Trauma-Informed Care


In recent years, trauma-informed care has been a front and center topic in healthcare. Trauma-informed care “is an approach that aims to engage people with histories of trauma, recognize the presence of trauma symptoms, and acknowledge the role that trauma has played in their lives.” 

At heart, this means that I, as a nurse, need to recognize that some of the symptoms I see in a patient are a result of their story. As I tell health and human service workers all the time: “The symptoms are in the story.”

I think all Christians need to attend a workshop on trauma-informed care. Because as we interact with people, whether they believe our truth claims or not, we need to get a better understanding of what lies beyond the surface.

We need to better understand the story behind the cynicism. We need to have greater empathy for the narrative behind the fear, the resentment, the inability to get involved, the anger toward authority of any kind.

We need to practice trauma-informed care. Specifically, as more and more attention is finally being drawn toward the refugee crisis, and sites like We Welcome Refugees pop up like daisies, (or sometimes dandelions) in a summer lawn, we cannot go into this work blindly, unaware of the trauma sustained by refugees and displaced people. 

One way to be ready is to learn how to give trauma-informed care. So how do we practice trauma-informed care? 

On the surface, it’s simple. Get to know the person behind the symptoms. Find out their story. Everyone has a story. If we practice active listening, we can better get to the heart of the story.

But beyond knowing the story, what do we do? It is completely unrealistic to think we can know everyone’s story. It is beyond our ability to be able to spend the kind of time it takes to get to the heart of why a person reacts the way they do.

SAMHSA – The Substance Abuse and Mental Health Services Administration offers these characteristics of organizations that have a “trauma-informed” approach. These organizations: 

  1. Realize the widespread impact of trauma and understand potential paths for recovery;
  2. Recognize the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
  3. Respond by fully integrating knowledge about trauma into policies, procedures, and practices; and
  4. Seek to actively resist re-traumatization.*

These six principles guide the approach: 

  1. Safety
  2. Trustworthiness and Transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment, voice and choice
  6. Cultural, Historical, and Gender Issues

On a practical level, what does this mean?

For starters, using these principles, a church or refugee organization can develop their own models of care for refugees and others who they long to reach. A church or faith organization needs to recognize signs of post traumatic stress disorder, and know how to direct the person and family for counseling. A church needs to see this as a mutual work, not a hierarchy. The refugee family is NOT below the other families in the church. The refugee family is NOT to be an object of pity. Rather, they should be seen as full partners in the settlement process.  Organizations must understand the need for cultural competency and, within trauma-informed care, seek to care for the person in culturally responsive ways.

There is so much more to say on these topics, and I will write more in the coming days, but let us not enter blindly. Let us enter with humility and determination. We are not Saviours, we are partners in this process. 

It may sound easy on the surface to open your heart and home to refugees, but ask anyone, anyone who has worked in the field for a long time and they will tell you about burnout. They will tell you about how you can’t meet the needs of everybody. They will tell you about their clinic, how after you give out 30 numbers to 30 patients, you have to turn people away. They will tell you about waking every day, begging “Lord Have Mercy.”

Because the problem is so big. Because that is the reality.

Blogger’s Note: Would that these principles of trauma-informed care be used on everybody that enters the doors of our churches. Just as packages that contain breakable items declare in bold letters: “Fragile! Handle with Care!” so do many people wear invisible signs: “Fragile! Handle me carefully.”

Here is an excellent article The Resilient Refugee, written by an ATCK and expat writing friend. Anoter great article What the Migrant Crisis Says About Us is written by a thoughtful writer and researcher who I was privileged to meet in February at the Families in Global Transition Conference.

*These principles are taken directly from SAMHSA

When My Anxious Thoughts Multiply Within…..

I woke with a headache. It started at the base of my neck and before long wound its way up to my temples. I was acutely aware that it was a headache born of anxiety.

“When my anxious thoughts multiply within….”

Policeman are out in full force here in the city. Army men parade the streets. All the surrounding towns have loaned their safety units to Boston. Random checks are occurring in the subway and people clutch their arms to their bodies a bit tighter.

It’s part of the terrorist process. For the bombs don’t just terrorize for the moment, although their worst physical impact is felt then. Bombs and attacks terrorize far longer than the actual event. It’s like dominoes. The terrorist domino effect – where one thing happens and pretty soon you have a world spinning to try to keep the dominoes from crashing down.

I work in state government and we have received email upon email giving us resources, recognizing that even those not directly involved feel the ripple effect of the sadness and terror that reigned on Monday. Articles on grief and post traumatic stress flood my inbox. And I am grateful for the attention that the Department of Public Health is finally giving to what people around are experiencing.

But for me it’s not enough. For there has to be a faith element that wraps around all these resources. A recognition that the God who sustains and heals will continue and work through and beyond man-made resources.

And I find the answer in an age-old Psalm, sung for generations, sung to those in captivity, those in exile, those in war, those fleeing their enemies.

“When my anxious thoughts multiply within me, Thy consolations delight my soul”.* This is the missing ingredient to all the other resources.

*Psalm 94:19 “A text of this kind shows us forcibly the power of Divine grace in the human heart: how much it can do to sustain and cheer the heart. The world may afflict a believer, and pain him; but if the grace which God has given him is in active exercise in his soul, the world cannot make him unhappy. It rather adds by its ill-treatment to his happiness; for it brings God and his soul nearer together — God the fountain of all happiness, the rest and satisfaction of his soul.”~Charles Bradley, 1845

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Confessions of Compassion Fatigue

Confession – as I listen to the radio I am not feeling much of anything besides tiredness and incompetence. A tsunami in Japan has taken the lives of over 10,000 people and caused a nuclear crisis and I am sitting at work figuring out how to spend the remainder of our significant educational budget for a preventive health program on something that matters. Ouch.

In the 1950’s a new word made it into our lexicon of trauma related diagnoses. The word was “Compassion Fatigue” and was first seen in nurses. As a nurse, it makes sense that we were the people who first displayed a tendency towards these symptoms.  The symptoms included negativity, lessening of compassion, tiredness, and feelings of hopelessness, sadness, and inadequacy for the job at hand. It was the ‘cost of caring’.

The word has evolved over time and is often called ‘Disaster Fatigue’. Used by the media and donor organizations to describe the response to tragedies and world events over time, it gives an accurate picture without having to be explained.  Events that have such massive implications that our brains can’t quite take it in and our responses show a disconnect between what we see and hear and how our hearts and bank accounts respond.

If I list off the events from August 2010 until now I know immediately why I have compassion fatigue. News and events have transported us from Pakistan to the Middle East to Japan and includes floods, revolutions and tsunamis. Every aspect of human need has been affected. The need for shelter, security, food, safety, and the list goes on so that self-actualization seems laughable. The pain and shock of people and nations are felt across oceans and continents creating a sort of secondary trauma zone. How much am I as a human capable of caring before I move into the disaster fatigue zone? Not very much it turns out.

Guilt threatens to overtake me, making me less likely to move back to a place of caring and concern and instead move me to an avoidance that perpetuates my apathetic state.

So now that I’ve confessed in the blogosphere for everyone to see, what answers do I have? How do I encourage myself or any potential reader?

Only this – that the promising piece of working through compassion fatigue is allowing myself to be moved to a place of quiet but important humility of my place in this big world. In that quiet space I become far more able to see that I have huge limitations, I make mistakes and I do things out of self advancement and not true compassion. Rather than discouraging me, this recognition ultimately leads me to a reliance on a God who “will not grow tired or weary, and whose understanding no one can fathom” and in the comfort of those age-old words, I can lose the guilt and rely on a never-ending resource of compassion and strength, available to all in crisis.

Do you not know? Have you not heard? The LORD is the everlasting God, the Creator of the ends of the earth. He will not grow tired or weary, and his understanding no one can fathom. Isaiah 40:28

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