Table of contents
My motivation for writing this essay
Video discussions of this topic
The origins of trauma-informed care
Trauma-informed care in other settings
Trauma-informed care in mental health practice
What’s the problem with “trauma-informed?”
Trauma-informed care in online business (coaches and other service providers)
Be an informed consumer: questions to ask and elements to look for
Why am I writing this and where am I coming from?
I am a masters-level social worker. I have had professional training, experience and supervision in treating trauma, and am a Certified Clinical Trauma Professional. I also have coaching certificates from three different organizations.
I no longer work with trauma in my practice. I am no longer seeking or serving clients who want to start their trauma healing journey.
However because trauma is so pervasive among women, people of marginalized genders and of the global majority, it can come up in the work I do with entrepreneurs. When it does, it is within the scope of my practice to address it as it relates to the issue at hand.
In my prior practice, I worked with a number of trauma-survivor clients who had been harmed as a result of work with other therapists who were not trauma-trained and experienced.
I also worked with some trauma-survivor clients who had been negatively affected by work with other service providers who did not understand trauma.
As a result, I have long been concerned about the proliferation of the term “trauma-informed” and its variants in the online business space.
My belief is that if you use the word trauma in your marketing, it will attract folks who have experienced trauma to you.
If your training is inadequate, harm may occur to you, your client and your business.
My colleague Nicole Lewis-Keeber and I share this concern. (We also co-founded the Business Therapy Centre.)
Nicole has a special program addressing this issue called Do No Harm. As an alumni of this program, I highly recommend it.
Video discussions
In this live broadcast from the Business Therapy Center’s Youtube channel, Nicole and I talked about our concerns.
I invite you to listen in, so you can be informed as a consumer.
In our second video, we discuss questions to ask when you are evaluating trauma-informed certification trainings, and the trauma-informed-ness of any service provider who uses the title in their marketing.
Origins of trauma-informed care
Over a 30-year period, the concept of trauma-informed care arose out of social service, health and mental health agencies coming to understand so many of their clients have been affected by trauma, and that trauma responses can influence their behaviours and that institutional responses to behaviours driven by trauma responses constitute a barrier to access. (References 1 and 2)
In order to eliminate these barriers, these agencies began to identify how, as organizations (not individuals), they could provide what is called trauma-informed care. Work in this area has been documented in the literature since at least 2009.
The 1998 publication of the ACES Study also had an influence on the development of trauma-informed care.
The ACES and Pair of ACES data clearly demonstrate the connection between adverse childhood experiences and adverse community environments (IOW trauma) and a) brain development; b) social, emotional and cognitive impairment; c) disease; d) disability and e) early death.
With these connections clearly made, it became even more important for social service, health and mental health agencies to appropriately serve their clients.
In the US, in the 1990s, the Substance Abuse and Mental Health Services Administration took the lead with regard to policy and practice. They define a trauma-informed approach as incorporating “awareness of trauma and its impact into all aspects of organizational functioning” and in their work explicitly distinguish a trauma-informed approach from trauma-specific clinical interventions.
The overall intention of the trauma-informed care movement was to educate service providers so they could change their perspective from “What’s wrong with you?” to “What happened to you?”. (This phrase is credited to Gladys Noll Alvarez, LICSW. Oprah used the concept for her book title, some 13 years later.)
But despite the research and fairly widespread implementation of trauma-informed care in social service, health and mental health agencies across the US and Canada, there is no national or global standard for certification as such, nor for the meaning of terms such as trauma-informed, trauma-aware and trauma-sensitive, etc.
Trauma-informed care in other settings
Trauma-informed trainings in the other arenas came first in the profession of Yoga.
Many Yoga teachers became aware of the risks for trauma survivors in engaging in Yoga classes and developed classes specifically to support trauma survivors.
The trainings then expanded into Yoga teachers who wanted to create safer spaces in classes that were not trauma-specific. The Centre for Trauma and Embodiment at the Justice Resource Institute is one leader in this area.
With more popular recognition of the need to create safer spaces for trauma survivors, the meditation community also became engaged.
Programs were developed to train meditation teacher trainees and mentors in ways of supporting trauma survivors in the process of meditation. David Treleaven is one of the prominent teachers in this field.
Trauma-informed care in mental health practice
Prior to all this, the field of mental health research had been looking into how to “treat” trauma. Pierre Janet (1859-1947) was one of the first researchers in the field of dissociation and traumatic memory.
Since that time, many, many practitioners and researchers have continued to develop treatment modalities for mental health clinicians to address the psychological, spiritual and other harms caused by trauma.
The terms that are applied to organizations aren’t used within the clinical sphere to indicate an individual’s training or lack thereof.
For clinicians, standards of practice are set by their licensing and governing bodies.
You cannot call yourself a specialist in any area of practice without some sort of certification that is recognized by your governing or licensing body.
Thus, the standard for training for clinicians is a specialized professional certification.
There are pre-requisites to specialized professional certification, that usually include the completion of academic qualifications (usually a masters or doctorate in clinical practice) and licensing requirements.
All of the modalities now used by clinicians are taught by institutes that were set up to teach and certify clinicians in their use.
These trainings are usually lengthy (over many years) and require not only education but also supervised implementation of the treatments with clients.
Most of the training institutes require ongoing continuing education in order for the certification to be considered current, as do governing and licensing bodies.
Most of the training institutes also ensure that their training standards meet the requirements of the governing bodies to qualify for continuing education credits.
Most clinicians are also required to consult when clinical issues arise and to refer to qualified practitioners when specific treatment issues arise that are outside their scope of practice, and there are penalties when these standards are not followed.
What’s the problem with trauma-informed?
Since about 2019, there has been a trend of non-clinical service providers online, such as VAs, graphic designers, life and business coaches, designating themselves “trauma-informed.”
None of the above applies to these online business service providers.
They are not clinicians, nor are they situated within the ecosystem of social service, health and mental health agencies. This they have no regulation or oversight.
And again, trauma-informed or other similar designations are not regulated or overseen in any way–not even for social service, health and mental health agencies.
Anyone can say they are trauma-informed.
But there are no guarantees that they actually are.
Caveat emptor: Trauma-informed care in online business
So where does this leave you as a consumer who has possibly experienced trauma and who wants to evaluate a service provider’s assertion that they are “trauma-informed?”
Please keep in mind there are no national or universal standards for trauma competencies or certifications for non-clinicians (people who are not regulated mental health practitioners).
In order to help you understand the range of trauma-related skills, from organizations and agencies through to clinicians, I have laid agency competencies across a developmental continuum of skills in order to help you understand the range of skills and to be able to locate the practitioner you are interviewing along this continuum.
- The most basic might be called trauma aware. The practitioner is aware of the prevalence of trauma amongst their clients, and able to explain and advocate for trauma-informed care.
- Trauma-sensitive can mean the practitioner is aware of the prevalence of trauma and is building more knowledge of trauma. They are able to interact with trauma survivors in the course of mundane (non-therapeutic) activities in ways that cause minimal harm.
- Trauma-responsive can be understood as the initial stage of integrating trauma principles into work with clients. This skill can be understood as having basic or advanced levels of implementation. Examples of trauma-responsive skills could include grounding and orienting when a client is overtaken by trauma responses.
- Trauma-informed can be understood as the direct practice of psychotherapy to address and heal trauma. It can have basic or advanced levels of implementation.
For your reference, here is a framework, the Developmental Framework for Trauma-Informed Individuals , that was developed by two researchers in 2019, on behalf of the Department of Health and Social Services of the state of Delaware.
This document lays out in very detailed terms what they consider to be the skills and competencies across the levels, based on the professional literature. It is the document I have used for the basis of the definitions above.
Since there is no agreed-upon standard of certification, as a consumer, you will need to ask questions to gather information when you are considering a program, training or service provider.
My colleague Nicole Lewis-Keeber and I developed a list of questions to support you in being an informed consumer.
Questions to ask a “trauma-informed” service provider
- How long have you worked with this issue directly with clients?
- Do you have supervision?
- What are your plans for ongoing skill-building and continuing education
- Have you had therapy yourself?
- Are you a trauma survivor?
- What is your motivation for using the trauma-informed designation as part of your marketing or title?
- What work have you done around the role of intersecting oppressions and trauma?
- In the context of trauma, what is your understanding of the role of power dynamics between you as a service provider and a client?
- How do you define trauma?
- How do you know it’s time to refer a client to a therapist?
- What are your processes for referral to a therapist?
- Do you have a network of trained and experienced trauma therapists to whom to refer your clients?
- How do you handle complaints? What is your dispute resolution process?
Questions to ask about a “trauma-informed” certification
In addition to the questions above as they relate to a training, you can also ask:
- Is anti-oppression training inherent in the program?
- Does the training include issues of consent?
- Does the training address how to address and repair harm caused by the practitioner?
- Is the training educational only or does it include supervised skills implementation? (role plays with feedback from a senior practitioner; recorded sessions submitted to supervisor for feedback, etc.)
- What are the qualifications of the trainers?
- Are the trainers supervised?
- What is the trainer’s experience working with trauma and trauma survivor clients?
Elements that should be included in a “trauma-informed” certification
Defining trauma
Any “trauma-informed” certification should include information on:
- defining trauma (DSM and other definitions)
- types of trauma: individual, generational, intergenerational, relational, societal, systemic
- oppressions and trauma
- adverse childhood experiences: ACES and Pair of ACES
- How trauma, and especially childhood trauma, can show up in our current-day responses and behaviours
Recognizing and responding to trauma responses
This material should be provided with the sole purpose of enabling service providers
- to recognize trauma responses in clients when they are occurring and
- to respond supportively and in the least harmful ways possible under the circumstances.
Therefore, any of these programs should also include material on applying the information on trauma so that service providers are able to recognize trauma responses and respond to them only by
- applying containing techniques that serve stabilization and safety
- referring to a mental health practitioner
The training in recognizing and responding to trauma responses should include synchronous, real-time practice with feedback from a senior practitioner, as well as ongoing supervision in the use of these skills.
Scope of practice
Because of the stigma associated with therapy and mental health / mental illness, as well as accessibility, people will often choose coaching when what they really need is therapy. Additionally, when people have experienced trauma, they may not be able to recognize that what they need is therapy, or some form of support from a mental health professional.
Therefore any “trauma-informed” program should include training on the concept of scope of practice. Participants should be led through work in which they clearly identify their scope of practice. They should identify what issues and types of interactions are outside the scope of their practice and trained to identify them when they arise in the course of their work with clients.
Risk
Because of the factors mentioned above, a client’s personal safety can become an issue. Safety can also arise because of the prevalence of partner abuse and especially of abuse by men toward their female intimate partners (current and/or former).
Therefore, “trauma-informed” training programs should include training on recognizing issues of risk and safety, and how to respond and refer appropriately.
In particular, should the service provider become aware that the client may be considering taking their own life, they should be trained to recognize that, respond if the risk is immediate, and refer if it is not.
If the program doesn’t include that, I recommend very strongly a training such as the LivingWorks ASIST program.
Referral
They should be trained in how to refer to other professionals (in other words, how to handle the referral conversation), and to which professionals to refer under what circumstances.
Ongoing supervision
Any service provider claiming to be trauma-informed should be mentored, supervised by or consulting with a senior trauma practitioner, meaning meeting with them formally on a regular basis. I would expect that the “trauma-informed” certification would provide a roster of appropriate professionals to provide this service. As a non-clinician, service providers can run into trauma-related situations with their clients and find themselves out of their depth very quickly. Having ongoing supervision of some sort will prevent the service provider from becoming overwhelmed and/or responding in ways that cause harm.
Therapy
Finally, any service provider claiming to be trauma-informed should also have an ongoing relationship with their own therapist. Working with trauma, even indirectly as a service provider, is taxing and requires support.