lvo@nswnma.asn.au

Suddenly, this term is everywhere, but it’s rarely explained.

Behind the buzzword are decades of evidence about what actually helps people who’ve struggled with experiences of trauma to move on, and what sets their recovery back.

So, who is “trauma-informed care” really for? And what does it look like in practice?

Where did the term come from?

The term “trauma-informed” emerged in the early 2000s, building on clinical research about trauma from the 1990s.

Influential psychiatrist Judith Herman found that people recovering from post-traumatic stress disorder (PTSD) did better when services prioritised their safety, offered choice, and supported their sense of control.

Around the same time, clinicians and traumatised people themselves began documenting a troubling pattern: health and social services were sometimes making things worse, leaving patients more distressed than when they arrived.

This is known as re-traumatisation – when a professional or service unintentionally recreates the conditions of a traumatic experience, triggering the same distress. Placing an adult who experienced childhood neglect in an isolated seclusion room, for example, can evoke the very feelings the original trauma produced.

In the late 1990s, large-scale research, such as a landmark US study, was also revealing that trauma was far more common than previously thought. Just over half of participants reported at least one traumatic event in childhood, including abuse, neglect or family violence, and these experiences were strongly linked to lasting effects on mental and physical health.

Together, this growing body of work helped name and quantify experiences that had often been invisible in health systems. The central question in health care shifted from “what’s wrong with you?” to “what happened to you?”

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Everyone seems to be talking about trauma. Do we know more about it? Or has the meaning changed? In this five-part series, we explore the shifting definition of trauma, why talking about it doesn’t always help, and what else can work.

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Care that doesn’t cause further harm

Trauma-informed care is not a specific treatment or set of rules.

While individual practitioners can work in a trauma-informed way, the concept is mainly about how organisations or systems – such as a hospital or school – can work with people who’ve experienced trauma. It’s based on evidence about what they need to feel safe.

The starting point is an assumption: any person using your service may have experienced trauma, whether or not they disclose it, and your organisation’s practices could unintentionally make things worse. So trauma-informed care focuses on how to avoid re-traumatisation.

The most widely used framework organises this into “the four R” principles:

• realising how common trauma is
• recognising its signs in clients and staff
• responding through trauma-aware policies and practices
• resisting re-traumatisation, by fostering safety.

What does this look like in practice?

While experiences of trauma can be diverse, evidence suggests six key elements can help people with PTSD avoid re-traumatisation:

• physical and emotional safety: creating environments where people feel secure and in control. For example, not asking people to disclose sensitive information unnecessarily, and allowing people to choose where they sit in a room
• trustworthiness and transparency: being clear about what is happening and why. For example, explaining what is recorded in case notes and who can access them
• choice and empowerment: supporting independence wherever possible. This could mean offering people the choice of what they disclose, and how fast treatment proceeds
• peer support: connecting patients to people with similar experiences and backgrounds. This may include access to peer workers or to information written by people with lived experience about what to expect and what their rights are
• collaboration: viewing patients as equal partners in their care. For example, involving clients in decisions about their goals and treatment options
• cultural humility: recognising the historical and ongoing trauma faced by marginalised communities, addressing staff biases, and tailoring services accordingly. This could mean offering to arrange a clinician from the same cultural background when requested.

Some different scenarios

In health care, trauma-informed care might mean a clinician explains what will happen in an examination before it begins, asks for consent before any physical contact, and offers choices such as having a support person present.

In social services, it might look like intake processes that don’t ask people to repeat traumatic histories already on file, waiting areas designed to feel welcoming, and staff trained to notice distress without escalating it.

In workplaces, it can mean a culture where people feel safe speaking up, and mental health support that is clearly set out in policy.

The risks of this term’s popularity

Interest in the term “trauma-informed” has soared over the past ten years.

This has been driven in part by advocacy organisations that have long pushed services to recognise trauma and prevent harm.

But some services and non-clinical businesses, such as hairdressers or gyms, may use the term simply to signal awareness that trauma exists, without realising that genuine trauma-informed practice requires active, systemic change.

So popularity has its risks.

The key issue is accountability. There is no internationally recognised standard or certification that health workers and organisations are required to meet, and no regulation of who can use the term. It is easy to claim and hard to verify.

This matters because people with trauma histories are vulnerable. If a service promises to meet their needs and fails to, the consequences are real: delayed recovery, worsening symptoms and health, and lost trust in services that could have helped.

Without accountability, the term risks concept drift, diluting what “trauma-informed” actually means and making it harder for people to know whether a service delivers on it.

The bottom line

Greater public awareness of trauma and its long-term effects is a good thing. People with trauma histories don’t only interact with therapists. They navigate welfare systems, workplaces and schools, and reducing re-traumatisation in those settings can make a real difference.

But our concern is that wider use has not consistently translated into improved care or increased clarity for consumers because organisations can use the term without being held to any standard.

For the term to have real value, organisations and practitioners must be able to show – not just claim – how they are meeting trauma-informed principles.

Bronwyn Milkins, Postdoctoral Researcher in Youth Trauma and Dissociation, The Kids Research Institute Australia; Hayley Jackson, Research Fellow in Youth Mental Health, The Kids Research Institute, and Jeneva Ohan, Professor, Healing Kids, Healing Families, The Kids Research Institute Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.