Trauma: Why we talk about being responsive

We’re getting used to thinking about trauma-informed care in human services. It took a while, but the concept has caught on; hopefully not just as a passing fad. Government and private foundation-sponsored grants now often include trauma-informed requirements.

But at Aldridge Palay, we like to talk about moving beyond trauma-informed to being trauma-responsive. Why? Because awareness is important, but not important enough to stop there if you also have a role in healing—and when it comes to trauma, we all have a role to play in healing.

Of course, identifying and treating trauma and trauma-related issues is the job of mental health. And mental health is a bit ahead of other human services in becoming ‘trauma informed’. After all, Substance Abuse & Mental Health Services Administration (SAMHSA)*. is a leading resource for trauma-informed care. Mental health professionals offer established psychotherapeutic treatments. These treatments require years of training and experience and are, well, treatments. The rest of us don’t do ‘treatment.’ Even then, for many vulnerable populations, availability or access can be a problem. And so, this treatment happens once or twice a week at best and sometimes not at all.

What about the rest of the time? This is where the rest of us come in—and where being responsive is most important. Even if a person dealing with trauma is receiving specific mental health treatment for that trauma all of the other services they may receive, the environments in which they receive them and the people who provide those services are all part of that person’s healing. This means schools, community centers, healthcare providers, I/DD providers, and providers of other social services. We all have to do what we do in a way that promotes healing from trauma. We must provide environments and interactions that help people feel safe and calm. We must provide them voice in their own care, and we must communicate genuine caring. We all hope to think that we, our organizations, our staff, do this already. Deep down, though, we know it’s just that—a hope. The only way to be sure is to consciously make our organizations into things that, before anything else, help people feel safe, calm and cared for. This is a big challenge, to be sure, but it is not an insurmountable one.

Trauma Responsive Care is the next step from learning about trauma to actually responding supportively to someone with trauma—it is meeting this big challenge.

Along with learning that trauma exists, the human services world is learning just how pervasive it is in our population. Most of the time, we will know little to nothing about that person’s trauma history and so we have to respond ‘as if’ they have one, as Lara talked about in her recent blog “Make Way for Humans!” in an article called ‘As If: A Case for Trauma as Universal Precaution.

This isn’t just fluff. This makes sense in improving quality in any service you might provide—and it creates the supportive, calm interactions that people with trauma need in order to heal—this means all people, those served and those doing the serving.

What about the impact of trauma? Let’s start with children. If you don’t support children, you support people who used to be children and you hire people who used to be children to do it. Last year one in seven children experienced abuse or neglect**. According to the CDC, the lifetime cost of child abuse and neglect, when tabulated in 2008, was $124 billion. This is comparable to other top-tier public health issues like strokes and type two diabetes.

Childhood also provides our best handle on trauma in the general population, through the Adverse Childhood Experiences Study, or ACES. According to this survey, which simply asks if the respondent experienced any of a short list of ten adverse events known to be traumatizing, 64% of adults have experienced one or more adverse childhood experience.

Now, remember how child abuse and neglect can cost as much as serious health conditions? Well, child abuse and neglect are ‘adverse childhood experiences’ and the more of these experiences a person has, the higher their risk of suffering from some of those other top-tier public health issues later in life. It just keeps adding up. Add poverty and we’re not even scratching the surface.

That’s for the general populations. Another name for this group is “the people you hire”. What about the people you’re in business to support, your customers? Let’s take a quick look at four clusters of populations human service organizations work with:

  • Many mental health professionals believe that trauma is under diagnosed and hides within other chronic mental and emotional health issues, like borderline personality, depression, anxiety, and substance abuse.***

  • It’s estimated that maybe as much as 60% of the homeless have significant mental health issues and maybe as much as 80% are dealing with substance abuse.****

  • The US Department of Veterans Affairs reports that anywhere from 11% to 20% of veterans are dealing with PTSD.*****

  • Researchers in the field of intellectual and developmental disabilities have estimated that as many as 90% of people with IDD could be traumatized. A National Public Radio Report, based on U.S. Department of Justice statistics estimated that a person with an intellectual disability is seven times more likely to be the victim of a sexual assault than people without an intellectual disability.******

This of all means that trauma is highly prevalent in all areas of human services. It means that trauma could adversely impact more than half of the human services workforce, who, by the way, work in ‘vicarious trauma factories.’ And it means that practically all of the people your agency supports could at any given time, be adversely affected by trauma.

It also means if your agency is supporting people in need and the impact of trauma on your organization doesn’t scare you, then you’re not living up to your mission and you’re paying for the privilege.

* Substance Abuse and Mental Health Services Administration (SAMHSA). (Link) Retrieved August 21, 2019

** Center for Disease Control and Prevention (CDC). (Link) Retrieved August 21, 2019

** Ibid. (Link) Retrieved August 21, 2019

*** Grasso, D., J. Boonsiri, D. Lipschitz, A. Guyer, S. Houshyar, H. Douglas-Palumberi, J. Massey & J. Kaufman. Posttraumatic Stress Disporder: The Missed Diagnosis, HHS Public Access. (Link). Retrieved August 21, 2019

**** SAMHSA. (Link). Retrieved August 21, 2019

***** United States Department of Veterans Affairs (VA). (Link). Retrieved August 21, 2019

****** Sobsey, D. Violence and abuse in the lives of people with disabilities: The end of silent acceptance? Baltimore: Paul H. Brookes Publishing Co,1994.

****** National Public Radio. (Link). Retrieved August 21, 2019