Handover | Issue 42 - July 2018

An update from Suzette Poole, Clinical lead, Te Pou o te Whakaaro Nui on our Trauma-informed care project. 

Recognising we need to provide both support and services that are trauma-informed is not new to nurses working in mental health, addiction and disability services. I am sure that many of you reading this article will have attended learning opportunities to enhance your own knowledge and skills about trauma-informed care. 

However, there is no national approach to developing trauma-informed mental health, addiction and disability services and there are very few New Zealand developed resources.  

In New Zealand the impact of colonisation on the wellbeing of Māori people, the impact of historical trauma events and their contribution to negative health disparities experienced by many whānau (extended family), hapū (sub-tribes), and iwi (tribes) need to be considered in any trauma-informed approach.  

A trauma-informed approach recognises and understands trauma can negatively affect whānau, groups, organisations and communities, as well as individuals. We know that developing trauma-informed approaches is not unique to mental health and addiction services. People who have experienced trauma may be engaged with a range of services such as health, education, justice, mental health, addiction or social services.  

People have different responses to trauma and we need to be aware of the event, the experience by a person or a population and the effects of the event. People providing services may have experienced trauma in their personal and or professional lives which may impact on their health and wellbeing. Worker wellbeing is an important component of a trauma-informed approach.  

New Zealand based research is emerging. The He Oranga Ngākau, Māori approaches to trauma-informed care research project is well on the way to developing a practice framework. Te Kotahi Research Institute at the University of Waikato are leading out research about Māori approaches to trauma-informed care. Results of this three-year project will be published and will include practice principles that could contribute to the developement of a framework that supports Māori providers, counsellors, clinicians and healers in working with Māori. https://researchcommons.waikato.ac.nz/handle/10289/11805  

Our scan of the literature revealed a plethora of information and resources about trauma and trauma-informed care. One of the challenges was that the terms trauma-informed approach and trauma-informed care are used interchangeably in the literature and used in multiple ways.  

The key thing is that we must continue shifting our lens to understanding more about what has happened to a person rather than a focus on what’s wrong with a person.  

One definition is: Trauma-informed care is a strengths-based service delivery approach that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasises physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment (SAMHSA, 2014, p.10).  

Part of being trauma-informed is also understanding what trauma is - the lasting adverse effect on a person’s or collective’s functioning and mental, physical, social, emotional or spiritual wellbeing, caused by events, circumstances or intergenerational historical traumatic experiences  
(Te Pou o te Whakaaro Nui, 2018, p.16).  

We discovered that most of the research, initiatives and resources to support services and communities to develop trauma-informed approaches emanate from the USA, Canada, UK and Australia. Therefore, we must be mindful that the use of or adaption of any overseas designed trauma-informed care resources requires careful consideration to ensure that we are culturally respectful of and responsive to Māori people.  

What actions are we taking?   

We have greatly enhanced content about trauma-informed care and how to support Māori people in the refresh of Let’s get real that describes the values, attitudes, knowledge and skills needed to support people with mental health and addiction needs, following feedback from the sector. We have acknowledged that worker wellbeing is an important component of a trauma-informed approach. In the refresh of Let’s get real the Real Skill - Maintaining professional and personal development, includes a section on worker wellbeing Once the refreshed framework is approved by the Ministry of Health, we will be developing workforce development resources which will include content about trauma- informed care. https://www.tepou.co.nz/resources/lets-get-real-draft-refreshed-framework/860  

We have made available to the sector a video presentation from Joe Rafferty the chief executive from Mersey Care (UK) who has supported their own workforce with self-care and workplace wellness initiatives. This has resulted in a 40 per cent reduction in staff sickness – a great result. https://www.tepou.co.nz/resources/striving-for-perfect-care-and-a-just-culture/851  

We are working in collaboration with the other workforce centres; Werry Workforce Whāraurau, Le Va and Te Rau Matatini to focus on the development of a trauma-informed approach for New Zealand.  

We have published  

  • a literature scan about trauma-informed care  
  • a list of organisations that have produced resources about trauma-informed care  
  • a list of resources about trauma-informed care  
  • profiles on New Zealand stories of change about trauma-informed care initiatives.  

If you have any queries about trauma-informed care, please contact Suzette Poole, Te Pou clinical lead.

Go to our Trauma-informed care page.

Do the best you can, until you know better. Then when you know better, do better. 

- Maya Angelou