1. Trauma Informed Practice
Shelley Gilbert BSW
Legal Assistance of Windsor
WEFIGHT
Trauma Informed Practice
Introduction
Developing an understanding of the impact of trauma and then establishing direct practice and organizational strategies to assist allows our clients the opportunity to fully participate in the legal process and helps their representative to put their best case forward.

2. Introduction What is it? 4 Principles of Trauma Informed Practice
Trauma Awareness
Emphasis on Safety and Trustworthiness
Opportunities for Choice, Collaboration and Connection
Strengths Based and Skill Building
We’re going to look real briefly at this idea of Trauma Informed Practice or TIP. Many people use these principles instinctively…..grass roots organizers in the migrant worker community, those working with people working in the sex trade industry, may already recognize and ensure choices are provided or the skills people bring to the table. But when these principles are employed together, they provide the best opportunity to reach out to individuals who have experienced trauma and support them in the most respectful and helpful manner.

3. Trauma Informed Services
Embed an understanding of trauma in all aspects of service delivery
Place priority on trauma survivor’s safety, choice and control
Create a treatment culture of nonviolence, learning, and collaboration
So TIP services are informed about trauma, and those services work at the client, staff, agency and system levels incorporating the core principles of trauma awareness, safety and trustworthiness, choice and collaboration, and building of strength and skills
When these principles are employed, the connections between trauma, mental health & substance use are discussed in the course of work with all clients, trauma symptoms/adaptations are identified, and supports and strategies are offered that increase safety and support connection to services.

4. 4 Key Principles 1. Trauma Awareness
A trauma-informed approach begins with building awareness among staff and clients of:
The high prevalence of trauma
How the impact of trauma can be central to one’s development
The wide range of adaptations people make to cope and survive
The relationship of trauma with substance use, physical health and mental health concerns.
BC Trauma-Informed Practice Guide, 2013
This knowledge is the foundation of an organizational culture of trauma-informed care

5. Trauma as an Event Individual
Experiencing, witnessing, or being threatened with an event or events that involve serious injury, a threat to the physical integrity of one’s self or others, or possible death. The responses to these events include intense fear, helplessness, and/or horror.
Women’s Co-occurring Disorders and Violence Study
Intergenerational or multi-generational trauma
Happens when the effects of trauma are not resolved in one generation. When trauma is ignored and there is no support for dealing with it, the trauma will be passed from one generation to the next.
Many of us have experienced a traumatic event in our lives , but if we couple the event with factors such as length of time the event goes on, the age of the victim, the level of violence used and the amount of destruction in one’s family or community we begin to recognize that some events may cause life long responses…these responses may improve, they may change, they may be retriggered, but the memory of the even will not go away
Aboriginal Healing Foundation, 1999:A5

6. What Does Trauma Look? Manifestations
Post Traumatic Stress Disorder
Physically showing fear, inability to follow conversation, looking distracted, exhaustion
No shows, late, distractions during interviews, inability to take the bus, always accompanied
Sleeping throughout the day, easily startled, no shows, unfocused
Often childhood or compounded trauma
Inability to maintain employment, stay in school, anger
Intrusive recollection/re-experiencing – e.g. nightmares, flashbacks
Avoidant/numbing – e.g. detachment, avoiding people and/or places
Hyper-arousal – e.g. hyper-vigilance, difficulties with sleeping and/or concentrating
Duration of disturbances is more than one month
Causes significant problems with daily functioning
APA, 2000
Physical
unexplained chronic pain
stress-related conditions (i.e. chronic fatigue)
headaches
sleep problems
breathing problems
digestive problems
Emotional
depression
anxiety
compulsive and obsessive behaviours
overwhelmed with memories of the trauma
difficulty concentrating
fearful
emotionally numb
loss of time and memory problems
suicidal thoughts
Spiritual
feelings of shame, guilt
self-blame
self-hate
feel completely different from others
no sense of connection
feeling like a ‘bad’ person
Interpersonal
frequent conflict in relationships
unable to trust
difficulty establishing and maintaining close relationships
experiences of revictimization
trouble setting boundaries
Behavioural
drug and alcohol use
shoplifting
eating disorders
self-harm
high-risk sexual behaviours
suicidal impulses
gambling
isolation
justice system involvement

7. Key Principle 2. Emphasis on Safety and Trust-Worthiness
Welcoming intake procedures
Adapting the physical space
Providing clear information and predictable expectations about programming
Ensuring informed consent
Creating crisis plans
Providing culturally competent care/service
BC Trauma-Informed Practice Guide, 2013
Trauma Survivors:
Likely have experienced boundary violations and abuse of power
Need to feel physical and emotionally safe
May currently be in unsafe relationships
Service Providers:
The safety and mental health needs of service providers are also considered within a trauma-informed service approach.
Key component of Service Provider safety:
Education and support related to vicarious trauma. 2

8. Key Principles 3. Opportunity for Choice, Collaboration and Connection
Service providers are encouraged to:
Communicate openly
Equalize power imbalances
Allow the expression of feelings without fear of judgment
Provide choices as to course of action
Work collaboratively with both the client and supports
Trauma-informed services create safe environments that foster a client’s sense of efficacy, self-determination, dignity, and personal control.
Consider the following areas of choice:
When, where and by whom services are provided
Priorities and goals that will inform service plan
Who attends appointments and meetings, e.g. support people
Ask permission to ask a question; or engage in policy based practice, e.g. checking belongings at beginning of residential program
Guarino et al. 2003; Fallot & Harris, 2009; Gender Matters, 2003

9. Key Principles 4. Strengths Based and Skill Building
Service providers:
Help clients identify their strengths
Further develop resiliency and coping skills (could be related to culture/identity)
Teach and model skills for recognizing triggers, calming, centering and staying present
Support an organizational culture of “emotional intelligence” and “social learning”
Maintain competency-based skills, knowledge, and values that are trauma informed
BC Trauma-Informed Practice Guide, 2013

10. Systemically
Trauma informed systems deliver and promote services that are culturally safe, take into account a socio-historical understanding of client/patient experiences and are informed by an awareness of the existence and impact of social inequities and systemic discrimination
BC Trauma-Informed Guide, 2013

11. TRAUMA INFORMED INTAKE PRACTICES
TIP can be seen in flexible intake and assessment processes that:
Create safety (including cultural safety)
Engage – establish a therapeutic relationship
Do not “press for compliance.”
Screen for present concerns
Normalize client experience(s)
Set boundaries
Identify symptoms
2011 Focus Groups of BC Addictions and Mental Providers
Staff collaboration can reflect on how to:
Provide clear, practical information at initial contacts about what to expect, choices for being contacted and rationale for processes
Provide opportunities for questions
Respond to people who arrive in distress
Guarino et al. 2003; Fallot & Harris, 2009; Gender Matters, 2003