Following the American Psychological Association’s Guidelines
Introduction
Not many people outside of the medical field or human services are familiar with the term Trauma Informed Care or the services it provides. Unfortunately, unless you are providing Trauma Informed Care, or are in need of it, you have most likely never heard of it. Trauma Informed Care is a service offered to help survivors of trauma recover and get back to leading their normal lives. In New York State, it is given most often to traumatized children. The services are also offered to the families of victims. Its history is dynamic and heroic. Though Trauma Informed Care has begun to make changes within New York, despite the state’s increasing need for the services, there are still problems with the service that may prevent optimum action from taking place.
What Is It?
The nature of trauma informed care is still relatively unknown by many individuals today. In short, according to Adam D. Brown and his associates, informed trauma care is an organized framework of treatment that combines understanding, recognizing, and responding to the impact of any trauma experienced by the victim (2013). Trauma Informed Care takes care of the individual’s safety in physical, psychological, as well as emotional vulnerabilities while also caring for the providers. This framework helps victims feel empowered and reestablish a sense of control over their lives (2013).
Trauma informed care in Ney York State is particularly sensitive when working with children and adolescents. The trauma youths go through takes a special understanding. Essentially Trauma Informed Care is exactly what it sounds like. It is care that is given by an individual who is informed about the impact and consequences trauma can have on the physical, emotional, and psychological capacities of youths. This is according to “Creating Trauma-Informed Systems: Child Welfare, Education, First Responders, Health Care, Juvenile Justice,” written by Amanda Zelechoski, and her associates, and published in American Psychology, Youth Trauma (2013). Understanding is most important to the framework of Trauma Informed Care. A clinician must understand that the trauma experienced may have stemmed from many different things. The youth may have felt overwhelmed, abused, threatened, or involved in any overly stressful situation where they suffered or witnessed violence of any kind. Oftentimes adolescents will act out dramatically or violently because of the trauma. The clinician bases their reaction on how well they understand the pain the youth is going through. Furthermore, clinicians must understand that the trauma has psychological and biological effects on how people think and behave. As Zelechoski pointed out in the article, there is a high rate of youth trauma in New York State, making it a good place to start instigating the Trauma Informed Care framework (2013).
Clinicians in residential youth facilities that use Trauma Informed Care must also be very careful never to punish individuals for how they reveal their trauma. This risks re-traumatizing them which can result in debilitating circumstances for the youth later in life. As part of the Trauma Informed Care framework, clinicians must recognize signs of revealed trauma and respond accordingly. What appears to be a tantrum may be a reaction to traumatic memory. The commitment not to punish individuals for their trauma is imperative. Proper use of Trauma Informed Care suggests that clinicians in New York State understand that youths require care and nurturing. It also encourages healing, as well as making youths feel safe, according to Hilary B. Hodgdon’s “Development and Implementation of Trauma-Informed Programming in Youth Residential Treatment Centers Using the ARC Framework”, published in Journal of Family Violence (2013). It is likely that the trauma occurred in environments that did not promote emotional or psychological health; the clinicians must understand this and compensate for the comfort that youths never received. Clinicians must offer environments, as well as care that fosters understanding, safety, and peace while allowing the survivors of trauma to maintain control over the space and begin to feel empowered once again (Ko et al., 2008). After these tools are granted to the survivors of trauma, they can begin to confront the memories that keep them trapped, and eventually maintain safety and a sense of empowerment without the help of a clinician.
History of Trauma Informed Care in NYS
TIC began simply to improve community wellness. Trauma Informed Care recognized that nobody understands process of healing from past trauma like the individual who has suffered through it. Much like this, Trauma Informed Care also understands that the families of the traumatized, as well as the communities they were involved in, may also need healing. Trauma Informed Care also began in an effort to help individuals next to the traumatized individuals heal and move on. In New York State, there was more prevalence for Trauma Informed Care that catered to youths as the victims and families as the perpetrators, or witnesses. This effort was because New York’s juvenile judicial system has gained growing notoriety for the past decade according to Caryl B. Dierkhising and the authors of Trauma-Informed Juvenile Justice Roundtable: Current Issues and New Directions in Creating Trauma-Informed Juvenile Justice Systems (2013).” In 2005, the National Center for Trauma Informed Care was launched, and youths in residential facilities across the country began receiving Trauma Informed Care. New York State continued to show the highest need for the services through 2012, as revealed in studied published in Journal of Child and Adolescent Trauma (2012).
It was found early on that New York State’s requirements of Trauma Informed Care were vast. 80% of the youths in residential facilities were initially resistant to the method of care but still needed help. Most of the trauma happened in the form of emotional and physical abuse, though some children were also forced to perpetrate violence themselves, even though they did not want to. Trauma Informed Care nearly failed in New York when it was first introduced because youths were so against accepting what it had to offer (Zelechoski et al., 2013). This was found to be due in part to the fact that the National Center for Trauma Informed Care initially instigated their program only in juvenile detention centers and mental health facilities. In these places, youths were found to be the most volatile or to not understand the methods . In 2006 clinicians were able to gain progress with youths in residential facilities based on comfort levels they had managed to achieve over the past year. It became imperative to the Trauma Informed Care framework that the youth forms a trusting bond with their caregivers in order to begin the healing process. In 2007, Trauma Informed Care methods expanded and began being used at nearly every youth residential facility available in New York State. Youths in shelters supported housing, behavioral health units, emergency services, and other residential centers were more obliging to the method (Ko et al., 2008). Slowly the Trauma Informed Care method began to see success as children and adolescents in different youth residential facilities across the state began to feel comfortable revealing their traumatic experiences, as well as the effects of the trauma itself. The understanding and responsiveness of the trained staff have been helping to allow children and adolescents regain their sense of control and learn to feel empowered again since its implementation. While crime rates have yet to decrease significantly due to the Trauma Informed Care, there is definitive research that suggests the overall mental health of New York State’s youth population is better off since the advent of this method. Families and communities may have also been saved, according to Adam D. Brown and the authors of ‘Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care,” published in Journal of Family Violence (2013).
Potential Problems
While the Trauma Informed Care seems too good to be true for some and appears to be improving the mental health and overall wellbeing of many youths in New York State, there are a few potential problems that may occur. For instance, projections suggest that in another three to five years there will no longer be enough funding to hire the staff necessary to properly care for the traumatized youth of New York State . This movement is happening for several reasons. Primarily, the country is broke and typically the job of these clinicians is state funded. Many of these jobs are being cut. It also costs a significant amount of money to train individuals; it is money the government does not have. Also, there are many disadvantaged youths in New York State who fit the criteria for an individual that has been traumatized, and they are now living in a residential youth facility. However, another reasons, and perhaps the largest, that there will not be enough money or enough staff to fully care for the traumatized youth of New York State is because the definition of a traumatized individual has expanded. When Trauma Informed Care was first implemented, a traumatized individual was defined as somebody who had witnessed violence, been a part of violence, or had experienced something overwhelmingly stressful. Now a traumatized youth is defined as anybody who finds themselves living in a residential facility . This set of rules is not satisfactory for those who have been traumatized in the traditional sense because they face missing out on the care that could benefit them and otherwise stop them from making any bad decisions.
Another issue trauma informed care has run into is that professionals only cater to individuals who find themselves living in residential facilities. While this set-up is logical at first glance, it is not necessarily practical anymore. When Trauma Informed Care was first implemented, youths in New York State did not know what it was. Not only that, but they were resistant to it. Clinicians had to force themselves on the public in order to make an attempt at helping anybody. This method was incorrect on the part of the clinicians because part of this framework insists that the individual we allowed to choose their services. Despite this oversight, in today’s climate, youths are more open to speaking with clinicians using this framework. Otherwise, the framework is also showing an improvement in the overall well being of youths. Still, there are many youths that have experienced trauma who are not forced to live in a residential facility. They have been a part of violence, whether suffering it themselves or witnessing it, or they have been overwhelmed by stress but their circumstances have yet to land them in a facility and so they are lost to the system. These are the individuals who sometimes grow and carry on the cycle of trauma, because they never receive access to the Trauma Informed Care methods. If clinicians could somehow reach more individuals, or set up individual offices where traumatized youths who had not yet found themselves living in a facility could seek their services, more individuals would be benefitted. This might also solve the problem of funding because rather than finding individuals in residential facilities, youths around the state could begin seeking out professionals. By making appointments and finding the professionals themselves, it ensures that the victims of trauma are ready to begin receiving help with their coping instead of having it forced on them, as well.
Conclusion
In sum, Trauma Informed Care was an pivotal step in youth residential trauma care. Clinicians understood that they needed to the individual’s trauma into consideration in order to properly care for the victim and help them recuperate. While New York’s initial reception to the methods was bad, clinicians prevailed, and the youths of the city eventually accepted this groundbreaking framework. Eventually, it allowed clinicians to help the youth of New York, improving their overall mental health, as well as their overall well being. Problems loom ahead for the Trauma Informed Care framework if nothing is done. Staff may run low, leaving youth to cope on their own. Some children and adolescents who are not living in facilities are also on their own. However, if these problems can be rectified, Trauma Informed Care will continue helping the youth of New York for many years to come.
References
Briggs, E. C., Greeson, J. K., Layne, C. M., Fairbank, J. A., Knoverek, A. M., & Pynoos, R. S. (2012). Trauma Exposure, Psychosocial Functioning, and Treatment Needs of Youth in Residential Care: Preliminary Findings from the NCTSN Core Data Set. Journal of Child and Adolescent Trauma, 1-15.
Brown, A. D., McCauley, K., Navalta, C. P., & Saxe, G. N. (2013). Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care. Journal of Family Violence, 693-703.
Dierkhising, C. B., Ko, S., & Halladay Goldman, J. (2013). Trauma-Informed Juvenile Justice Roundtable: Current Issues and New Directions in Creating Trauma-Informed Juvenile Justice Systems. The National Child Trauma Stress Network, 1-8.
Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazolla, J. (2013). Development and Implementation of Trauma-Informed Programming in Youth Residential Treatment Centers Using the ARC Framework. Journal of Family Violence, 679-692.
Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., . . . Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 396-404.
Zelechoski, A. D., Sharma, R., Beserra, K., Miguel, J. L., DeMarco, M., & Spinazzola, J. (2013). Traumatized Youth in Residential Treatment Settings: Prevalence, Clinical Presentation, Treatment, and Policy Implications. American Psychology: Youth Trauma, 245-268.
