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Cost of Trauma and TICP Savings (personal, financial, community)


Trauma-Informed Care and Pracrtice (TICP) PART 2: NEED FOR TRAUMA-INFORMED APPROACH IN HUMANS SERVICES



In 1872, Charles Darwin described trauma as being lived out in the theatre of the body (Van der Kolk, 2020). Van der Kolk translates this as reflected changes to voice and facial expressions linked with painful memories, which subsequently affect movement, breathing, and body awareness (may experience floundering and lack of reciprocity).


Trauma, from this perspective, is a rigid and defensive state that can lead to long-term brain changes if unaddressed, ultimately impacting social behaviors and nurturing capabilities (contributing to intergenerational trauma). This social disconnection is thought to be a primary cause of suicide among trauma survivors, rather than the actual event, and that the challenge is to re-establish a sense of purpose and reward (Van der Kolk, 2020).


TICP aligns with the biopsychosocial perspective, providing an alternative lens for addressing numerous social issues encountered by practitioners across various fields, including education (McNaughton et al., 2022), child and family services (Connell et al., 2019), youth services (Bendall et al., 2018), mental health (Benjamin et al., 2019), welfare (Wall et al., 2016), and corrections (McLaughlan, 2024). Donaldson (2018) notes that two-thirds of individuals presenting for early psychosis intervention reported experiencing childhood trauma, with up to 87% of service users having a history of sexual or physical assault. Historically, service users have been made to feel shame about their situations, attributed to individual failings rather than systemic social and environmental factors (Maté, 2020).


Maté (2020) argues that altering environmental factors, which are within our control, can facilitate healing, as biology cannot be separated from social and psychological contexts. Inequality, unemployment, lack of trauma-informed education, and loss of meaning represent common challenges within human services, presenting compounding stressors that contribute to what Maté (2019) describes as a psychosocial disconnect. TICP may thus serve as a mechanism to provide insights into collective and proactive measures to address these issues, enabling appropriate early interventions (Kerbage, 2022; Silberg, 2021).


Maté (2019; 2020) argues that the drivers of addiction stem from a disconnect between self and agency, distorting the brain's endorphin and dopamine mechanisms, which are directly related to environmental factors (see Rat Park study: Gage & Sumnall, 2019). For example, stress experienced by mothers during pregnancy can reduce dopamine neurons in utero, impairing the child's self-regulatory abilities later in life (Maté, 2020). This has been linked to predispositions for addiction, where the child learns to rely on external means for soothing, a phenomenon that can persist even when placed in a nurturing environment. The potential benefits of TICP span a diverse range of service users, starting from unborn children and extending across age groups and socio-economic demographics affected by trauma.


Holistic TICP service provision for families and youth (including foster care) help to minimise avoidable stressors; and access to quality resources is a preventative measure for supporting future generations and communities from addictive predispositions. Within the family and child services however, it appears a TICP framework is yet to be introduced. However, the introduction of a TICP framework in family and child services remains limited. Wall et al. (2016) highlight a lack of uniform training and education to ensure adherence to TICP principles, insufficient commitment from stakeholders to adopt trauma-informed frameworks not tied to policy, and concerns regarding fragmented responses that may inadvertently retraumatise individuals (McNaughton et al., 2022; Bateman et al., 2014).


Although there is no universal definition or model of TICP, the Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) guidelines have been adopted as an overarching framework in many human service and health-related contexts in Australia and abroad (Kezelman & Stavropoulos, 2019; Bateman et al., 2014).

 

The Mental Health Coordinating Council (MHCC) provides a free Trauma-Informed Care and Practice Organisational Toolkit (TICPOT) to assist individuals and organisations in transitioning to trauma-informed workplaces. This comprehensive three-stage resource includes planning, audits, support, and implementation strategies (staff training, screening tools, leadership frameworks, etc.) (MHCC, 2018a; MHCC, 2018b). These resources support the assertion that enhancing service provision through TICP can be cost-effective, incurring no additional operational costs compared to existing programs, while yielding significant savings by addressing the impact of unmitigated trauma (Bateman et al., 2014).


Annual trauma-related costs are estimated between $6.8 billion and $24 billion for unaddressed childhood trauma and abuse, which encompasses conditions such as depression, suicide (and attempts), alcohol abuse, and eating disorders (Kezelman et al., 2015). Additional costs include over $1 billion for acute stress disorder (ASD) and post-traumatic stress disorder (PTSD), due to higher service costs for hospitalisation (Phoenix Australia, 2022); $6 billion to $36 billion for workplace harassment (Human Rights Commission, n.d.); $15.6 billion for violence against women and children (Department of Social Services, 2022); $7.2 billion for school bullying (Le et al., 2021); and $43 billion to $70 billion for mental illness and suicide prevention (Department of Health, 2022).


These figures indicate a critical need to adopt trauma-informed approaches across human services in Australia to achieve long-term savings while addressing the intergenerational impacts of trauma. The extensive costs associated with unaddressed trauma stem from the profound ways in which adverse events affect individuals and their significant others. These impacts create unsustainable demands on both direct and indirect support services and contribute to productivity losses that extend to the human services workforce, manifesting as burnout, vicarious trauma, bullying, harassment from overstressed colleagues, and exposure to abuse or violence from service users (Donaldson, 2018).


See Part 3 to continue reading...



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