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Trauma-Informed Health Care

Trauma-Informed Health Care

Introduction

People with intellectual and developmental disabilities (IDD) are at greater risk of adverse life events and more likely to experience trauma compared to others in the general population. The experience of trauma has many negative consequences including poor physical, mental and emotional or social outcomes across the life span.

People with IDD often can’t verbalize their distress. Instead, this may present as concerning and difficult to manage behaviours. These in turn, can lead to interventions that are further traumatizing such as psychotropic polypharmacy and restraints. Therefore, in health care for people with IDD we need to think of, and screen for, trauma in every encounter with patients referred because of concerns about emotional and behavioural distress or previously diagnosed with psychiatric disorder.

The practice support tools in the Mental Health section are trauma-informed. Key terminology related to trauma is listed in the glossary below.

Download: Glossary Trauma-Informed Care

Browse the resources below to learn more about trauma and intellectual disabilities and trauma-informed health care.

 

  • Trauma-informed care

    Trauma-informed care has 5 guiding principles: trauma awareness and acknowledgment; safety and, trustworthiness; choice, control, and collaboration; strengths-based and skills-building care; awareness of cultural, historical, and gender issues. Ideally, delivering such care involves the entire health care system, including managers, receptionists, nurses, physicians and allied health professionals.

    Watch “Equity Essentials: Trauma- and Violence-Informed Care” by EQUIP Health Care, a research and implementation program that involves health equity interventions implemented in a range of health care settings. [Video, 6:21 minutes]

    Trauma-informed care is not trauma-specific treatment; it does not propose to heal specific past traumas. Rather, trauma-informed care acknowledges that patients can experience trauma in the very settings tasked with their care and healing. Trauma-informed care does not imply that family doctors need to be trauma specialists. Read more about the guiding principles and how to apply these in primary care, in:

    Eva Purkey, Rupa Patel, Susan P. Phillips. Trauma-informed care. Canadian Family Physician Mar 2018, 64 (3) 170-172.

    Gopal DP, Hunter M, Butler D, O’Donovan D, Hart N, Kearney G, Blane D. Trauma-informed care: what does it mean for general practice? Br J Gen Pract. 2023 Apr 27;73(730):229-231.

    Esden JL. Adverse childhood experiences and implementing trauma-informed primary care. Nurse Pract. 2018 Dec;43(12):10-21.

  • Trauma and intellectual and developmental disabilities

    People with intellectual and developmental disabilities (IDD) are more vulnerable to experiencing trauma and experience more stressful and traumatic life events than those without IDD, often beginning at a young age. Chronic experience of trauma can have significant negative impact on health and wellbeing. Trauma in IDD can also arise when a person’s supports and environment do not match their developmental profile, skills and abilities. In general, people with IDD experience poorer health and inequities in accessing healthcare, such as greater exposure to painful medical procedures, discontinuity in care, frequent hospital visits. These experiences may have a traumatic impact on both the patient and their caregivers.

    The tipsheet and additional resources below are a good start to learn more about trauma and intellectual and developmental disabilities. Check back regularly for updated resources.

    Dunn, Chanda. Trauma and individuals with intellectual and developmental disabilities University of Tennessee Centre on Developmental Disabilities; Vanderbilt Kennedy Centre for Excellence in Developmental Disabilities. 2018. [tipsheet]

    Selected resources:

    Beail N, Frankish P, Skelly A, editors. Trauma and Intellectual Disability: Acknowledgement, Identification & Intervention. Shoreham-by-Sea, Sussex, UK: Pavilion; 2021.

    Bradley E, Korossy M. Are difficult behaviours described in intellectual and developmental disabilities and autism actually adaptive responses to feeling unsafe? Journal on Developmental Disabilities. 2022;27(3)

    McNally P, Taggart L, Shevlin M. Trauma experiences of people with an intellectual disability and their implications: A scoping review. J Appl Res Intellect Disabil. 2021 Jul;34(4):927-949. doi: 10.1111/jar.12872. Epub 2021 Mar 26. PMID: 33772975.

  • Understanding trauma

    Understanding the role of the autonomic nervous system (ANS) when triggered into survival responses, offers insights for prevention and treatment approaches of trauma behaviours. Watch “Trauma and the Nervous System: A Polyvagal Perspective” by the Trauma Foundation and the Polyvagal Institute, for a basic introduction of how trauma and chronic stress affects our nervous system and how those effects impact health and well-being. [Video, 8:57 minutues]

    Read more:
    Porges SW. Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 2022;16:871227.

Clinical leads

The mental health tools in this section have been updated from a trauma-informed care perspective under the clinical leadership of Elspeth Bradley, MB BS PhD FRCPC FRCPsych, a psychiatrist and psychotherapist in intellectual and developmental disabilities (IDD). She is an Associate Professor at the University of Toronto and currently holds courtesy appointments at The Centre for Addiction and Mental Health and at St Michael’s Hospital, Toronto. Dr. Bradley has had the pleasure of contributing to the Developmental Disabilities Primary Care Program since its inception in 2005 and of working with people with intellectual and developmental disabilities and autism (ASD) for several decades in the UK and Canada. Published research includes outcomes from a population-based study of psychiatric disorders in adolescents with IDD and ASD; clinical research has drawn attention to complexities in diagnosing psychiatric disorders in people with IDD and ASD, in the absence of an understanding of their lived experience and mental distress consequent to adjusting to frequent disruptions and adversity in their daily lives. Her current focus on trauma, triggers and emotional engagement as a necessary pre requisite to any psychiatric evaluation, is described in a recently co-authored book Responsive Communication: Combining attention to sensory issues with using body language (intensive Interaction) to interact with autistic adults and children

Kerry Boyd, MD FRCPC, Associate Clinical Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, Ontario. Her clinical work includes working with people who have developmental disabilities. Education and research initiatives have focused on promoting inclusion and care for people with IDD. As an AMS Phoenix Fellow she brought expertise together as Curriculum of Caring course developer. More information on the Curriculum of Caring.

  • Supporting materials
    • Trauma-informed care

      Trauma-informed care has 5 guiding principles: trauma awareness and acknowledgment; safety and, trustworthiness; choice, control, and collaboration; strengths-based and skills-building care; awareness of cultural, historical, and gender issues. Ideally, delivering such care involves the entire health care system, including managers, receptionists, nurses, physicians and allied health professionals.

      Watch “Equity Essentials: Trauma- and Violence-Informed Care” by EQUIP Health Care, a research and implementation program that involves health equity interventions implemented in a range of health care settings. [Video, 6:21 minutes]

      Trauma-informed care is not trauma-specific treatment; it does not propose to heal specific past traumas. Rather, trauma-informed care acknowledges that patients can experience trauma in the very settings tasked with their care and healing. Trauma-informed care does not imply that family doctors need to be trauma specialists. Read more about the guiding principles and how to apply these in primary care, in:

      Eva Purkey, Rupa Patel, Susan P. Phillips. Trauma-informed care. Canadian Family Physician Mar 2018, 64 (3) 170-172.

      Gopal DP, Hunter M, Butler D, O’Donovan D, Hart N, Kearney G, Blane D. Trauma-informed care: what does it mean for general practice? Br J Gen Pract. 2023 Apr 27;73(730):229-231.

      Esden JL. Adverse childhood experiences and implementing trauma-informed primary care. Nurse Pract. 2018 Dec;43(12):10-21.

    • Trauma and intellectual and developmental disabilities

      People with intellectual and developmental disabilities (IDD) are more vulnerable to experiencing trauma and experience more stressful and traumatic life events than those without IDD, often beginning at a young age. Chronic experience of trauma can have significant negative impact on health and wellbeing. Trauma in IDD can also arise when a person’s supports and environment do not match their developmental profile, skills and abilities. In general, people with IDD experience poorer health and inequities in accessing healthcare, such as greater exposure to painful medical procedures, discontinuity in care, frequent hospital visits. These experiences may have a traumatic impact on both the patient and their caregivers.

      The tipsheet and additional resources below are a good start to learn more about trauma and intellectual and developmental disabilities. Check back regularly for updated resources.

      Dunn, Chanda. Trauma and individuals with intellectual and developmental disabilities University of Tennessee Centre on Developmental Disabilities; Vanderbilt Kennedy Centre for Excellence in Developmental Disabilities. 2018. [tipsheet]

      Selected resources:

      Beail N, Frankish P, Skelly A, editors. Trauma and Intellectual Disability: Acknowledgement, Identification & Intervention. Shoreham-by-Sea, Sussex, UK: Pavilion; 2021.

      Bradley E, Korossy M. Are difficult behaviours described in intellectual and developmental disabilities and autism actually adaptive responses to feeling unsafe? Journal on Developmental Disabilities. 2022;27(3)

      McNally P, Taggart L, Shevlin M. Trauma experiences of people with an intellectual disability and their implications: A scoping review. J Appl Res Intellect Disabil. 2021 Jul;34(4):927-949. doi: 10.1111/jar.12872. Epub 2021 Mar 26. PMID: 33772975.

    • Understanding trauma

      Understanding the role of the autonomic nervous system (ANS) when triggered into survival responses, offers insights for prevention and treatment approaches of trauma behaviours. Watch “Trauma and the Nervous System: A Polyvagal Perspective” by the Trauma Foundation and the Polyvagal Institute, for a basic introduction of how trauma and chronic stress affects our nervous system and how those effects impact health and well-being. [Video, 8:57 minutues]

      Read more:
      Porges SW. Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 2022;16:871227.

  • Meet the team

    Clinical leads

    The mental health tools in this section have been updated from a trauma-informed care perspective under the clinical leadership of Elspeth Bradley, MB BS PhD FRCPC FRCPsych, a psychiatrist and psychotherapist in intellectual and developmental disabilities (IDD). She is an Associate Professor at the University of Toronto and currently holds courtesy appointments at The Centre for Addiction and Mental Health and at St Michael’s Hospital, Toronto. Dr. Bradley has had the pleasure of contributing to the Developmental Disabilities Primary Care Program since its inception in 2005 and of working with people with intellectual and developmental disabilities and autism (ASD) for several decades in the UK and Canada. Published research includes outcomes from a population-based study of psychiatric disorders in adolescents with IDD and ASD; clinical research has drawn attention to complexities in diagnosing psychiatric disorders in people with IDD and ASD, in the absence of an understanding of their lived experience and mental distress consequent to adjusting to frequent disruptions and adversity in their daily lives. Her current focus on trauma, triggers and emotional engagement as a necessary pre requisite to any psychiatric evaluation, is described in a recently co-authored book Responsive Communication: Combining attention to sensory issues with using body language (intensive Interaction) to interact with autistic adults and children

    Kerry Boyd, MD FRCPC, Associate Clinical Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, Ontario. Her clinical work includes working with people who have developmental disabilities. Education and research initiatives have focused on promoting inclusion and care for people with IDD. As an AMS Phoenix Fellow she brought expertise together as Curriculum of Caring course developer. More information on the Curriculum of Caring.