Trauma Informed Practice

The term ACE is used to describe a wide range of stressful or traumatic experiences that children can be exposed to whilst growing up. ACEs range from experiences that directly harm to those that affect the environment in which a child grows.

Aces have been categorised into two categories

1. Child Maltreatment which includes:

• Verbal abuse
• Physical abuse
• Sexual abuse
• Emotional and physical Neglect

2. Household adversity which includes:

• Mental illness
• Domestic violence
• Alcohol abuse
• Drug abuse
• Incarceration
• Parental separation

There is a distinction between ‘normal’ stressful life events, such as parental divorce or illness of a loved one, and adverse childhood experiences, very traumatic life events, such as being or seeing someone else physically or sexually abused. These are experiences that will often be associated with post-traumatic stress disorder 

Research indicates the presence of a greater number of Aces indicates the greater risk of negative outcomes. (Bellis et al 2014)  These negative outcomes include poor physical and mental health, chronic disease (such as type II diabetes, chronic obstructive pulmonary disease; heart disease; cancer), increased levels of violence, and lower academic success both in childhood and adulthood.

Watch - Adverse Childhood Experiences (ACEs) (Wales) - YouTube

Type 1 trauma

Events which are one time or short lived occurrences.

Type 2 trauma (also referred to as complex or developmental trauma)

Comprises chronic traumatic events, which persist over longer periods of time (eg, repeated abuse, neglect, separation and other adverse experiences). This type of trauma generally occurs in the context of relationships (Kinoglu, 2017; Herman, 1992).

“Trauma results from the way children experience adverse events not the events themselves.

Some children suffer multiple adverse events without being traumatised, whereas others are overwhelmed by apparently less serious experiences.”  Furnivall & Grant (2014)

ACEs can create dangerous levels of stress and compromise a child’s healthy brain development, which can result in long-term effects on learning, behaviour, health and quality of life into adulthood.

Paediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain.

View the 16 minute Ted Talk

www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime

The UK Trauma Council also offer a guidebook on Childhood Trauma and the brain.

UK Trauma Council - Childhood Trauma and the Brain resource

Fight, Flight, Freeze responses are our body's natural automatic and primitive, inborn response that prepares the body to "fight" or "flee" from perceived attack, harm or threat to our survival.

The threat system in the brain allows us to detect and respond to danger. It helps us step back instantly from a speeding car or avoid an angry dog in the park. In other words, stress and threat are a normal part of life for everyone. We all need to activate a fight-or-flight response at times to keep us safe. But abuse and neglect create a world where danger is frequent and unpredictable, and punishment can be extreme. Exposure to ongoing domestic violence, neglect, and physical abuse can lead to long-lasting changes in how the brain responds to perceived danger. This can lead to hypervigilance to threat and/or excessive avoidance. (Information taken from Childhood trauma and the Brain UK Trauma Council)

When repeatedly exposed to ACEs and stress which is frequent, chronic and uncontrolled Corticotrophin releasing hormones (CRH) is continually produced by the brain which means the person remains in a heightened state of alert, unable to return to their natural state.  In a heightened neurological state a child is unable to think rationally and it is physiologically impossible for them to learn or develop in the same way a child not having these experiences will.

Watch this 6 min video to understand the impact on brain body and behaviour

Understanding how stress can affect an individual is important. Knowing this will make us less likely to trigger other people’s stress levels. We should pay attention to ‘how’ we engage with other people, as well as to ‘what’ we do.

Think about what may have happened to someone, rather than judging what is ‘wrong’ with them

When a child/person is consistently exposed to an environment of threat they can become stuck in a state of arousal- a default setting.

The Window of Tolerance refers to the zone you can be in when your emotions are balanced and controlled, and you are thinking clearly and reacting rationally – you’re functioning at your most effective. When you are in your Window of Tolerance, you can manage everyday life well, including planning ahead, stress, pressure, and defusing perceived ‘threats’ to your emotional balance.

Each individual’s window of tolerance is different. Those who have a narrow window of tolerance may often feel as if their emotions are intense and difficult to manage.

A narrowed window of tolerance may cause people to perceive danger more readily and react to real and imagined threats with either a fight/flight response (they go above the window) or a freeze response (they go below the window) more often and with more intensity than they used to expect.

Hyperarousal

Behaviour / emotions you might see are

• Angry outbursts and impulsivity
• Fear
• Flashbacks
• Tension/shaking
• Anxiety
• Unable to rest
• Emotional overwhelm
• Racing thoughts
• Feeling unsafe
• Sleep issues
• Panic
• Defensiveness
• Hypervigilance
• Intrusive Images
• May be very difficult to be in busy or crowded environments
• Difficulty concentrating
• Tight muscles
• “Deer in the headlights” freeze

Hypoarousal

• Depression
• Emotional numbness
• Emptiness
• Feel disconnected
• Low energy
• Flaccid body
• Memory loss
• Shut down
• Physical lethargy
• Disabled cognitive processing ‘I just can’t think’
• Blank stare
• Feelings of shame
• Inability (or lack of desire) to speak
• Dissociation
• Slow digestion
• Blood pressure may drop

(Information from www.ptsduk.org)

Watch The Window of tolerance

Trauma-Informed Practice is a strengths-based approach, which seeks to understand and respond to the impact of trauma on people’s lives. The approach emphasises physical, psychological, and emotional safety for everyone and aims to empower individuals to re-establish control of their lives.

The intention of trauma-informed practice is an increased understanding of the ways in which present behaviours and difficulties can be understood in the context of past trauma. (Wilkinson 2018)

“Trauma results from the way children experience adverse events not the events themselves. Some children suffer multiple adverse events without being traumatised, whereas others are overwhelmed by apparently less serious experiences.” Furnivall & Grant (2014)

Diverse responses to trauma can be influenced by a range of factors the intensity, frequency, duration and types of adverse experiences; and the characteristics of individuals.

Click here to read our 7 Min Brief on Trauma Informed Practice.

Responding to Adverse Childhood Experiences (2019) identified over 100 interventions which were identified and collated across four common approaches:

1. Supporting parenting
2. Building relationships and resilience
3. Early identification of adversity
4. Responding to trauma and specific ACEs

Key principles of a trauma informed approach

A programme, organisation or system that is trauma-informed, is one that

• realises the widespread impact of trauma and understands potential paths for recovery
• recognises the signs and symptoms of trauma in clients, family, staff and others involved in the system
• responds by fully integrating knowledge about trauma into policies, procedures and practices
• seeks to actively resist re-traumatisation.

A trauma-informed approach adheres to key principles:

Throughout the organisation, staff and the people they serve feel physically and psychologically safe. The physical setting is safe and interpersonal interactions promote a sense of safety.

Organisational operations and decisions are conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members of clients.

There is true partnering and levelling of power differences between staff and clients and among organisational staff, from direct care staff to administrators. There is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making.

Throughout the organisation and among the clients served, individuals’ strengths are recognised, built on, and validated and new skills developed as necessary.

The organisation aims to strengthen the staff’s, clients’ and their family members’ experience of choice and recognise that every person’s experience is unique and requires an individualised approach

(Information taken from Trauma-informed practice: what it is and why NAPAC supports it – NAPAC)

What we can all do:

• Hold in mind that a person’s behaviour or reactions might be related to childhood adversity. Meet Strong Emotions & Distress - By Giving Power & Control, accept and allow. Create Safe and supportive interactions, minimise perceived threat, allow people to feel the psychological safety to experience and process their emotions so that they can learn to regulate them.
• To make sense of a child/young person’s current difficulties by considering “what happened to you?” instead of “what’s wrong with you?” And go on to ask, “how has this affected you?” and “who is there to support you?”
• Use protective factors to build resilience e.g. secure attachment, opportunities for positive activities and supportive networks.
• Continue to raise awareness

It is important to ensure that service responses do no re-traumatise individuals; that all organisations can work towards being trauma informed by ensuring that physical environments, staff behaviour and organisational policies and procedures reflect trauma-informed-principles and values.

Positive Steps - Opening Doors Trauma Informed Practice for the Workforce – you tube clip

 

Research in Practice have produced a useful resource to support organisation to become more trauma informed. Developing-and-leading-trauma-informed-practice.pdf (researchinpractice.org.uk)

A Trauma Informed Organisational Development Framework produced by Lancashire Violence reduction network provides a resource to

• Promote discussion about how we respond to trauma;
• Reflect on current practices;
• Identify what trauma informed practices and resources organisations already

have in place;

• Guide organisations to understand the process of embedding a trauma informed approach;
• Carry out self and peer evaluations against specific statements;
• Facilitate collaborative learning;
• Identify developmental needs and next steps;
• Develop a common language within and across multi-agencies;

Encourage leaders to:

• Think about their organisation through a trauma informed lens;
• Develop infrastructure to support cultural change;
• Incorporate understanding of trauma in all policies and practices;
• Develop reflective practice and critical thinking;
• Minimise the impact of vicarious and secondary trauma; and
• Provide effective supervision to the whole workforce.

It provides a self-assessment framework to determine whether the organisation is

1. Trauma aware
2. Trauma sensitive
3. Trauma responsive
4. Trauma Informed

Safe Hands Thinking Minds website has a wealth of information and resources on adversity, culturally, trauma-informed, infused, and responsive practice: produced by Dr Karen Treisman

YoungMinds compiled a collection of resources to raise awareness about the impact of adversity and trauma on the mental health of children and young people. Find resources including a poster and e-book on their website at youngminds.org.uk/addressing-adversity-book

Trauma and the Brain (9 minute video)

Shows the impact of trauma on the brain, particularly on memory.

The Three Main Parts of the Brain (3 minute video)

An animated video by Dr Russ Harris which demonstrates a simple way to explain the three main components of the brain and their functions.

The Brain and Trauma (5.5 minute video)

What does School feel like for children and teens living with trauma pain? This video is a collation of some of their voices. Made by parents of children with trauma. Relevant even if you don’t work in a school: consider these examples to think about possible triggers in your working environment or in your working pattern.

Beacon House (website)

Beacon House develops freely available resources about trauma and adversity. Resources include a Comic Strip illustration of how a shift from traditional language to trauma informed descriptions of vulnerable individuals can create compassion instead of blame, hope instead of hopelessness and connection rather than disconnection.

A free online course, funded by the Home Office Early Intervention Fund, for practitioners, professionals and volunteers who work with children, young people and their families. It will take approximately 50 minutes to complete. E-learning: Introduction to Adverse Childhood Experiences Early Trauma Online Learning

For information regarding our 1 day face to face course Trauma Informed Practice log on to our training system https://www.warringtonsafeguarding.org/

Understanding non engagement through a trauma informed lens - Practice Guidance