Trauma Informed Care

Question 1

What are the first principles of trauma-informed care

Answer 1

• Principles aimed at recognising patterns of trauma and identifying treatment priorities in general practice.
• Developed by the blue knot foundation.

1 - Prioritise Safety
2 - Foster the capacity to soothe psychological arousal
3 - Validate person and perceptions
4 - Empower and collaborate
5 - Connect and stay involved

Question 2

1 - Prioritise Safety

Answer 2

Optimise safety in their environment, relationships, intrapersonal experiences, physiology and perspective.

• Safety takes precedence over detailed history-taking. Caution against distress through retelling of traumatic experiences.

Questions to consider asking to gauge safety:
- Is there anyone in your world who invades you, disconnects from you or confuses you?
- How do you help yourself feel safe?
- Often people that have these types of health problems are experiencing difficulties at home. Is this happening to you?
- Sometimes these symptoms can be associated with having been hurt in the past. Has this ever happened to you?

Question 3

2 - Foster capacity to soothe psychological arousal.

Answer 3

• Management of dysregulation of biological stress.
• Discussion of physiological regulation and affect regulation in bottom up and top down approaches
  
  • Bottom up - Start with body. Aim to sooth distress using techniques such as sensorimotor grounding, rhythm and movement E.g. mindfulness, rhythmic patterns
  • Top down - Brain to body. Cortical use of story, dialogue, ritual and metaphor. Active listening to assist with thought organisation. Distraction can also be a tool.

Question 4

3 - Validate Person and Perceptions

Answer 4

Counteract altered sense of self (resulting in shame and self-loathing) caused by trauma.

Build dignity by offering whole-hearted validation.

It does not required unquestioning belief. The priority is to focus on how the person’s experience has affected them.

Question 5

4 - Empower and Collaborate

Answer 5

Counteract experience of domination, feeling trapped or neglect seen in traumatised individuals.

Aim at moving away from a passive sense of self (extrinsically determined) to an active sense of self (intrinsically determined).

Identify any coping or defence mechanisms, even negative ones such as addictions or compulsions, as active attempts to manage overwhelm and to keep the individual safe. Evidence of bravery, determination and resourcefulness.

Identify ambivalence to ongoing trauma and work with patient to challenge this ambivalence.

Re-iterate that you will abide with patient regardless of their decisions.
- “whatever you decide to do about the situation, I will remain with you on this journey. I will keep reminding you of your worth and will continue to offer options for help that we can explore together”.

Question 6

5 - Connect and stay involved

Answer 6

Offering an attuned, available, accessible therapeutic relationship is an antidote to shaming, disconnecting, confusing, poorly attuned or unreliable relationships.
- Micro-connections - Rapport, trust
- Macro-connections - Planned regular appointments, practice recall systems.