Using a Trauma-Informed Approach

What is trauma?

Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being.

Childhood experiences can have an impact on health and well-being into adulthood. The more Adverse Childhood Experiences (ACEs) a person has, the greater the possibility of negative health outcomes. For more information about the impact of ACEs visit these resources:

CDC: About Adverse Childhood Experiences
Nadine Burke Harris: How childhood trauma affects health across a lifetime

Reminders of these experiences can have a re-traumatizing effect on people who have experienced trauma. That's why more and more people are calling for a "trauma-informed approach" to programs that involve sensitive topics -- including sexual health education programs.

What is a Trauma-Informed Approach?

For Health Educators, a trauma-informed approach to programming means understanding, recognizing, preparing for, and responding to the effects trauma may have on program participants.

Understanding

There are six guiding principles to consider when looking through a trauma-informed lens. They are: Safety; Trustworthiness; Choice; Collaboration; Empowerment; and Cultural, Historical, and Gender Considerations [1, 2].

• Safety: Ensuring physical and emotional safety, including where and when services are delivered and an awareness of an individual's discomfort or unease.
   
• Trustworthiness: Ensuring trustworthiness through clarity, consistency, and interpersonal boundaries.
   
• Choice: Allowing individuals to take part in decision-making regarding their level of participation, and building small but important choices into programming.
   
• Collaboration: Communicating respect for participants' life experience and history; communicating respect for the fact that individuals are the experts on their own lives; identifying tasks that can be worked on together.
   
• Empowerment: Ensuring that individuals have a voice during programming.
   
• Cultural, Historical, and Gender Considerations: Acknowledging the role culture, history, and gender can play in trauma; actively moving past cultural stereotypes and biases; understanding the healing value of traditional cultural connections; recognizing and addressing historical trauma.

Preparing

What can I do to prepare myself, my program, and my space? Get to know your participants as much as you can before you meet them. Find out:

• What on-site and community-based resources are available to participants?
   
• Were you asked to come in for a specific reason?
   
• Have there been any sexually based incidents that participants have encountered or heard a lot about recently?

Be comfortable with any adaptations that may have been made to your curriculum using A Trauma-Informed Approach to Evidence-Based Programs (PDF).

Recognizing and Responding

Recognizing and responding doesn't mean being constantly on the lookout for a young person who may be "triggered" by something you say. It also doesn't mean you have to (or even should) do the work of a therapist or social worker while implementing activities.

What it does mean is that you recognize that some of the behaviors that students exhibit aren't necessarily because they are being purposely disruptive. It means your response comes from a place of making sure every student feels safe and included. It means not asking yourself "what's wrong with this kid?" but instead "what may have happened to this kid?"

Finally, remember that secondary or vicarious trauma can have a very real impact on educators. Make sure you are consistently practicing self-care.

Resources

SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach
SAMHSA: The purpose of this paper is to develop a working concept of trauma and a trauma-informed approach, and to develop a shared understanding of these concepts that would be appropriate across an array of service systems and stakeholder groups.

Guide to Trauma-Informed Sex Education
CARDEA: This guide provides facilitators, educators, and youth-serving professionals with concrete strategies for integrating a trauma-informed approach into sex education and pregnancy prevention programming.

The National Child Traumatic Stress Network
This comprehensive website offers information and resources for educators, mental health professionals, parents and caregivers, and more.

The Institute on Trauma and Trauma-Informed Care
University at Buffalo: The Institute offers online courses and resources for those wanting to better understand trauma.

Implementing a Trauma-Informed Approach for Youth across Service Sectors (PDF)
youth.gov: This brief provides an overview of trauma, ways that youth cope with trauma, trauma at the systems level, and core principles of a trauma-informed approach. The brief is based on a 2013 webinar that features youth presenters as well as content experts.

A Checklist for Integrating a Trauma-Informed Approach into Teen Pregnancy Prevention Programs (PDF)
Use this checklist to find out where your program is already integrating principles of a trauma-informed approach and where you can improve. A list of resources follows the checklist.

References

[1]	Fallot, R. D., and Harris, M. (2009, July). Creating cultures of trauma-informed care: A self-assessment and planning protocol. Community Connections.
[2]	National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint, SAMHSA. (2015, August). Trauma-informed approach and trauma-specific interventions.