Trauma-Informed Care

This article discusses trauma-informed care as a suitable therapeutic strategy for individuals suffering from PTSD. It covers the prevalence of trauma, its neurobiology effects, and the implementation of TIC. The article draws from the case of Amir Daud to inform the discussion.

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Trauma-Informed Care
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Trauma-Informed Care
Introduction
Amir Daud is suffering from post-traumatic stress disorder (PTSD). Post-traumatic stress
disorder constitutes a mental health concern that comes about when a person undergoes or
witnesses a traumatic event and the effects thereof become sustained for either a short or long
period of time. The American Psychiatric Association (2018) describe PTSD as a
trauma/stressor- associated disorder that comes about as a result of exposure to both threatened
and actual events such as sexual, physical and psychological violence; death of loved ones;
persecution; fatal tragedies; terrorist attacks; and accidents among other triggers. Victims of
Post-traumatic stress disorder continue to actively and adversely react to the traumatic event after
the actual event is long over (Shalev, Liberzon, & Marmar, 2017).
Moreover, victims experience excessive anxiety, fear, mental and physical distress, and
their brain stays in a hyper-alert mode for the next possible traumatic event. Furthermore, PTSD
victims continue experiencing the trauma by constantly having intrusive memories, nightmares,
and flashbacks, and will try to avoid trauma-associated cues besides having near complete or
complete alteration of feelings and thoughts (Raja, et al., 2015). From Amir’s case study, he
vividly showcases these symptoms and indeed the anxiety disorder he is suffering from is PTSD.
This paper will draw from the case of Amir Daud to inform the why trauma-informed care is a
suitable therapeutic strategy for Amir's treatment.
Prevalence of Trauma
According to Substance Abuse and Mental Health Services Administration’s (SAMHSA)
(2014), trauma emanates and refers to;

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“Trauma results from an event, series of events, or set of circumstances that is
experienced by an individual as physically or emotionally harmful or threatening and
that has lasting adverse effects on the individual’s functioning and physical, social,
emotional, or spiritual well-being”
From this definition, it can be seen that trauma have the potential of impacting all facets
of people’s lives and wellbeing. According to the 2007 Australian Bureau of Statistics (ABS)
figures, women and men who had undergone physical abuse by age 15 constituted 10%
(779,500) and 9.4% (702,400) respectively. With regard to sexual violence, women were
reported to experience more of it than their men counterparts by the age of 15. The ABC results
on the same showcase that 12 %( 956,600) and 4.5 %( 337,400) women and men respectively
experienced sexual abuse by age 15. In a 2010 (National Association for the Prevention of Child
Abuse and Neglect (NAPCAN) survey, Australia's substantiated childhood abuse leading to
trauma stood at neglect 29%; physical abuse; 23%; sexual violence; 10%; emotional abuse38%.
Empirical research has showcased that approximately two out of three patients presented
for mental health services in healthcare facilities posit a serious underlying multifaceted trauma
which is secondary to childhood sexual and physical violence (Mills, et al., 2011).Amir is such
one example having had undergone immense suffering as a child back in Afghanistan in form of
discrimination and persecution besides witnessing the killing of some of his most close relatives.
He then endures more suffering while in detention where he further witnessed self-harm of some
of his fellow detainees. Mills, et al., (2011) contend that if indeed chronic effects, emotional
abuse and the effects of seeing or growing up in an environment with high levels of violence,
poverty and substance abuse are added up this ratio is even higher.

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One of the most important predictor that a person is bound to be present in the mental
health system is having have had experienced childhood trauma and indeed the more prolonged
and severe the trauma is, the more severe are both physical and psychological health
consequences are in during adulthood (Kezelman, & Stavropoulos, 2012). This assertion
squarely fits the case of Amir. Having been born a Hazara, a minority ethnic community in
Afghanistan, he undergoes the discrimination and persecution that the Hazara's have been
subjected to for years. Witnessing his own family members being massacred is indeed the most
traumatic event that he experienced.
McCarthy, et al., (2016) observe that victims of trauma have a tendency to be re-
victimized and re-traumatized later in life as adolescents and adults. Moreover, Farro, Clark, &
Hopkins Eyles, (2011) contend that experiencing or witnessing violence during childhood
potentially elevates the likelihood of being a victim or perpetrator of the same later in life.
According to the World Health Organization (WHO), the most common triggers of PTSD
constitutes death of loved ones( 30.5%) witnessing violence being perpetuated to others (21.8)
and having undergone interpersonal violence (18.8%) (Stein et al., 2010)
Trauma’s Neurobiology Effects
Trauma impacts children in many aspects of their biological development and
functioning. Children exposed to the risk of threats that of significant intensity, frequency and
duration like neglect, discrimination, sexual and physical violence and persecution including
murder often activate an alarm reaction (“fight, flight, freeze”). While this response to actual or
perceived danger is quite normal to acute stress, traumatic encounters such as these during
childhood often trigger alarm reactions that impact the neurobiology of the central nervous
system and the brain (Humphreys, Sauder, Martin, & Marx, 2010). The vast majority of the brain

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sequentially and structurally develops during childhood and therefore early traumatic life
experiences posit disproportionate impacts on the developing brain. Exposures to chronic
traumatic stress and abuse extensively alter the nervous system thereby predisposing the child to
contract violent, impulsive and overactive reactions (Schore, 2009).
The resulting effect of these traumatic life experiences in children is PTSD and the same
can occur in adolescents and adults as well. Alteration of the brains’ proper response to normal
stress as triggered of by trauma often leave patients in prolonged psychological and biological
impacts including avoidance, hyperarousal, depression, sleep disturbance, anxiety, agitation,
substance abuse hypervigilance, flashbacks, nightmares, and memories. Arden and Linford
(2009) admit that the attachment relationships a child is exposed to during childhood contribute
greatly in shaping the developing neuronal connections and networks in the brain.
Being the governing system that controls attachment, learning, nurturing instincts,
implicit memory, immune system, motivation, and stress response, the limbic system is very
critical in the development of the emotional and social wellbeing facets of people. The systems’
circuits are by and large wired together by attachment experiences and therefore are easily
altered by stress and trauma (Delima & Vimpani, 2011). The limbic region and the neurons are
in other words genetically orchestrated to connect with one another through early child-care
connections. Neurochemicals such as Vasopressin, Cortisol, Dopamine, Serotonin,
Norepinephrine, Epinephrine, Neuropeptides, and Oxytocin on the other hand help neurons to
communicate with one another and are critical in influencing attachment, stress, mood, and
behavior (Arnsten, 2009).
In particular, the Amygdala region of the brain is critical at processing, interpreting and
assimilating the emotional functioning of the brain besides being responsible for storing

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permanently fears experienced in the past (Bremner, 2008). By receiving inputs directly from the
sensory system across the brain, the amygdala rapidly processes and determines what emotional
response the brain is to take. In the case of fearful circumstances, the amygdala stimulates the
brain to trigger the sympathetic nervous system and the adrenal glands leading to the discharge
of stress neurotransmitters and hormones including adrenaline. These chemicals then activate the
flight or fight responses to face impending danger. If the brain and the body are unable to relieve
these arousal chemicals when the fearful situation passes by producing enough calming
hormones such as cortisol, then one may continue feeling stressful and may end up with PTSD
conditions (Arnsten, 2009).
Critique of Trauma-Informed Care Evidence
Like other psychiatric conditions, PTSD is subjected to similar prevention, management
and treatment methodologies in care; psychotherapy and medication or a combination of the two.
However, Raja, Hoersch, Rajagopalan, and Chang (2014) assert that most effective treatment
involves determining the type of care by actively working with a mental health practitioner and
specifically identifying the trauma and its implications on the patient. This type of care is
referred to as trauma-informed care (TIC). TIC is basically an organizational structure and
treatment framework in which managing PTSD constitutes comprehensively understanding,
determining and responding to the impacts of all manner of trauma and their impacts. Hopper,
Bassuk, and Oliver (2010) in a peer-reviewed article defined TIC as;
“Trauma-informed care is a strengths-based Framework that is grounded in an
understanding of and responsiveness to the impact of trauma, that emphasizes physical,
psychological and emotional safety for both providers and survivors, and that creates
opportunities for survivors to rebuild a sense of control and empowerment”

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By and large, TIC is premised on the fact that symptoms exhibited by patients with
mental disorders are more or less related to experiences of trauma. As such, for the most optimal
recovery outcomes to be realized, then the causes of a patient’s symptoms and behaviors must be
comprehensively understood by service providers. Moreover, interventions that are trauma-
informed demands that all aspects of healthcare service delivery ought to be guided by trauma
histories of victims. TIC at its minimum is geared at advancing victims of PTSD a sense of
safety by striving to curb re-traumatization besides taping on the strengths lodged within them to
advance opportunities of rebuilding control (Johnson, Parkinson, Tseng, Kuehnle, 2011).
The definition by Hopper, Bassuk, and Oliver (2010) espouses TIC as trauma
intervention that is cognizant of the significance of trauma awareness by service providers for
purposes of fully incorporating the same into their service delivery. TIC recognizes the
importance of cultural competence, support to victims’ control, choice and autonomy, integrated
care, healthy relationship formation, power-sharing and clinging on the hope that recovery is
indeed possible. For the case of Amir, he has been exposed to traumatic circumstances since
childhood and therefore the proper understanding of his history, the causes of his PTSD
presentation and how best to extend a strength-based approach intervention that will enhance his
safety and control levels is critical to his overall recovery.
Few empirical studies examining the efficacy and the evidence of outcomes of TIC exists
today. In a meta-analysis in which Stalans, (2009) utilizes a nine-site quasi-experimental study
over a six month program period, the observation was that women diagnosed with mental
disorders and were subjected to an integrated counseling under an all-inclusive trauma-informed
and patient-involved healthcare services showcased improved mental health symptoms. Muskett

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(2014) assert that TIC is instrumental in minimizing restraints and seclusion, especially for
inpatient mental health setups.
Implementation
From the foregoing TIC posits as a very ample strategy for the treatment and
management of PTSD. Premised on the need to institute organizational frameworks, policies,
practices, and culture that support an understanding of the impacts and implications of trauma, as
well as the suggestion of recovery plans and re-traumatization prevention strategies, SAMHSA
(2014) suggest that trauma interventions ought to be informed by the symptoms and causal
factors of particular traumas. Indeed, Raja, et al., (2015) asserts that in the healthcare settings,
TIC ought to be approached from a universal trauma precautions viewpoint especially for
patients with expansive trauma history trauma such as in the case of Amir. The Universal trauma
precautions promote the careful employment of patient-centered care and communication in
which careful trauma screening, shared decision making, and safe clinical environments are
advanced. Healthcare practitioners offering trauma-informed care ought to collaborate in care by
opening clear referral pathways as well as remaining proactively aware of their own trauma
histories and capacities in the face of patients’ trauma (Raja, Hoersch, Rajagopalan, & Chang,
2014).
Raja et al., (2015) assert that organizations that endeavor to adopt TIC approaches ought
to emphasize on the significance of communication of the transformation process, proactively
engaging patients in their own care, training mental healthcare staff on the tenets of TIC,
advancing safe working and healing environments of workers and patients and engaging in
partnership with other organizations involved in the safe for best practice exchanges. Moreover,
healthcare organizations ought to institute trauma screening approaches that aid patients to make

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a connection between traumatic experiences, unhealthy behavior and positive health outcomes
[Mental Health Coordinating Council, 2013]. Actively recognizing the impacts of trauma on
patients’ development offer healthcare providers an opportunity to promote a sense of hope and
safety in patients by extending specialized services to address past trauma, as well as
collaborating and supporting clients contribute in their own care and trauma control through
strength-based approaches. Hiring a trauma-informed workforce is also a tenable implementation
approach
Conclusion
PTSD posits long-term effect on victims and adversely contributes to an individual’s
underdevelopment and slowed active participation in the society. Patients are constantly
reminded of the traumatic events through persistent flashback, intrusive negative thoughts, and
dreams. PTSD triggers off after victims become exposed to traumatic conditions in which case
the brains neurobiology is extensively compromised. Amir’s childhood and detention
experiences contributed to his PTSD condition and they often return to haunt his current life
subjecting him to frequent episodes trauma remembrance. He, therefore, tries to avoid engaging
with others. Amir is amongst millions of others who experience the same globally. However,
with the advancement of TIC, Amir is bound to effectively recover from his condition. Indeed, it
stands out to be the most appropriate therapeutic approach to treat Amir’s condition following its
emphases to tackle traumatic conditions by tracking the history, cultural orientations and
symptoms of patients.

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