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TICP Programs and Trauma Focused Services (not the same)

Trauma-Informed Care and Practice (TICP) PART 3: Need for Trauma Informed Approach in Human Services



Trauma-informed care emphasises full transparency about the services provided to create a safe and predictable environment from first contact. This approach ensures support is person-centered and minimise stressors when accessing services (NSW Mental Health Commission, 2017).


Trauma-Informed care and practice (TICP) implements trauma informed principles into policies and procedures within all levels of the organisation and their programs (SAMHSA, 2014). Use of recovery-oriented language and how service users are spoken to is important (MHCC, 2022).


While TICP training and programs have been primarily in health and therapy settings (McNaughton et al., 2022), it is expanding into fields such as education, disability services, and criminal justice, with emerging practices like trauma-informed correctional care and trauma-informed sentencing (McLaughlan, 2024). ‘Realise’ (understanding trauma's impact), ‘Recognise’ (identifying behaviors), ‘Respond’ (ensuring safe practices), ‘Resist’ (avoiding triggers) are adapted to meet context of respective programs based on SAMSHA (2014) guidelines, and extended to include Replenish (focusing on strengths), and Regenerate (reviving) in the following First Nations approach (Tujague and Ryan, 2024).


Within a trauma-informed justice system, terminology around ‘those who have been harmed’, and ‘those who have harmed’, rather than using victim and perpetrator, is considered more helpful when working with First Nations people in Canada (CAMH, 2017). Although the former is still used within Australian trauma-informed literature, utility of TICP is extended to recognising humanity in offenders and that chronic adversity can lead to developmental challenges and any number of maladaptive stress responses, e.g. violence, anger or withdrawal (McLaughlan, 2024). Research indicates targeted interventions, and positive relationships can reverse neuropsychological trauma, and this is important to note for prevention and sentencing, as may not be identified or accessible outside a trauma informed framework (Peckham, 2023).


Trauma-informed programs in educational settings at this stage are reported to lack best-practice guidelines, though reported findings are encouraging for improved student and staff outcomes (Newton, et al., 2024). The ReLate (Reframing Learning and Teaching Environments) program for example, were implemented in two schools reporting positive adjustment, benefits extending to home life, friendships, learning, and leisure activities (and improved relationships between staff and students); however, mixed findings emerged regarding perceived efficacy of staff when the program was delivered over four months versus twelve months (Avery et al., 2022; Diggins, 2021).


Trauma-Informed Positive Education (TIPE) is an alternative strengths-based program designed to shift attitudes toward discipline from reactive to proactive. Both studies reviewed reported positive outcomes for staff and students (Stokes, 2022; Schimke et al., 2022), including significant improvements in the educational experiences of vulnerable students. One school program spanning two and a half years focused on body, relationship, and stamina, while another lasted three years and addressed adverse childhood experiences (ACEs) and the social-emotional needs of First Nations students (Schimke et al., 2022).


Tujague and Ryan (2023) point out the limited TICP programs and publications for First Nations people in Australia, attributing this scarcity to deep historical injustices and the government's failure to address ongoing social issues, which complicate effective responses (Menzies, 2019). Menzies stresses the necessity of a trauma-informed lens to understand these communities and advocates for culturally appropriate, evidence-based strategies. For example, investing in TICP services within child protection is essential to address high child removal rates resulting from systemic neglect of skill development opportunities due to colonisation.


In response to these needs, Tujague and Ryan (2024) published the manual Cultural Safety in Trauma-Informed Practice from a First Nations Perspective: Billabongs of Knowledge, which was well received by communities. Requested by program participants, this manual serves as a valuable resource for health and social science disciplines from a First Nations-led perspective, offering strategies to enhance self-awareness, regulate emotions, and prevent re-traumatisation by attuning to bodily emotions and sensations (among other culturally appropriate techniques).


There is an urgent need for education regarding what it means to be trauma-informed within the social sector, and how this understanding can manifest in policy reforms. Smith and Monteux (2023) question the efficacy of TICP, arguing that there is limited evidence supporting its effectiveness. They contend that trauma-informed principles often overlap with existing expectations in quality social care and that an emphasis on trauma may alter individuals’ self-perception, leading them to feel damaged. Another argument is that individuals may be deterred from seeking psychological assistance if precluded from receiving a formal diagnosis. The authors assert that trauma is only one lens through which to view human suffering and may not necessarily be the most effective perspective; emphasising the need for organisational changes across everyday practices, rather than being confined to clinical settings (Smith & Monteux, 2023).


Trauma specialists advocate for system-wide integration and robust social care as foundational elements of TICP (Keselman, 2021). This integration necessitates the application of TICP principles to ensure predictable, person-centered support that is transparent and does not inflict harm (Kezelman, 2021; SAMHSA, 2014). TICP does not imply capacity for treatment (referred to as trauma-focused) though may coordinate supports, or provide referrals and information (Mclaughlan, 2024).


It will be limitation of the approach if seen to be unnecessarily gathering sensitive and personal information out of context due to inadequate training, or if there is an expectation to disclose trauma history when accessing social supports. This may dysregulate service users nervous system and create barriers, mistrust and feeling unsafe. An online directory supporting adult survivors of sexual abuse provide a potential framework for extending TICP supports in a way that may help navigate these risks; herein educating service users around choice and how to communicate needs (see Australian Psychological Society, 2024).


Understanding how adverse events affect functioning is a key step in healing, as is having an avenue to address it. Trauma-focused services treat trauma and unless otherwise specified, outside the scope of TICP.


The following is a very brief description of some of the emerging and existing treatment research (and foreseeable issues that need to be addressed moving forward). It is by no means exhaustive and there are many other treatment modalities that warrant further exploration within this field (e.g. transcranial magnetic stimulation / theta burst stimulation etc).


EARLY INTERVENTION: Although the timing of support is critical to avoid potentially long-term damage from significant or multiple adverse events, psychosocial interventions to prevent PTSD in youth have shown negative effects when the traumatic event is ongoing, such as in cases of political violence, war, and absence of parental involvement (Kerbage et al., 2022). However, a combination of different therapies (e.g. art and creative expression) for potentially traumatic events have proven effective shortly after and within a three month timeframe (Kerbage et al., 2022). 


Debate over the efficacy of widely recommended evidence-based treatments for trauma highlights the need for ongoing research into new approaches (Van der Kolk, 2020). Cognitive behavioral therapy (CBT) and pharmacological interventions are commonly recommended for trauma-related symptoms, including depression and anxiety in youth and adults (Phoenix Australia, 2022; Wall et al., 2016). Trauma specialists, however believe these methods often fall short, with 33-66% of patients failing to achieve remission (Van der Kolk, 2015; Kezelman & Stavropoulos, 2019; Herpers, 2024).


Discussing traumatic events can trigger autonomic responses that disrupt Broca’s area (speech) and the frontal lobe (rational thought), potentially making cognitive behavioral therapy less effective for those with trauma histories when reflecting on adverse events (Van der Kolk, 2015). Lanius et al. (2020) demonstrated anomalies with autobiographical memory in PTSD patients who displayed a reverse profile; meaning when in a resting state, these functions shut down, though were activated when recalling traumatic events. Similar trends were discovered using heart rate variability studies in PTSD patients (Thome et al., 2022) and illustrate the range of complexities with how trauma can be expressed.


A criticism with common trauma medications, is that numbing negative feelings reduces capacity for experiencing positive emotions (Van der Kolk, 2020). In contrast, body-focused interventions such as yoga, somatic therapy, breathing techniques, eye movement desensitisation and reprocessing (EMDR), polyvagal interventions and trauma-informed emotional freedom technique (EFT), have been effective in addressing trauma-related symptoms, largely due to the anatomical connection of approximately 80% of the nervous system's fibers linking directly from the organs to the brain (Van der Kolk, 2020; Porges & Dana, 2018; see Kezelman & Stavropoulos, 2019). It is always essential to build a client's capacity for self-soothing and regulation before processing trauma to avoid destabilisation (Kezelman & Stavropoulos, 2019; Porges & Dana, 2018).


Cost prohibitive and exploitative treatments are also areas of concern. Despite recognising the antidepressant effects of generic ketamine over 20 years ago, regulatory and financial barriers delayed commercial registration, while the patented formulation was registered at $600–$900 per dose (compared to $5 for generic ketamine). This resulted in both treatments being equally effective but largely inaccessible due to the Australian Government refusing to subsidise costs or providing approval for the generic treatment based on comparative studies (Rodgers et al., 2024).


Similar issues could impede future low-cost psychedelic-assisted therapies, with MDMA and psilocybin treatment potentially costing Australians $25,000 out of pocket due to extensive protocol requirements (Rodgers et l., 2024; Herpers et al., 2024; Chrysanthos, 2023). Government can potentially mitigate many of these costs and challenges by drawing on historical case studies and protocols used in the 70’s and 8’s (e.g. trauma and couples counselling) and international findings to standardise procedures for reducing cost (see Passie, 2018).



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