Trauma informed care

What is trauma informed care?

Trauma informed care is a term that is used to describe the importance of considering the impact of trauma on a person’s mental and physical wellbeing. 

It is about recognising the negative impact that that traumatic experiences can have on a person’s ability to feel safe and build trusting relationships with the professionals who are caring for them. 

Trauma informed care should focus on what a person needs rather than ‘what is wrong with them’, recognising that traumatic experiences can impact on the way that people think, act, communicate and understand others. 

It is important to understand that sometimes people who have experienced trauma struggle to engage with services for a number of reasons, including: 

• They don’t feel able to express their emotions – or feel that they have previously been “told off” for the way they have reacted to intense emotion.
• They don’t know where they stand or they don’t know what to expect.
• Believing they are too damaged/can’t be “fixed”.
• Thinking that no one really cares. 

Trauma informed care is a way to think about those difficulties and make sure that these feelings and beliefs are not reinforced so that that people are able to get good care when they need it. 

6 key principals of trauma informed care and how you can support

Safety 

This might be about creating a physically safe space. For professional appointments this might be away from home/at home or avoiding a location. 

It might be about helping the person you care about remove items from where they live which remind them of the traumatic event. 

It might be about supporting them access services that could help if they are not currently safe from harm, such as domestic violence services or requesting an early help worker to manage challenges in parenting. 

You could also help with creating a calm space where they can go when they need time alone. 

Choice

Professionals involved should be clear with the person you care for about the choices they have in terms of access to support, frequency of visits and other areas of decision making. 

Goals for care should ultimately be decided by the patient with support to think about what is practical and realistic. It might be that they are supported to breakdown bigger goals in to steps in order to be able to build their confidence and personal worth – but this will only come from them feeling empowered to choose. 

Be aware that sometimes people who have suffered trauma may feel that they have very little control over what happens in their life. This can make decision making hard and being given responsibility for making choices can feel 
overwhelming. You can help by talking through the options, encourage them to identify the pros and cons of each possible choice. Encourage them to take time in thinking through their decisions. 

Remind them that you believe in them and their ability to take some control in this process. 

Trust

Being a listening ear and not sharing the things they tell you without speak to them about this first; or if they tell you something worrying be really honest, open and clear about who you are going to tell and why. 

Professionals should be very clear about what they are and are not able to offer they should be clear about their responsibilities around confidentiality and the times when they may need to share information. They should be consistent and do what they say they will do. There may on occasions be times when this is not possible (ie if staff are off sick) but there should be clear communication at these times with an explanation and a plan. 

Empowerment

Making sure that people feel empowered to get their voice heard is arguably the most important part of trauma informed care. 

It is important to understand that people who have experienced trauma might feel powerless to control what happens to them. 

You and professionals can start to show them that this is not the case by really listening to them and acting upon what they are saying. 

It is important to listen to concerns that they have and encourage them to make decisions and take action to resolve them where they can. 

Collaboration

Everyone’s voice should be heard, the best plans are those that take into account the thoughts and opinions of everyone important. 

You know the person you are caring for better than most, so it is important that your experience and opinions are taken into account. 

If you don’t feel that you are being asked, speak up! It’s fine to make contact with the professionals who are supporting the person you care for. Even if there are issues with consent that mean there is some information that they can’t share with you, you can still speak to them and ask that the things you tell them are considered in the care planning process. 

In addition to the impact of collaboration on direct care, it should also be used to ensure that services are fit for purpose. 

LPFT do this in a number of ways, for you there is a carers council that is regularly attended by senior staff within the trust to try to ensure that your experiences are heard. 

LPFT also hold roadshows and consultation events at times of significant service change in the way services are provided. You can find up to date information about these on the trust website or social media feeds. 

Be patient and see what else you can do to help. 

Cultural consideration

Trauma focused care should never be discrim­inatory, the impact of gender, age, religion, sexual orientation, disability, race and ethnicity should be considered when caring for someone. 

You might notice this in different ways, for example: 

• Helping a person to find LGBT social groups to increase the likelihood that they will feel accepted and benefit from increased socialising. 
• Including things like prayer/worship/ attendance at a building of religious or spiritual significance in wellbeing and safety planning. 
• Including a persons physiotherapist in care planning to ensure that they are able to focus their work to match goal setting and offer advise in regards to realistic expectations of physical ability if wanting to swim more regularly. 
• Ensuring that people are offered a same sex practitioner where this is possible and appropriate. 
• Planning in advance for the potential impact of a person fasting during Ramadan. 
   

What might trauma informed care look like?

How care is delivered and the things that are put in place will depend on the individual and the experiences they have had, so it’s impossible to give an exhaustive list, but the following are examples of a trauma informed approach. 

• A person highlighting that when they are struggling with emotional distress they can find to hard to communicate verbally and therefore a plan is agreed to empower them to maintain engagement by carrying communication cards to shut down a conversation that is becoming overwhelming/communicate their needs. 
• Someone who has suffered a gender specific sexual assault being supported by staff of a single gender. 
• Recognising the impact of trauma on processing and communication and ensuring that care planning/review is spread over a number of sessions in order for the person to be able to go away and think about what has been discussed in order to ensure they are able to have their voice fully heard in the plans. 
• Not making assumptions, but talking to someone about what they want to achieve – ie, for someone who has experienced some form of trauma associated with religion. They may not want to ever attend a place of worship again but for another person this may be much more complex if they hold on to a faith which they seek to practice. They may wish to work towards re-engaging with their local place of worship and want support to do so. 
• Recognising that someone who has previously been admitted to hospital, may be distressed by attending the same building for community appointments, therefore appointments are arranged in an alternative clinical environment, home or community location. 
• Recognising that a person may struggle in re-telling their story so completing the “all about me” and “all about my relative documents so that professionals are able to familiarise themselves with these prior to appointments. 
   

Looking after yourself

It’s important to look after yourself. If you are not well, either physically or emotionally, then it makes it very difficult for you to care for someone else. If you are struggling it is important to seek help. 

Below are a few tips that you may find useful to support your own wellbeing.

• Take time for yourself and do something that you like, even if it is for 30 minutes or an hour a day (e.g. read a book or have a relaxing bath).
• Find someone to talk to. Having a friend or peer to offload to can be really beneficial to your own mental health. You could also join LPFT’s carers WhatsApp group, which consists of LPFT carers who support each other and will understand what you are going through. Email donna.bradford@nhs.net to join.
• Join LPFT’s carers education and support group and learn about your relative’s condition, how services are run, and meet others in similar situations to you. Email donna.bradford@nhs.net to join.
• Email the LPFT carers email address and let us know that you need some support - lpft.carers@nhs.net
• Ask about family therapy available through the Trust.
• Take courses through Lincolnshire Recovery College. There are lots of courses suitable for carers.
• Remember the Samaritans are also available if you need support.