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Jun
14

Trauma-informed Practice: How important is this for domestic and family violence services?

Introduction

Neuroscientific research is revolutionising knowledge about a range of brain and mind phenomena. Its revelations have advanced our understanding about the impacts of trauma on the brain and, along with it, pathways to recovery, treatment and services.

Yet recovery is not limited to recovery from the lived experience of trauma, but often from that of treatments, practice and systems as well. Our traditional treatment and service approach is hierarchical, with care being imposed, and treatments being prescribed. Services often mirror the power and control experienced in past abusive relationships. For this reason, all services to which those with a lived experience of unresolved trauma present should integrate trauma-informed principles into their practice systems. And that includes domestic and family violence services.

Background

Complex, interpersonally generated trauma is highly prevalent and severely disruptive. It is associated with a diversity of mental health issues, poor physical health, substance abuse, eating disorders, relationship and self-esteem issues and contact with the criminal justice system.

Substantive research has established the profound effects of extreme experiences on the developing brain throughout the life cycle. It has provided the scientific basis for understanding the dynamics of trauma as well as recovery. Neuroplasticity research has documented the capacity of the brain to change itself, and of ruptures to repair, and new pathways to be laid down. It has shown that, with the right interventions, trauma can be resolved and repercussions on the next generation, minimised. When a parent has resolved their trauma, their children can do well. The challenge is to translate this research into effective practice.

So why have we done so little to assimilate these ground-breaking insights? The evidence is irrefutable yet there is a substantial `disconnect’ between our research knowledge and response in terms of policy, practice, and service-delivery.

The Problem

Currently in Australia:

  • complex trauma and its effects are often unrecognised, misdiagnosed and unaddressed
  • people impacted by trauma present to multiple services over a long period of time; care is fragmented with poor referral and follow-up pathways
  • a `merry go round’ of unintegrated care risks re-traumatisation and compounding of unrecognised trauma
  • escalation and entrenchment of symptoms is psychologically, financially and systemically costly.[i]

Trauma and domestic violence

Recognising we all have different personal definitions of trauma, we can nonetheless define trauma as  an experience of real or perceived threat to life, limb and one’s sense of self. Trauma can arise from single or repeated adverse events that threaten to overwhelm a person’s ability to cope and/or to integrate the experience.

When the traumatic stressors are interpersonal - premeditated, planned, and perpetrated in relationships of care, it is more damaging and constitutes complex trauma. Experiencing and/or witnessing domestic violence is a form of complex trauma.

Domestic and family violence can include a range of abuses that cause trauma: emotional, psychological and economic abuse as well sexual and physical violence. It occurs predominantly between intimate partners, and is often gendered, committed primarily by men against women, but also against children and other vulnerable individuals. Children exposed to violence in the home are especially vulnerable and can experience profound impacts on their physical, psychological and emotional health and wellbeing.  

Childhood trauma which is interpersonally mediated affects early attachment dynamics. Individuals who, as children, observe violence in the home, whose parent/s is/are abusive towards the other, or who are themselves abused, will struggle as a result of the changes to their brain development and functioning which arise from this traumatic exposure. Research suggests that the younger the child, the more harmful the traumatic experiences are in terms of brain development. Those affected may also incorporate abuse into their relationships as adults, including their relationships with services. Abusive patterns, including gendered attitudes can seem normal. The use/abuse of power and control, experiences of betrayal, secrecy, silence, fear and shame are common elements in families in which abuse/violence occur. In turn all of these factors help perpetuate cycles of violence/abuse.

The complex needs of trauma survivors

The inter-relationship between domestic and family violence, child abuse and substance abuse (including alcohol, drugs and tobacco) is well established. Alcohol is not only an important risk factor for family violence, including child abuse, but also a ‘coping mechanism’ adopted in response to complex trauma. As is common to other coping strategies, such as overeating, smoking or physical inactivity, alcohol, in turn, becomes a risk factor for physical and mental health issues and a range of psychosocial challenges. In addition, traumatic experiences impact on the mental wellbeing of survivors, sometimes severely. Trauma is associated with a range of adaptive responses and patterns, many of them unconscious, that are later diagnosed as psychiatric ‘disorders’.

What is Trauma-Informed Practice?

‘Trauma-Informed Care and Practice’ is a strengths-based framework that:

  • is grounded in an understanding of, and responsiveness to, the impact of trauma,
  • emphasises physical, psychological, and emotional safety for both providers and survivors, and,
  • creates opportunities for survivors to rebuild a sense of control and empowerment.[ii]

It recognises the prevalence of trauma and is sensitive to and informed by the impacts of trauma on the emotional, psychological and social wellbeing of individuals and communities.

Why Develop Trauma-Informed Practice

Traumatised people often experience services as unsafe, disempowering and/or invalidating. Service culture, philosophy and practice need to be informed by an understanding of the impacts of people’s lived experiences, past and present, their reactions to them and ways of coping. Services need to acknowledge people’s strengths and resilience in the face of adversity.

The strategies people adopt to cope are dependent on their resources at the time. In asking the question: “What happened to you?” services need to shift from entrenched perceptions, to approaches which do not blame or pathologise individuals for their attempts to manage their traumatic stress. They need to accommodate the vulnerabilities and sensitivities of trauma survivors to minimise the potential for re-traumatisation and harm in services. Understanding domestic violence and childhood abuse as trauma requires us to ask ‘what might have happened to cause this person to behave in this way?’, not ‘what can I diagnose this behaviour as’?

Building a Trauma-Informed Practice

When a human service becomes trauma-informed, every part of its organisation, management, and service delivery system is assessed and modified to ensure a basic understanding of how trauma impacts the life of the individual seeking services. It requires substantive top to bottom organisational change which attunes to diversity (e.g. gender, ethnicity, age, socioeconomic status, culture) as an underlying principle.

A trauma-informed practice commits to and acts upon the core principles of safety, trustworthiness, choice, collaboration & empowerment.[iii]  It values and respects all individuals, along with their choices, autonomy, culture and values, while building hope and optimism for a better future.

Safety, both physical and psychological is core to this process and must be informed by an understanding that many trauma survivors struggle to feel safe. Of people presenting to domestic violence services, some have never felt safe, in their bodies, relationships and/or homes. Services need to be safe havens, which prioritise each client’s understanding of safety, rather than that determined by the service.

Because repeated experiences of betrayal are common in the lives of those impacted by domestic and family violence, trust often builds slowly. In services it is facilitated through the sharing of power, information and mutually agreed boundaries. The dynamics of power must be not only recognised and acknowledged but actively addressed, as abuse of power may continue to characterise current intimate relationships.

Many people remain in chaotic and unpredictable relationships and feel out of control in the present, as well as the past. They often present at their most distressed and vulnerable, and are easily triggered and struggle to regulate their emotions. Predictability and a sense of control, through choice and collaboration, enable them to better manage their emotional highs and lows.

The experience of relationships registers in the brain, correlates with neural activity, and is crucial to well-being. Just as traumatic experiences have potentially negative impacts on brain development, structure and functioning, so too, new and positive experiences can aid recovery. As the original trauma occurred in the context of relationships, the types of relationships encountered in systems of care are pivotal. While negative relational experiences, including those with services, compound emotional and psychological problems, positive relational experiences have great healing potential and enable integration within the brain.

Trauma in the workplace – staff experiences and vicarious/work-induced trauma

 Many people who present to domestic violence services have experienced multiple unresolved traumas which have been compounded over time by further experiences and/or patterns of violence and abuse. It is important to also acknowledge that it is not only ‘clients’ who have a lived experience of complex trauma but many workers as well. ‘Trauma sensitivity’ needs to infuse policy and practice within each service, as a shared responsibility of all staff and managers. It also needs to be understood that interactions with clients can readily trigger staff reactions. This is most marked when staff members themselves have unresolved trauma histories, as many do. It is important for staff and organisations to understand the ways in which prior and present traumatic stress affects their interactions with clients, the performance of their roles and that of the organisation as a whole. Stress is contagious, and attentiveness to wellbeing for both staff and clients needs to be a priority.

Staff well-being fosters empathy and understanding. However it requires self-awareness, and self-care, supported by organisational responsiveness and trauma-informed protocols. In these ways the risk of escalating stress, vicarious trauma and burnout are minimised.

Conclusion

The benefits of a trauma-informed domestic and family violence system are manifold not just for clients but also for staff and organisations.  Given that domestic violence is traumatic, and that many involved in violent relationships will also have a childhood history of trauma, all services working with domestic violence survivors need to be trauma-informed.

Building a Trauma-Informed Domestic and Family Violence Practice: Key Principles

  • Safety – physical and emotional
  • Trust – built over time between trauma survivor and service
  • Empowerment and skill acquisition
  • Maximising client choice and control
  • Collaboration – sharing power
  • Building positive relational experiences
  • Understanding trauma, its prevalence, dynamics and impacts
  • Understanding client complexities – coping and culture
  • Be informed about trauma experiences of staff – both direct and vicarious
Click here to find out about Blue Knot Foundation’s training to support your work in this area.


[i] Kezelman C.A. & Stavropoulos P.A. Blue Knot Foundation, formerly Adults Surviving Child Abuse 2012, Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery

[ii] Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). ‘Shelter from the storm: Trauma informed care in homelessness services settings’, The Open Health Services and Policy Journal, 3, 80–100.

[iii] Fallot, R. D. & Harris, M. (2009). Creating Cultures of Trauma‐Informed Care (CCTIC): A Self‐Assessment and Planning Protocol. Available at http://www.theannainstitute.org/CCTICSELFASSPP.pdf

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