Article

Frontline Initiative Trauma-Informed Care

An introduction to Trauma-Informed Care

Author(s)

Karyn Harvey Ph.D, is the AssistantExecutive Director (Quality Supports) at The ARC Baltimore, MD and the author of Trauma-Informed Behavioral Interventions: What Works and What Doesn’t.

“Trauma” is a broad term for an event or series of events that make a person feel threatened. These events can range from less serious to quite severe. Either way, trauma can lead to a lifetime of fear and anxiety. For example, a child may feel threatened by a snarling dog. For decades after, he or she may have a negative reaction when placed in a similar situation. Generally, more traumatic events lead to more persistent fears and anxieties.

Many people with intellectual and developmental disabilities are considered “vulnerable”. That is, susceptible to injury—physical, emotional or financial— from another person. Many people with disabilities have been teased or bullied at some time in their lives. They are called the “R” word or much worse. They have been made to feel left out, ignored, or marginalized. We know that they are more likely than the general public to be physically or sexually abused. We also know that charging offenders is very difficult.

Recent research suggests that the effects of trauma are more widespread and damaging than previously thought. In a study of over 7,000 people with disabilities, over 70% reported they had suffered physically, sexually or financially. For many, the abuse was ongoing.

DSPs who understand trauma-informed care know how trauma can have profound effects on a person. Effects range from environmental sensitivities (loud noises, bright lights) to behaviors like distrust of others, despair, and powerlessness. To move past trauma, individuals need an ongoing sense of safety, connection to others they can trust, and a sense of empowerment. DSPs who provide quality support are perceived by the person as kind and safe. They have the persons’ best interests at heart. They also help strengthen the person’s connections to others.

DSPs can work to understand how trauma impacts the person’s life and behavior. Then, they can work to create soothing, calm environments. They can convey respect, understanding, and provide ongoing opportunities for communication among people being supported and others in their lives.

Because of this, anxiety and fear can be reduced. DSPs can help the person feel a sense of control or power over their own lives. This can be as simple as having a real choice in their life. This is a very liberating feeling!

With these ingredients and staff that provide a sense of safety, connection and empowerment, people with disabilities who have experienced trauma have been able to heal. They have been able to live meaningful and rewarding lives. This often comes down to the quality of support the DSP provides while working with the person. As a DSP, you are a key contributor to the person’s quality of life.

Symptoms of PTSD

When severe trauma occurs, it can cause post-traumatic stress disorder (PTSD). PTSD has three main symptoms: re-experiencing (or remembering), avoidance, and hyper-arousal.

Symptoms of re-experiencing can include continually talking about bad things that happened. This makes it difficult for the person to focus on the present. Re-experiencing may include repeated nightmares or flashbacks—vividly re-experiencing a traumatic event in the present, even though it happened long ago.

Avoidance can include what is known as “hyper-vigilance.” The person may place too much attention on details of safety and day-today existence. They may repeatedly check on who is working or what is happening in their home or work environment. They may repeatedly perform such “safety rituals.”

Finally, hyper-arousal can manifest as distress, property destruction, an impulse to fight, or actually fighting with others with very little reason. This can look like someone has a “chip on their shoulder” or some kind of ongoing issue to settle. However it is actually often based on the experience of past trauma. Strong startle responses and an inability to relax or settle down are also often common.