Trauma, often called mental trauma or psycho-trauma, is an emotional reaction to a painful incident or set of events, such as car accidents, rape, or natural catastrophes (APA, 2022). Traumatic experiences often elicit a physical, emotional, or psychologically stressful response, although people's subjective experiences vary from person to person, ultimately impacting individual reactions to the same occurrences. In other words, not everyone who experiences a potentially traumatic situation develops psychological trauma, although they may feel distressed and suffer (Storr et al., 2007). However, after experiencing a significant traumatic event or sequence of events, some persons will acquire post-traumatic stress disorder (PTSD) (Forman-Hoffman et al., 2016). This difference in risk rate can be ascribed to protective traits, such as temperamental traits, and environmental traits, like resilience and a readiness to ask for help, that certain people may possess that help them deal with distressing situations (Wingo et al., 2014).
Incidences of trauma have often been reported to result in complex and extensive psychological and physiological consequences. For some people, trauma has long-lasting adverse effects on the individual's ability to function as the mental, physical, social, emotional, or spiritual well-being has been negatively impacted. In contrast, others are more likely to engage in high-risk behaviors like smoking, drinking, using illicit drugs, and having risky sex as a coping mechanism (SAMHSA, 2014). These health and well-being consequences have made it imperative for health and social service providers to gradually realize the importance of incorporating Trauma-Informed Care (TIC) principles into their practice to guarantee survivors' safety, empowerment, choice, and satisfaction of their specific needs so that they can take a more active role in their treatment and rehabilitation (Rosenberg, 2011).
There is a growing awareness that many persons who use human services may have previously experienced trauma and that to respond to such incidents, service delivery approaches may need to change (Mahon, 2022). Trauma-informed (TI) approach consists of various organizational cultures and practices that evaluate the occurrences and influence of trauma on patients and the strategies employed by those healthcare services and professionals to avert further victimization (Emsley et al., 2022). Koetting (2016) described trauma-informed care (TIC) as an evidence-based integrated intervention in healthcare delivery that identifies, reflects, and understands the long-term consequences of traumatic events to the affected individual. Quadara and Hunter (2016) defined TIC as "frameworks and strategies to ensure that the practices, policies, and culture of an organization, and its staff, understand, recognize, and respond to the effects of trauma on client well-being and behavior." In essence, trauma-informed care or service is a strength-based framework that raises providers' knowledge of the effects of trauma, guiding and supervising client-care interventions, actions, and behaviors, giving survivors a chance to regain control and empowerment, and reducing the possibility of re-traumatization (SAMHSA, 2014).
A trauma-informed approach responds to people who have experienced trauma by realizing the effects of the trauma and the potential of recovery, recognizing trauma indicators, and responding to them by integrating policies and procedures that will forestall further revictimization of the said victim (SAMHSA, 2015). Five important anchor points of the trauma-informed approach are safety, trust, choice, collaboration, and empowerment (Shier & Turpin, 2017). The practice of trauma-informed care begins with a mindfulness of the traumatic event and the feeling/response of the individual towards the traumatic event, which is highly reliant on the attitudes and knowledge of service providers. This is affirmed by Baker et al. (2016) position that service providers' attitudes toward TIC are a particularly quantifiable indicator of whether a service is trauma-informed and quality-assured.
Reviews of TIC comprised cross-sectional studies that concentrated on factors connected to TIC attitudes. One such study was conducted by Jacobowitz et al. (2015) with 172 participants in a mental hospital in the United States. They discovered parameters linked to the emergence and mitigation of staff PTSD. In addition, the researchers concluded that employees with more outstanding education were more likely to have attended a recent TIC meeting. In another cross-sectional study, Sundborg (2019) examined the association between knowledge and dedication to TIC (n = 118) among people in the health sector holding clinical, administrative, and managerial responsibilities in the United States. According to the author, the relationship between understanding and dedication to TIC is substantial and partly mediated by traumatizing beliefs. However, when a human services organization in the United States was preparing for TIC, Marvin and Volino (2018) gave information regarding the knowledge and attitudes of the staff members, in which TIC knowledge and attitudes were not statistically significant.
One study conducted by Hall et al. (2016) gave 34 nurses from an Australian emergency department an 18-item tool before and after a one-day TIC teaching program. As a result, the capacity to discuss painful events with clients has reportedly increased. However, there needed to be discernible effects of education in understanding how the emergency department setting can be re-traumatizing. In a separate study, Palfrey et al. (2019) matched pre-post data for 102 allied health professionals working in an Australian service for people with drug addiction and mental illness concerning a one-day training on TIC. Along with concrete examples of how practice is expected to improve, a considerable rise in confidence and awareness regarding TIC techniques was noted. The MHNs who participated in a related study by Stokes et al. (2017) explained the relationship between trauma and challenging behavior. The discussion centered on how interactions between nurses and patients can propagate trauma. In this approach, MHNs risk re-traumatizing their patients, who re-traumatize the MHN due to their reactions. The MHN runs the risk of passing on that trauma to additional patients, perpetuating the trauma cycle.
In the United Kingdom, Emsley et al., (2022) interviewed 11 professionals from health organizations on their practice and implementation of a trauma-informed approach, and they also analyzed 24 documents containing UK health policies. Findings indicated that though trauma-informed approaches were integrated into the national and regional health policies, they needed to be represented in the National Health Service (NHS) budgetary allocation or legislation. The study concluded that trauma-informed care needed more representation and practice in the UK health sector. Factors such as leadership, service user involvement, organizational culture, and budgetary allocation were implicated to have impeded the implementation of TIC practice at the organizational level. Whereas at the professional practice level, lack of interest and the belief that TIC is "a passing trend" that lacks substance may have contributed to its weakened popularity and implementation.
Relatedly, in a combined qualitative and quantitative study, Champine et al., (2022) investigated the level of awareness about trauma-informed approach among education and community partners in a community in Pottstown, Pennsylvania. The study was part of a community-based, trauma-informed initiative called The Pottstown Trauma-Informed Community Connection (PTICC), whose purpose is to encourage a trauma-informed community. In this longitudinal study, data from 82 participants were utilized, and paired sample t-tests were used to analyze the data. The study sought to measure if the participants understood what it meant to be trauma-informed. Results reveal that the education and community participants had a significant understanding of the positive impact and benefits of TIC and the benefit of the TIC community initiative. Their scores, however, did not indicate any change in their perception towards organizational-level implementation of TIC.
In a Nigerian study, Effiom et al., (2020) examined the impact of trauma-informed counseling as an intervention strategy for reintegrating internally displaced persons who suffer from trauma such as war, rape, torture, and natural disasters. This qualitative study observed the significant importance of trauma-informed counseling in the social integration of this vulnerable population. Similarly, Oladimeji and Olorode (2022) investigated the relationship between trauma-informed teaching and academic performance in students with special needs in Ibadan, Nigeria. This correlational research employed 150 secondary student participants, and two instruments were used to elicit responses, which included the Academic Performance Rating Scale (APRS) and a self-structured questionnaire by the researchers. Results from the study suggest a positive and significant relationship between trauma-informed teaching and academic performance (r = .669**, N= 150, p<.05). The study concluded that trauma-informed teaching techniques can improve academic performance among students with special needs.