As usual, my disclosures first: I am neither a scholar of nor a specialist in trauma-informed care. Though, caring for homeless and immigrant persons in the US, and rural impoverished individuals in Southern Mexico and Guatemala, certainly makes me feel like I should be both a scholar and specialist in the field. Should you be in either camp, I welcome you to respond and share your views.
Twice in the past two years I’ve had occasion to attend formal trauma-informed care (TIC) trainings. Once, the patient population in question was trafficked persons in the US and, more recently, the homeless in general. For starters, TIC is a strength-based service delivery approach “that is grounded in an understanding of and responsiveness to the impact of trauma and one that emphasizes physical, psychological and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment” (Hopper, Bassuk & Olivet 2010). In my training, we learned (or re-learned) that common causes of traumatic stress can be: major accidents, catastrophic illness, extreme poverty, interpersonal violence, military combat, natural disasters, unexpected loss of a loved one, undocumented immigration, as well as insidious or historical trauma (ie racism or slavery). In my global health experience, these traumatic stressors are overwhelmingly common among the communities in which I work.
Approaching global health with a trauma-informed care perspective is appropriate, though unfamiliar, territory for me and one that I feel compelled to more explicitly explore. Many of us already question how global health service delivery is designed and implemented, but if we can further push our questions toward a TIC perspective, I suspect the efficacy and impact of service delivery will improve. For example, the traditional approach to health care delivery in most countries (this includes the US) is one of rigid hierarchy, but if we were to take a TIC approach, it would instead be one of power-sharing. Our traditional approaches to global health are often reactive and crisis-driven; we view certain governments and communities as “working the system;” Western-trained health care providers are the ‘experts’ who set the agenda and establish the goals; and we tend to view the communities with whom we work as ‘broken,’ ‘needing protection,’ and ‘vulnerable.”
A trauma-informed care perspective would instead value the lived experience of the individual; see a person (family, or community) as advocating for him or herself, doing what it takes to survive and protecting the self. Outsiders need to earn the trust of the person, rather than expect it. Goals should be set, decisions should be made and control should be given to the individual. In this way, autonomy, self-efficacy and healing may occur and, ultimately, it will affect peoples’ access to/uptake of services. Instead of asking ourselves, “what is wrong with that country/community?” we can ask, “what happened in that country/community?” But to make this a possibility, organizations, policies and systems need to be well-grounded in TIC.
Maybe there are many names for this already: liberation theology, anti-colonialism or feminism, even. But if we specifically address the histories of trauma (of individuals, families and communities), believe that recovery from its effects is possible, and that a mechanism for this recovery could be our therapeutic alliance, a new window is opened.
Starter Resources:
- Trauma Stewardship
- By Laura van Dernoot Lipsky and Connie Burk
- Shelter from the Storm: Trauma-Informed Care in Homeless Services Settings
- By Hopper, Bassuk & Olivet (2010)
- Caring for Trafficked Persons: Guidance for Health Providers
- By the IOM, UN.GIFT and London School of Hygiene and Tropical Medicine (2009).