of the mental health impacts will meet the diagnostic threshold for PTSD.  It is therefore suggested that professionals need to be well attuned and sensitive to presenting patterns of behaviour, relationships, and thought patterns that indicate an emerging trauma related response.  Traditionally trauma has been understood using a medical model, and its treatment was the responsibility of trauma specific services. The American psychiatric association define trauma as,.

‘Direct personal experience of an event that involves actual or threatened death. or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another’. (APA, 2000).

However, the substance abuse and mental health service administration (SAMHSA) broadened the definition to a less medicalised description of trauma, in recognition of traumas relationship with systemic factors that impact people though the course of their lives.  They assert that,

‘Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual is functioning and mental, physical, social, emotional, or spiritual well-being’ (SAMHSA, 2014).

Trauma informed care was conceptualised following the SAMHSA led conference ‘Dare to vision’ in 1994.   At this conference, survivors of physical and sexual abuse spoke of the impact of re-traumatisation that frequently occurred in inpatient and residential settings.  They drew attention for the need for all services to operate with an awareness of trauma and its impacts. 

Trauma informed services are not designed specifically to treat trauma related difficulties, instead they seeks to address the barriers that those affected by trauma can experience while accessing the care, support and treatment they require for a healthy life.  Within such a model of care, trauma does not need specific diagnosis, as services are designed with an inbuilt assumption that all who come into contact with the organisation may have been exposed to trauma.

Although the language of adversity, trauma, and trauma informed care are common parlance in many areas of clinical practice, with guidelines emerging recommending universal training of health and social care staff, trauma and trauma informed care is not yet a core component of occupational therapy training.  There is however an argument that if we are not trauma informed, then we risk the potential of being trauma creating. 

This #OTalk will consider the following questions:

  1. The impact of trauma is far reaching.  What is your understanding of trauma, systemic trauma and trauma informed care? how does it manifest in the people whom you come into contact with in your daily practice?
  2. How confident do you feel in your understanding of the principles of trauma informed care, and how did you/ might you develop your knowledge?
  3. How do you feel trauma informed care is applied in your workplace setting?  What do you feel are the main barriers to having a trauma informed approach in your setting?
  4. What specific skills/approaches/interventions do you feel we can bring as Occupational therapists to a trauma informed approach?
  5. For staff to truly listen, bear witness to, and remain present to another’s trauma, it is important that we are adequately supported.  What support systems do you feel we need as OT’s to practice trauma informed care.

References

Duncan, G., (2021).  The future of mental healthcare in prison in the UK:  A National consultation and review.  Centre for mental health, London

Ford, K., Hughes, K., Hardcastle, K., Di Lemma, L., Davies, A., Edwards, S., and Bellis, M (2019.  The evidence base for routine enquiry into adverse childhood experiences: A scoping review. Science direct

Jones and Wesley (2006). Psychological trauma: a historical perspective Psychiatry 5(7) Elselvier. London pp.217-219

Substance Abuse and Mental Health Services Administration (2014).SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication. Rockville, MD: Substance Abuse and Mental Health Services Administration

Treisman, K (2018). Becoming a more culturally, adversity, and trauma-informed, and responsive organisation.  Winston Fellowship report.  London

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