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Trauma _______________________________________________________________________________
On August 26, 2002, Addictions and Mental Health Services (AMH) distributed a trauma policy to guide the state and community programs in improving approaches to persons with traumatic experiences. The policy has been updated with input from community providers, consumers, and other parties. Please review and discuss the attached policy with your staff, and begin to implement. An implementation plan addressing the Trauma Policy Action Plan is being developed. This will be posted on the OMHAS Web site when completed. If you have any questions, please contact Diane Lia, Program Policy and Development Specialist, at diane.lia@state.or.us or (503) 945-6197.
It is the policy of the Addictions and Mental Health Services (AMH) of the Oregon Department of Human Services that all state and community providers, and those who oversee public mental health and addiction services are informed about the effects of psychological trauma, assess for the presence of symptoms and problems related to that trauma, and develop and offer services that facilitate recovery in accordance with Oregon Administrative Rules.
Definition of psychological trauma In this policy, psychological trauma refers to the cluster of symptoms, adaptations, and reactions that interfere with the functioning of an individual who has extreme suffering (including neglect and deprivation), as a result of severe physical abuse and injury, sexual abuse and/or exploitation, witnessing or surviving severe community or domestic violence (including accidents, natural or human-caused disasters). This includes effects of mistreatment, abuse, neglect, or coercive interventions in the broad context of health services (e.g., outpatient, hospital, residential, employment, or criminal justice settings).
The long-term adverse effects of interpersonal violence, abuse, neglect, and other serious traumatic experiences are seen in people from infancy to old age, across gender, race, culture, socioeconomic status, intelligence, or educational level. However, most people who ask for help for themselves or family members do not usually seek services specifically for trauma-induced problems.
The symptoms that are adaptations to the effects of psychological trauma are sometimes not recognized as associated with prior trauma by survivors or clinicians. The cluster of issues, personal adaptations, problems, and symptoms that are seen in these individuals may result in Post-Traumatic Stress Disorder (PTSD), but more commonly other behavioral health conditions including mood, anxiety, and substance use disorders.
Children and adolescents with labile emotions, impulsivity, difficulty in maintaining attention, self harm, or unmanageable behaviors should also be evaluated for a history of abuse or other traumatic events.
People who experience social impairment as a result of psychological trauma will frequently describe suffering from depression, anxiety, difficulty controlling arousal of emotions, dissociation, suicidal thoughts, self-harm, guilt, low self-esteem, mistrust of others, substance misuse or relapse, and unsatisfactory interpersonal relations.
Significant progress has been made, and efforts will continue, to identify, validate, and disseminate evidence-based and promising practices to reduce the risks and consequences of psychological trauma. Mental health and addiction service agencies must implement policies and procedures to identify and treat psychological trauma and to provide services and trauma-specific treatment within a trauma-informed model. Trauma-informed services are not specifically designed to treat symptoms or syndromes related to sexual or physical abuse or other trauma, but they are informed about, and sensitive to, trauma-related issues present in survivors. A trauma-informed system is one in which all components of a given service system have been reconsidered and evaluated in the light of a basic understanding of the role that trauma plays in the lives of people seeking mental health and addictions services. A trauma-informed system uses that understanding to design service systems that accommodate the vulnerabilities of trauma survivors and allows services to be delivered in a way that will avoid inadvertent re-traumatization and will facilitate consumer participation in treatment. It also requires collaborative relationships with other public and private practitioners with trauma-related clinical expertise.
Trauma-specific services are designed to treat the actual consequences of trauma. Treatment programs designed specifically for survivors of childhood trauma are consistent on several points: the need for respect, information, connection, and hope for clients; the importance of recognizing the adaptive function of “symptoms�; and the need to work collaboratively in a person-directed and empowering way with survivors of abuse. All treatment providers should recognize a person’s right to receive services in the most integrated setting in the community. Traumatized individuals seeking help must be given opportunities to be involved as partners in the planning and evaluation of services offered. They should also be given the opportunity to invite and include family and/or friends in that process. *
When psychological trauma is not recognized or addressed, people may be unintentionally traumatized or re-traumatized by the agencies and providers trying to serve them. Re-traumatization can be overt as in the use of coercive interventions, such as seclusion or restraint. It can be less obvious and insidious as occurs when clinicians are not sensitive to the potential inflammatory impact of their words or behavior or when the design and physical environment of treatment facilities emphasize control more than comfort.
Unless people are able to recover from the adverse effects of trauma, those effects may continue throughout their lives. Parents who have experienced trauma without effective support or treatment, may negatively affect their children’s development. Children and adolescents who have experienced trauma may have great difficulty in interpersonal relationships.
OMHAS recommends a coordinated approach within mental health and addiction and other social and health services that recognizes, responds to, and helps people recover. This approach encourages other human service agencies to promote the reduction of negative effects of psychological trauma on an individual’s health, safety and independence.
*The definitions of trauma-informed and trauma-specific services were adapted from Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services, Jennings, A. (2004). National Association of State Mental Health Program Directors.
AMH Trauma Policy - Final (PDF) DHS Trauma Policy - Draft (PDF) Trauma Policy - Amendment (PDF)
Reducing the Use of Seclusion and Restraint: A National Initiative for Culture Change and Transformation (Kevin Ann Huckshorn, RN, MSN, CAP, ICADC) (Powerpoint)
Creating Violence-Free and Coercion-Free Mental Health Treatment Environments for the Reduction of Seclusion and Restraint: The Emerging Science of Trauma Informed Care (Kevin Ann Huckshorn, RN, MSN, CAP, ICADC) (Powerpoint)
OMHAS generally finds the following sites to be useful but does not accept responsibility for any negative consequences nor does OMHAS endorse all of the contents of any particular site.
CMHS’s National Center for Trauma Informed Care: This new NCTIC Web site is designed to help public mental health systems integrate trauma informed approaches and interventions into their programs to improve efficacy and outcomes. It represents a growing and diverse community that is committed to transforming traditional programs and services to be more supportive of and empowering to trauma survivors.
Gift From Within: An International Nonprofit Organization for Survivors of Trauma and Victimization
Models for Developing Trauma-Informed Behavioral Health Systems and Trauma Specific Services. (Anna Foundation) (PDF) This report was written to support states in implementing a trauma informed behavioral health model for state mental health system and to list the trauma specific models and status of research to date. It summarizes the evolution of trauma services, describes who should receive trauma specific services and list trauma informed and trauma specific services for populations including children, parents and adult survivors of trauma.
National Child Traumatic Stress Network
PTSD Research Quarterly Newsletter (PDF)
SAMHSA's Center on Women, Violence and Trauma SAMHSA Publications on Disaster Response and Recovery
Sidran Institute (Traumatic Stress Education and Advocacy)
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