Trauma-Informed Care (TIC)

🔹 Understanding Trauma

▪️ What is Trauma?

Trauma occurs when someone experiences events that are overwhelmingly distressing, beyond their capacity to cope. These events can have lasting psychological, emotional, and physical effects.

Trauma is not defined by the event itself, but by how it impacts the individual.

▪️ Common Signs of Trauma

Anxiety, fear, or panic
Sadness, hopelessness, confusion
Relationship difficulties or social withdrawal
Impulsive or risky behaviour
Physical symptoms (e.g., chronic pain, gut issues, sleep problems)

▪️ Duration

Trauma effects may be short-term or persist for years, depending on the severity, frequency, and personal vulnerability.

🔹 Types of Trauma

1. Single-Incident Trauma

Definition: One-off, overwhelming event
Examples: Car accidents, assaults, natural disasters
Features: Easier to identify; may lead to PTSD if untreated

2. Childhood Trauma

Definition: Trauma before age 18, during developmental years
Examples: Abuse, neglect, domestic violence
Features:
- Impairs attachment, learning, and social skills
- Often manifests later as anxiety, depression, or relational problems

3. Complex Trauma

Definition: Repeated, prolonged trauma (often from childhood)
Examples: Chronic abuse, neglect, witnessing family violence
Features:
- Deep impact on emotional regulation, identity, and daily functioning
- Changes brain structure (e.g. enlarged amygdala → hypervigilance)
- Often associated with risky coping behaviours and chronic health issues

🔹 Trauma in First Nations Communities

▪️ Historical and Collective Trauma

Indigenous Australians have endured trauma from colonisation, forced removals, racism, and cultural disconnection, resulting in intergenerational trauma.

▪️ Contributing Historical Factors

Dispossession of land and culture
Stolen Generations and forced assimilation
Suppression of language, spirituality, and governance
Systemic racism and marginalisation

▪️ Impacts

↑ Rates of PTSD, anxiety, depression
↑ Suicide, especially among youth
Chronic illness, substance misuse
Poorer educational, social, and justice outcomes
Disrupted family and cultural relationships

▪️ Intergenerational Trauma

Trauma transmitted from one generation to the next
Leads to emotional stress, poor attachment, risky behaviours, and impaired cultural identity in children and families

Trauma Impacts

Mental health: Depression, anxiety, PTSD, emotional dysregulation
Physical health: Chronic pain, somatic complaints, sleep disturbances
Social functioning: Interpersonal difficulties, distrust, social withdrawal
Healthcare engagement: Fear of authority, avoidance of medical settings, perceived shame or stigma

🔹 Trauma-Informed Care (TIC)

▪️ What is TIC?

A model of healthcare that acknowledges the widespread impact of trauma and seeks to avoid re-traumatisation. TIC builds safety, trust, empowerment, and healing into all aspects of care.

“Do no further harm.” – the core principle of TIC.

▪️ Why It Matters

Many patients with mental health conditions have a trauma history.
Trauma can explain difficult behaviours or engagement issues.
TIC is especially important in communities with complex trauma histories, including Aboriginal and Torres Strait Islander communities.

🔹 Core Principles of Trauma-Informed Care

Principle	Practical Implementation
Safety	Calm, respectful spaces; private consultations; emotionally safe interactions
Trust	Transparent communication; consistency in clinicians
Choice	Involve patients in care decisions; provide options
Collaboration	Shared goal-setting and decision-making
Empowerment	Focus on strengths and resilience; offer tools for self-management
Respect for Diversity	Provide culturally safe, inclusive, and appropriate care

🔹 TIC in Clinical Practice

1. Creating Safe Spaces

Physical safety:
- Ensure the space is calm, private, and culturally welcoming (e.g. warm lighting, Indigenous artwork)
- Use warm lighting, artwork, quiet zones
Use non-threatening, respectful communication and calm body language.
Ensure privacy and confidentiality in clinical settings.
Train staff in calm, non-threatening communication

2. Trauma-Sensitive History Taking

Build rapport first
Explain why trauma history is relevant
Use open-ended, gentle questions
- “Have there been experiences that still affect your wellbeing today?”
- Example: “I’ll explain each step of the exam before we begin—please let me know if you’d like to pause.
Explain procedures in plain language and outline what patients can expect.
Avoid re-traumatisation: Never pressure for details.

3. Supportive Responses

Validate: Acknowledge courage and distress:
“Thank you for sharing. It makes sense that this still affects you.”
Empathise: Avoid quick solutions; offer presence and support.
“I’m here to support you when you’re ready.”
Respect boundaries:
“We can stop at any point or come back to this later.”

4. Choice and Control

Offer options and involve patients in decisions about their care.
Example: “Would you prefer to begin with counselling or medication, or both?”

5. Collaboration

Co-create care plans
Engage patients as active partners in their care.
Set achievable goals together

6. Empowerment and Self-Management

Highlight patient strengths
Support self-management and skill-building.
Example: Validate patient coping strategies and provide resources like breathing techniques or peer support.
Provide tools (e.g., BP monitors, apps, coping strategies)

7. Addressing Social Determinants

Link patients to housing, financial, or legal supports
Recognise trauma is worsened by poverty, racism, and instability

8. Cultural Safety

Understand how trauma intersects with culture, identity, and marginalisation.
Understand and respect cultural beliefs and healing
Involve Aboriginal Health Workers or Elders where appropriate

9. Referrals for Trauma-Specific Therapy

Refer to professionals trained in:
- Trauma-Focused CBT
- EMDR
- Culturally guided programs (e.g., Red Dust Healing)

Applying TIC in Clinical Settings

Setting	TIC-Informed Practice Example
General Practice	Begin consultations with rapport-building, offer patient choice in treatment plans, validate emotions without rushing history-taking.
Mental Health	Use gentle, open-ended questions. Explain why trauma questions are asked. Offer both individual and group therapy options.
Emergency/Acute Care	Respect personal space, explain each intervention, avoid unnecessary restraint or loud environments.
Community Health	Engage with family or cultural leaders where appropriate. Offer continuity of care with trusted staff.

Screening Considerations

Use gentle, open-ended questions (e.g. “Has anything in your past had a lasting impact on your wellbeing?”).
Avoid direct questioning unless appropriate and consented.
Consider tools like ACEs questionnaire only with patient understanding and readiness.

Clinical Language Tips

Avoid: “non-compliant,” “difficult,” or “manipulative”
Prefer: “understandably cautious,” “experiencing distress,” “working through trauma history”

Referral and Support Pathways

Refer to trauma-specialised mental health services (e.g. TF-CBT, EMDR).
Collaborate with:
- Social workers
- Aboriginal Health Workers
- Peer support programs
- Culturally specific trauma recovery services

🔹 Key Message

Trauma-informed care is not a treatment—it’s a lens through which all care is delivered.

It shifts the question from “What’s wrong with you?” to “What has happened to you?”

This shift fosters healing, trust, and better engagement—especially among trauma-affected individuals and communities.