Trauma-Informed Care

Trauma is the exposure to one or more events that overload the brain. It includes later internalization of many feelings—including powerlessness, helplessness, and loss of safety—and can lead to heightened stress and anxiety. Trauma can be individual (e.g., losing a family member) or collective (e.g., experiencing a pandemic or natural disaster). See The ASHA Leader article, "A Pandemic’s Pain: The Need for Trauma-Informed Services for Children."

Mental health needs of practitioners, as well as clients, patients, and students have increased since the COVID-19 pandemic began. The American Psychological Association’s (APA) 2022 Stress in America poll revealed serious national and financial stressors, widespread grief and sense of loss, continued hardships for vulnerable populations, caregivers’ concerns for children’s development, and entrenched, unhealthy coping habits. 

A trauma-informed model of care ensures the emotional and physical safety of those receiving services and the wellness of those providing such services. This model emphasizes the need for behavioral health practitioners and their professional organizations to recognize the prevalence and pervasive impact of trauma on their lives and on the lives of the people they serve—and to develop trauma-sensitive or trauma-responsive services. 

ASHA Virtual Town Halls on Trauma

Supporting Your Well-Being
In this discussion, panelists describe the differences between wellness, resiliency, and secondary trauma, and identify strategies and tools to mitigate and anticipate burnout, compassion fatigue, and secondary trauma.

Discussing Trauma-Informed Care With Clients, Patients, and Students
Panelists share ASHA and other resources—as well as tools and strategies that assistants, audiologists and SLPs can use to provide trauma-informed care in clinical practice.

Resources on Trauma

• Secondary Traumatic Stress
  A resource guide from the Administration for Children & Families about interventions that professionals can use to address compassion fatigue.
• Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy
  An article on the role of perceived coping self-efficacy in recovery from different types of traumatic experiences.
• Treating PTSD in First Responders: A Guide for Serving Those Who Serve
  A guide by the American Psychological Association that defines PTSD and includes information about moral injury, assessment, and treatments for first responders.
• Types of Trauma
  A webpage that provides definitions of different types of trauma.
• The Why, What, and How of Trauma-Informed Educational Practices
  A tutorial that describes trauma and provides strategies for CSD educators seeking to mitigate the effects of trauma on students.

Resources for Audiologists

ASHA Resources

• ASHA Voices: When Brain Injuries Lead Patients to the Audiologist
  Two experts share stories and observations from their careers.
• Blast-Related Ear Injury in Current U.S. Military Operations: Role of Audiology on the Interdisciplinary Team
  This presentation—from an audiologist who is a colonel in the U.S. Army—addresses the vital role that audiologists play on interdisciplinary teams in assessment and management of veterans with ear injuries.

Additional Audiology Resources

• Hearing Aid Use for Patients With Posttraumatic Stress Disorder
• Impact of TBI, PTSD, and Hearing Loss on Tinnitus Progression in a U.S. Marine Cohort
• Interview With Michael Harvey, PhD, Clinical Psychologist: A dialogue about patients who need hearing aids but don’t want them.
• Traumatic Deafness: A Pictorial Review of CT and MRI Findings
• Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training
• Trauma-Informed Care With Deaf Persons

Resources for SLPs Working With Children and Youth

These ASHA resources may be helpful in supporting your clinical service delivery for children and families. Additional resources are also helpful with interprofessional education and interprofessional practice (IPE/IPP).

ASHA Resources

• A Pandemic’s Pain: The Need for Trauma-Informed Services for Children
  Lessons learned about trauma-informed care from the COVID-19 pandemic.
• Adversity Exposure, Syntax, and Specific Language Impairment: An Exploratory Study  
  A study of specific language impairment in a group of children with known histories of adversity (e.g., chronic poverty, traumatic events, and maltreatment).
• ASHA Voices: In the Schools, an SLP Responds to Trauma
  A podcast interview with an SLP who worked at Marjory Stoneman Douglas High School (the site of a 2018 school shooting).
• Autobiographical Memory in Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, Hearing Loss, and Childhood Trauma: Implications for Social Communication Intervention
  A tutorial to instruct SLPs on how to address autobiographical and episodic memory deficits in groups at risk.
• Insights Into Connecting With Students Experiencing Trauma
  An SLP shares signs of trauma to watch for in children—and strategies to calm them and connect with them.
• Prevalence Versus Evidence: A Closer Look at the Research Available for Serving Children Exposed to Maltreatment and a Response to Hyter’s Call for Trauma-Informed Care
  A discussion of the pandemic’s impact on maltreatment and the SLP’s role in prevention and intervention.
• School-Based Speech-Language Pathologists’ Attitudes and Knowledge About Trauma-Informed Care 
  Preliminary evidence that trauma-informed care trainings may help SLPs who work with children who have experienced trauma. 
• Strategies for Working With Students Who’ve Experienced Trauma
  A short example of what behaviors a student who has experienced trauma may exhibit in school and strategies to utilize during speech-language sessions.
• The Childhood Trauma and Attachment Gap in Speech-Language Pathology: Practitioners’ Knowledge, Practice, and Needs
  A study to better understand SLPs’ knowledge and current practices related to developmental trauma and attachment.
• Using Trauma-Sensitive Approaches to Address Pandemic Stress
  A description of how SLPs can look for signs of stress and help lessen the burden of pandemic-related stress.
• Working With Students Battling COVID Anxiety
  Information related to how school-based practitioners may note warning signs of pandemic-related stress and mental health issues.

Additional SLP Resources

• Narrative Exposure Therapy for Children and Adolescents (KIDNET): A book chapter referenced by Carol Westby during the "Discussing Trauma-Informed Care With Clients, Patients and Students" virtual town hall on how to help a child construct a chronological narrative using rocks and flowers that includes traumatic experiences.
• On Trauma and Language Development: An essay that discusses trauma’s impact on language development and what SLPs can do to help.   
• Resources on Trauma-Informed Care for Schools Before, During, and After Possible Emergency Events: A list of webpages that professionals can use to provide support related to emergency events.
• Sharing Power: A Tool for Reflection [PDF]: A tool designed to help providers self-reflect to find opportunities to share power in trauma-responsive care
• Supporting Child and Student Social, Emotional, Behavioral, and Mental Health Needs [PDF]: An informational document from the U.S. Department of Education.
• Addressing Trauma and Fostering Resilience: A Video Collection on Trauma-Informed Practice: A series of videos where experts provide strategies to assist clinicians with using trauma-informed practices.
• Trauma-Informed Care in the NICU: A podcast designed to provide information on the concept of trauma-informed, age-appropriate care as a biologically relevant paradigm for hospitalized infants, families, and professionals.

Resources for SLPs Working With Adults

ASHA Resources

• 5 Strategies for Working With Rehab Patients After Medical Trauma
  An article describing considerations working with patients after receiving emergency or acute medical care.
•  The Relentless Hurt of Trauma
  How to recognize and understand trauma triggers to inform treatment of adult patients. 

Additional Resources

• A Trauma-Informed Toolkit for Providers in the Field of Intellectual Disabilities: A free toolkit designed to provide support for people with intellectual/developmental disabilities who have experienced trauma.
• Disability Advocates Urge for Investment in Launch of 988 Hotline: A Mental Health Crisis Deserves a Mental Health Response: An article related to the rollout of a National Suicide Prevention hotline in the United States.
• How To Handle Memories of Trauma: An article discussing the considerations of potential trauma in caregivers of persons with disabilities.
• ICU-diary.org: A diary network created by ICU nurses who cooperate with patients, relatives, and other medical disciplines to provide an account of the patient’s stay in the ICU. Research indicates reduced post-traumatic stress disorder following surgery when patients and families keep a record of details during an ICU hospital stay.
• Improving Recovery From Sexual Assault With Trauma-Informed Care: People with intellectual and developmental disabilities are seven times more likely than the rest of the population to experience sexual violence. This blog from The Arc shares how one group is building the capacity of their community to respond in an informed, effective, and sensitive way.
• National Center for PTSD: PTSD Coach Online: A website for anyone who needs help with upsetting feelings. Trauma survivors, their families, or anyone coping with stress can benefit.
• Post-Intensive Care Syndrome: What It Is and How To Help Prevent It: An article that provides an overview of strategies to reduce stress and increase multidisciplinary collaboration to improve patient outcomes.
• Stress, PTSD, and Parents of Kids With Disabilities: A blog written by a psychologist supporting caregivers of children with disabilities and related trauma.
• Student Mental Health Is in Crisis. Campuses Are Rethinking Their Approach: An article considering students in communication sciences programs and their mental health.

Resources on Mental Health

• Connecting Audiologists and Speech-Language Pathologists With Mental Health Resources
  An ASHA webpage that provides (a) information on wellness and trauma and (b) links to online resources designed to help practitioners.
• Encouraging Staff Wellness in Trauma-Informed Organizations [PDF]
  An infographic that shows how chronic emotional stress can lead to negative organizational outcomes and suggests strategies to promote staff wellness.
• Preventing Burnout in Healthcare Workers
  An article that shows how one hospital helped with “healing the healers” during the pandemic.
• SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach [PDF]
  Guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA) on a trauma-informed approach to support people who have had traumatic experiences.
• Six Dimensions of Wellness
  A resource from the National Wellness Institute that defines six factors that professionals can address to foster wellness. This resource includes links to free wellness tools, exercises, and resources to assist with wellness.
• Stop Framing Wellness Programs Around Self-Care
  An article that argues for the importance of “framing employee distress as a collective rather than [an] individual problem.
• Strategies for Encouraging Staff Wellness in Trauma-Informed Organizations
  A brief about the impact of trauma on providers, organizations, and ways to prevent problems with case examples.