Trauma-Informed Care and Employment Services

Trauma-informed care is an understanding that the traumatic events that happened to an individual may affect their development and behavior. In trauma-informed care, we ask the question: “What happened to you?” rather than the question, “What is wrong with you?”

What is Trauma-Informed Care?

Trauma-informed care is actually a systematic approach for ensuring that people who have a trauma history, which may or may not include a formal mental health diagnosis, get the support they need without being re-traumatized in the process of getting support. While the development of a trauma-informed employment services program is beyond the scope of this article, we will give you some information about how you can take a trauma-informed approach in your work as an employment consultant or vocational rehabilitation counselor.

What Is Trauma?

The first step in developing a trauma-informed approach is understanding trauma. The American Psychological Association (APA) defines trauma on their website as “an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical.”

The APA website also explains that longer term reactions can include:

unpredictable emotions,
flashbacks,
strained relationships, and
physical symptoms like headaches or nausea

Trauma can be acute or ongoing. Acute trauma involves one event, such as an incidence of rape, being mugged, or experiencing a natural disaster. Ongoing trauma includes such experiences as domestic violence, childhood abuse, repetitive bullying, living in a war zone or being in combat, food insecurity, racial microaggressions, and systemic discrimination. These are merely examples and not an exhaustive list.

The Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 publication, “Trauma-Informed Care in Behavioral Health Services” explains that the effects of trauma are cumulative; people who have experienced trauma in the past are more likely to have severe traumatic responses to new trauma.

What Are the Consequences of Trauma?

In their 2014 article, “The Biological Effects of Childhood Trauma.” De Bellis and Zisk demonstrate that trauma has serious consequences for brain and other biological development. It can kill brain cells, dysregulate important brain circuits, alter brain volume, and interfere with the immune system, among other things.

In the 2019 article, “The Legacy of Trauma,” DeAngelis lists these long-lasting and even transgenerational effects of trauma:

Risky health behaviors
Higher rates of anxiety, depression, PTSD, and other mental illnesses
Increased incidence of disease
Fear of trusting others
Emotional volatility and overprotectiveness
Intolerance of weakness in others
Learning difficulties
Substance use disorders
Feelings of alienation
Compromised parenting
Heightened poverty

Who Is Affected by Trauma?

It is likely that many, if not most, people that you work with in employment services have been affected by trauma. This is because a trauma history is common for persons who have:

mental health conditions;
substance use disorders;
experienced systematic discrimination and oppression due to poverty, racial identity, gender identification, sexual orientation, and other marginalized statuses; and/or
many other types of disabilities

For example, people who have had accidents that resulted in significant injuries such as brain or spinal cord injuries have experienced a traumatic event that continues to affect them throughout their lifetime.

People with developmental disabilities, intellectual disabilities, physical and other disabilities may have been discriminated against, bullied, or abused as children. O’Sullivan, Watts, and Strauser in their 2019 article, “Trauma-sensitive Rehabilitation Counseling” describe a national study of child abuse, which determined children with disabilities experienced maltreatment at a rate 1.7 to 3 times higher than children without disabilities. Keep in mind that participants may have been traumatized in a variety of ways in their lives, but don’t make any assumptions.

A Trauma-Informed Approach for Employment Services

Huebner and Smith, in their 2020 webinar, Key Aspects of Trauma state that in order to heal, trauma survivors need a safe space where they experience compassion, understanding, and empathy. As an employment consultant or vocational rehabilitation counselor, you can:

recognize the signs of trauma
establish a good working alliance providing safety, trust, and mutual respect
use good listening skills such as OARS from Motivational Interviewing
understand that the individual may or may not be aware of the impact of trauma in their lives
be culturally responsive

This last point is critical. You cannot provide a sense of safety, trustworthiness, collaboration, or empowerment to people if you are ignoring their cultural needs or practicing forms of discrimination whether intentional or unintentional, so it is important to take responsibility to educate yourself about the impact of disability and race, as well as other marginalized identities such as ethnicity, sexual orientation, age, religion, gender identity, geography, and income. For example, view this short video of Kay Ulanday Barrett who experiences the intersection of transgender, disability, and racial minority identities. #RaceAnd: Kay Ulanday Barrett

One last reminder–don’t forget to take care of yourself! A trauma-informed practice includes attending to your own wellness. Check out our resources below for caregiver wellness, as well as other resources to support you in your journey to provide trauma-informed employment services.

Resources

Project E-3 Resources on Trauma-Informed Care for Vocational Rehabilitation

PTSD in the Workplace

Job Accommodations Network PTSD Resources Page

Depression, PTSD, & Other Mental Health Conditions in the Workplace: EEOC Document