Be sure to visit VAWnet frequently, as more and more tools for best policies and methods are finally making way to assist in leveling the field for victims/survivors and their advocates in Interpersonal Family Violence (domestic violence, child abuse and trauma).
Special Collection: Trauma-Informed Domestic Violence Services: Understanding the Framework and Approach (Part 1 of 3)
This is PART 1 of a 3-part collection that also includes Building Program Capacity (PART 2 of 3) and Developing Collaborations and Increasing Access (PART 3 of 3). PART 1 provides an overview of the framework and research supporting trauma-informed approaches to working with survivors and their children.
TABLE OF CONTENTS:
- Framework and Philosophy
- Research on Domestic Violence, Trauma, and Mental Health
- Research on the Incidence, Prevalence, and Impact of Trauma
- Neurobiological and Clinical Research on Trauma
- Research on Resilience
- Key Organizations
- Domestic Violence and Trauma
- Trauma and Trauma-Informed Services
- Specialized Information and Assistance
This Special Collection was developed by the National Center on
Domestic Violence, Trauma & Mental Health (NCDVTMH) in partnership
with the National Resource Center on Domestic Violence. Contact NCDVTMH for specialized technical assistance and training on this and related topics.
A cross-section of a tree reveals its story as told by the pattern of growth rings, reflecting the climatic conditions in which the tree grew year by year, and documenting injuries sustained throughout its life. Much in the same way, humans experience periods of trauma and resilience over the course of our lifespans. A trauma-informed approach seeks to understand the ways in which these experiences shape us.
INTRODUCTION | BACK TO TOP
In the past 30 years, there has been a profound shift in understanding about the impact of trauma on individuals, families, and society. A growing number of studies have documented the impact of trauma on the brain and have demonstrated that violence and trauma can affect our physical health, mental health, and relationships with others (Felitti, Anda, Nordenberg, et al, 1998; De Bellis, Van Dillen, 2005; Classen, Pain, Field, Woods, 2006; Lanius, Bluhm, Lanius, Pain, 2006;Lyons-Ruth, Dutra, Schuder, Bianchi, 2006; McEwen, 2006; Nemeroff, 2004; van der Kolk, Roth, Pelcovitz, Sunday, Spinazzola, 2005; Yehuda, 2006). At the same time, research on trauma and resilience, combined with what we have learned from the experiences of survivors, advocates, and clinicians has begun to clarify helpful ways to respond, both within and across cultures and communities. This emerging body of knowledge offers information that can be helpful to the domestic violence (DV) field in its work with survivors and their children.
Building on over 20 years of work in this area, the National Center on Domestic Violence, Trauma & Mental Health (NCDVTMH) has put into practice a framework that integrates a trauma-informed approach with a DV victim advocacy lens. The term trauma-informed is used to describe organizations and practices that incorporate an understanding of the pervasiveness and impact of trauma and that are designed to reduce retraumatization, support healing and resiliency, and address the root causes of abuse and violence (NCDVTMH 2013 adapted from Harris and Fallot 2001). The resources compiled in these linked collections reflect this integrated perspective.
The goals of this Special Collection series are to provide:
- Basic information about the different ways in which trauma can affect individuals and to highlight current research on effective ways to respond to trauma;
- Practical guidance on developing trauma-informed DV programs and services; and
- Resources that will help support collaboration between DV programs, and mental health, substance abuse, and other social services agencies and that will increase awareness about trauma treatment in the context of DV.
A Note About Gender: Intimate partner violence perpetrated by men against their female partners is epidemic. At the same time, whatever a person’s gender or their partner’s gender, they may experience intimate partner violence, and gendered language can minimize the experiences of many survivors. We have attempted to use language in this Special Collection that reflects our analysis of gender oppression and other forms of oppression, as well as our commitment to serving all survivors of domestic violence.
The mission of the National Center on Domestic Violence, Trauma & Mental Health is to develop and promote accessible, culturally relevant, and trauma-informed responses to domestic violence and other lifetime trauma so that survivors and their children can access the resources that are essential to their safety and well-being. NCDVTMH provides training, support, and consultation to advocates, mental health and substance abuse providers, legal professionals, and policymakers as they work to improve agency and systems-level responses to survivors and their children.
DEFINITIONS | BACK TO TOP
The following terms are used by victim advocates, service providers, policymakers, researchers, and academics working at the intersection of trauma and domestic violence. Being familiar with the meaning of these terms will deepen your understanding of the field and make it easier to communicate with others about trauma and trauma-informed services. The "jump to" box below will take you to full definitions that are listed at the end of this collection.
- Individual Trauma
- Collective, Organizational, and Community Trauma
- Historical Trauma
- Intergenerational Trauma
- Insidious Trauma
- Secondary Traumatic Stress (Vicarious Trauma)
- Compassion Fatigue
- Reflective Practice
- Peer Support and the Peer Movement
FRAMEWORK AND PHILOSOPHY | BACK TO TOP
Being abused can affect how we feel, think, and respond to other people and the world around us. It can also increase our risk for developing mental health and substance abuse conditions. Experiencing multiple forms of abuse and oppression over the course of our lives can further increase these risks. At the same time, stigma associated with substance abuse and mental illness allows abusers to use these issues to increase their control over their partners, undermine them in custody battles, and discredit them with friends, family, and the courts, underscoring the importance of ensuring that responses to survivors are both DV- and trauma-informed (Warshaw, Moroney, & Barnes, 2003; Briere, Woo, McRae, Foltz & Sitzman, 1997; Goodman, Dutton, & Harris, 1997; Warshaw et. al, 2009; Jacobson, 1989; Lipschitz et al, 1996; Goodman, Dutton, Harris, 1995; Friedman & Loue, 2007).
A TRAUMA-INFORMED APPROACH
Over the past three decades, as knowledge about trauma has increased, there has been a significant reassessment of the ways mental health symptoms are understood. We now have a better understanding of the role that abuse and violence play in the development of mental health and substance abuse conditions. Trauma-informed approaches reflect an understanding that “symptoms” may be survival strategies—adaptations to intolerable situations when real protection is unavailable and a person’s coping mechanisms are overwhelmed. Trauma-informed approaches focus on resilience and strengths as well as psychological harm. They also reflect an awareness of the impact of this work on providers and emphasize the importance of organizational support and provider self-care (Warshaw, Brashler & Gill, 2009; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005; Saakvitne, Gamble, Pearlman, & Lev, 2000).
With the growing understanding that the majority of people seeking services in domestic violence, as well as mental health, substance abuse, and other service settings have experienced interpersonal trauma, an approach for integrating this awareness into practice has evolved. Using a trauma-informed approach has come to mean that everyone working in a service setting understands the impact of trauma in a similar way and shares certain values and goals, and that all the services and supports that are offered are designed to prevent retraumatization and to promote healing and recovery. For us, it also means thinking about people within the entire context of their lives and experiences; ensuring that our services are welcoming, inclusive and culturally attuned; and working together to address the underlying causes of oppression and abuse (Harris & Fallot, 2001; Warshaw, Brashler, & Gill, 2009; Kimerling, Alvarez, Pavao, Kaminski, & Baumrind, 2007; Golding, 2000).
Like DV victim advocacy, the trauma-informed movement within the mental health services field has historical roots in social and political advocacy. For over a hundred years, people diagnosed with mental illnesses (many of them women) fought to protect their rights and resisted what they saw as the "medicalization" of women’s issues (Levin, Blanch and Jennings, 1998). The mental health advocacy movement laid the groundwork for the adoption of trauma-informed approaches in the mental health system. Most recently, trauma-informed approaches are surfacing in hospitals and health clinics, classrooms and daycare settings, child welfare programs, homeless shelters, and job training programs.
Combining a trauma-informed approach with a DV victim advocacy perspective provides a more integrated framework for working with survivors. This framework can serve as a powerful tool for bridging perspectives and building collaboration between fields. See Thinking about Trauma in the Context of DV Advocacy: An Integrated Approach by the NCDVTMH (2013).
RESEARCH ON DOMESTIC VIOLENCE, TRAUMA, AND MENTAL HEALTH | BACK TO TOP
A large body of research has documented the links between abuse and mental health, while advances in the fields of traumatic stress, child development, and neuroscience have generated new models for understanding the impact of trauma on survivors of domestic violence and their children. These findings, particularly when grounded in survivor and advocacy perspectives, provide new insights into the effects of interpersonal abuse across the lifespan and suggest new strategies for support.
Intimate partner violence is associated with a wide range of mental health consequences. Those who have been diagnosed with mental health and/or substance abuse conditions or who are experiencing psychiatric disability are at greater risk for abuse, and abusers may use their partners mental health or substance abuse condition to undermine and control them. Included in this subsection are some background materials on the relationships between domestic violence, mental health, and trauma.
- Intimate Partner Violence and Lifetime Trauma | PDF (6 p.)
by Carole Warshaw for the National Center on Domestic Violence, Trauma & Mental Health (May 2011)
This article reviews available research exploring the link between histories of physical and sexual abuse in childhood and intimate partner violence victimization in adulthood.
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- Prevalence of Intimate Partner Violence and Other Lifetime Trauma among Women Seen in Mental Health Settings | PDF (6 p.)
by Carole Warshaw for the National Center on Domestic Violence, Trauma & Mental Health (May 2011)
This document provides a brief review of the available research documenting the prevalence of lifetime abuse among women receiving mental health services.
RESEARCH ON INCIDENCE, PREVALENCE, AND IMPACT OF TRAUMA | BACK TO TOP
Epidemiological research studies have measured the incidence and prevalence of violence and trauma in various populations, and findings of these studies confirm what those working in the domestic violence field have long known: that women and children in the United States face a high level of social and interpersonal violence.
The National Intimate Partner and Sexual Violence Survey conducted by the Centers for Disease Control (CDC) clearly documents the high rates of domestic violence and sexual assault experienced by women in the United States, as well as the traumatic health and mental health effects of gender-based violence, and the fact that the majority of victimization begins early in life.
The Adverse Childhood Experiences (ACE) study, the largest epidemiological study ever done in the United States, has documented the high rates of childhood adversity experienced by adults in this country as well as the strong relationships between childhood trauma and a range of consequences in adulthood, including health and mental health conditions, substance abuse disorders, and a higher risk of experiencing abuse in adulthood, including domestic violence. This study also demonstrates that many people have multiple types of traumatic experiences, and that the impact of trauma is cumulative: the more types of trauma experienced, the higher the risk of more serious consequences. At the same time, many factors can help to mitigate these effects, including a person’s resiliencies and strengths as well as access to social supports.
Learning about the cumulative impact of trauma within a framework that recognizes strengths and resiliency can help survivors to make sense of the ways they have been affected and to recognize the strengths and skills it took to survive their experiences.
Centers for Disease Control National Intimate Partner and Sexual Violence Survey (NISVS)
This website presents the NISVS data in a number of different formats. The study not only highlights the prevalence of domestic and sexual violence in the United States but also the differential impact on women, including significantly higher rates of fearfulness, PTSD, concerns for safety, injury, and need for DV advocacy services.
National Center for Children Exposed to Violence
This website, hosted by the Yale Child Study Center, provides statistics on the number of children who witness domestic violence every year, the impact of witnessing DV, and strategies for effective response. It includes similar information on other types of violence children experience including community violence, school violence and media violence. It also includes a list of relevant books and journal articles.
The Adverse Childhood Experiences (ACE) Study & Website
This website provides basic information about the ACE study, the largest epidemiological study ever done in the United States. The ACE study has documented extremely strong relationships between childhood trauma and a whole range of consequences in adulthood, including health conditions, mental health and substance abuse disorders, a higher risk of experiencing trauma and abuse including domestic violence, and premature death. The website provides a tool to calculate your ACE score in six languages; frequently asked questions about the ACE study; and contact information for potential speakers.
The Centers for Disease Control and Prevention Website, ACE Study Page
This website provides information on the major findings of the ACE study, including prevalence data in three major ACE categories (abuse, neglect, and household dysfunction), and demographic information on ACE study participants. It also includes a list of peer-reviewed journal articles based on ACE study findings organized by subject, including a section on interpersonal violence.
NEUROBIOLOGICAL AND CLINICAL RESEARCH ON TRAUMA | BACK TO TOP
Neurobiological research has shed light on the impact of adversity and chronic stress on the brain. When an individual perceives a threat to her or his safety, a complex set of chemical and neurological events known collectively as the "stress response" is triggered. Over time, survival responses that are adaptive in dangerous situations (e.g., shutting down, constantly surveying the room for danger, expecting to fight or run away at a moment’s notice) may occur whether or not danger is present. People who have experienced trauma may also become less able to regulate arousal and emotional responses. Being aware of the neurobiology of trauma can help advocates to better understand the effects of trauma on survivors and on themselves. Research on the effects of trauma on the developing brain can also help inform our responses to the needs of children exposed to DV, as well as to adult survivors who may have experienced trauma earlier in life.
Center on the Developing Child
Harvard University’s Center on the Developing Child provides a wealth of information on child development and the effects of abuse and neglect on the developing brain.
Promising Futures: Best Practices for Serving Children, Youth, and Parents Experiencing Domestic Violence
This new website was developed by Futures Without Violence, formerly the Family Violence Prevention Fund, and is designed to help domestic violence victim advocates enhance their programming for children and their mothers. If you are just starting to think about how your program’s policies could better reflect an equal commitment to mothers and children, or you have been delivering holistic services for all family members for years, this website has information and tools that can help you advance your practice. More specifically, it includes a report on 16 Trauma-Informed, Evidence-Based Recommendations for Working with Children Exposed to Domestic Violence.
Trauma Information Pages
Trauma Information Pages focus on emotional trauma and traumatic stress, including PTSD and dissociation, whether following individual traumatic experience(s) or a large-scale disaster. The purpose of this site is to provide information for clinicians and researchers in the traumatic-stress field. This site includes selected full-text articles about trauma—versions of preprints, published articles, and chapters on a variety of trauma-related topics.
- The Amazing Brain: Trauma and the Potential for Healing | PDF (7 p.)
by Linda Burgess Chamberlain for The Institute for Safe Families (2008)
Designed specifically for parents and caregivers, this resource describes how the brain works, how it is affected by trauma, and how it can heal.
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- A Science-Based Framework for Early Childhood Policy: Using Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children | PDF (36 p.)
by the Center on the Developing Child at Harvard University (August 2007)
Combining knowledge from neuroscience, behavioral and developmental science, economics, and 40 years of early childhood program evaluation, the authors provide an informed, nonpartisan, pragmatic framework to guide policymakers toward science-based policies that improve the lives of young children and benefit society as a whole.
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- In Brief: The Science of Early Childhood Development | PDF (2 p.)
by the Center on the Developing Child at Harvard University
This edition of the InBrief series addresses basic concepts of early childhood development, established over decades of neuroscience and behavioral research, which help illustrate why child development—particularly from birth to five years—is a foundation for a prosperous and sustainable society.
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- InBrief: The Impact of Early Adversity on Children's Development | PDF (2 p.)
by Center on the Developing Child at Harvard University
This edition of the InBrief series outlines basic concepts from the research on the biology of stress which show how major adversity can affect developing brain architecture and reset the body's stress response system to high alert.
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- In Focus: Understanding the Effects of Maltreatment on Early Brain Development National Clearinghouse on Child Abuse and Neglect Information | PDF (13 p.)
by the National Clearinghouse on Child Abuse and Neglect Information (October 2001)
This document is an easy to understand review of how the brain develops, the effects of maltreatment on brain development, and implications for policy and practice.
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- Trauma Annotated Bibliography | HTML
by the International Society for the Study of Trauma and Dissociation
This annotated bibliography on trauma was peer reviewed by the ISSTD and represents a thoughtful summary of what are believed to be salient information in the articles noted.
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- The PILOTS Database | HTML
by the US Department of Veteran’s Affairs (2007)
The Published International Literature on Traumatic Stress (PILOTS) Database is an electronic index to the worldwide literature on PTSD and other mental health consequences of exposure to traumatic events.
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RESEARCH ON RESILIENCE | BACK TO TOP
Resiliency is our inherent capacity to make adaptations that result in positive outcomes in spite of serious threats or adverse circumstances. Experience working with survivors and research on resiliency show that there are some factors that appear to support and enhance our resiliency. Having a supportive community, whether through one's family, neighborhood, school, church, sports activities, or hobbies, is one factor that supports resiliency. A feeling of being valued and belonging is important, as well as being able to engage other people in positive ways. For children, factors that support resiliency include the response of caregivers and other caring adults who take an interest in the child and his or her development, sees him or her as a separate person, and helps him or her develop the ability to cope.
- Ordinary Magic: Resilience Processes in Development | PDF (12 p.)
by Ann S. Masten for the American Psychologist (March 2001)
This article concludes that resilience is made of ordinary rather than extraordinary processes, offering a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology.
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- Disaster Preparation and Recovery: Lessons from Research on Resilience in Human Development | PDF (16 p.)
by Ann S. Masten and Jelena Obradović for Ecology and Society (2008)
While this paper focuses on resilience in the face of disaster, it also provides a helpful overview of the resilience research literature. The authors build on four decades of theory and research on resilience in human development to offer lessons for planning disaster response and recovery, lessons that are also relevant for domestic violence survivors and their children.
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- Resilience Bibliography | HTML
by the Child Witness to Violence Project
This page provides a bibliography of resilience research articles of particular relevance for children exposed to DV. Links to full text are available for some of the articles.
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- Promoting resilience: Helping young children and parents affected by substance abuse, domestic violence, and depression in the context of welfare reform | PDF (23 p.)
Children and Welfare Reform Issue Brief No. 8 by Jane Knitzer for the National Center for Children in Poverty (February 2000)
This is Issue Brief #8 in a series based on a growing body of research that suggests that successful policies for families must take into account the needs of children when addressing the needs of parents and the needs of parents when addressing the needs of children.
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- Building Resilience: The Power to Cope With Adversity | PDF (2 p.)
by William R. Beardslee, Mary Watson Avery, Catherine C. Ayoub, Caroline L. Watts, and Patricia Lester for Zero to Three (2010)
This resource provides a synopsis of resiliency capabilities within the individual child, family, caregiving, and community levels. It states children who have grown up in challenging environments are still capable of engaging in age-appropriate activities, relating to others, and understanding their family life.
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- Positive Changes Following Adversity | PDF (8 p.)
by Stephen Joseph and Lisa D. Butler for the National Center for Posttraumatic Stress Disorder (Summer 2010)
This issue focuses on positive change following adversity or the concept of posttraumatic growth. It provides a summary and analysis of research in this burgeoning area that brings together research from the trauma and positive psychology fields, offering another way to look at traumatic experiences focusing on the positive changes and growth that can ensue.
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KEY ORGANIZATIONS | BACK TO TOP
The following list includes key national organizations that provide information on trauma and domestic violence or assistance in implementing trauma-informed approaches. All of the sites listed have a public service mission and speak to a wide variety of audiences.
Domestic Violence and Trauma
National Center on Domestic Violence, Trauma & Mental Health
The mission of the National Center on Domestic Violence, Trauma & Mental Health (NCDVTMH) is to develop and promote accessible, culturally relevant, and trauma-informed responses to domestic violence and other lifetime trauma so that survivors and their children can access the resources that are essential to their safety and well-being.
Academy on Violence and Abuse
The Academy on Violence and Abuse (AVA) was formed in order to help strengthen the capacity of the healthcare community to provide the best possible care to those whose health is adversely affected by violence and abuse, and to prevent future occurrences of violence and abuse in society. Most of the trauma-related information on this website relates to the developmental effects of trauma on children.
Trauma and Trauma-Informed Services
The following organizations provide information and assistance on trauma-related topics relevant to the work of domestic violence programs and services. Organizations included focus on trauma-informed care broadly rather than promoting a single model.
National Center for Trauma-Informed Care (NCTIC)
NCTIC is a Substance Abuse Mental Health Services Administration (SAMHSA)-sponsored national center focusing on the implementation of trauma-informed approaches across a variety of health and human services.
National Child Traumatic Stress Network (NCTSN)
Established by Congress in 2000 and funded by SAMHSA, NCTSN is a collaboration of academic and community-based service centers whose mission is to raise the standard of care and increase access to services for traumatized children and their families across the United States.
The Indian Country Child Trauma Center (ICCTC)
The Indian Country Child Trauma Center (ICCTC) was established to develop trauma-related treatment protocols, outreach materials, and service delivery guidelines specifically designed for American Indian and Alaska Native (AI/AN) children and their families. It is part of the National Child Traumatic Stress Network, funded by the Substance Abuse Mental Health Services Administration (SAMHSA) under the National Child Traumatic Stress Initiative.
National Center for Children Exposed to Violence
The mission of the NCCEV is to increase the capacity of individuals and communities to reduce the incidence and impact of violence on children and families; to train and support the professionals who provide intervention and treatment to children and families affected by violence; and, to increase professional and public awareness of the effects of violence on children, families, communities and society.
The ACEs Connection
The ACEs Connection is a social networking site for people involved in implementing trauma-informed approaches across the country. The site offers regularly updated information about innovations in trauma-informed services, upcoming events, and advancements in knowledge and practice.
The Anna Institute (formerly the Anna Foundation)
This site is dedicated to Anna Jennings, an artist and sexual abuse survivor who took her own life after being repeatedly misdiagnosed by the mental health system. The site includes much of her artwork as well extensive resources on trauma and trauma-informed care.
SAMHSA’s GAINS Center focuses on expanding access to community-based services for adults diagnosed with co-occurring mental illness and substance use disorders at all points of contact with the justice system.
National Center for PTSD
The National Center for PTSD is a center of excellence for research and education on the prevention, understanding, and treatment of PTSD. The National Center for PTSD may be of interest to domestic violence programs and service providers working with current and former members of the military.
National Disaster Technical Assistance Center (DTAC)
SAMHSA’s Disaster Technical Assistance Center (DTAC) assists States, Territories, Tribes, and local entities with all-hazards disaster behavioral health response planning that allows them to prepare for and respond to both natural and human-caused disasters. DTAC may be of particular interest to domestic violence programs and services with a focus on trauma-informed disaster planning and response.
Department of Defense Family Advocacy Program
The Family Advocacy Program (FAP), managed by the Office of the Secretary of Defense and implemented by the military services, provides resources for families experiencing child abuse and domestic abuse, including prevention services, early identification and intervention, support for victims, and treatment for offenders.
*See the related VAWnet Special Collections: Sexual Violence in the Military and The Intersection of Domestic Violence and the Military.
REFERENCES | BACK TO TOP
- References: Trauma-Informed Domestic Violence Services | PDF (7 p.)
by the National Center on Domestic Violence, Trauma, and Mental Health for the National Resource Center on Domestic Violence (April 2013)
This list provides bibliographic references for the 3-part VAWnet Special Collection series, Trauma-Informed Domestic Violence Services.
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DEFINITIONS | BACK TO TOP
1. Individual Trauma. Trauma is the unique individual experience of an event or enduring condition in which the individual experiences a threat to life or to her or his psychic or bodily integrity, and experiences intense fear, helplessness, or horror. A key aspect of what makes something traumatic is that the individual’s coping capacity and/or ability to integrate their emotional experience is overwhelmed. Trauma often impacts individuals in multiple domains, including physical, social, emotional, and/or spiritual (Giller, 1999; Pearlman & Saakvitne, 1995; van der Kolk & Courtois, 2005).
2. Collective, Organizational, and Community Trauma. The terms collective trauma, organizational trauma, and community trauma refer to the impact that traumatic events can have on the functioning and culture of a group, organization, or entire community (e.g., the effects of the 1999 Columbine High School shooting, Hurricane Katrina, and the 9/11 terrorist attacks on their respective communities).
3. Historical Trauma. Historical trauma refers to cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences. Understanding historical trauma means recognizing that people may carry deep wounds from things that happened to a group with which they identify, even if they did not directly experience the event themselves. Historical trauma follows from events such as the colonization of generations of Indigenous Peoples, the enslavement of Africans and their descendants, and the losses and outrages of the Holocaust. While the term refers to events that occurred in the past, it is important to remember that for many communities the trauma or oppressive conditions associated with the historical trauma have been institutionalized and are ongoing (Packard, 2012; BigFoot, 2000; Willmon-Haque & BigFoot, 2008, Braveheart, 1999).
4. Intergenerational Trauma. Intergenerational trauma refers to the effects of harms that have been carried over in some form from one generation to the next. The concept is similar to historical trauma, although it is frequently used to refer to trauma that occurs within families rather than in larger (e.g., racial, ethnic, cultural, or religious) groups.
5. Insidious Trauma. Insidious trauma refers to the daily incidents of marginalization, objectification, dehumanization, intimidation, et cetera that are experienced by members of groups targeted by racism, heterosexism, ageism, ableism, sexism, and other forms of oppression, and groups impacted by poverty. Maria Root, who coined the term insidious trauma described the concepts as follows:"Traumatogenic effects of oppression that are not necessarily overtly violent or threatening to bodily well-being at the given moment but that do violence to the soul and spirit. " (Root 1992; Brown & Ballou, 1992)
6. Trauma-Informed. A trauma-informed program, organization, system, or community is one that incorporates an understanding of the pervasiveness of trauma and its impact into every aspect of its practice or programs. In such settings, understanding about trauma is reflected in the knowledge, attitudes, and skills of individuals as well as in organizational structures such as policies, procedures, language, and supports for staff. This includes attending to culturally specific experiences of trauma and providing culturally relevant and linguistically appropriate services. It also includes recognizing that not only are the people being served potentially affected by trauma but that staff members may be as well.
Central to this perspective is viewing trauma-related responses from the vantage point of "what happened to you" rather than "what’s wrong with you," recognizing these responses as survival strategies, and focusing on survivors’ individual and collective strengths. Trauma-informed programs are welcoming and inclusive and based on principles of respect, dignity, inclusiveness, trustworthiness, empowerment, choice, connection, and hope. They are designed to attend to both physical and emotional safety, to avoid retraumatizing those who seek assistance, to support healing and recovery, and to facilitate meaningful participation of survivors in the design, implementation, and evaluation of services. Supervision and support for staff to safely reflect on and attend to their own responses and to learn and grow from their experiences is another critical aspect of trauma-informed work.
The term trauma-informed services was originally coined by Maxine Harris and Roger Fallot in their edited book, Using Trauma Theory to Design Service Systems (2001) and has been adapted by multiple writers and in multiple service settings. This working definition by NCDVTMH is adapted specifically for the DV field and incorporates some of the original elements as well as other elements and concepts critical to our work with survivors.
7. Trauma-Specific. The term trauma-specific refers to interventions or treatments designed to facilitate recovery from the effects of trauma. There are a number of promising and evidence-based treatment modalities that address PTSD and other trauma-related conditions (e.g. depression, substance abuse, complex PTSD), although few have been designed specifically for domestic violence survivors. Trauma-specific services, while intended to address the consequences of trauma, may not always be trauma-informed. In other words, they may focus on treating trauma symptoms without necessarily being attuned to the experience of trauma or ways the service setting and processes may themselves be retraumatizing (Harris & Fallot, 2001; Warshaw, Brashler & Gill, 2009; Warshaw, Sullivan & Rivera, 2012).
8. Triggering. A trigger is something that evokes a memory of past traumatizing events including the feelings and sensations associated with those experiences. Encountering such triggers may cause us to feel uneasy or afraid, although we may not always realize why we feel that way. A trigger can make us feel as if we are reliving a traumatic experience and can elicit a fight, flight or freeze response. Many things can be a possible trigger for someone. A person might be triggered by a particular color of clothing, by the smell of a certain food, or the time of year. Internal sensations can be triggers, as well. Once we become aware of triggers, we might feel an impulse to "get rid of all possible triggers. " Of course, we will avoid violent images or angry tones in our speech and try to make the environment calm. However, there will always be trauma triggers that we cannot anticipate and cannot avoid. Part of trauma-informed work is supporting survivors as they develop the skills to manage trauma responses both in our service settings and elsewhere in the world (National Center on Domestic Violence, Trauma & Mental Health).
9. Retraumatization. Retraumatization occurs when any situation, interaction, or environmental factor is itself traumatic or oppressive in a way that also replicates events or dynamics of prior traumas and evokes feelings and reactions associated with the original traumatic experiences. Retraumatization may compound the impact of the original experience.
10. Revictimization. Experiencing abuse—including physical or sexual abuse or sexual assault—increases our risk of experiencing violence or abuse in the future. Revictimization may occur in a similar or different context. When examining the prevalence of revictimization, it is important to consider the social context and the factors that put people at greater risk for being victimized (Kimerling, Alvarez, Pavao, Kaminski, & Baumrind, 2007; Lindhorst & Oxford, 2008; Classen, Palesh, Aggarwa,l 2005).
11. Secondary Traumatic Stress (Vicarious Trauma). Secondary traumatic stress (sometimes called vicarious trauma) refers to the emotional effects that can occur when an individual bears witness to the trauma experiences of another. For example, DV victim advocates may experience secondary traumatic stress from listening empathically to survivors recounting their stories. Individuals affected by secondary traumatic stress may themselves experience trauma-related responses as a result of the indirect trauma exposure or may find themselves re-experiencing trauma that they have experienced in their own lives. The cumulative effects of secondary traumatic stress may be seen in both professional and personal life.
12. Compassion Fatigue. Compassion fatigue is a related term used to describe exhaustion and desensitization to violent and traumatic events encountered in professional work or in the media. Both secondary traumatic stress and compassion fatigue can result from bearing witness and connecting empathically to another person’s experience and being emotionally present in the face of intense pain (Pearlman and Saakvitne, 1995; Prescott, personal communication, 2005).
13. Resilience. Resiliency is our inherent capacity to make adaptations that result in positive outcomes in spite of serious threats or adverse circumstances. Experience working with survivors and research on resiliency show that there are some factors that appear to support and enhance our resiliency. Having a supportive community, whether through one's family, neighborhood, school, church, sports activities, or hobbies, is one factor that supports resiliency. A feeling of being valued and belonging is important, as well as being able to engage other people in positive ways, whether through one’s ability to relate to others or through one’s capacities and talents. For children, factors that support resiliency include the response of caregivers and other caring adults, namely having at least one person who takes an interest in the child and their development, sees them as a separate person, and helps them develop their ability to cope (Masten, 2001;Masten, 2009; Masten & Wright, 2009).
14. Reflective Practice. The term reflective practice was coined by Donald Schon, who described it as "the capacity to reflect on action so as to engage in a process of continuous learning." In our day-to-day work, reflective practice involves a process of mutual and ongoing learning in an organization. As an approach to supervision, it removes the authoritarian "top-down" focus of some administrative supervision, replacing it with a collaborative approach that allows the knowledge, expertise, and experience of program staff to be shared, strengthened, and applied to our mutual goal of increasing safety and empowerment for battered women and their children. In individual DV work, the advocate approaches all her encounters with survivors with a readiness to examine her own practice and to reflect with and about the survivor's needs and experience in order to meet the survivor's goals (Schon, 1983).
15. Peer Support and the Peer Movement. Peer support is a way for people from diverse backgrounds who share experiences in common to come together to build relationships in which they share their strengths and support each other’s healing and growth. Peer support promotes healing through taking action and by building relationships among a community of equals. It is not about "helping" others in a hierarchical way but about learning from one another and building connections. Mental health, substance abuse, and domestic violence all have strong traditions of peer support, although these traditions differ somewhat in their histories and their specific goals. In the mental health community, the peer movement is a term used to describe the political advocacy movement of people with mental health diagnoses who seek to increase their control over services and change laws limiting their rights (formerly called the consumer, ex-patient, or survivor movement). The peer support movement, however, does not focus on diagnoses but is rooted in compassion for oneself and others (Blanch, Filson, Penney, et al, 2012).