Trauma-Informed Approach, Part II: Delivering Better Emergency Management Services

In Part 1 last month I introduced trauma-informed approach (TIA), a modality that recognizes how an individual’s past trauma affects their behaviour and our interactions with them.

I referred to the significant prevalence of trauma among the population and the value of practicing TIA to foster a greater sense of safety, control and empowerment. I gave the real-life example of Charlie (not her real name) whose experience of past trauma came rushing to the surface when her BC community was ordered to evacuate because of a possible tsunami.

In Part II, I go into TIA in more depth, looking at what emergency management (EM) leaders should consider in adopting TIA in practice.

TIA is currently practiced in healthcare, the criminal justice system, child welfare and other fields but it has not been adopted widely in EM. I believe it should be fully integrated into EM policies, procedures, and delivery practices. All EM professionals should at least have a basic understanding of the modality and how it can be applied.

The power of trauma

Trauma is the response to, or experience of, a powerfully negative event or series of events. It can have a global effect on a person’s health and wellbeing and a direct physical impact on the body. The hippocampus -- which plays a central role in forming, organizing and storing memories, and connecting memories with emotions and sensations -- can change when exposed to trauma. Trauma can compromise the cardiovascular and endocrine systems, impact sleep, cause depression and anxiety, and even damage skin and hair. Untreated trauma can have long-term consequences for an individual’s self-esteem, ability to concentrate, resilience in stressful circumstances and their ability to work.

Moreover, mounting evidence suggests that trauma can be passed down from one generation to the next. Studies in epigenetics show that the DNA expression of children and grandchildren can be affected by the trauma of their predecessors. Following the U.S. Civil War, descendants of Union Army prisoners who stayed in Confederate prisoner of war camps were found to have shorter life expectancies than the average population.

Emergency personnel can unintentionally re-traumatize individuals if they do not understand trauma’s lasting, complex effects. Staff, for example, may need an individual’s cooperation in filling in and following the forms and processes mandated by their institutions. Unless these requirements are handled with tact and sensitivity, the procedures can establish or accentuate distrust, suspicion or emotional disconnection for those with a history of trauma. As a result, they may be unable to cooperate or to provide information that would be valuable in serving them.

A viable response

TIA demands “fundamental changes in how systems are designed, organizations function and practitioners engage with people,” according to the Public Health Agency of Canada. The goal of TIA is to minimize the potential to retraumatize. Even those who have not experienced trauma benefit from this approach.

Public Health Agency of Canada outlines four key principles for service providers:

1) Seek to Understand: Organizations should develop policies and processes that facilitate an understanding of the impact that trauma and violence can have on the lives and behaviours of individuals. Staff should be trained in TIA and be encouraged to understand the connection between current behaviours and past trauma/violence.

2) Create a Safe Space: Look for ways to help people feel understood and accepted. EM leaders should put themselves in the shoes of those being served. Consider doing a walk-through of procedures, processes, evacuations, announcements etc. With past trauma in mind, ask what it might feel like to experience these activities. Train staff in techniques to help individuals feel they are safe, secure and valued.

3) Facilitate Connection, Collaboration and Choice: Give staff opportunities to self-reflect and analyze the power differential between institutions and those bring served. Train and set expectations for the way staff communicate. Support staff in creating safe spaces, building trust, and offering choice where possible.

4) Support Resilience: Consider training staff in the techniques of “motivational interviewing,” which can help nurture empowerment in individuals. Foster a culture of emotional intelligence among staff. While it can be a challenge in EM, explore ways to offer services tailored to the needs or circumstances of individuals.

Conclusion

Trauma-informed approach can help EM leaders immensely in improving both the quality and effectiveness of their services. More research is needed on the specific benefits of applying TIA to EM programs. However, based on the experience in other sectors there are almost certainly benefits for EM. When our interactions with people are carried out with greater sensitivity, empathy and understanding, when they feel empowered, disruptions are reduced, resilience is improved, and time itself – the most precious resource in any emergency – is saved.