Trauma Informed Practice

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1️⃣ What is a safe and secure environment?.2️⃣ System wide trauma informed competence 3️⃣ Healing, hopeful and trusting relationships. 4️⃣ Cultural Competence. 5️⃣ Client choice, voice & self advocacy

The purpose of this website is for all healthcare staff to be aware of behaviour and responses that may trigger a trauma reactions and responses. As it is impossible to know in advance who is or is not a trauma sufferer and wht may or my not trip the threat switch, it is best practice to approach everyone in a Trauma informed way.

This has a knock on effect of also protecting staff from the effect of vicarious trauma. Which is the trauma unsupported staff may experience when dealing with sufferers trauma.

Why is trauma informed practice important? For two reasons. One, to prevent misdiagnosing signs of trauma as another mental health condition, ie an emotionally unstable personality disorder. See all the Red Flag Behaviour changes but in particular trauma stimulus and hair trigger rage for more info.

So what is this complicated sounding business of offering ‘Trauma Informed Practice’?

Well the good news is that it’s not complicated and draws on areas of care that have been banded around for years but have yet to make it into every day practice.

trauma informed practice is patient centered care

There are 6 principles to Trauma Informed Practice, which are:

1️⃣ What is a safe and secure environment?

For any person whose body is in trauma mode from precious distressing experiences with healthcare personnel. All treatment spaces must make the person feel safe, so they can start to regain trust in the service.

▶️ Treating people as people and not numbers. So instead of asking for numerical info, start by acting as people do in life and ask for their the name and then if need be, ask for number identifiers.

This might sound like hard work or will be expensive to implement but it only needs a change in perspective. For example:

▶️ a health care provider explaining why they are asking sensitive questions

▶️ responding with compassion when a person refuses a medical exam or test

▶️ asking what approaches to care were helpful or harmful in the past.

Lots of research in this area focuses on mental health services because of established links between trauma and mental distress. But trauma occurs as often, if not more often, in physical health care environments. So these spaces should be:

#️⃣ accessible

#️⃣ physically comfortable

#️⃣ psychologically safe

#️⃣ everyone must be aware of every procedure

▶️ Beneficence is the principle of doing good and inflicting the least harm to the patient.

It can be helpful for staff to provide

▶️ information in a variety of ways that are accessible,

▶️ to check that all parties involved understand the pros and cons of the treatment from both perspectives.

This helps people to make informed decisions (instead of just decisions) about the support that they might want to access.

Safe care

#️⃣ prevents errors;

#️⃣ learns from the errors that do occur;

#️⃣ is built on a culture of safety that involves health care professionals, organizations, and patients

Navigating different agencies and staff can be confusing and overwhelming,particularly when individuals may have difficulties concentrating and remembering due to increased anxiety as a result of trauma related experiences.type of question is too hard to answer and/or to break it down into smaller, more manageable options for them to choose from and to make decisions at a pace that feels comfortable for them.

▶️ Barriers to safety

The biggest barrier to safe care and treatment, is the healthcare providers whose actions and/or care that is meant to treat, heal or soothe.

act in a way that causes you to:

▶️ feel scared,

▶️ feel you are being lied to

▶️ reject you by not believing you or dismissing your concerns.

▶️ Leaves you with more injuries

The benefits of offering safe care

▶️ Safe Care improves job satisfaction and staff morale.

▶️ Improved satisfaction scores among patients and their families.

▶️ improves the reputation of health care providers

▶️ Reduces the expenses of complaint handling allowing more money to be allocated to grass roots care.

2️⃣ System wide trauma informed competence

#️⃣ Trustworthiness 

Some people have very good reasons not to trust other people as this is what has helped them to survive in the past.

If healthcare services have let people down in the past, them it is normal to be concerned that

▶️ they may be misdiagnosed again

▶️ all staff involved will treat them differently and/or be judgmental.

This makes accessing healthcare overwhelming as it generates the conflict of a person

▶️ wanting help but feeling that the poor experiences of the past may happen again

▶️ frightened that their concerns will be dismissed again.

▶️ apprehensive in case they are treated with contempt again

As a result, building trust with people who have been traumatised by the healthcare system is extremely important and can take time.


There are a number of things that professionals can do that can help to build trust, whether this happen in one single or longer-term interactions.

▶️ staff paying attention in an open and welcoming way when anyone enters the service.

#️⃣ with appropriate eye contact and smiling

#️⃣ introducing (or re-introducing) themselves,

#️⃣ using small talk to help people to feel more comfortable and

#️⃣ gaining a sense of whether people might appreciate more communication or if they would prefer to sit quietly on their own.

#️⃣ Making sure that all decisions are transparent

Timely: reducing waiting times and detrimental delays for both, recipients and providers of care. Waits and harmful delays potentially produce life threatening illnesses worsening quality outcomes throughout the continuum of a patient care.


3️⃣ Healing, hopeful and trusting relationships

Relationships in healthcare are healed slowly by providing care that is:

▶️ consistent and

▶️ does not vary in quality based on personal aspects such as:

#️⃣ gender

#️⃣ ethnicity

#️⃣ geographic location

#️⃣ socioeconomic status

definition trauma infograph
What does Trauma mean

4️⃣ Cultural Competence

Culture competence is the acknowledgement that everybody has

▶️ unique needs,

▶️ beliefs, and

▶️ preferences

that can affect the way he, they or she:

▶️ views

▶️ receives, and

▶️ participates in health care.

If healthcare is to respect diversity and integrate the concepts of cultural
competence and patient- and family-centered care into the care delivery system. Then they cannot do this without:
▶️ a respectful staff-patient partnership
#️⃣ asking open-ended questions,

#️⃣ exploring cultural similarities and differences,

#️⃣ accommodating the patient’s needs whenever possible.


This can be done by a slight change of

▶️ Use inclusive language to collect patient information. For example, when conducting a patient history, use neutral language when inquiring about sexual history.

▶️ Encourage candidness among patients who indicate they are sexually active by routinely asking if their partners are “men, women, or both,” but do not require the patient to disclose this information


▶️ Train staff in the concept of cultural humility to develop

#️⃣ self-awareness and

#️⃣ a respectful attitude toward diverse points of view.

Do not expect everyone to understand everything about every culture; instead all to gather information that may influence care about

📶 individual needs

📶 beliefs

📶 preferences


▶️ Provide resources and tools to meet the cultural and religious needs of the most frequently encountered populations.

For example, if the hospital serves a large Orthodox Jewish population, make staff aware of the dietary needs, customs, and religious practices that may affect care in this population. Include professional chaplains in care delivery whenever possible, as a valuable resource for cultural, religious, and spiritual sources
▶️ Create a patient resource center to provide materials and information on common health concerns, hospital services and programs, and community resources. Provide these materials in the hospital’s most frequently encountered languages and in a manner that meets health literacy needs of the population.
▶️ Provide mobility assistance and specialized equipment for patients with physical disabilities. Patient should be assigned to rooms that can accommodate his or her mobility needs, and any service animal, cane, or walker should be readily accessible to the patient.
▶️ Train staff on the unique needs of dying patients and their families, including how to work with the organ procurement organization and how to address the needs of potential donor families.

JCAHO_ARoadmapforHospitalsfinalversion727

https://www.viahope.org/wp-content/uploads/2017/12/JCAHO_ARoadmapforHospitalsfinalversion727.pdf

5️⃣ Client Choice, Voice and self advocacy

#️⃣ Collaboration

Is a situation where two or people from different organisations or backgrounds, work together through a meaningful sharing of power and decision making to choose, create, manage and evaluate treatment plans. 

Collaboration is not:

▶️ the use of multiple patient satisfaction surveys,  service user and focus groups. If the results are never implemented

▶️ and never using the information to improve the way health care facilities and provider practices are designed, managed, and maintained. on a checklist of services provided.

▶️ People understandably want to be involved in decisions that affect them.

#️⃣ It is important for organisations to identify areas where there is a culture of

📶 ‘doing with’ people

#️⃣ ‘doing to’ people

▶️ Sometimes, there may be external or legal restrictions that result in limits to collaborative working being placed on staff and visitors to services but it is still important in these instances to discuss this and to strive to rebalance power wherever possible.

▶️ Rebalancing power also includes taking this approach in staff teams and recognising the importance of all staff in an organisation and how they all have valuable roles in supporting an Adversity and Trauma Informed approach, regardless of whether they are involved in

#️⃣ clinical practice,

#️⃣ the security of a space,
#️⃣ providing admin or reception services or

#️⃣ part of a maintenance or domestic services team.

Inviting people with lived experience to assist in service change in a meaningful way

#️⃣ design,

#️⃣develop,

#️⃣deliver (e.g. peer support, training)

#️⃣ and evaluate services

▶️ Choice

Choice is the act of deciding what course of action will suit your needs best. Yes,It can be difficult to make a choice. But its your choice and only you can decide. Effective: providing services based on scientific knowledge to all those who could benefit. In this context, Evidence Based Medicine is incorporating scientific knowledge into treatment and procedure options. Which is why you need all the facts to make a decision that is 


is very important, having a degree of choice and freedom can sometimes feel hard, as it can be difficult to think about or to communicate goals and some people may not know what they need or want from a service.

Being asked about this can feel overwhelming for some individuals and it can be helpful at these times to check whether all understand

#️⃣why they are there,
#️⃣how long staff can work with them for and

#️⃣ what a service is for,

#️⃣what the service is and is not able to provide.

in your best interests and the negatives consequences of your choice are not outweighed by the pluses

#️⃣in your best interests

#️⃣ and the negatives consequences of your choice are not outweighed by the pluses

Which is why you need to know all the facts to make a decision. This is called an informed decision.

#️⃣ Empowerment

What does the term empowerment mean? It is the process of gaining freedom and power to do what you want or to control what happens to you.but limited by resources, treatment guidelines and protocols. Reigning in expectations of all parties. Compromise.

6️⃣ Staff self care

1️⃣ Trauma Informed Practice infograph

trauma informed practice infograph from the pen of

2️⃣ Safe Health Treatment infograph

safe health treatment should always infograh from the pen of

3️⃣ The Power Threat Meaning Framework

power threat framework
The Power Threat Meaning Framework Boyle & Johnson 2018