Principles of Trauma Informed Care
This experiential module focuses on understanding responses to trauma triggers and strategies fostering individual and organizational resilience. The activities in the module also underscore the importance of debriefing and coaching when working in trauma-impacted settings such as child welfare. Alternative/ supplemental activities include use of publicly available resources providing an overview of principles of trauma informed care. Some activities in this module may be used in conjunction with Module 2: Self-Assessment - Understanding Stress and Trauma.
- Social workers will understand aspects of individual and organizational resilience
- Social workers will be able to identify differences between fight, flight and freeze responses to trauma triggers
- Social workers will gain an appreciation for the need for debriefing after exposure to trauma in work settings
Audience: Intermediate (some activities may be adapted for beginning trainees)
I. Exploring Individual and Organizational Factors in Resilience
Activity Title: Individual and Organizational Factors in Resilience
Modality: Small Group Activity
Learner Level: All Levels
Duration: 20-30min depending on time available
Materials: Large chart pad paper and pens
- Co-Facilitators draw a pie graph with three equal sections on the chart pad paper and label the sections:
- Internalized Love and Support on the part of the Trauma Survivor
- High Expectations on the Trauma Survivor to return to functioning
- Opportunities for the Trauma Survivor to participate meaningfully in planning
- Co-Facilitators ask each group to identify which would make sense to do first in developing a working relationship with an adult trauma survivor.
- Groups are encouraged to develop consensus at each small group and Co-Facilitators can utilize the Gradients of Agreement Activity in conjunction with this activity.
- Co-Facilitators are encouraged to debrief in a large group, hearing responses from each small group and encourage discussion about differences of opinion among each group.
- This activity can be followed by the ABCs of Self-Care activity as the idea of self-care planning is to be developed in a trauma-informed coaching relationship first, then setting the goal or outcome of symptom reduction followed by creating a plan to get there incrementally and adaptively.
- Co-Facilitators can inquire what might occur if these elements are done in another order such as: 1. High Expectations, 2. Opportunity to Participate 3. Internalized Support – especially when compounded by elements of Historic or Cultural Trauma, Complex Trauma or Vicarious Trauma.
- Co-Facilitators can inquire what happens when individuals receive these elements in coaching or supervision but are not supported as values by the administrative or bureaucratic areas of the organization or agency.
- An adaptive variation is to have participants use these three areas to scale the quality of their current supervision or coaching processes as an opportunity to ‘coach up’ and advocate for more of what they need in any area.
II. Responses to Trauma Triggers
Activity Title: The Elephant Story: Fight, Flight or Freeze
Modality: Individual Reflective Journal Activity, small group activity, large group activity
Learner Level: All levels
Materials: The Elephant Story (provided in text below)
- Co-Trainers read the story The Elephant Story. Alternatives include having participants read the story on-line before the lesson or assist in the reading of the story, taking turns reading sections.
- Following the story, learners are asked to take time and imagine what causes people to react differently to a perceived threat (as a reflective journal activity, small or large group discussion – pending availability of time).
- Co-Facilitators are encouraged to inquire into how early childhood experiences, perceive risk and relative danger and the amygdala and hippocampus regions of the limbic region of the brain can impact the fight, flight and freeze response.
- Co-Trainers are encouraged to inquire if anyone has heard of ‘appease’ as a fourth way of responding to trauma? Encourage participants to share if they do. If not, Co-Trainers can explain that it is often connected to sexual assault or domestic violence where appeasing an aggressor is often an automatic survival response. Appeasing a perpetrator or aggressor may allow for a degree of impact while surviving the threat of worse injury or death.
- Co-Facilitators can ask the series of reflective questions in regard to fight, flight and freeze responses:
- Why would the brain cause the body to become as small as possible, freeze and have eyes wide open with the heart rate increased as a survival instinct? How can freezing create safety?
- Why would the brain cause the body to be filled with adrenaline and shut down the part of the brain where complex thinking occurs and cause it to just run, as fast as possible? How can flight create safety?
- Why would the brain cause the body in its highest stress arousal stage to become the most aggressive, the most developmentally regressed? How can fighting create safety?
The Elephant Story: Fight Flight or Freeze (a true story)
In December of 2013 I took a trip to Kenya with three other Social Workers on a visit to schools, hospitals and non-profits to learn about local best practices regarding child safety and wellbeing. I hoped bring home ideas to try out at our agency when working with families in a culturally diverse setting. During the trip we did a lot of work with hundreds of children and parents across the country but also took time for self-care activities, including a safari outside of Nanyuki in the Northern region of the country, heading toward Mt. Kenya from Nairobi.
When we arrived it was around dinner time so we were escorted immediately into the dinning room that had large windows looking out onto a watering hole, just beyond a gully and low lying electrical fence. We sat down for dinner for a only a few minutes when suddenly a herd of elephants appeared out of the darkness so we rushed through dinner and asked the staff if it was ok to go outside to see the elephants. We were told that it was fine but to not take photos with a flash.
We went outside, along with another group of tourists speaking another language kind of loudly on their cell phones. I took some photos, without the flash and while doing so caught the attention of the largest elephant in the group. She locked her eyes onto me, and slowly began walking in my direction from the back of the herd. There was a curious baby elephant who had wandered very close to where we were standing, just on the other side of the gully and electric fence from us. The baby elephant was incredibly curious and cute but all I could see was this massive elephant steadily and purposefully walking towards me. Its head was forward and it flapped its ears a few times and trumpeted, showing me how massive she was.
I was scared and slowly and instinctively crouched down to appear smaller and less of a threat. The next day while out on safari our guide told us that behavior is what predators like lions or leopards do before they attack a baby elephant. I sensed that I had even further stressed out the large elephant so I slowly stood back up, not sure what to do. Just then the massive matriarch blasted a loud trumpeting sound with her trunk in the air, ears flapping out to the side and began charging directly towards me. At that moment we were only about 10 feet away with only a shallow gully and low-lying electric fence separating us. The gully was so low I could have easily jumped over both it and the electric fence so it offered no solace in the moment with a giant elephant charging only feet away.
I immediately turned to my right and noticed the other group had fallen immediately silent and were standing frozen next to a tree. I then looked behind me hearing my travel companion screaming at the top of her lungs and making a sprint back to the restaurant, making it all the way back inside by the time I had even registered that she was gone. Then I looked down and noticed my hands were balled up into clenched fists and I was standing in a boxer’s stance facing the elephant, as if I was squared off against it, ready to fight. What was I going to do, punch an elephant? All I could think was, “I know which of us would die in nature.”
III. The Importance of Supervision and Debriefing
Activity Title: Traumatic Saturation Sponges
Modality: Large Group Activity
Learner Level: All levels
- 8 sponges (non-scrubby ones – just plain is preferred);
- a bucket of water;
- 6 paper plates to hold a wet sponge;
- Reflective journals or blank pieces of paper and pens
- Co-Facilitators fill up the bucket of water high enough to fully submerge both sponges and set up one paper plate on one side of the bucket and 5 on the other side with a dry sponge on each of the paper plates.
- Co-Facilitator explains that sometimes Traumatic moments can happen multiple times over the life of a child or adult while repeatedly dunking the sponges into the bucket, representing multiple moments or experiences of trauma.
- Co-Facilitator explains that some trauma survivors can feel emotionally flooded as a result of their traumatic experience, similar to how a sponge can become saturated in water, while holding up both sponges fully saturated (do not squeeze or wring out the sponges when you hold them up).
- Co-Facilitator explains that talking about the trauma and creating a narrative of resilience can aid in healing, while wringing out each saturated sponge onto the dry sponges on either side of the bucket. Using Co-Facilitators can help, one on either side each with a sponge.
- Co-Facilitator then wrings out the sponge in the line of sponges into the next one on the plate next to it and the same from that sponge to the next one in line, resulting in each sponge having some degree of water wrung into it, but less in each one as it moves down the line until no water can be wrung out of the last sponge. Then repeat the process on either side of the bucket.
- Without explicitly making the connection, ask the participants write in their reflective journals or on blank pieces of paper what its like to work in a trauma-impacted setting as a provider without regular supervision to unload the impact of trauma they have been exposed to. What may occur over time?
- An adaptation to this activity is to label the paper plates: Social Worker (on either side of the bucket), then Supervisor, Manager, Director, Coach on the side with 5 plates. Participants can also draw happy faces on each of the paper plates with markers before the sponges are put on, allowing them to smear when wet, creating a visual representation of trauma impact.
Review of Principles of Trauma Informed Care
To supplement the activities described in this module, facilitators may provide a copy of a handout of the "Principles of Trauma Informed Care" developed by Substance Abuse and Mental Health Services Administration. Options for using the handout include reviewing the document at the start of the module (particularly for beginner audiences) to provide an overall framework for understanding guiding principles. The document may also be used at the closing of activities 1 and 2 to help integrate ideas that participants may have generated in their small and full group discussions.
Principles of Trauma Informed Care
1 Safety - Throughout the organization, staff and the people they serve feel physically and psychologically safe.
2 Trustworthiness and transparency - Organizational operations and decisions are conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members of those receiving services.
3 Peer support and mutual self-help - These are integral to the organizational and service delivery approach and are understood as a key vehicle for building trust, establishing safety, and empowerment.
4 Collaboration and mutuality - There is true partnering and leveling of power differences between staff and clients and among organizational staff from direct care staff to administrators. There is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making. The organization recognizes that everyone has a role to play in a trauma-informed approach. One does not have to be a therapist to be therapeutic.
5 Empowerment, voice, and choice - Throughout the organization and among the clients served, individuals' strengths are recognized, built on, and validated and new skills developed as necessary. The organization aims to strengthen the staff's, clients', and family members' experience of choice and recognize that every person's experience is unique and requires an individualized approach. This includes a belief in resilience and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. This builds on what clients, staff, and communities have to offer, rather than responding to perceived deficits.
6 Cultural, historical, and gender issues - The organization actively moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, geography), offers gender responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses historical trauma.
Key Resources and Reading
Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., ... & Layne, C. M. (2008). Creating trauma-informed systems: child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice , 39 (4), 396-404.