Trauma-Responsive Organisations

The Trauma Ecology Model

Daryl Mahon

• Publisher: Emerald Publishing Limited
• Year: 2022
• Print ISBN: 9781803824307
• eBook ISBN: 9781803824314
• Topic: Social Sciences
• Subtopic: Leadership
• Index: Social Sciences

Practitioners, organisations and policy makers in health and social care settings are increasingly recognising the need for trauma-informed approaches in organisational settings, with morbidity and financial burdens being of growing concern. Servant leadership has a unique focus on emotional healing, service to others as the first priority, in addition to the growth, well-being and personal and professional development of key stakeholders.

Mahon provides a 'how to' approach to the systematic implementation of the Trauma Ecology Model for those working in both trauma specific, and non-specific organisations. He goes beyond the idea of trauma-informed care principles only, and seeks to incorporate trauma responsiveness at all levels, including leadership, supervision, treatment, through an implementation framework. Unique to this approach is the focus on servant leadership, the first of its kind. Servant leadership is used as the foundation to operationalize several of the six principles of trauma-informed care, making organizations a safer and healthier environment for employees and service users.

1

TRAUMA-INFORMED APPROACHES IN ORGANISATIONS: THE TRAUMA ECOLOGY MODEL

Daryl Mahon

CHAPTER LEARNING OUTCOMES

(1) Understand the prevalence and impact of trauma

(2) Examine how organisations can be responsive to trauma survivors needs

ABSTRACT

In this chapter, an overview of the trauma-informed approach is described. The background and context to trauma, its impact on the person, and organisational responses are considered. More specifically, I distinguish between trauma specific and non-specific organisations by defining the characteristic of each. This chapter sets the tone for the remainder of the book by introducing a conceptual model for both specific and non-specific trauma organisations. In order to do this, I outline the differential components that are deemed necessary for organisations to be trauma-responsive; in doing so, I introduce the Trauma Ecology Model to the literature, outlining its various components.

Keywords: Trauma-informed care; implementation; ACEs; Trauma Ecology Model; adversity; organisational context

INTRODUCTION

The genesis of trauma-informed approaches in research terms can be traced back to the Adverse Childhood Experiences (ACEs) research study. This large retrospective study investigated the correlation between childhood trauma and subsequent health in 17,000 adults. Findings suggest that ACEs impact all aspects of a person’s wellbeing, such as physical, mental and emotional health, and possibly reduce life expectancy (Felitti et al., 1998; Shonkoff, Garner, the Committee on Psychosocial Aspects of Child and Family Health, the Committee on Early Childhood, Adoption, and Dependent Care, & the Section on Developmental and Behavioral Pediatrics, 2012) . The study was mainly carried out with White middle-class Americans, which may impact generalisability. Childhood trauma was found to be a common occurrence with 30% disclosing substance use in the home; 25% reported sexual abuse; 27% reported physical abuse; 9% neglect, and 17% reporting experiencing emotional neglect. The impact of traumatic stress can be devastating and long-lasting, interfering with a person’s sense of safety, ability to self-regulate, sense of self, perception of control and self-efficacy and interpersonal relationships (Hopper, Bassuk, & Olivet, 2010).

Traumatic experiences are said to have a cumulative impact on the individual insofar as the more experiences a person has been exposed to, the more likely they are to have poor physical and mental health problems. Survivors of childhood trauma are more likely to have poor health outcomes and draw on differential medical treatments and resources (Read, Hammersley, & Rudegeair, 2007; Shevlin, Housten, Dorahy, & Adamson, 2008). Survivors of trauma, especially during childhood, are significantly more likely to experience health issues such as chronic lung, heart and liver disease as well as depression, sexually transmitted diseases, tobacco, alcohol and substance use throughout life.

Childhood trauma is also linked to increase social service costs (Centers for Disease Control and Prevention, 2012; Hughes et al., 2017) and premature mortality (Rogers, Power, & Pinto Pererira, 2019). As such, healthcare systems and policy makers are increasingly recognising the need to have trauma-informed and responsive organisations. No universal definition of trauma exists, as such, practitioners and organisations may have their own conceptualisations. However, the following popular definition is provided by SAMHSA (2014, p. 2):

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

Both the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Disorders (ICD-11) have reorientated their attention on the definition and recognition of trauma and its effects. In the DSM-5, trauma is understood as being triggered by external traumatic stimuli, especifically exposure to actual or threatened death, serious injury or sexual violence through direct or indirect experiencing or witnessing of the event/s (American Psychiatric Association, 2013). At the same time, the ICD-11 goes further and includes complex post-traumatic stress disorder (C-PTSD) as a new category (Karatzias et al., 2018). To be ‘diagnosed’ with C-PTSD, an individual needs to meet all criteria for PTSD in addition to difficulties that affect regulation, self-concept, relationships, and attachments. However, this book and indeed trauma-informed care go beyond this diagnosis or the pathologising of individuals. Another way to think about PTSD and C-PTSD, especially if like many others, using disorder specific diagnoses does not sit with your beliefs around trauma and the inappropriateness of pathologising trauma with a diagnosis, is to use Type 1 and Type 2 categorisations, see Table 1.

Table 1. Types of Traumas.

Type of Trauma	Description
Single incident trauma	Single incident trauma (Type 1) trauma is generally a single event that involves witnessing or experiencing an event that involves threat of serious injury or death. For example, natural disasters, accidents, or one-off incidents such as an assault
Complex trauma	Complex trauma (Type 2), on the other hand, involves prolonged and repeated experiences of trauma, abuse, or neglect, often referred to as complex trauma. This usually occurs in interpersonal relationships
Secondary trauma	Secondary trauma is defined as indirect exposure to trauma through a first-hand account or narrative of a traumatic event. The vivid recounting of trauma by the survivor and the clinician’s subsequent cognitive or emotional representation of that event may result in a set of symptoms and reactions that parallel PTSD. Secondary trauma is very often experienced by professionals working in organisation who provide services to those who have experiences trauma
Intergenerational trauma	Intergenerational trauma – sometimes referred to as transgenerational trauma – is a term that is used to describe the impact of a traumatic experience, not only on one generation, but on subsequent generations after the event
Source: Adapted from SAMHSA (2014).

It is important to note that the above-mentioned nomenclature fails to account for the possible social causes of trauma, for example, poverty, marginalisation, and racism. C-PTSD may be more prevalent, and as such, persons with multiple trauma incidences may be overrepresented in accessing care in health and social care organisations. While I don’t propose that all people with mental health difficulties have experienced trauma, a large percent will have, and as such becoming trauma informed as a standard service delivery model will benefit those who have experienced trauma (Filson, 2016).

While it is important to acknowledge and be responsive to trauma, it is equally important to realise that not everyone who accesses services has experienced trauma. It is also essential to understand that even those who have experienced traumatic encounters will not develop mental health or other psychological problems. Indeed, many people who have experienced trauma can go on to experience Post-Traumatic Growth, a rather positive experience involving positive changes. As such, I tend to agree with Sweeney and Taggart (2018) position that it is important not to replace one dogma (bio-medical model), with another (trauma informed), as this removes the ability for people to individualise their experiences and the explanations that fit their narratives. At the same time, many factors can impact on trauma, and contemporary research suggests that where trauma undermines important valued social identities trauma and can be experienced as more pronounced. Conversely, where such identities can be maintained or enhanced, it can act as a protective factor (Muldoon et al., 2019).

Thus, viewing all adverse experiences through a pathological trauma lens are largely unhelpful, and it is as dogmatic as the other ideologies that it is attempting to upsurge.

WHAT IS TRAUMA-INFORMED APPROACHES?

There are several definitions of trauma-informed approaches in the literature (Fallot & Harris, 2001; Gerrity & Folcarelli, 2008; Harris & Fallot, 2001; Hopper et al., 2010; Substance Abuse and Mental Health Services Administration, 2014). In this book, a working definition is used from SAMHSA (2014, p. 9):

A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.

From the above definition, trauma-informed approaches seek to change the culture within an organisation. Although many speak about trauma-informed approaches in relation to the six principles (Table 2), trauma-informed approaches go far beyond six principles that stand in isolation. Trauma-informed approaches seek to establish system-wide cultures that are trauma-informed and embedded throughout governance, leadership, policy, and practice contexts. It is this system-wide implementation that this book is concerned with in all its components, including specific and non-specific trauma organisations.

Table 2. Trauma-Informed Approach Principles.

Si...

Table of contents

• Cover
• Title
• Introduction
• 1. Trauma-Informed Approaches in Organisations: The Trauma Ecology Model
• 2. Servant Leadership: It Really is Trauma Informed
• 3. Servant Leadership Supervision in Trauma-Responsive Organisations
• 4. Servant Leadership-Informed Peer Support
• 5. Diverse, Intersecting and Multicultural Considerations in Trauma-Responsive Organisations
• 6. Trauma Screening and Assessments: Considerations for Specific and Non-Specific Trauma Services
• 7. Providing Choice and Preferences to Service Users Accessing Trauma Treatment: A Multicultural Lens
• 8. Co-production in Trauma-responsive Organisations
• 9. Developing a Trauma-responsive Organisation: An Implementation Science Approach
• Index