Positive Approaches Journal, Volume 13, Issue 1

Volume 13 ► Issue 1 ► June 2024

The Importance of Place in Trauma-Informed Care: A Wellness Approach

John Thvedt & Christine Martin

Abstract

This article delves into the synergy between trauma-informed care and positive supports, framed within a wellness perspective. Trauma-informed care emphasizes creating healing environments, while positive supports focus on strengths and resilience. By merging these approaches, practitioners can bolster interventions for trauma-affected individuals. Key principles and strategies for implementing a wellness-oriented approach to trauma-informed care are discussed, emphasizing collaboration, empowerment, and self-care for both providers and recipients. 

Keywords: Trauma-informed care, positive supports, wellness, empowerment, collaboration, self-care, mindfulness, polyvagal theory.

Temple Grandin has expressed how emotions tie to specific places, highlighting the significant impact of environments on individuals, especially those with autism and/or individuals with intellectual and developmental disabilities (IDD). Most of us have fond memories of happy times in a positive environment. Difficult events are also remembered as a picture of the place and time. People, places, and things create our life stories. Whether places are remembered with happy or sad associations, they generally do not impact our daily lives. However, for the significant number of individuals with autism and/or IDD who have a trauma history, the physical environment can significantly impact their reactions, motivations, and fears, causing acting out behavior. These incidents often lead the individual and those who support and care for them into confusion and despair.

Introduction

Throughout the history of the human service system in our efforts to help, the place of service and the environment has been a significant factor. When we sought to treat and to protect people with disabilities, they were placed in an institution. When we believed that we needed to train people in production, workshops were created. As we learned more, we embraced the concepts of normalization, inclusion, and individual rights, as community living arrangements were developed. As we now begin to understand the significant impact of trauma on people’s lives, and the crisis in our workforce and communities, we should consider the need to create inclusive environments that will support peace and reduce potential triggers or conditions that may cause re-traumatization.

Trauma victims experience triggering memories in certain places, leading to disruptive behaviors. While Functional Behavior Analysis (FBA) dominates as best practice for autism and IDD, the analysis becomes more complex when seeking to understand the problematic behavior of an individual who has experienced trauma. We need to acknowledge that a behavior that is a function of post-traumatic stress may serve NO useful function (other than survival) for the person. It may be a visceral reaction based on an altered stress-response system, leading to dysregulation of processes such as heart rate variability, digestion, and immune function (Dale, et.al. 2022).

When teaching individuals replacement skills to manage triggered responses, wellness and mindfulness approaches have emerged as complementary, strength-based, positive supports. The concept of "Setting Events," frequently used in behavioral psychology, refers to situational factors that can influence behavior. People can be triggered by places, sounds, and odors. These associations with environments often trigger a "flight or fight" response. As we look to support people who have experienced so much trauma in their lives, it is vitally important that we create environments where setting events are identified and addressed/reduced as much as possible.

Polyvagal Theory emphasizes the physiological aspect of trauma healing, suggesting that safety cues are pivotal in mitigating trauma's impact. Safety, in this context, isn't just the absence of threat, but encompasses a sense of safety detected through positive social cues. Additionally, the theory underscores how trauma alters physiological responses, emphasizing the importance of creating safe, supportive environments.

Mindfulness-based practices represent a promising approach for addressing aggressive and destructive behaviors in individuals with an intellectual disability and autism (ID/A). These interventions not only reduce challenging behaviors, but also significantly enhance the quality of life, offering a holistic alternative to traditional treatments. Mindfulness and acceptance training programs can significantly improve the quality of life for individuals with developmental disabilities and their families (Hastings, R., & Manikam, R. 2013). Mindfulness is “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment by moment” (Kabat-Zinn,2003).

Resilience, vital in navigating life's challenges, is nurtured through wellness practices. Acknowledgement that supporters may have a trauma history is important when attempting to “support the supporters.” Direct care providers need resources to prioritize self-care so that they can maintain the quality of service they provide. Trauma informed care includes the need for shared wellness for all stakeholders.

Ultimately, the goal of supporting individuals with ID/A is to enhance their well-being while recognizing and addressing the impact of trauma on both individuals and supporters. This approach emphasizes understanding environmental factors and psychological dynamics for all involved parties. Shared Wellness is an example of how person, place, and relationships are served, resulting from the practical integration of trauma informed care, behavior analysis, mindfulness, and polyvagal theory. Shared Wellness, a project under the umbrella of Shared Support South (SSS), is located in Hatfield, Montgomery County. Shared Wellness provides essential services to individuals with intellectual disabilities (ID) and extends its reach to various community populations facing challenges.

Principles of a Wellness-Oriented Approach to Trauma-Informed Care:

The core principles included in the Shared Wellness philosophy include:

Strategies for Implementation:

The center is dedicated to wellness approaches that can have a transformative impact on trauma-informed care by providing a supportive environment that prioritizes healing, resilience, and holistic well-being. Shared Wellness serves as a safe and empowering space where individuals affected by trauma can access comprehensive services and supports tailored to their unique needs.

An example schedule for an individual would be the following:

Conclusion

A wellness-oriented approach to trauma-informed care, within the context of positive supports, offers a holistic and empowering framework for promoting healing, resilience, and well-being among individuals affected by trauma. By integrating principles of empowerment, collaboration, and self-care, practitioners can enhance the effectiveness and sustainability of interventions, while honoring individuals' strengths, dignity, and inherent capacity for growth and recovery. Moving forward, continued research, training, and implementation efforts are needed to advance this approach and ensure that all individuals have access to trauma-informed care that supports their holistic wellness and flourishment.

Setting events are places and/or inner spaces deeply embedded within cultural contexts, shaped by norms, values, and beliefs, that influence individuals' experiences and responses to trauma. Culturally competent trauma-informed care acknowledges the diversity of settings and recognizes the impact of culture on individuals' coping mechanisms, help-seeking behaviors, and healing practices. 

Incorporating these places into trauma-informed care requires practitioners to adopt a comprehensive approach that considers the physical, social, and cultural dimensions of individuals' environments. This may involve conducting thorough assessments, collaborating with individuals to identify triggers and coping strategies, and creating supportive environments that prioritize safety, trust, and empowerment. By addressing setting events (i.e., places and/or inner spaces) within the context of trauma-informed care, practitioners can enhance the effectiveness and relevance of interventions, ultimately promoting healing, resilience, and holistic well-being for individuals affected by trauma, to improve their everyday lives.