By Fr. Ragan Shriver
A few years ago, a treadmill accident left me with a broken foot. For the next eight weeks I walked around with a boot. During this time no one asked me, “What is wrong with you?” Instead, I was asked, “What happened to you?” The difference between these two questions, though subtle, defines the core of trauma-informed care: a human person is not equated with a problem or illness he or she is experiencing.
My broken foot was the result of a traumatic injury that impacted my behavior (how I walked), my attitude (frustrated due to the pain) and my recreational life (no jogging). In other words, my life had been altered by the injury, but my whole being was not called into question.
Unfortunately, this is often not the case when people seek support in a behavioral health setting. Instead, they often face questions about their being rather than receiving treatment for the specific injury, which may be some other type of trauma like abuse, violence, or disaster. Yet, the scar of this trauma impacts a person’s behavior, attitude, and life, just like my broken foot did. Emotional trauma can result in anxiety, depression, addiction, or other behavioral/social difficulties. The trauma-informed approach seeks healing for the injury, and it avoids defining a person based on the impacts from the injury.
This approach grew out of the Adverse Childhood Experiences study (ACE) and subsequent research, which were developed after Kaiser Permanente’s research arm studied obesity treatment. Many of the subjects in the Kaiser Permanente study who had reduced their weight regained it. In follow-up interviews, they said that they needed the weight to feel safe or that eating numbed negative feelings. When questioned further, almost 75 percent of the subjects described a history of trauma. Kaiser then partnered with the Centers for Disease Control and Prevention in the ACE study to investigate the impact of childhood trauma on the lives of 17,000 persons enrolled in Kaiser’s insurance plan. The result showed that 64 percent of the subjects had experienced at least one adverse experience in the years prior to age 18.
In subsequent research, more work was done to identify how trauma impacts people’s lives. A chain reaction to trauma was identified that indicates the likelihood of early death for victims. The chain begins with a painful event leading to negative emotions and self-appraisal, resulting in maladaptive behaviors that temporarily curb negative feelings and numb the low self-esteem. But these behaviors, such as smoking, overeating, use of substances, and non-suicidal self-injury, yield poor health outcomes. People with a trauma history are four times more likely to have substance use disorders than the general population, leading to such conditions as asthma, diabetes, obesity, and overdose, which may result in early death. The conclusion is that trauma is a significant factor leading to a serious public health concern.
In the years since the original research, further study and practice have better equipped service providers to support survivors seeking recovery from adverse childhood experiences or other traumas. Interventions are founded on a clear definition of trauma. Basically, trauma is something that overwhelms a person’s internal systems, thus compromising the ability to cope. An analogy might be a city that is hit with a flood. The water disposal system cannot handle the extra rain, causing flooding and erosion in the short term and mold or rust in the long run. The system has been overwhelmed and will need external support to recover. In the same way when an individual experiences trauma the physiological reaction can overwhelm the typical stress response system, bringing about anxiety or depression leading to maladaptive patterns of behavior and long-term negative health outcomes.
Many ministers who serve people interacting with the justice system have begun using trauma-informed care for their clients. It means providing universal screening for trauma in clients’ histories, creating physical environments that convey safety and comfort, engaging in therapeutic interventions that deal directly with the experience of adversity, and creating positive alternatives to destructive coping strategies.
One very important component is a positive, healing relationship between a minister and the person being served. However, many victims of past trauma have difficulty trusting others. Aware of this, ministers express a desire to be trusted by the person and ask if they can create such an environment together. This type of approach gives an element of control to the client, creating an empowering partnership that can lead to healing.
But along with the people being ministered to, ministers themselves also need to also be cared for sensitively. This is due to the possibility of vicarious trauma. Hearing others speak of atrocities that have happened in their lives can take a serious toll on providers, leading to emotional and behavioral reactions just as those who primarily experienced trauma. Hopefully, all ministers seek quality supervision based in trauma-sensitive theory, outlets for stress relief, and collegiality with others.
Trauma-informed ministry may seem like a recent development, but we can look to the important role that Jesus played in meeting people where they were, accepting people, allowing those he encountered to know of the Father’s unconditional love for them, and empowering his followers. Our services are truly grounded in our savior, the truest healer of trauma, Christ Jesus.
Fr. Ragan Shriver is the director of social work program at the University of Tennessee.