Have you heard the term trauma informed care?
Have you wondered what it is or why it seems to be the topic of so many conversations? If so, you’re not alone.
For this month’s ISP pipeline, we will give a brief introduction of trauma informed care and answer this key question: How might trauma informed care influence and shape our work within the ISP process? What is trauma, anyway? Trauma consists of those experiences which overwhelm, terrify, and violate a person.
This can be:
- a single experience (such as an injury or assault) OR experiences that happen over time (such as abuse or neglect)
- experiences of systemic oppression and adversity (such as racism, ableism, and sexism)
- Toxic Stress- prolonged experience of stress in the body over time, typically without protective supports
We use the words trauma, adversity, and toxic stress interchangeably because they can impact us in similar ways. For example, they can activate our fight/flight/freeze response.
Unfortunately, trauma is very common, and even more so for people who experience disabilities. What is trauma informed care? One of the biggest misconceptions about trauma informed care is that it is a therapy for people who have experienced trauma. Trauma informed care is not about a therapy for trauma (although that is important and needed). It is a way to do our work differently so that we actively reduce re-traumatization for people.
The reality is, even with our best intentions, the service systems designed to help people can be traumatizing. Think about the amount of paperwork, the direct support workforce crisis and eligibility assessments that focus on deficits. With trauma informed care we use strategies that help people to regulate and reduce the time spent in fight/flight/or freeze mode.
Trauma informed care is an approach our work which focuses on creating safe experiences, restoring power, and valuing both the people engaging in services and those providing services.
Create a Safe Context
This is where we start: for someone to be able to engage in services they need to feel safe. This includes both physical safety and emotional safety. We often talk about safety during the planning process, but typically only from the perspective of a supporter. We think about if someone can safely navigate the internet without support, or if someone can navigate their community safely. We sometimes forget to dive in and understand if someone feels safe with a support provider assisting them with personal hygiene, or if they feel emotionally safe when they walk into their ISP meeting. Safety might look like:
- Someone fully understanding their rights and knowing who they can go to if they have a concern.
- A conversation with parents to listen to and address fears before talking about their child’s goals around relationships and sexuality.
- Ensuring that a person’s voice and perspectives are heard when their group home is looking to hire additional support staff.
Restore Power
Some people have had very negative experiences with the ISP process. Historically, ISP meetings may have been a time in which a person’s restrictions, variances, and approved independent time in someone’s community were all talked about. It may have been a time when well-intentioned decisions were made that took power and control away from a person. Even when strengths and goals were also discussed, the loss of power is likely the memorable experience from this process. Providing a corrective experience will take time and require us to build trust.
If you work with someone who does not want to take part in their ISP meeting, try to understand why. Take steps to create a process they can engage in. Is the meeting not accessible for their learning or communication style? Do they have the final say on who their team members are? Have they had traumatizing experiences in previous ISP meetings? When someone can drive the planning process, they are more likely to engage in the plan and services. Restoring power throughout the ISP process might look like:
- Using supported decision-making to help the person in making choices and directing their life.
- Supporting the person to build relationships and supports outside of the service system.
- This includes identifying when we, as paid supporters, are getting in the way of a person building relationships.
- Ensuring that people have the needed information, time, and support to consent to their plan and services.
- This includes providing clear options about what to do if they do not consent to parts of their plan.
Value the Person
When someone walks through your doors, do they feel valued? Do they feel like you want them there? We want to deliver culturally responsive, inclusive services where people feel valued. Valuing the person throughout the ISP process might look like:
- Gathering feedback to understand how the process is working for people receiving services. Do they feel heard? Do they feel respected? Do they feel like they went through this process without being judged? Use this feedback to enhance or restructure how your team communicates about and structures services.
- Use the person’s preferred pronouns on their paperwork and when interacting with them. Share your pronouns when you start meetings with new people.
- Learn more about your privilege and how it may impact the services you provide. Discuss as an organization how you can create more inclusive services.
- Take implicit bias tests to better understand unconscious or automatic biases you may have.
- Read up on privilege checklists to better understand the perspectives of others. Some examples are:
Trauma informed approaches can’t be captured in a checklist and most certainly can’t be simplified into one pipeline article. The intention of this month’s article is to start the conversation. Trauma informed care involves changes in how we do our work, and how we support our workforce. For more information please check out:
Things to Consider When Providing a Trauma Informed ISP Meeting:
- Schedule the meeting at the person’s preferred location at their preferred time of the day.
- Make sure the person has easy access to a door to take a break and a good way to communicate they need a break.
- Have water and snacks available.
- Provide access to fidgets that work for the person (some ideas are rubber bands, colored pencils and paper, pipe cleaners, stress balls, play-dough).
- Provide an agenda and refer to it along the way, so someone can see where they are in the meeting.
- Be aware of your language:
- Use plain language. Define acronyms, don’t assume someone knows them.
- Use discretion with when and where you talk about sensitive topics. Someone might not want to talk about their sex life or their bowel movements in front of 6 people. Those might be conversations they have with a trusted support provider before the meeting.
- Use person centered language opposed to systems based language.
- Talk about who will support me with taking a shower, not who will be showering me.
- Talk about my evening support workers teaching me how to do laundry, not my graveyard staff doing my laundry.
- Provide clear, easy to process take away resources that show what is involved in the ISP process and what someone should expect.
- Provide time, space, and support when people are asked to consent to plans. Someone might need to take a day, or a week to process the information, ask questions, and provide feedback before they feel ready to sign a plan. That is OK and should be encouraged!!
Author- Kelli Downey is a 2018 graduate of Trauma Informed Oregon’s train-the-trainer program.
Remember, we do not need to know someone’s trauma history, or even if someone has or has not experienced trauma to be able to provide trauma-informed care.