Towards a Definition of Trauma-Informed Care

Background and Purpose

It is only relatively recently that the high prevalence and negative effects of childhood trauma have been widely understood. Trauma-informed services aim to establish trustworthy and collaborative relationships with clients, shifting therapeutic focus from “what’s wrong with you” to “what happened to you?” The term “trauma-informed care” (TIC) is now widely used by mental health practitioners in a variety of settings; however, the specific elements of TIC are not agreed upon or well-defined. The purpose of the current study was to understand how professionals in the field of child welfare perceive and operationalize TIC in their practice.

Methods

Nine in-depth interviews were conducted with professionals proving TIC (self-defined) in a county child welfare system. Interviews included three domains of questions: (1) interviewee’s professional background, (2) TIC definition and practice, and (3) coordination of services within the county. Interviews were transcribed and uploaded to Dedoose 9.0 for 6-step thematic analysis. Coding was conducted independently by two members of the research team; discrepant coding decisions were resolved through discussion. Data within each code was examined for manifest and latent themes; these themes and the relationships among them were elaborated upon via memoing, resulting in a concept map of main findings. Multiple coders, reflexive memoing, and peer review by social services professionals enhanced analytic rigor.

Results

Participating interviewees included 8 social workers and 1 psychologist. Three themes were present in interviewees’ descriptions of TIC. The first was the primacy of building a trusting therapeutic relationship resulting in emotional safety: “Those relationships are so important -- for them to have somebody who shows up for them when there's a lot of times that there's nobody that's able to do that for them in their homes.” The second was that all clients have unique responses to trauma that require an individualized therapeutic response: “...[put the] survivor's needs first. And that means working really hard to see each survivor as an individual.” The third was the importance of empowerment when recovering from trauma: “...giving the survivor a voice...do they feel empowered to be an advocate for themselves?” Even while acknowledging the importance of centering trauma in mental health care, interviewees had difficulty distinguishing TIC from other forms of therapy they provide or have provided, saying that TIC was a “buzzword” or just another way to describe practice that has been going on for years.

Conclusions and Implications

The current study contributes to the existing research regarding TIC by exploring practitioners’ perceptions and examples of TIC in their work. The study begins to clarify some of the ambiguity in the definition of TIC in the child welfare field by suggesting three concrete ways TIC is operationalized: relationship-building, individualized care, and empowerment. Describing elements of TIC in this way is a crucial step in creating and using standardized measures to assess the quality of TIC in various child welfare contexts. Additionally, knowledge of these TIC elements can be used to hone TIC training among practitioners to help better serve survivors of trauma.