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Aldridge Palay is a consulting firm specializing in mental health and intellectual and developmental disabilities. We provide policy analysis, create content for clinical and staff development, and custom-design tools for community assessment for service needs. We also consult on the business of providing services in the mental health and intellectual and developmental disability market.
Trauma Responsive Care
An estimated 90% of individuals with intellectual and developmental disabilities (IDD) have experienced traumatic stress.*  This stress can take the form of trauma-causing experiences that may seem more obvious, such as abuse and neglect, but it can also come from events that are unfortunately common occurrences, like uncontrolled and sudden changes in living environments. It can also take the form of daily stressors such as bullying, exclusion, powerlessness and voicelessness, repeated over years. In fact, the system of care itself can often cause as much harm in the form of traumatic stress, as it does good. The effect on the brain is the same.**  

There is not enough knowledge in the field about how trauma affects individuals with IDD.***   We do know that individuals with emotional distress are more likely to “act it out” if they have no way to express it and be supported for it.**** 

These confusing and sometimes dangerous behaviors can pose some of the greatest challenges to residential placements, work, and hospitalization. It can also be extremely stressful for staff and contribute to things like increased incidents and higher staff turnover.

Obviously, Direct Support Professionals need to be trained to recognize the effects of trauma on the brain, on relationships, behavior and emotions in individuals with IDD. They also need to know how to intervene effectively, and how to advocate for essential treatment. This is Trauma-Informed Care.

Trauma-informed approaches help staff to understand what trauma is; Trauma-Responsive Care (TRC) is the next step. It is a person-centered approach for healing trauma, based on brain science and implemented through relational interventions. TRC trains staff to respond in practical, effective and compassionate ways to people affected by traumatic stress. Our model centers on helping people feel safe, connected, and in control, starting with building trust, self-regulation, healing experiences and positive identities in the people we serve.

This can only be accomplished through positive, compassionate relationships and so TRC progresses to helping staff to identify and manage their own stressors DSP’s need to be taught
to manage their own stress responses to a variety of situations, to better handle the needs of the person they are serving, and to feel calm, competent and satisfied with their jobs. This creates a new and vital role for management. DSP’s can help the people we serve feel safe, connected and in control only if they also feel safe, connected and in control. Management needs to seriously review and revamp policies and practices to provide the best possible support for staff and therefore for the people served.

TRC provides guidance on implementing individual plans, including many tools and interventions our field depends on, such as medication and behavioral interventions. This starts with a systematic process to make team decisions about when to seek medical treatment and psychotropic medication and when and how to implement a behavior management plan. TRC allows us to use these powerful tools more appropriately and effectively. TRC also incorporates psychotherapy, trauma-focused brain-body work and other evidence-based and emerging therapies that may not have been traditionally considered for our population.

Our Mindful Management system provides organizational direction that cultivates relational, strengths-based approaches that are calming and present-focused. Mindful Management creates an organizational culture built on compassion, connectedness and trust through supervision practices, training and support from the top tier of an agency to its front-line staff members.

Because merely ‘informed’ is not enough
What is Trauma?
What is Trauma Responsive Care?
* Sobsey, D. Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance? Baltimore: Paul H. Brookes Publishing Co,1994.

** Herman, J. Trauma and Recovery. Basic Books, 1992.

*** Wigham et al. “The Effects of Traumatizing Life Events on People With Intellectual Disabilities: A Systematic Review”, Journal of Mental Health  Research in Intellectual Disabilities, 4, 19-39.

**** Harvey, K. Trauma-Informed Behavioral Interventions: What Works and What Doesn’t. AAIDD, 2012.