Trauma-Informed Care isn’t therapy. It recognises the impact of trauma and provides people with the kind of environment in which they can flourish.
Most of the children in care have experienced multiple and repeated traumas. These “adverse childhood experiences” make children feel vulnerable and frightened.
They become unable to trust others and build positive relationships. They are at increased risk of ill-health, social problems and early death.
You don’t have to be a therapist to be therapeutic
There are six principles to Trauma-Informed Care.
Here we outline how a Trauma-Informe Foster Home could look like for a child in care.
Children have already experienced many traumas by the time they arrive at their new foster home.
The abuse and neglect, the disruption and separation from family, issues at school – to name a few.
In their new homes, it’s vital that they can feel safe, both physically and emotionally, as soon as possible. Central to Trauma-Informed Care is to avoid, as far as possible, re-traumatising the child.
This is why we have Safe Caring policies. The children don’t know us. They don’t know our histories, our intentions or our personalities. They don’t know that we aren’t going to abuse them.
Safe Caring is more than a policy. It’s a robust way of demonstrating to the child that they are safe. It’s about consistency, routine and stability.
Trauma-informed safety takes Safe Caring a step further. It is about minimising all the things that can trigger a specific child’s threat response.
When we are exposed to threat, our brains go into fight-or-flight mode. You can read more about this in How Trauma Hijacks The Brain.
Traumatised children are in constant survival-mode. They are anxious and hyper-vigilant, constantly on the look out for threats. Their number one priority is to keep themselves safe.
To achieve safety, they may become ultra-compliant. They may lie or distort the truth. They may isolate themselves. They may fight and challenge us.
Trauma-informed safety recognises these acts as a child’s way of staying safe. Rather than challenge the act itself, we should be minimising the threats that the child is protecting themself from.
2. Trustworthiness and Transparency.
How safe a child feels with us is also dependent on how much they believe they can trust us.
Looked after children will have been surrounded by lies and secrecy. They will have been blamed and shamed for decisions they have made.
Even in care, it is hard for them to know what to believe. We may tell them that a social worker will be here this afternoon. When they don’t arrive, how does the child respond? Were we lying?
How can they trust us next time, when we say the social worker will definitely be here this afternoon?
These simple things erode trust. The child is looking for us to confirm their belief that adults cannot be trusted.
A simple trick for building trust is to place appropriate qualifiers around statements:
For example “Your social worker told me they expect to be here this afternoon, as long as the traffic isn’t too bad. If they can’t make it, they will rearrange.”
Another difficulty children in care face is with decision masking. They often have no idea how adults make decisions or who can decide what.
Their own parents may be telling them one thing and foster carers telling them something else. They don’t know who to trust or who to believe.
Decisions are often made in their absence and they are not always told the whole story.
Secrecy and half-truths do not protect children. They expose children to their fear of the unknown. They make the world a scary place, impossible to understand.
We can explain to children how to make good quality decisions
We can show transparency and trustworthiness in simple ways. We can ask for their input into their notes and meetings. We can negotiate with them about sharing information. We can explain why we have certain rules and routines.
Children in care are often terrified of making decisions. They worry that they will get it wrong and that there will be some negative consequences. Often, this has been their experience in the past.
Trauma affects the development of key parts of the brain that deal with logic and decision making. As soon as we ask a child to make a decision, their threat response kicks in and they can freeze. We need to start slowly and given them safe options so they can practice making decisions.
Importantly, we can explain to them how to make good quality decisions:
- That we need to gather all the information.
- Consider possible options.
- Weigh up those options to see what will work.
- Check with others to see if we missed anything.
- Then act on the decision as best as we can.
Children can handle more truth that we sometimes give them credit for. By showing them how we use information and how we make decisions, we increase their confidence in us and involve them in their care.
3. Peer Support
When they start a new school, looked after children have often found all the other looked after children by the end of their first day.
Sometimes, carers despair of this and want their foster child to make friends with a different social group. But it is important to see this seeking out of peers as a positive thing.
They want to know that there are other children and young people who know what it is like to be them.
What they are seeking is peer support. They want to know that there are other children and young people who know what it is like to be them. They want companions with whom they can open up, be honest, and share experiences.
Carers fear that peers may be sharing unhelpful coping mechanisms or survival tips. This may well be happening. But that is not to say we should discourage it out of hand. The benefits of having that peer support can often outweigh the risks.
We all know the benefits that recovering alcoholics gain by coming together for mutual support. In the same way, it can be useful for children in care to have structured time with their peers. Many fostering agencies bring children together for workshops and activities.
Peer support is most effective when it is contained and part of a wider social mix. After all, alcoholics will socialise with people who aren’t alcoholics. So it is useful for foster children to also socialise with friends who aren’t traumatised.
4. Choice – Voice and choice and Empowerment
Trauma-informed choice is about the child’s role in their own jouney out of trauma.
Typically, services are seen as the answer to someone’s problem. The reason for this is that we tend to frame people’s needs as a need for a service intervention.
For example, “Sally self-harms. Sally needs to see a therapist”.
When we think of the problem as an illness, we think the solution is treatment.
We believe that if the child accepts the professional’s expertise and complies with treatment, they will get better. When they don’t get better, we blame the child for not engaging or cooperating with the services that have been imposed on them.
Care then becomes a matter of controlling treatment, not facilitating recovery;
“If you don’t go to see your therapist, then don’t complain about needing to self-harm”
Seeing needs as interventions also limits choice. Interventions are, by their nature, delivered at people. They are based on diagnostic criteria and standardised approaches. They depersonalise the recipient and demand compliance.
Being “trauma-informed” does not mean being “trauma-obsessed”
Too often, a child’s trauma looms so large in our thinking that it is hard to see past it. We concentrate on all the problems a child has experienced and lose sight of their strengths.
When all we see are problems, our care plans focus on reducing risk, rather than enabling recovery.
But being “trauma-informed” does not mean being “trauma-obsessed”.
For a start, we need to think differently about the problem. For example, “Sally self-harms to reduce her overwhelming anxiety.” This already sets us off down a different path. Sally’s self-harm ceases to be a problem to be fixed. Instead, it is a sign of her resilience.
When we can think of the problem as a traumatic injury, we start to see the solution as one of healing.
Choice is then about reframing needs as desired outcomes. How the world could be. These desired outcomes are set by the child themself. When we do that, we often discover other possible options.
For example: “what would it be like, Sally, if you weren’t so anxious?”
This invites a desired outcome, such as “I’d be relaxed and have lots of good friends. I’d enjoy going out more and I’d sleep better.” We can then explore what will help the child achieve this.
It opens up a door to different possibilities. It is inclusive of a role for community, friends and social networks. Hobbies and interests become part of a recovery plan.
Choice builds on the child’s strengths and resilience.
Choice builds on the child’s strengths and resilience. I know many foster children who amaze me with their ability to just get out of bed every day. That they are able to function at all is testament to their incredible resilience.
By working with the child to discover their definition of “better” , we show that we trust them to know themselves. We recognise, and try to level, the huge power differences that exist between the child and the state.
We are invited to become part of their plan, we share their goals and get involved in their decision making.
5. Collaboration, Mutuality and Partnership
The care team recognise that everyone has a role to play in a trauma-informed approach.
We want to create a genuine partnership between everyone who has a role to play in that child’s recovery.
This should go beyond services to include friends, youth workers, mentors and clubs.
It doesn’t mean that everyone has a seat in LAC review meetings. But it does mean that everyone is recognised and feels that their contribution is valued.
Foster carers are ideally placed to coordinate this collaboration. We know the child, their friends and clubs. We drop them off places and get involved in their hobbies.
Many children in care do not want the world and his wife knowing their business. This is understandable. But once we have some shared goals, we can involve the child in who needs to know what.
We need to be clear that collaboration is not a way for friends and club leaders to report back on the child’s behaviour. This isn’t about keeping tabs on children or creating an army of unqualified social workers.
We want those involved in the child’s recovery to be sensitive, pro-active and positive. We also want them to feel connected and supported.
This extended care team should feel like an informal network, not a top-down power structure.
6. Cultural, Historical, and Gender Issues
Trauma-informed care recognises that trauma exists in a cultural context. All trauma occurs against a backdrop of gender, race, religion, sexual orientation etc.
It is important to explore the relationship between trauma, culture and identity.
For example, religion may have been a feature of a child’s abuse. Or they may have been sexually abused by a same-sex perpetrator.
This interplay between culture, identity and trauma can impact on the child’s development. It also affects how the child makes sense of what happened to them. For example “it’s because I am evil” or “it’s because I am gay”
Look for multiple, overlapping aspects of culture and identify. For example, being gay, black and Christian. Our identity shapes how we experience events. It’s not about whether an event is worse for one person than for another. It is that their experience of that event will be different.
There may be a historical cultural context. Such as occurs with Female Genital Mutilation. The abuse is perpetrated by people who have undergone it themselves, and who think it is the right thing to do. These people are often family members.
Sensitivity to the cultural aspects of trauma should run throughout Trauma-Informed Care. From Safety through to Collaboration.
- Trauma-Informed Care isn’t a therapy. It’s a therapeutic approach to caring for someone who has experienced trauma.
- It’s is important to avoid experiences that are re-traumatising
- Trauma-Informed Care builds on the child’s strengths and resilience
- Attention is placed on the child’s recovery, not our treatment or care plan.
- Care should be collaborative, not prescriptive.