Get Real Quick Takes: What is Trauma-informed Practice?

What is trauma-informed practice? Learn how trauma is defined and understood, and strategies for helping. This podcast is part of ermha365's Skills for Support Workers training podcasts, available on our website and produced  part of the Developing the growing new NDIS (psychosocial disability) Workforce Project supported by the Victorian Government. In this episode, peer support workers Tamara and Charlotte share how you may recognise when a person has a history of complex trauma and how to respond.

ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.

If you have been affected by anything discussed in this episode you can contact:
Lifeline on 13 11 14
13 YARN on 13 92 76 (24/7 crisis support for Aboriginal and Torres Strait Islander peoples)

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All content © 2023 Get Real: Talking mental health & disability.

Transcript

ermha365: 0:00

Get Real is recorded on the unseeded lands of the and Wurundjeri peoples of the Kulin Nation. We acknowledge and pay our respects to their elders, past and present. We also acknowledge that the first peoples of Australia are the first storytellers, the first artists and the first creators of culture, and we celebrate their enduring connections to country, knowledge and stories.

ermha365: 0:27

We recognise people with lived experience of mental ill health and disability, as well as their families and carers. We recognise their strength, courage and unique perspective as a vital contribution to this podcast so we can learn, grow and achieve better outcomes together.

Robyn : 0:49

Welcome to Get Real Talking Mental Health and Disability. You're listening to Skills for Support Workers, a special podcast series to build your knowledge and skills. What is trauma-informed practice? To break this down, Ellen Maple chats with Margie, Tamara and Charlotte. You'll hear from two people with lived experience of trauma and their approach to supporting others. You'll learn how trauma is defined and understood and strategies for helping. Tamara and Charlotte share how you may recognise when a person has a history of complex trauma and how to respond.

Ellen: 1:24

Hello, my name is Ellen Maple. I would like to acknowledge and pay my respects to the original custodians of this land, to elders, past and present and emerging, on whose country this recording is taking place and of wherever you are listening to us from. Today we're talking about trauma-informed practice. We'll be defining that for you, giving you some stories and examples of what that might look like in practice and hopefully giving you some tips to take away when you're working in a trauma-informed way or trying to build your own trauma-informed practices as a community support worker. So today we're talking about trauma-informed practice. With me here I've got Margie Saugill, a PhD student at Monash University, and Tamara Stilwell, who's a person with many range of experiences. I'll let her introduce herself. Margie, I'm wondering if you could help get us going today by giving us a bit of a definition of what trauma-informed practice is.

Margie: 2:15

My experience with trauma-informed practice, or understanding of it, would be that it's a strength-based approach and it is recognising that people experience trauma throughout their life. significantly, a lot of people may have experienced in childhood and it affects the person and we need to understand the crisis or their mental health issues that they're currently experiencing may be impacted upon due to the past trauma and understanding how what's happening now is being impacted by that as well. So it can be around modifying our practice to be able to support those people the best way we can.

Ellen: 2:54

So, essentially, trauma-informed practice is a practice model. So it's about what we do when we're working with people who may have experienced trauma in their life. Absolutely Does it mean you have to understand and know all about the trauma the person's experienced?

Margie: 3:08

No, i don't think it does, and it certainly doesn't mean that you need to go into any great detail about the experience of trauma that they have had. It's more identifying how our practice can impact on it, whether you're in the community or in a hospital as I work, how the other structures that are surrounding that person are impacting on what's going on at the moment, and how we can adapt our practice to be more understanding and more focused on supporting them in a really conducive way to making their situation better.

Ellen: 3:44

Okay, so we're trying to support people and understand the structures that surround them. So those structures are probably what things that are happening to them that they can't control. Sometimes Maybe they're living circumstances, maybe poverty, maybe family violence or histories of abuse, or being disempowered by, even sometimes even by people who are meant to be there to help us, like doctors or other health professionals. Perhaps Are they the kind of structures that you're referring to.

Margie: 4:10

Definitely, for example, in the hospital context. When somebody goes into a hospital system, all of a sudden they're bounded by a different set of rules and regulations that they're not used to and there becomes big power imbalance and that can really impact somebody who's experienced trauma in the past because of the power imbalances that occurred. Then examples may be somebody who's been in a prison system who finds themselves now in hospital can have a traumatic experience related back to that. It may be a female that's experienced sexual abuse as a child really struggles if there's a male case worker in the community or a male nurse having to attend to personal care. So they're just a couple of examples of multiple things that can impact on somebody's current situation.

Ellen: 5:02

So the thing that causes the trauma might be having a lack of choice, lack of control of their environment. So use the example of prison and how coming to hospital might feel a bit like prison if you don't get to choose the food you eat and the routine and the sounds and those kinds of things that can bring back memories of times when people didn't have choice or control over what's happening to them.

Margie: 5:24

in those moments That can really trigger a person and it can impact their emotions. It can impact their behaviors, which becomes very difficult for people to manage. But once we have that appreciation of what is actually happening for that person, it allows us to better help that person.

Ellen: 5:42

So you just mentioned by having a better understanding of what's happening with that person. I'm wondering how do we do trauma informed practice? What does that mean for me? How do I know if I'm being trauma informed when I go out to deliver my support to somebody that I'm there to help?

Tamara: 5:57

I think one of the key things with trauma informed practice is having a good understanding of how trauma can transpire with an individual. So we look at that sort of in this sense of emotional, physical A lot of people end up with secondary sort of physical symptoms stomach aches, aches and pains, those types of things Behaviorally, how that person is dealing with the situation cognitive functioning can also be impaired or changed And looking at existential, which is really around that belief system And it might have somebody who starts really believing that the world is a very unsafe place or they might gravitate back towards religion in a heavy sense that if I pray more, if I'm really good, bad things will happen to me. So when we start looking at the way that behaviors will transpire in the individual, we have a better understanding of how we work delicately with that person. To get sort of some of this information you can get the trauma informed guidelines off of the Blue Knot Foundation and you can download it free as a PDF which gives you a sheet of sort of how different symptoms can transpire out of trauma and complex trauma.

Tamara: 7:10

But I think about as a practitioner. I had a woman that I was working with who was also attending some of our group sessions and she had poor body hygiene and I was asked by a few of the people in the group if I could actually talk to her about her lack of body hygiene. And, as you can imagine, this was not an easy conversation. And in sort of delicately, sort of exploring this with this woman, she was actually quite aware of the fact that she had poor body hygiene But because of her traumatic experiences she found actually the process of getting naked, having a shower and touching herself to clean unbearable, so she stopped doing that. So, just having that insight there, i didn't have to learn extensively about what happened to her, but we were able to sort of talk about strategies in which she might be able to keep herself clean. That wasn't going to trigger the really negative emotions that brought all that trauma back up for her. I think certainly working in that trauma informed atmosphere is really trying to think about what might be motivating this person's behavior. We need to be conscientious about not prying into somebody's trauma, especially when somebody is not comfortable with telling us about that trauma, and we also need to be careful, as support workers too, that we're not getting inundated by stories of people's traumas. We need to know that we're not trauma trained psychologists to deal with that trauma from a resolving the trauma. We're really there to be trauma informed, to help them come with strategies to build capacity so does not further triggering them, are working within what they're comfortable with.

Tamara: 8:57

I know for myself I have a trauma based disorder. One of the big triggers for me was if I was feeling quite unsafe was quite natural for me to sit down on the floor And often move myself into kind of a small space, so you know, between a wall in a bookcase and not behind the bookcase. But just to try to find a small place where I felt protected And to have workers in the system stand over me was very threatening. So it really helped if somebody could actually just get down on the floor with me and talk to me until I felt safe.

Tamara: 9:30

I had one instance in which I was screamed at in that sort of space trying to feel safe and the woman said you know, get up out of there. If you don't get up out of there, i'm gonna drag you out of there and I'm not doing my back in because of you. So all that did was sort of you know, re traumatize and ignite that trauma. So a lot of it is around our response and, yes, we have to make sure that we're safe and they're safe, but there's a lot more sort of caring, empathetic ways in which we can go around and being creative and having adaptability for the individual to make things work for them.

Ellen: 10:04

Wow, there's just so much you've just given us, then, to think about their time around. Thank you, some big points for me listening to what you've just shared with us, with the idea of emotional responses caused by trauma, that we might see people behaving in emotional ways that seem unusual to the context and maybe they're communicating to us or that's something for us to notice that perhaps the missing piece is past trauma. So we're seeing people's. Sometimes you hear what terms like emotional dysregulation, which is just a fancy way of saying people's emotions not being matched to the circumstance, so they might be laughing in times when they went. Perhaps everybody else is crying and it's quite sad, or they're crying unpredictably or very excited about things that exciting from from our perspective.

Ellen: 10:45

We're making some judgments there, but it seems out of context. So maybe some of those behaviors are happening. Sometimes they lead to a diagnosis of a mental illness, but sometimes it can also be because of the situation of passing that happened. That could be triggering matters well, which is really interesting. And in terms of the question around how do we do trauma informed practice, a lot of what I heard you describe them was about pace, was about, you know, connecting where the person is paying attention, slowing down and up to notice what's happening and perhaps an attitude of curiosity. So not knowing is okay, but being curious is important, because you're not necessarily inviting the answers that what's happening, but you're just aware there could be things that you don't know but impacting on that person in that moment.

Tamara: 11:30

Obviously being thoughtful in the sense of asking questions to the person. You seem quite distressed. Is there anything I can do to help you right now? What do you need? some of those really simple baseline questions that allow people to realize that they're with someone that's safe, so not somebody's not going to force them to do anything. Of course you know, sometimes we have to take action if somebody is an immediate physical danger or danger to somebody else. But usually on our role, that is the exception and not the sort of the norm. Sometimes it is allowing that space, explanation, thinking why this person might be acting this way and asking them you're laughing, can you talk to me about what's happening for you? so it's again not what's funny, but what's happening for you. That might be a response of when I get really nervous. I laugh because they don't know what to do, and that's quite actually a common response for somebody who has experienced trauma, and then you might next question might be what is it that's making you nervous right now?

Ellen: 12:33

and maybe that's the thing to keep uncovering?

Tamara: 12:35

Yeah, absolutely, and you know, is that something that we can work through? can we remove what's triggering?

Ellen: 12:40

you know how do we tolerate it, whatever the strategy might be that you work towards. Thanks for that, margie. your work predominantly has been in a hospital setting and we know the people we support in the end. I S interact with hospitals for a whole range of different reasons, whether it's through the psychiatric ward, through accidents, emergencies, just general health problems. often that's a vulnerable group. When you're working with people in that hospital environment, how are you able to recognize or know when they might be bringing with them past experience of trauma?

Margie: 13:09

We don't always know A lot of the information we'd probably get from an NDIS worker if they've got a community case worker And sometimes they have had past hospital admissions.

Margie: 13:21

So we have previous notes, that sort of talk about trauma, that make us aware of their past history, so we don't have to ask that question again and again.

Margie: 13:30

I think that's one of the frustrating things people who come into hospital deal with is being asked the same question over and over, especially If it's having to repeat something that was traumatic to them and if they're currently being triggered as well, that may lead to a crisis that leads to the hospital admission. That can also be retraumatising to have to go back and visit that again and again. But I think that the flip side of that is sometimes we don't know that they've experienced trauma. But I think through experience working in the area, through reading education, that there's typical themes that might come up for people that have experienced trauma. For example, people who've had past trauma or neglect often feel that they haven't been validated. So it's very important to be able to sit and listen and validate that experience for them now, because if they're coming into the hospital environment or even if they are in the community and people aren't believing them or doubting them. That is also very triggering for a person and can really be distressing.

Ellen: 14:37

We hear again. That's an unworthy view. They're validated, which some people who have been working in the field something that we hear a lot of people who are new might not know quite what that means. But essentially we're talking about usually we say that we're believing people when they say things And people are telling us that this happened, that we first of all assume that it's correct, that what they're saying is the truth. That's our first assumption. But the other part of validation, i think too, is validating and noticing the emotional state that that theme presented to you with. So it might not just be you're talking about. You know, i believe that you were assaulted and you also seem really frightened. How can I help you feel safe in this moment? So it's more than just believing what's said, but it's also hearing the way that it's said and noticing the impact that's having on the person too. That's right.

Margie: 15:22

And acknowledging that it is very distressing. It is very hard. It's about sitting with that person and taking the time to listen.

Ellen: 15:31

Charlotte, tell us a little bit about how you became to be a peer worker at Irma.

Charlotte: 15:35

First off in my journey, i was an Irma consumer through the MHCSS program.

Ellen: 15:42

That's the Mental Health Community Support Services. So really having sort of outreach support.

Charlotte: 15:47

I was offered the opportunity to work with a peer worker at the time as well, which greatly helped my journey to becoming a with ermha with and doing my certificate for working ermha as as well, And fortunately I was offered a job as a peer worker in the PSS team, the Psycho-Social Services, and have been here for the last eight months Amazing and doing some wonderful things while you've been here as well, Thank you.

Ellen: 16:14

So today we're talking about trauma. To start us off, I thought it would be great to hear your own definition of how you view trauma in your work.

Charlotte: 16:21

There's a few aspects to trauma, so to me, it's ensuring physical and emotional safety for all that are involved in the situation at the time, gaining some trust with the client so that's being consistent and respectful and professional, and keeping those professional boundaries in place so that everyone's clear on what's going on. I offer choices to the people that I work with as well, so what they are asking for in their journey, what type of support they're requiring from me whether that's just a phone call or more in-depth, detailed conversation and support it's up to the consumer. Also, working in collaboration with other support workers that are working with consumers and making sure that everybody is on the same page, it's a really big thing for me to collaborate with a consumer as well as a support facilitator to make sure that everyone knows what they're doing to help support a particular client.

Ellen: 17:21

I'm wondering about the uniqueness of your role as a peer worker and how that might work differently in terms of trauma-informed approach when you work with somebody who's experienced trauma. We're using the word trauma willy-nilly here and we haven't yet quite defined it, but my understanding of trauma is essentially an event in your life or a series of events that cause you some psychological harm in some way. So it's a diagnosable level of harm that impacts your life and it can be connected to a whole range of different things, often associated with anxiety disorders, some personality disorders and the like. Being a peer worker, there's an assumption. I think sometimes It's my assumption working in mental health that anybody who I work with that has a diagnosis of mental illness or mental disability that's receiving our support has probably experienced trauma in some way, shape or form. I might not know what it is, but I can almost expect to find it one day, and I therefore take that approach with people. Being a peer worker, there's a sense. You know what does that mean for you in your work and relationship with people?

Charlotte: 18:26

When I'm working with people and I explain to them my role as a peer worker and then I come from my own experience they tend to open up to me about what is bothering them and what has happened, So I can sit with them and be like I've been there too.

Charlotte: 18:45

I understand what you're saying. I understand the emotions you're going through and the lack of motivation, Everything you're telling me. I hear you and I've seen physical, seen clients just that weight lift off their shoulders, being able to share with someone that knows what they've gone through because they've been there too. For me, that helps to open up that trust and that respect, because we both know that there's we've both had trauma so we can hold hands, guiding each other through the journey, rather than pushing someone from behind or walking in front of them and walking beside them through this And you've received specialist training about how you do that as a peer worker and when you would do it and when it's appropriate to disclose or not disclose, almost the last, absolutely Disclose what not to, as a self preservation as well as a preservation and not retraumatising our clients as well, absolutely So it's just professional boundaries we've had in place.

Ellen: 19:44

So I'm hearing you talk about having the peer worker role, being able to accelerate trust, because the way that you hear people, people feel heard much more quickly from you because they know you've been there, they feel seen, that you know, i hear you, i see you, is really a big deal for people And I think, for the non-peer workers listening. I think there's something in that too that people aren't going to assume that they, that you have the experience they've had. So you have to work really hard to make sure people know that you hear them, that you see them and that it's going to be okay.

Charlotte: 20:18

Absolutely, And when that. when that does happen with consumers, I've found that they like to ask questions about how I have come to where I am now and what strategies and counselling and things that I've done to actually help myself so that they could potentially try those things themselves.

Ellen: 20:39

It's almost like you're further down the journey, but on the same journey, absolutely.

Charlotte: 20:43

And we're just sharing the toolbox. Amazing, absolutely Share the toolbox, great.

Ellen: 20:49

I wonder if we can just figure out two or three takeaway. you know tools for the toolbox, or strategies or things that you do in your role Do you think are really important for trauma-informed work?

Charlotte: 20:59

I like to build on mutual experiences that myself and the consumers I work with have. So not necessarily the whole scenario, but the emotions and the, the mental, the thoughts that make make be experienced is. It's a mutual experience that we can share and converse over And this is how I've worked it If you tried this, if you tried that, and we both can share our toolbox and strategies and coping skills. And my biggest thing is to just listen and not not necessarily to respond, but for the client to be heard and hear all of what they've got to say. It's the biggest tool in the kit.

Ellen: 21:40

Yeah, just listening, it's such a. It's so powerful, so overused as a word, but I don't think we can really undersell it. It's just such an important strategy to just you know we have two ears, one mouth, as the saying goes. Just listen before you speak, absolutely.

Charlotte: 21:56

Absolutely, absolutely. So that's they're my. They're my main things is when, when I'm working with somebody is definitely listen, listen. It's the biggest thing that you can do And it's the biggest, biggest gift that you can give somebody that really needs to be heard.

Ellen: 22:12

And a strategy worth practicing.

Charlotte: 22:13

Absolutely.

Ellen: 22:14

And that you probably need to come back to regularly. Am I listening well enough?

ermha365: 22:20

If you've been affected by anything discussed in this podcast, you can phone Lifeline on 131114 or go to lifeline dot org au.

Robyn : 22:32

You've been listening to Get Real talking mental health and disability brought to you by the team at erma365. Thanks for listening and we'll see you next time.