The term "trauma informed care" is a concept in the mental health field that is gaining momentum. Here in Delaware, there are several initiatives underway that are implementing new policies to make programs trauma informed in its delivery of mental health services across the state. But what does being trauma informed mean exactly?

Trauma informed programs are those that evaluate the way they provide services, from management to direct care, and take the steps necessary to transform services so that they are sensitive to the needs of trauma survivors.

Essentially, trauma informed care

means being informed about trauma and having an understanding of

how it affects the individuals

who are seeking help.

This is especially important, as most people seeking public mental health services have experienced some type of trauma in their lifetime.

According to The National Center for Trauma Informed Care (NCTIC), "Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization. Trauma-specific interventions are designed specifically to address the consequences of trauma in the individual and to facilitate healing".

The NCTIC identifies the following as being important to recognize:

• The survivor's need to be respected, informed, connected, and hopeful about their own trauma recovery

• The correlation between trauma and symptoms of trauma; such as substance abuse, eating disorders, depression, and anxiety

• The need to work collaboratively with survivors, their family and friends, and other human services agencies to empower the survivor and reduce re-victimization within "the system"

Trauma informed services seeks to change the attitude or mentality of working with survivors from "What is wrong with you?" to "What has happened to you?". The latter places more importance on understanding the person's experiences, instead of retraumatizing the person with more shame and guilt.

For a program to be truly trauma informed, these paradigm shifts must occur beyond the direct interventions with survivors. To transform an entire system, it requires a broad approach and includes everyone that comes in contact with survivors.

So for example, even receptionists and non-clinical staff need training to develop understanding and sensitivity to the impact of trauma so that their interactions with survivors are conducive to healing.

Trauma informed services pays close attention not only to how trauma is being treated by therapists, but also the often overlooked details such as the office environment, hours of operation, safety, or even the type of reading material in the waiting room.

The question must be asked "could this possibly be triggering or retraumatizing to a survivor?", and if the answer is yes, steps must be taken to reverse that. For example, it is common for mental health hospitals to check on each patient in their room, at least every hour throughout the night. These "night checks" are to ensure safety.

However, imagine how such a procedure could be triggering or retraumatizing to a patient whose step-father entered her room at night to molest her. Since this type of procedure in a hospital usually cannot be completely eliminated, a trauma informed approach to this would be to let patients know who will be doing the checks, how often, and ask what the least intrusive way of checking on them would be. In the coming years, I hope to see many more programs and services that are trauma informed, and therefore less survivors that are retraumatized while getting the help they need and deserve.