Introduction to Trauma-informed Care and the Use of the TIC Checklist

Trauma-informed care (TIC) can be defined as an approach of service which is aimed at responding to and understanding the impact of the trauma of an individual (Purkey et al., 2018). It helps in promoting positive results by responding to the emotional safety, mental safety, and psychological safety of the patient. This, in turn, improves the well-being of the individuals by serving their needs and applying a positive approach to their care services. Any organization can form a framework for trauma-informed care so that the organization’s culture can identify the behaviour of the individuals and can interact with them for providing a physical, mental, and emotional manifestation. The interpersonal interactions in an organization with all the trained staff members can help in avoiding the recurrence of trauma to the survivor and help in getting an improved quality of life. Trauma-informed care is not a set of rules and regulations. It is based upon not one size fits all approach. This care works on different approaches and principles which can be bent in the way of an individual's trauma history and his present behavior. It can be changed according to the interaction of the people in the organization such as customers, patients, and the whole environment of the organization. Six guiding principles for trauma-informed care are Safety, trustworthiness and transparency, Peer support, collaboration and mutuality, empowerment of voice and choice, and cultural, historical, and gender issues (Brooks et al, 2018).

A study by Wilson et al (2015) identified the best information care in domestic violence and conducted a qualitative analysis for identifying the basic principles. This study gave six principles of trauma-informed care for individuals of domestic violence. These were establishing emotional safety, restoring choice and control, facilitating connection, support in coping, responding to identity and context, and building strength. The importance of applying these principles to the individual of family violence is to heal them and emphasize the community and social context of family violence (Brooks et al, 2018). Establishing trauma-informed care and emotional safety, it is meant that the organization in which the individuals are working should be physically and mentally safe for them. The interpersonal interactions between the staff should promote a feeling of safety and the organization's culture should understand the perspective of safety towards the people. Connections can be facilitated by maintaining trustworthiness and transparency in the organization with the people working, along with their family members, and a culture of honesty can be developed. The commitments between the organization and the individuals should be followed with complete transparency towards each other. Supported coping means utilizing the experience of the people who have lived trauma. The organization can take help from peers who have suffered from the trauma and emerged as survivors in delivering the services. Peer support helps in making use of the stories and building up trust between the individuals and their peers (Han et al., 2021). This helps in better healing and recovery of the individuals as they are motivated by the experiences of their peers. By responding to the identity and context of the trauma survivor, the individual can experience control over themselves and hence experiences of trauma can be removed. Collaboration and mutuality by emphasizing partnership and minimizing the power gap differences between the organizational staff can help in making new meaningful relationships between the staff members. It can help in better decision-making in the organization. When the individual gets the choice of power, it helps in healing the identity crisis faced by the survivor. Building strength can be done by empowering the people by helping them in recognising their strengths. The organization can empower people by believing in the individuals and making shared decisions making and understanding the aim of the people they serve (Wilson et al. 2015).

Reviewing the checklist in the organization is a very important aspect of giving trauma-informed care. Few questions can be reviewed and responded to know whether the checklist is implemented in the organization or not. These questions recognize the trauma symptoms and behaviors of the individual from the experience (Conover et al., 2015). Promoting awareness about trauma helps to minimize the risk of relapsing of trauma episodes or replication of the trauma episodes. Creating a safe environment for the patient, and creating amicable relationships check whether the organization is showing commitment to trauma-induced care. The checklist can be implemented by involving all the stakeholders and incorporating the approach at all levels of the organization. These approaches include Policies, the physical environment of the organization, governments, and leadership, training and workforce development, financing, evaluation, screening, assessment and treatment services, and cross-sector collaboration. Psychoeducation and peer support should be incorporated into the TIC-led approach in DV programs to address the mental meets of the survivors (Wilson et al. 2015). TIC checklist can be implemented in the DV programs by assessing the goal of empowerment and restoration of the ability to choose and control which is diminished due to the abusive partner.

Develop a checklist

Tic At Organisational Level (Carr et al., 2018)

Is the organization well connected to the community and has developed an identity of its own?
Are the organizational procedures and policies cultural and gender supportive?
Is the organization providing a transparent and trustworthy approach to dealing with trauma-informed care?
Is the family violence hotline available to the clients 24 hours a day?
Is there mutual understanding and collaboration between the staff members in the organization and do they provide peer support to the clients?
Are the policies and procedures of the organization adaptable and flexible towards the client's needs and interests concerning the choice of the client and the organization with which the client wants to engage with?
Is the organization working towards social justice concerning domestic and family violence in the community?
Does the organization help in providing safe and protected shelter to the survivors of domestic violence such as women and children?
Does the organization work with the social justice system and the local police to bring justice to the victims of family violence?
Is the family violence hotline number easy to approach and is displayed in public places and on social media for better reach of the clients?

TIC at Program Level (Carr et al., 2018)

Is the program offering various approaches to the survivors for telling their stories which can include writing, art, music, or movement?

Is the program enabling the survivors or the clients to suggest changes in the prospective program which can help them in restoring their choice and control?

Is the program learning focused and helps in engaging the clients in various other recreational activities?

Does the program support the mental and physical well-being of the clients by aiding them in recovery and healing?

Does the program enhance the critical thinking, problem-solving and constructive abilities of the survivors so that they can utilize their abilities and come out of the traumatic feeling?

Is the program suitable for the local community and is based on the cultural beliefs and vernacular designs of the locality (Ranjbar et al., 2020)?

Does the program take into consideration the needs of the children of the family violence and takes enough measures to provide them safe shelter and meet their needs?

Does the program has any tie-up with the local schools to provide education to the children of family violence?

Does the program include any professional development course or curricula regarding trauma-informed teaching for the staff members?

Does the program collaborate with the family members of the clients except for the abuser for providing improved services to the clients?

TIC Implementation At The Staff Level (Carr et al., 2018)

Does the staff adopt the non-judgmental approach in interactions with the survivors?
Does the reaction of the staff shame or embarrass the client?
Does the staff is asking too many questions in continuation?
Is the staff using respectful language and considering tone and choice of words while speaking to the client?
Is the staff offering enough space and time for the survivors to tell their stories?
Are all the policies explained clearly to the client?
Is this staff able to create various opportunities for the clients to connect and develop bonding between them?
Does the staff support the clients in developing strategies for coping and identifying their strengths of the clients?
Does this staff support the holistic approach to the healing of the client and adopts a multidimensional approach for the well-being of the client?
Does the staff support the client’s relationship with their children who was subjected to the family violence?

C. Critical Reflection

The six guiding principles of trauma-informed care help in forming a framework for supporting clients suffering from trauma. These principles can be applied in various fields of trauma-induced care such as homeless shelters for older men, out-of-home care for the youth between the ages of 11 to 16, family violence hotline, and indigenous health service in rural settings. The strength of these principles lies in the fact that they are not bound to a certain technique or regulation but have a flexible approach which helps in giving the client the best service in alignment with the principles (Purkey et al., 2018). In this assessment, we have focused on the family violence hotline. During the development of the checklist. During the development of the trauma-informed care checklist about the family violence hotline, it was important to know about the various levels at which trauma-centered program works. These hotlines are part of various family violence-related organizations that help the clients in informing and seeking help during any dangerous situation of family violence. The trauma-informed approached use by his hotlines is to first calm down the client and ask about the location and address. Immediate action is taken to inform the local police of that area so that the police can intervene in the matter and rescue the client. While reading about the literature on trauma-informed care in the case of family violence, I noticed that in most cases women are the victim of family violence, along with the children. The majority of the abusers in these cases are intimate partners (Sharma, 2015).

The General TIC checklist focuses on the service provider understanding the responses of the client and validating their feelings about the trauma (Wilson et al. 2015). The general checklist allows the client to have control over the whole process by making decisions about the treatment. During the process of developing a checklist for family violence clients, I explored the literature about the psychology of the clients and thought about their mental state in which they need to take help of a hotline to rescue themselves and their children. This made me explore the fact that the hotline numbers should be in plain view of the public by displaying them on social media and in various public places so that the client does not need to search the number when in a situation of family violence. Also, the number should be easy to use so that it can be immediately dialed in an emergency. The organizations should keep on reviewing their trauma-induced care programs and train the staff for continuum development (Wilson et al. 2015). The Mental Health Coordinating Council (MHCC) has taken the appreciative initiative of introducing trauma-informed care and practice organizational toolkit TICPOT. This is a quality improvement and implementation resource which can be used by organizations who are interested in improving their trauma-informed care approach (MHCC, 2018).

References

Brooks, M., Barclay, L., & Hooker, C. (2018). Trauma-informed care in general practice: Findings from a women's health centre evaluation.  Australian Journal of General Practice ,  47 (6), 370–375. https://doi.org/10.31128/AJGP-11-17-4406

Carr, S., Hardy, A., & Fornells-Ambrojo, M. (2018). The trauma and life events (TALE) checklist: development of a tool for improving routine screening in people with psychosis.  European Journal of Psychotraumatology ,  9 (1), 1512265. https://doi.org/10.1080/20008198.2018.1512265

Conover, K., Sharp, C., & Salerno, A. (2015). Integrating trauma-informed care principles in behavioral health service organizations.  Psychiatric Services (Washington, D.C.) ,  66 (9), 1004. https://doi.org/10.1176/appi.ps.201400526

Han, H. R., Miller, H. N., Nkimbeng, M., Budhathoki, C., Mikhael, T., Rivers, E., Gray, J., Trimble, K., Chow, S., & Wilson, P. (2021). Trauma informed interventions: A systematic review.  PloS One ,  16 (6), e0252747. https://doi.org/10.1371/journal.pone.0252747

Mental health coordinating council MHCC, (2018). Trauma-informed care and practice organizational toolkit. TICPOT-Stage-1.pdf (mhcc.org.au)

Purkey, E., Patel, R., & Phillips, S. P. (2018). Trauma-informed care: Better care for everyone.  Canadian Family Physician,  64 (3), 170–172.

Ranjbar, N., Erb, M., Mohammad, O., & Moreno, F. A. (2020). Trauma-informed care and cultural humility in the mental health care of people from minoritized communities.  Focus (American Psychiatric Publishing) ,  18 (1), 8–15. https://doi.org/10.1176/appi.focus.20190027

Sharma I. (2015). Violence against women: Where are the solutions?.  Indian Journal of Psychiatry,  57 (2), 131–139. https://doi.org/10.4103/0019-5545.158133

Wilson, J. M., Fauci, J. E., & Goodman, L. A. (2015). Bringing trauma-informed practice to domestic violence programs: A qualitative analysis of current approaches.  The American Journal of Orthopsychiatry ,  85 (6), 586–599.

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