Trauma Informed Care in Occupational Therapy
Terms like trauma-informed care, trauma-responsive care, and healing centered care have gained real popularity on social media and out in the world in the last several years. I think the public discourse about trauma is, in some ways, so helpful- allowing people to see they are not alone, the experiences they have that leave them physically or emotionally hurt, uncomfortable, and questioning themselves are harmful and can be described with this one word that others understand. In other ways, I think there is a risk of watering down the definition when we become less able or less attuned to the nuance involved with an idea as broad as “trauma.” For those of us who work with or care for traumatized children, I think doing a deeper dive is essential.
Defining Trauma
Dr. Bruce Perry is a leading expert in the field of childhood trauma. He describes trauma as an experience or circumstance that overwhelms a person’s ability to cope. Trauma is what happens when, after an event, the child is not able to return to their baseline state- their body, emotions and thoughts become “dysregulated” and they need support to re-regulate them.
There are immediate, acute responses to trauma such as an elevated or depressed heart rate and breathing rate, dilation of the pupils, changes in skin tone and perspiration. The prevailing emotions might be fear or terror and it may become difficult to think clearly or at all.
In my practice, it’s been most helpful for me to move away from thinking about trauma as a certain type of specific event and more as the child’s response to an experience. When I started working as an OT, I leaned on my training and thought a child was “traumatized” if they had experienced an event from a list of “traumas”- a car accident, an assault, neglect or abuse, a natural disaster, etc. The list seemed endless but at the same time was discrete- these things = trauma. I learned over time, from people like Bruce Perry, that trauma is in the response more than in the event. Two children could experience the same exact event and come out the other side with vastly different responses. One child might experience abuse and become resilient, strong, and have a clear sense of how they want to treat others because they know what it’s like to be treated badly. Another child might experience the same abuse and become chronically anxious, have difficulties building relationships, and be emotionally volatile. It became clear that I had to think about each individual child’s experience and how that experience changed them. It didn’t matter if what they went through was on the “list of traumas” or not- if they experienced ongoing symptoms, they were “traumatized” and would benefit from trauma-responsive intervention.
There are also long-term effects of trauma. The ACEs study provided us with evidence at the population level that when people are exposed to high levels of stress in childhood, their risk of poor health outcomes such as heart disease, diabetes, substance abuse disorder, mental illness, and early death etc. increases dramatically in adulthood compared to the population of people who have fewer or no adverse experiences as children.
At the individual level, we also see impacts of prolonged exposure to adversity. In working with hundreds of traumatized children over the last 12 years, I have directly observed the challenges with sensory regulation, emotion regulation, social relationships, and memory and learning that stem from early trauma. The brains and nervous systems of children who experience overwhelming stress in their early years change in response to that stress.
What is Trauma Informed Care?
Trauma informed or trauma responsive care is the structural attempt to create systems and environments that are respectful of one’s trauma experience. The National Child Traumatic Stress Network defines a trauma-informed child and family service system as “one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers.” They outline 7 key components of a trauma informed system
Visual: NCTSN
“Routinely screen for trauma exposure and related symptoms.
Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms.
Make resources available to children, families, and providers on trauma exposure, its impact, and treatment.
Engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma.
Address parent and caregiver trauma and its impact on the family system.
Emphasize continuity of care and collaboration across child-service systems.
Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.”
This list is full of actions- do screenings, provide access to treatment and resource, engage in efforts to strengthen, address parents and caregivers… I use the terms “trauma responsive” to better describe the action associated with this type of care. Creating systems to best facilitate healing takes more than just information, it requires careful and evidence informed action.
How can OTs be trauma responsive?
Occupational therapists are charged with supporting people of all ages to do the things they want to do and need to do in a way that is satisfying to them. We use meaningful activities to engage our clients and bring about healing and growth. In my work, I almost exclusively work with traumatized children so trauma-responsive work is essential and, at this point, not something I could “remove” because it is the backbone of my practice.
Here are some of the ways I have made my practice as a therapist, consultant, and administrator trauma responsive
Screenings and Assessments: I utilize tools such as the ACE screener, Neurosequential Model of Therapeutics Metric, and various general and specific questions about a child’s experience to understand my client’s early experiences.
Education: I discuss with families and children how stress impacts the developing brain, using kid-friendly language to make this information accessible.
Providing Resources: I tailor resources to families based on their readiness, offering articles, videos, or thoughtful conversations at the pace and depth families are ready for.
Continuing Education: I do a lot of continuing education about trauma, child development, and occupational therapy to stay informed and provide the best options for my clients.
Self-Monitoring: I remain vigilant for signs of vicarious stress when working with heavy cases, ensuring I maintain strong boundaries regarding time off and access to my availability.
Collaboration: I build relationships with colleagues to enhance our understanding of shared cases and provide spaces for processing the emotional weight of trauma-focused work.
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The information provided on this blog is for informational purposes only. It is not intended to assess, diagnose, treat, or prevent any medical or mental health conditions. The content shared on this site should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental health professional, or other qualified healthcare provider with any questions you may have regarding a medical or psychological condition. Never disregard professional advice or delay seeking it because of something you have read on this blog.
