Trauma informed care holds that for people affected by trauma (and particularly experiences of complex trauma during childhood), dynamics of power and control can have significant impacts on the outcomes of support and treatment activities. For people whose trauma involved a significant loss of power and control (especially interpersonal trauma such as physical and sexual assault), any reminders of these experiences during treatment can seriously impact on successful engagement and retention.
Having said this, a third critical principle of trauma informed care is to foster opportunities to rebuild control. Control in this sense might mean development of self-efficacy, or developing a greater sense of personal control over reactions to stressful situations. A good example of this is supporting a young person to manage an urge to flee a situation that reminds them of their trauma even when it is important for them to stay and deal with the situation.
Supporting opportunities to rebuild control might mean helping a young person expand on the ways they can deal with difficult or unpleasant moods, thoughts or situations – such as working on alternatives to using substances. It also might mean control in terms of being able to exercise greater self-determination in terms of how and when they access supports and treatments.
This aspect of trauma informed care involves a range of activities, from supporting the development or enhancement of skills and techniques, to managing unpleasant trauma related reactions like powerful emotions and unhelpful thinking patterns. It might involve supporting the young person to rethink the links between their experiences of trauma, and how they relate to and engage with the world, now and in the future. It might also involve assisting the person with making important decisions.
Many key skills that AOD practitioners use every day are consistent with this aspect of trauma informed care – a motivational approach to change, a focus on skills and capabilities which support flexible and adaptive responses to stressors, and a non-judgemental “functional” understanding of behaviour.
Some examples of how these skills can apply to assisting with rebuilding control can be found elsewhere in the YSAS AOD toolbox: