Trauma Informed Care Notes

Trauma Psychoeducation

• Psychoeducation on Trauma (Youth-Focused)

  • should be pitched to the lowest common denominator of understanding
    → not about “dumbing down,” but ensuring clarity, accessibility, and cultural/age appropriateness
    → don’t assume background knowledge — explain terms plainly, use metaphor/story, and reinforce with visual/somatic elements

  • youth can have language modeled on how to speak about it

• The 6F Alarm System

  • a newer or youth-friendly framing of the trauma response system

  • typically includes: fight, flight, freeze, fawn, flop, and flock

  • may be referred to as an “alarm system” to reduce shame and externalise the stress response (i.e., "your alarm went off — it doesn’t mean you’re broken")

  • opens space for validating all responses and making space for complexity (e.g., why someone might be passive or people-pleasing under stress)

Important Considerations

• The topic of trauma is vast, and this presentation is just an introduction.

• Acknowledge the existing knowledge and experience of the audience.

• Self-care is crucial as the topic can be impactful.

• Acknowledge and make space for judgments.

Brain Function and Filtering

• The brain processes $4$ billion bits of data per second, necessitating a filtering system.

• The nervous system settles when something is recognized, sorted, experienced before and the brain can predict what to do next.

Assumptions and Judgments

• Acknowledge judgments/assumptions as they influence perceptions.

• Try to hold these judgments lightly.

Presentation of Traumatized Individuals

• Trauma impacts can vary significantly across individuals and within the same individual over time.

• Traumatized individuals may present as:

  • Distressed

  • Quiet

  • Withdrawn

  • Tearful

  • In a daydream

  • Forgetful

  • Agitated

  • Frightened

  • Finding it hard to breathe

  • Flippant

  • Angry

  • Normal

  • Aggressive

  • Vague

  • Bored

Brain's Safety Mechanisms

• Brains are wired to keep individuals safe.

• Structures deep inside the primitive parts of the brain look for danger signals.

• When these structures activate, they take charge and put the body in a state of alarm.

The 6F Alarm System – Trauma Responses in Youth

Types of Triggers

• Short-Term Triggers:

  • Tend to be short term.

  • Require a physical response.

  • Are actually life-threatening.

  • Do not require much thought; thoughts can hinder the response.

• Long-Lasting Triggers:

  • Long lasting.

  • Can relate to the past or future.

  • Cannot be resolved with a physical action.

  • Are overwhelming and inescapable.

Fear, Anxiety, and Trauma

• Fear: A legitimate danger is present (e.g., presence of a tiger).

• Anxiety: Feeling fear in the absence of a real threat (e.g., worrying a tiger might appear).

• Trauma:

  • A person thought they or their family members were going to die.

  • The experience overwhelmed their ability to cope.

  • They felt powerless to act to keep safe.

  • They saw or experienced very distressing things.

Trauma, the Overwhelmed Brain, and Memory

• Prediction + Reaction Simultaneity:
  The brain under trauma tries to predict danger and respond to it at the same time → like “trying to fly the plane while we build it.”

• Memory Distortion:
  Trauma experienced under high arousal can:

  • prevent memories from forming

  • create memories without context/timeline

  • lead to fragmented or missing memories
    → The brain keeps trying to process the event and make meaning from it

• Resulting Symptoms:

  • Intrusive thoughts, flashbacks, nightmares

  • Internal conflict: the brain wants to process it and avoid it at the same time

Avoidance and Disengagement

• Avoidance of reminders of what happened.

• Refusal to talk about the event.

• Shutting down feelings.

• Disengaging from the world, both physically (withdrawal) and mentally (dissociation).

• Use of drugs and alcohol.

Hypervigilance and Risk-Taking

• Feeling hypervigilant and unsafe, with the alarm system constantly on high alert.

  • Reactive, tense, startle response, poor sleep, irritable.

• Risk-Taking as Nervous System Regulation

  • When danger becomes familiar:

    • Trauma can organise the brain around danger

    • Risk feels “safe” because it’s predictable or familiar

    • Youth may seek danger/risk to regulate their nervous system

  • Examples:

    • Substance use, crime, hypersexuality

    • High-risk behaviours serve a regulatory function — they feel “alive” or “in control”

Shame, Self-Blame, and Meaning-Making

• The brain tries to interpret experiences, feeling safest when the explanation is clear, even if the result is self-blaming.

  • • The brain craves explanation:
      → Uncertainty = danger, so the brain would rather blame us than have no explanation at all

      • “I deserved it” gives structure

      • Shame becomes a coping mechanism — it validates their worldview, even a painful one

    • Internalisation effects:

      • Shame, self-blame

      • Difficulties trusting others

      • Treating the self as an object to be used

    • Healing starts with bridging the gap:
      → “Owning” the shame gives a sense of control
      → From there, we can slowly rework the narrative: “You are good enough”

Recovery and Integration

• Over time, memories become more integrated, creating distance from the experience.

• Triggers may still cause upset, but their intensity decreases.

• The experience becomes part of personal history, extracting a wise lesson and moving on.

• Recovery involves:

  • Safety

  • Shock

  • Grief

  • Support

  • Rest

  • Re-engagement in life

Protection Mode

• Brain will stay in protection mode when danger is still present.

Impact of Trauma

• Big T Trauma:

  • Natural disaster

  • War/conflict

  • Sexual/physical assault

  • Terror attacks

  • Car accident

• Little t Trauma:

  • Financial stress

  • Relationship breakup

  • Health problem

  • Death of someone close

• The impact of an event varies; what is a little 't' for one person might be a big 'T' for another.

The Impact of Relationships

• Humans are social beings, and connection is vital for survival.

• When scared or hurt, the first response is to seek safety and regulation from caregivers.

• Being hurt by those meant to keep us safe confounds attachment and regulation systems.

• Rationalizing or accepting abuse may occur to maintain connection with caregivers.

• Early attachment relationship trauma can affect future relationships and decisions.

Acts of Omission

• Trauma isn't always from 'acts of commission'; omission causes wounds and hinders healing.

• Emotional and physical neglect during childhood increases the likelihood of developing PTSD.

Key Factors in Trauma

• Age at the time of trauma.

• Duration of the trauma.

• Support received during and after the trauma.

• How caregivers are coping.

• Other developmental/physical challenges.

Working in a Trauma-Informed Way

• Honoring complexity without being overwhelmed.

• Trauma exposure does not need confirmation to work in a trauma-informed way.

• Building skills and being a kind, supportive presence.

• Understanding your professional limits.

Assessing for Trauma

• Asking about trauma is crucial in thorough child assessments.

• Signs that might increase concerns:

  • Behavioral changes

  • Trauma symptoms

  • Developmental regression

• Remember, there may be no visible signs, making it important to always ask.

Asking About Trauma

• Be curious and interested in the child as a whole.

• Ask them directly.

• Use open questions.

• Avoid leading questions.

• Use age-appropriate language.

• Understand that disclosure requires safety and trust.

Example Questions

• "Hey, lots of kids experience things that can scare them or make them feel uncomfortable. Has anything like that happened to you? Tell me more about that?”

• "You mentioned that …made you feel gross/scared. Can you tell me a little bit more about that?”

Disclosures

• Disclosures are a taonga, to be valued and honored and should be treated with care.

Responding to Disclosures

• Listen and validate.

• Gather enough information to signal risk without needing too many specifics.

• Scaffold the client if they disclose too much, especially if you're not their primary support person.

• Don't make promises you can't keep.

• Inform the client about what you are doing with their information.

Immediate Actions

• Ascertain immediate risk and take steps with support.

• Be aware of workplace protocols and ethical obligations.

• Know agencies that can help, especially in immediate risk situations (e.g., police).

• Document verbatim soon afterward.

• Develop a plan for next steps with the client.

• Seek support for yourself; disclosures can be upsetting.

Trauma-Informed Approach

• In some roles, focus may be on other tasks (e.g., learning assessment) or a short timeframe.

• Acknowledge, validate, and gently close down trauma-related conversations.

• Offer support to get the right help from the right person.

Trauma Work Considerations

• Trauma work is complex, requiring strong assessment/therapeutic skills.

• Avoid starting trauma work that you cannot see through.

• Understand expectations from the client, family, workplace, and your availability.

Healing from Trauma

• Enhance safety.

• Allow for rest/recuperation.

• Remove barriers or do things to speed up the natural healing process.

Supporting Healing

• Create actual and emotional safety.

• Support ways to rest, recuperate, and regulate.

• Support completion of necessary and natural processes.

• Support people to 'lean into' and explore experiences rather than avoid.

• Transform trauma memories from disorganized details to a 'WISE LESSON'.

• Transition from 'protection mode' to 'growing mode'.

Therapeutic Models

• TFCBT (Trauma-Focused Cognitive Behavioral Therapy)

• EMDR (Eye Movement Desensitization and Reprocessing)

• Synergetic play therapy

• Somatic processing

• Psychodrama

• Creative therapies

Using Therapeutic Models Effectively

• Therapeutic models provide a scaffold for trauma work.

• Adapt models to keep the child in mind.

• Foundation is crucial, as is flexibility to incorporate new learning.

• Clients need you to hold the road map while they influence direction.

• Avoid searching for the 'perfect model'; learn to sit with uncertainty.

Trauma-Informed Care (TIC)

• Grounded in understanding neurological, biological, psychological, and social effects of trauma.

• Focuses on "What has happened to you?" rather than "What is wrong with you?”

Establishing Safety

• Those who have experienced trauma have a smaller window of tolerance.

• They exhibit heightened reactivity to perceived stress or danger.

• Establishing safety is a priority for life and therapy effectiveness.

Cognitive and Emotional Safety

• Encompasses the physical environment, sensory experience, and interpersonal interactions.

• Includes 'actual safety': Are basic needs being met in real life?

Social Connection

• We look to others to gauge our safety.

• Social connection is the antidote to stress.

• Regulated adults can invite children into their calm.

External Modeling and Support

• Young individuals need external modeling/support when responding to stress and threat.

• Involves:

  1. Estimation of threat

  2. Emotional and physiological reaction and their regulation

  3. Estimation of type, degree, and efficacy of protection action

• Healthy development transitions from external to internal regulation, aided by regulated adults.

• During overwhelming stress (trauma), children need adults to scaffold them.

Supporting Roles

• Those in supporting roles may also have been hurt by the child's experiences.

• They might carry their own past hurts.

• Parents might feel responsible and ashamed.

• Prior negative experiences with 'the system' can hinder trust.

• They face multiple stressors.

Supporting Caregivers

• Validate difficulties and name shame.

• Normalise reactions and support them to find calm.

• Help them expand their support network.

• Remember your judgments; avoid pressuring caregivers to be perfect.

• Emphasize their importance in their child's healing.

• Help them understand their child’s experiences.

• Remind them to QTIP (Quit Taking It Personally).

• Be regulated yourself!

Self-Care Strategies

• Breathe and slow down.

• Try to understand what you are observing.

• Prepare, be present, and debrief after sessions.

• Check in with yourself.

• Catch your thoughts.

• Focus on controllable aspects.

• Have backup support.

• Remember the power of empathy.

Self-Care Basics

• Basics like sleep, exercise, connection, fun, and rest are most effective.

• Reflect on what makes these basics hard to achieve.

• Engage in supervision.

• Advocate for a supportive system.

• Acknowledge the role's difficulty.

• Value compassion.

• Maintain realistic expectations.

Understanding Ourselves and Feelings

• A child’s emotions should be recognized, normalized, and validated before being challenged.

• Teach that all emotions have value.

• Know what to do when big feelings arise.

• A child should begin to understand where their feelings come from.

Communication

• Check your audience’s understanding (adults and children alike).

• Keep language simple, avoiding jargon.

Cultural Safety

• Are you honoring Te Tiriti o Waitangi (The Treaty of Waitangi) in your work?

• Are all clients able to see themselves represented in your therapeutic space and work?

• Integrate cultural elements such as images, metaphors, language, and rituals (tikanga).

• Recognize that Te Ao Māori worldview underpins TIC.

Maximizing Trustworthiness

• Prioritize task clarity, consistency, and reliable interpersonal boundaries.

Boundaries

• Define your professional limits.

• Expect clients to test boundaries.

• Manage expectations realistically.

• Maintain predictability.

• Behave consistently: do what you say you’ll do.

• Respect privacy and communicate who will hear what information.

• Mistakes and misattunements are normal to have.

Prioritizing Choice and Control

• Maximize a child’s capacity for making choices and having control.

Empowering Children

• Maximize the child’s sense of engagement and involvement.

• Focus on doing “with” rather than “to”.

Collaboration and Empowerment

• Listen to and understand, not fix.

• Communicate that you are in this together.

• Shift from care-taking to collaboration where appropriate.

• Slow down

Communicating Worth

• Communicate that “You matter”.

• Highlight internal strengths and sources of stamina.

• Reassure that reactions are expected and kept them safe.

• Treat people as if they were what they ought to be to help them become what they are capable of being.

Importance of Addressing Shame

• Shame is a key emotional aftereffect of trauma.

• Address shame by:

  • Avoiding ongoing shaming.

  • Understanding the person and their context.

  • Creating emotional safety.

Bio-Psycho-Social Factors

Bio: illness, injury, neurodiversity, intellectual ability, age*

• Chronological Age: The actual age of an individual measured in years, which can influence their life experiences and perspectives.

• Developmental Age: Refers to the physical, emotional, and cognitive abilities of an individual compared to typical development milestones for their chronological age.

• Street Age: The age perceived by others based on the experiences and environment in which an individual has matured, often distinct from chronological age.

• Emotional Age: Represents the emotional maturity of an individual, which may differ significantly from their chronological and developmental ages, impacting their responses to therapeutic interventions.
  Psycho: skills, thoughts/beliefs about self, thinking errors, the way I process information, reliance on avoidance
  Social… (to come)
  My needs will change as I age, as will my understanding of what happened
  What works for me in therapy will change… words might take on more significance
  Coming back into therapy isn’t a relapse…it’s a natural and normal part of healing. Sometimes I just want to be a kid and leave this stuff behind for a while!

Social Factors

• Attend to the child’s environment and the people in their life.

• Work with the family system to open opportunities for change.

• Consider peer relationships.

• Engage with the school environment.

Therapist Factors

• Personal well-being.

• Training, competence, and confidence.

• Support in the role.

• Ability to self-regulate.

• Access to ongoing training and support.

• Personal significance of the work.

• Liking children.

Foundations of Effective Therapy

• Engagement

• Stabilisation

• Processing

• Integration

• Completion

• Maintenance

Key Aspects of Therapy

• Keep your model in mind, but don't lose sight of the child and their needs.

• Maintain pace with the child; don't rush them.

• Allow children to be messy, and be present with them.

• Explain why processing is important using psychoeducation and metaphors.
  *Not all children are ready for processing.

Prerequisites for Processing Trauma

• Safety: processing isnt safe or effective if new wew traumas are being created

• Daily life: relative stability neededso things can ‘get worse before they get better’

• Attachment: a regulating attachment figure.

• Emotional regulation: coping strategies to keep feelings from becoming overwhelming

• Cognitive shift: processing will hopefully alowe a child to shift from blame/shame. Needs to be safety and space for this otherwise children can resist as they risk ‘biting the hand that feeds them’

  The Nutshell: can the child give anoverview of their traumatic memories without being completely overwhelmed. Like a ‘testflight’ if the mere thought of what happened sends the child into a complete pani the more work onthe other tests needs to happen to give an overview without overwhelm.

Processing with Children

• Processing is often non-linear.

• Involves moments of embodied expression within a window of tolerance.

• 'Toe in and toe out' model.

• The experience of safety during processing is key.

Clinical Interaction Example

• Focuses on interplay between stabilization and processing.

Case Study: Z

• Presentation: avoidance, dissociation, extreme mistrust, conflicted feelings about abuser.

• Strengths: expressive through dance and creativity, ability to say no, willingness to form attachment.

• Challenges: struggles to talk about abuse, trust issues, feelings of scary at night, cannot cope if her beliefs are challenged or contradicted by other facts

• Therapist’s main model: Psychodrama

• Significantly abused by family friend ("P").

Building Safety with Z

• Attunement and therapist self-regulation.

• Respect Z’s boundaries.

• Focus on Z’s strengths.

• Therapist to model their own boundaries.

Case Study: C

Single mum recovering addiction and FV. Social services have guardianship of children, mum in recovery soon to get full custody of kids back. Alleged abuse and FV by father at 3. Father no longer part of family unit.
Presentation – Chronic dysregulation of affect (anger) and nervous system, sexual reactive behavior, poor impulse control leading to unsafe behavior. Added complexity is impacts of mum’s P use while in utero.
Strengths: Highly engaged with therapist. Love of cars. Saw world in concrete way (e.g. goodies and badies). Able to talk in concrete way about abuse and its consequences. “ Dad did rude touching, I love him but he was bad to me so he can’t see me anymore”. Responded well to therapist being fun and kind, but also to being boundaried and following through on rules (e.g we always knock on this door. Making milk shake and cleaning up after. Putting away before starting on new activities) .
Challenges: Family system and mum’s own challenges. Short attention span and high physical activity levels.
Therapist’s main model: Somatic Psychotherapy

Interventions for C

Regulate nervous system, build on somatic strengths first and then integrate some trauma story using Window of Tolerance model (WoT)
Establish understanding and enactment of safe boundaries and behavior. Using traffic light framework as metaphor

Traffic Light Systems for C

Use of traffic light systems to concretise what is safe and what is not