Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers, and Educators

Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?’. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by ‘trauma-uninformed’ staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust.LEARNING OBJECTIVES• Appreciate broad-based definitions of trauma• Gain an understanding of what trauma-informed approaches are and why they have emerged, including the potential for (re)traumatisation in the mental health system• Consider how to practise trauma-informed approaches, including in ‘trauma-uninformed’ organisations, and the potential barriers to and opportunities from doing soDECLARATION OF INTERESTA. S. is funded by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship. This article presents independent research partially funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

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A paradigm shift: relationships in trauma-informed mental health services.

Purpose




The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK.




Design/methodology/approach




The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK.




Findings




There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed.




Originality/value




This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike.

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Trauma-informed mental healthcare in the UK: what is it and how can we further its development?

Adolescence—beginning with the onset of puberty and ending in the mid-20s—is a critical period of development during which key areas of the brain mature and develop. These changes in brain structure, function, and connectivity mark adolescence as a period of opportunity to discover new vistas, to form relationships with peers and adults, and to explore one's developing identity. It is also a period of resilience that can ameliorate childhood setbacks and set the stage for a thriving trajectory over the life course. Because adolescents comprise nearly one-fourth of the entire U.S. population, the nation needs policies and practices that will better leverage these developmental opportunities to harness the promise of adolescence—rather than focusing myopically on containing its risks. This report examines the neurobiological and socio-behavioral science of adolescent development and outlines how this knowledge can be applied, both to promote adolescent well-being, resilience, and development, and to rectify structural barriers and inequalities in opportunity, enabling all adolescents to flourish.

The Promise of Adolescence: Realizing Opportunity for All Youth

Children and adolescents with histories of traumatic exposure comprise a substantial portion of youth in residential treatment programs. However, until recently, little has been known about this specific population. Given the well-documented unique treatment considerations for traumatized youth, it is important to understand how the distinct needs of this population factor into the particular residential treatment setting approach. This paper presents a comprehensive overview of the current understanding of this vulnerable youth population, the impact trauma exposure can have on their clinical presentation and response to treatment, and the available empirical research regarding effective intervention strategies. In addition, policy implications specific to traumatized youth receiving treatment in residential settings are discussed.

Traumatized youth in residential treatment settings: Prevalence, clinical presentation, treatment, and policy implications

Despite increasing evidence in the public health field about the prevalence of adverse childhood experiences (ACEs) in the general population, little is known about the prevalence of ACEs among social service providers. Trauma backgrounds may influence both worker susceptibility to vicarious traumatization as well as clinical decision making. Similarly, individuals with trauma backgrounds are vulnerable to re-enactment of their history. With pressure on social service agencies to demonstrate successful client outcomes, it is critical that agencies explore factors that influence high-quality care. This exploratory study is the first investigation of ACE prevalence among workers in an agency that provides residential treatment, day treatment, and schooling for children with histories of trauma. Study results suggest a high prevalence of ACEs among these workers.

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Prevalence of Adverse Childhood Experiences (ACEs) among Child Service Providers

Organizational climate and burnout among home visitors: Testing mediating effects of empowerment

This article presents findings from a process evaluation of a pilot program to address parental substance abuse in the child welfare system. By placing substance abuse counselors in a local child welfare office, the collocation program was designed to facilitate early identification, timely referral to treatment, and improved treatment engagement of substance-abusing parents. Frontline child welfare workers in 6 of the 7 pilot sites endorsed the program as they found that the collocated substance abuse counselors provided additional resources and facilitated case processing. Findings suggest that clearly defined procedures and sufficient staffing of qualified substance abuse counselors could lead to better programs.

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Collocation: Integrating Child Welfare and Substance Abuse Services

Research links high youth exposure to community violence (ECV) with negative health consequences, and the World Health Organization recommends ECV as a new adverse childhood experience (ACE) category. The current study is among the first to include ECV within the ACE categories, examining ACEs and behavioral health (BH) service usage, using a population-based adult sample. Results reveal ECV and ACE associations in the expected direction. Respondents reporting ECV before age 18 had higher ACE scores than those without ECV. Results demonstrate ECV's predictive power for later BH needs and confirm its utility as a new ACE category. Practice implications include attention to ECV among adult populations and mitigating long-term costs through early intervention and prevention.

Exposure to Community Violence as a New Adverse Childhood Experience Category: Promising Results and Future Considerations

Adverse childhood experiences (ACEs) are linked to later life health problems such as behavioral health (BH) service use but less is known about how to counter this association. Using a population based sample of 807 adults, we examined the effects of protective factors in countering this association. ACEs were associated with increased BH service use while protective factors were associated with decreased BH service use. However, no significant interaction effect was found. Research is needed to develop a better measure of protective factors. Social workers need to be aware of ACE prevalence among clients and can foster protective factors.

Nina Esaki

Papers

Prevalence of Adverse Childhood Experiences (ACEs) among Child Service Providers

Organizational climate and burnout among home visitors: Testing mediating effects of empowerment

Collocation: Integrating Child Welfare and Substance Abuse Services

Exposure to Community Violence as a New Adverse Childhood Experience Category: Promising Results and Future Considerations

The effects of protective factors and adverse childhood experiences on behavioral health services use: Findings from a population-based sample.