Written by Robert Daylin Brown, Ed.D
These days, it is common to see many institutions take a trauma-informed approach in their services. We see trauma-informed teaching practices, trauma-informed medical services, trauma-informed mental health providers, and even trauma-informed physical fitness trainers. It is a good thing for our society to consider trauma-informed approaches in their work. But this leads to the important question: what exactly does trauma-informed mean? Is there a set of principles that all of these trauma-informed institutions follow?
Even though there may be subtle differences among various institutions (healthcare, education, justice system, mental health), all trauma-informed services must begin with an understanding of the basics of trauma and how it manifests itself in individual behavior and interpersonal relationships. It may seem obvious, but it’s impossible to be trauma-informed without adequate information and training on the nature of trauma and common trauma responses
Assuming that providers have foundational information on trauma, what else is necessary for an organization to be considered “trauma-informed?”
One of the clearest models of a trauma-informed approach came from researchers Leigh Kimberg and Margaret Wheeler of UC San Francisco. They authored a chapter on this topic in the 2019 book Trauma-Informed Healthcare Approaches.
Kimberg and Wheeler proposed the 4C’s paradigm for a trauma-informed approach. The four C’s are Calm, Contain, Care, Cope.
CALM
According to Kimberg and Wheeler, “because human beings biologically “co-regulate” with one another, healthcare providers and staff can use the relaxation of their own bodies and breath to create a calm, healing environment not only for patients but also for one another.” The idea here is that trauma-informed services begin with calm providers. Not only do providers need to remain calm and pay attention to their own nervous systems, but this calmness serves as a model for the patients and clients they serve. A calm, patient provider encourages a calm, patient environment.
CONTAIN
Service providers must learn how to properly contain trauma responses of their clients in a safe and nurturing way. Trauma responses can manifest themselves in a variety of ways, and a trauma-informed approach means providing service reliably with appropriate boundaries, all without re-traumatizing clients. This also includes the professionalism of respecting the timeframe of appointments, offering resources without requiring trauma survivors to disclose trauma details, and providing service without emotionally overwhelming clients. Conversations are driven by the client’s comfort with self-disclosure, and providers offer strategies and interventions in compassionate, non-judgmental ways.
CARE
Social service and healthcare are much more than the actual services provided for optimal health. Care is built on love. Care is built on holistic support (physical, emotional, spiritual, social). Kimberg and Wheeler ask providers to “practice self-care and compassion for yourself, the patient, and your coworkers. Adopt a compassionate attitude toward oneself and others, sharing messages of support, de-stigmatizing adverse coping behaviors, and adhering to the practice of cultural humility to promote healing.” Providers need to practice cultural humility. Providers need to share messages of support when clients disclose their trauma symptoms. Providers need to adopt policies and practices that minimize power differentials, especially when working with survivors of domestic violence, intimate partner violence, and structural violence.
COPE
This part of the 4C’s approach involves the interventions and strategies providers offer to clients, as well as the strategies providers use to care for themselves. The key here is to promote coping skills and interventions that promote resilience. Kimberg and Wheeler make the fantastic suggestion that clients learn how to “document a ‘Coping Strategies’ list instead of only ‘Problem Lists’ and include patient’s own words of wisdom and good self-advice.” This cope section of the 4C’s approach also includes connecting clients to community organizations and other resources that provide access to necessary resources.
For more information on trauma and healing please visit our resources on the TILA website.