U.S. government-funded trauma network reiterates commitment to trauma-informed care despite lack of evidence

CATEGORY: GOVERNMENT PROJECTS

Source: NCTSN
Read time: 2.1 minutes
 
This Happened
On September 6, 2024, the National Child Traumatic Stress Network (NCTSN) newsletter announced a new webpage reiterating their support of trauma-informed pediatric psychiatry.
 
Who Did This?
The NCTSN was founded in 2000 and has been continuously funded by the Substance Abuse and Mental Health Administration. Funding supports two sites—UCLA and Duke University—that co-direct a network of hundreds of sites that have been supported to create and disseminate knowledge about assessment and treatment of trauma in children and adolescents.
 
The Premise
The new webpage outlined the premise and guiding principles of trauma-informed care, and included links to other resources on its website.
The premise is that trauma causes such a wide range of problems for victims that the only type of credible care requires consideration of biological, psychological, social, and cultural factors. Most importantly, these considerations must extend across all of society where trauma victims make points of contact for services. Humanitarian ethics demand this special treatment because thoughtless healthcare practices, such as careless comments at the check-in desk or judgmental attitudes in the office, can retrigger victims and compound their suffering [1].
 
The six principles of trauma-informed care, as defined by SAMHSA, are [2]:
Safety
Trustworthiness and Transparency
Peer Support
Collaboration
Empowerment
Cultural and Historical Awareness
 
Analysis
There are numerous major concerns that have been expressed about trauma-informed care.
Lack of evidence. A recent review of trauma-informed care implementations could locate only six studies of decent quality, and none were randomized [1]. The review concluded: “We found limited, mixed, and conflicting evidence for the effects (or perceived effects) of trauma-informed organisational change interventions…” Another recent review that was written to critique the premature embrace by the Scottish government for establishing trauma-informed care in national policy also found a lack of evidence [3].
Conceptual. Nearly a decade after appearing on the scene out of the blue, the concept is still vague. People are still not sure what it is [3].
Control of Language and Ideas. The vagueness of the concept seems on purpose. Trauma-informed care is not simply treatment by a doctor or therapist who understands how to treat psychological trauma, although proponents place their umbrella over such care (imagine how impish it would seem to extend this type of language to surgeons who operate on broken bones as skeleton-informed care). The broad and vague conceptualization makes sense when understanding that trauma-informed care is a movement, not a science-based intervention. Trainers who provide workshops on trauma-informed care are careful to emphasize that becoming trauma-informed is a transformation process (see here). The long-term aim is to change the culture for professionals to think and talk about trauma victims as highly fragile humans.
Misrepresentation of science. According to proponents of trauma-informed care, the situation is urgent because trauma causes permanent biological damage to victims’ brains and bodies. Despite this being a common belief among trauma experts, this belief has been repeatedly debunked (see here, here, and here).
Unintended consequences. Framing of suffering in a way that humans are highly fragile has the possible unintended consequences of creating false beliefs of how people understand themselves and creates a sense of feeling less resilient than they really are [4].
 
Why Is This Happening?
This movement is consistent with the moral foundation of progressive liberals that human nature is almost completely molded by life experiences—such that individual differences in success or failure are caused by experiences, not unchanging heritable traits—and care for the disadvantaged must supersede all other moral concerns (such as tradition, loyalty, patriotism, and liberty). The progressive sensibility yearns for a predictability that the movement of life and society can be controlled, to be able to point at one thing and say with certainty, “This is the oppression that caused all my problems.” That is a false certainty that has little prospect of truly helping individuals with deep-seated problems.
 
 
References
[1] Natalia V. Lewis, Angel Bierce, Gene S. Feder, John Macleod, Katrina M. Turner, Stan Zammit, Shoba Dawson, "Trauma-Informed Approaches in Primary Healthcare and Community Mental Healthcare: A Mixed Methods Systematic Review of Organisational Change Interventions", Health & Social Care in the Community, vol. 2023, Article ID 4475114, 18 pages, 2023. DOI: 10.1155/2023/4475114.
[2] SAMHSA, “SAMHSA’s concept of trauma and guidance for a trauma-informed approach,” HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
[3] Mark Smith, Sebastian Monteux, and Claire Cameron (2021). Trauma: An ideology in search of evidence and its implications for the social in social welfare. Scottish Affairs 30(4):472–492 DOI: 10.3366/scot.2021.0385.
[4] Mark Smith and Sebastian Monteux (March 2023). Trauma-informed approaches: A critical overview of what they offer to social work and social care. Insights: A Series of Evidence Summaries. The Institute for Research and Innovation in Social Services.