“This project was supported by Grant #2017-MC-FX-K051 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect those of the Department of Justice.”
Traumatic events are a universal human experience. Each of us has experienced trauma in one form or another. However, repeated trauma can lead to severe negative outcomes. In addition to the trauma experienced during exploitation, victims/survivors of Commercial Sexual Exploitation of Children (CSEC) often endure trauma prior to their exploitation. For example, 70% to 90% of CSEC survivors have experienced sexual abuse prior to being trafficked (Lloyd & Orman, 2007), and 95% of youth who were sex trafficked reported a history of childhood maltreatment (Wolfe, Greeson, Wasch & Treglia, 2018).
These traumatic experiences affect the biological, psychological, social, and spiritual health of a person. In order to foster positive outcomes, providers must acknowledge how trauma adversely affects a survivor’s response to the environment, stress, and daily activities. Although research on trauma-informed mentoring is limited, trauma-informed care is used frequently in therapy practices, residential treatment centers, foster homes, and child welfare systems (Brown, McCauley, Navalta, & Saxe, 2013; Hodgdon, Kinniburgh, Gabowitz, Blaustein, & Spinnazzola, 2013; Johnson & Pryce, 2013). Trauma-informed practices can be applied to the mentoring relationship, which is particularly important when working with mentees who have experienced trafficking.
- A basic understanding of trauma is a key ingredient to a successful implementation of trauma-informed practices.
- Trauma Defined
- Trauma, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is exposure to “death, threatened death, actual or threatened serious injury, actual or threatened sexual violence.” Trauma can be experienced directly (i.e. traumatic experience happens to you), indirectly (learning a friend experienced trauma), by witnessing a traumatic event, or through repeated exposure to details of something traumatic.
- Trauma can be a one-time event (acute trauma) or can be prolonged (chronic trauma) (Bath, 2008). Most survivors of trafficking experience chronic trauma.
- Chronic trauma (i.e. repeated or prolonged exposure to traumatic events, like human trafficking) will require a lengthy recovery process (Bath, 2008). Service providers must recognize and prepare for this process before engaging in work with survivors.
- Trauma is “highly personal and the impact of a traumatic event is specific to the individual” (Buse, Burker, & Bernacchio, 2013, p. 15).
- Trauma and the Body
- Trauma has physical ramifications. For example, survivors of trafficking often experience headaches, stomach pain, memory problems, back pain, poor appetite, exhaustion, dizzy spells, pelvic pain, and gynecological infections due to the physical and psychological trauma they have faced (Oram et al., 2012a; Oram et al., 2012b; Zimmerman, et al., 2008).
- Trauma changes how your body responds to stress. In order to survive repeated trauma, the body, brain, and even nervous system learn to adapt (Child Welfare Information Gateway, 2014). As trauma is so pervasive it changes how our bodies respond and cope, healing from trauma must be holistic (biological-psychological-social-spiritual).
- Many people who have experienced something traumatic become fixated on safety. They may become alarmed just thinking about the traumatic event. The resulting actions are rooted in their aroused state, even though they are no longer in immediate harm (Perry, 1999).
- The resulting survival mechanisms are often mislabeled as problem behaviors such as aggression, not following rules, dissociation, acting out, distrust, etc.
- Exposure to a traumatic experience can result in Post-Traumatic Stress Disorder (PTSD). PTSD occurs if a person is consistently, for more than one month, re-experiencing the traumatic event, shows avoidance and numbing response to stimuli related to the trauma, experiences negative changes in mood or behavior (lack of interest in significant activities, alimentation, self-blame, persistent trauma-related emotions, etc.), displays changes in arousal or reactivity (DSM-IV).
- High levels of PTSD, anxiety, and depression have been found in survivors of trafficking (Oram et al., 2012b).
- Many of the “negative” behaviors displayed by youth who have experienced trafficking are actually skills which helped them survive exploitation. It takes time for the body to relearn how to cope and respond when trauma is absent. Service providers should work with survivors on identifying how to change and adapt past coping skills to more effectively serve them in recovery.
- Trauma Informed Practices
- Trauma-informed practices aims to address the unique needs of those who have experienced trauma. Services are offered in a manner that acknowledges the impact of past trauma and is tailored to meet the specific vulnerabilities of those who have experienced trauma (Harris & Fallot, 2001; Clawson, Salomon, & Grace, 2008).
- Trauma-informed practices are needed at all levels of an agency/organization. Every interaction, from check-in at the front desk to actual service delivery, should be offered with the unique needs of trauma survivors in mind (Clawson, Salomon, & Grace, 2008; Harris & Fallot, 2001).
- Trauma-informed practices take into account the impact of trauma. Services are designed to meet the unique needs of survivors and avoid re-traumatization (Harris & Fallot, 2001; Clawson, Salomon, & Grace, 2008).
- Although services should recognize and address trauma, it is important that services are strengths-based, rather than deficit-focused.
- Trauma-informed practices aims to address the unique needs of those who have experienced trauma. Services are offered in a manner that acknowledges the impact of past trauma and is tailored to meet the specific vulnerabilities of those who have experienced trauma (Harris & Fallot, 2001; Clawson, Salomon, & Grace, 2008).
- Trauma Informed Practices At a Glance
- The four “R”s (SAMHSHA, 2014)
- Basic realization and understanding or trauma
- Recognize signs of trauma
- Respond by applying the 6 principles
- Resist re-traumatization
- 6 Principles (SAMHSHA, 2014)
- Safety
- Trustworthiness and Transparency
- Peer Support
- Collaboration and Mutuality
- Empowerment, Voice, and Choice
- Cultural, Historical, and Gender Issues
- The four “R”s (SAMHSHA, 2014)
- We at the Center for Combating Human Trafficking and Youth Collaboratory are mindful to focus on strengths and resilience to keep us from becoming deficit based with trauma informed approaches.
- Trauma informed approaches shift the focus from “what’s wrong with you?” to “what happened to you?”.
- Including a strengths based approaches takes this a step further, recognizing the impact of trauma but shifting to focus on “what’s right with you?”.
- This focus helps align one’s identity with strengths and resilience, rather than aligning one’s identity with “what happened to you”.
General Practice Implications
Individuals
- Those who will be connecting with youth who have experienced trafficking should receive training on the impact of trauma as well as trauma-informed practices.
- All those intentionally engaging with survivors should be held accountable for ensuring that a trauma-informed environment is created.
- Youth experiencing trafficking have likely dealt with some form of childhood abuse or traumatic experience before they were exploited. Service providers will need to attend to trauma associated with both trafficking and early childhood experiences.
Service Providers
- Trauma-informed practices are not just about client interactions, but rather, how organizations incorporate the concepts of trauma-informed care into all aspects of daily operations. Organizations should assess their policies and procedures through a trauma-informed lens and adjust as necessary to better serve those who have experienced trauma.
Community
- Advocate for trauma-informed practices to be implemented across social service agencies and systems that youth engage with.
- Leverage opportunities and funding focused on building a trauma-informed community.
Mentoring Practice Implications
Individuals
- It is vital that mentors receive training on the impact of trauma and on implementing trauma-informed practices. Such training can greatly impact how they interact with mentees.
- For many youth who have experienced trafficking, trauma occurred in the context of relationships. With the right support and training, healing can occur in a healthy mentor relationship (Johnson & Pryce, 2013).
- Mentors can assist in building/strengthening the resilience factors of youth. Training on the unique risk and resilience factors associated with CSEC will assist mentors in developing activities/intentional engagement to address resilience.
Service Providers
- Encourage mentors to see their mentee’s behavior through a trauma-informed lens (“what happened to you” vs “what is wrong with you”) with a strengths perspective (“what is right with you”) assist them in developing trauma-informed responses. This is a skill that will take time to develop. Staff supporting mentors should encourage reflection on how trauma might be playing a role in a situation that has raised concern.
- Ensure that mentors receive continual training on trauma as the mentoring relationship develops. Failure to provide training on trauma leads to poorer outcomes in the mentee (Johnson & Pryce, 2013).
- Provide regular and ongoing support to mentors so that they know that they are not alone and aren’t expected to have all the answers.
- Offer peer mentor support sessions so mentors can share their experiences, learn from one another, and provide encouragement as they strive to better understand how trauma is impacting a youth’s day-to-day life.
Community
- Advocate for more trauma-informed communities which aim to address community and individual level trauma through community engagement and participation (Annie E. Casey Foundation, 2015).
- Encourage open dialogue about what trauma might look and how it impacts our communities.
Resources
- Organizational Trauma-Informed Assessment
- The Future of Healing: Shifting from Trauma-Informed Care to Healing Centered Engagement
- Developing a Trauma-Informed Agency
- Trauma Training Toolkit
- Childhood Trauma Changing Minds
- Language Matters - Trauma Infographic
Discussion Questions
- How does trauma affect an individual?
- How might trauma impact a young person physically?
- How might trauma impact behavior or thoughts?
- How might the impact of trauma present as negative behavior?
- What are the 6 principles of trauma informed practices?
- How are we incorporating these practices in our program?
- Why is it important to include strengths perspective in trauma-informed practices?
- What qualities/strengths might aid a young person in surviving childhood maltreatment and human trafficking?
- How can mentors incorporate trauma-informed practices and traditions into their mentoring relationship?
- Addressing:
- Safety
- Trust/Transparency
- Peer Support
- Collaboration and Mutuality
- Empowerment, Voice, and Choice
- Cultural, Historical, and Gender Issues
- Addressing:
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.
- Annie E. Cassey Foundation. (2015). A model move: Trauma informed community building. Retrieved from: https://www.aecf.org/blog/a-model-move-trauma-informed-community-buildi…
- Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3), 17-21.
- Brown, A., McCauley, K., Navalta, C., & Saxe, G. (2013). Trauma systems therapy in residential settings: Improving emotion regulation and the social environment of traumatized children and youth in congregate care. Journal of Family Violence, 28, 693-703.
- Buse, N., Burker, E., & Bernacchio, C. (2013). Cultural variation in resilience as a response to traumatic experience. Journal of Rehabilitation, 79(2), 15-23.
- Clawson, H. J., Solomon, A., & Grace, L. G. (2008). Treating the hidden wounds: Trauma treatment and mental health recovery for victims of human trafficking. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
- Child Welfare Information Gateway. (2014). Parenting a child who has experience trauma. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.
- Fallot, R., & Harris, M. (2009). Creating cultures of trauma-informed care: A self-assessment and planning protocol. (Community Connections. Washington, D.C.) retrieved from http://www.theannainstitute.org/CCTICSELFASSPP.pdf
- Fratto, C. (2016). Trauma-informed care for youth in foster care. Archives of Psychiatric Nursing, 30, 439-446.
- Harris, M., & Fallot, R. D. (Eds.) (2001). Using trauma theory to design service systems: New directions for mental health services. New York: Jossey-Bass.
- Keesler, J. (2014). A call for the integration of trauma-informed care among intellectual and developmental disability organizations. Journal of Policy and Practice in Intellectual Disabilities, 11(1), 34-42.
- Johnson, S. & Pryce, J. (2013). Therapeutic mentoring: Reducing the impact of trauma for foster youth. Child Welfare, 92(3), 9-25.
- Perry, B. (1999). Helping traumatized children: A brief overview for caregivers. Child Trauma Academy Press, 1(5), 1-17.
- Oram, S., Ostrovschi, N., Gorceag, V., Hotineanu, M., Gorceag, L., Tribug, C., & Abas, M. (2012a). Physically health symptoms reported by trafficked women receiving post-trafficking support in Moldova: Prevalence, severity, and associated factors. BioMed Central Women’s Health, 12(20), 1-9.
- Oram, S., Stockl, H., Busza, J., Howard, L., & Zimmerman, C. (2012b). Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: Systematic review. PLoS Medicine, 9(5), 1-13.
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). 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. Retrieved from https://store.samhsa.gov/system/files/sma14-4884.pdf
- Wolfe, D., Greeson, J., Wasch, S., & Treglia, D. (2018). Human trafficking prevalance and child welfare risk factors among homeless youth: A multi-city study. Retrieved from The University of Pennsylvania Field Center for Children’s Policy, Practice & Research website: https://fieldcenteratpenn.org/wp-content/uploads/2013/05/6230-R10-Field…
- Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Tchomarova, M., Ciarrocchi, R., . . . Watts, C. (2008). The health of trafficked women: A survey of women entering posttrafficking services in Europe. American Journal of Public Health, 98(1), 55-59.
Focus areas