5.6: Trauma-informed Care

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Todd LaMarr

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Trauma and Care

Toxic stresses in general are strongly linked to poor health outcomes across the lifespan and trauma-informed care is one approach to caregiving based on the recognition of this relationship. Caregivers of trauma-informed care strive to understand children’s behavior in light of previous traumas they have experienced, such as ACEs. Thus, trauma-informed care for infants and toddlers begins with first recognizing the prevalence and potential impact toxic stress and ACEs can have during the first three years. Caregivers also provide supportive care that enhances children’s feelings of safety and security, to prevent their re-traumatization in a current situation that may potentially overwhelm their coping skills. ^{^[1]}

Several key concepts of trauma-informed care applied to infants and toddlers include: ^{^[1]}

realizing the impact that trauma can have on infants and toddlers, and that reactions to a past trauma may inform the child’s current response to a potentially traumatic situation;
recognizing the signs and symptoms of trauma in infants and toddlers and the staff caring for them; and
resisting re-traumatization, to prevent a situation that represents a tolerable stress from evolving into a toxic stress (Substance Abuse and Mental Health Services Administration, 2014).

Six guiding principles to a trauma-informed approach. 1.Safety, 2. Trustworthiness and transparency, 3.Peer support, 4. Collaboration & Mutuality, 5.Empowerment Voice and Choice, 6.Cultural, Historical & Gender Issues.

Adopting a trauma-informed approach is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level. A trauma-informed approach reflects adherence to six key principles rather than a prescribed set of practices or procedures. The six key principles fundamental to a trauma-informed approach include: ^{^[3]} ^{^[4]}

Safety. Children feel physically and psychologically safe. The physical setting is safe and the interpersonal interactions infants and toddlers have with caregivers promote a sense of safety. This principle supports the belief from experts that positive relationships are at the heart of infant and toddler care and education (Lally & Mangione, 2017) and the critical importance of program policies such as primary caregiving, continuity of care and small groups in establishing and fostering such positive and secure relationships (De Schipper, Riksen‐Walraven & Geurts, 2006; McMullen, 2018; Ogren & Johnson, 2021).
Trustworthiness and transparency. Organizational operations and classroom practices are conducted with transparency and the goal of building and maintaining trust with children, families, among staff and others involved in the organization. This principle emphasizes open communication between a childcare program and enrolled families about foundational policies and practices as well as everyday routines and daily child updates.
Peer support. The term “peers” refers to individuals with lived experiences of trauma, or in the case of infants and toddlers, this can be family members of children who have experienced traumatic events. Peer support is a key vehicle for establishing safety and hope, building trust, enhancing collaboration and utilizing their stories and lived experiences to promote recovery and healing. This principle can mean a child care program explicitly creates a culture of respect and support and invites families of enrolled children and community members, especially those with lived experiences of trauma, into an open dialogue about how best to support children and families who have experienced trauma.
Collaboration and mutuality. Importance is placed on partnering because healing happens in relationships and in the meaningful sharing of power and decision-making. The organization recognizes that everyone has a role to play in a trauma-informed approach. For a child care program to become more trauma-informed may mean reaching out to other organizations or individuals for information, assistance and resources. National organizations such as the National Association for the Education of Young Children (NAEYC) and Zero to Three both have information and resources about trauma-informed care, but local organizations can be a great resource as well.
Empowerment, voice and choice. Throughout the organization and the families served, children’s strengths and experiences are recognized and built upon. The organization fosters a belief in resilience and in the ability of caregivers and communities to heal and promote recovery from trauma. Child care programs can provide training specially on infant and toddler mental health and trauma-informed care, emphasizing the significant role of relationships between caregivers and children. Staff are empowered to do their work as well as possible with adequate organizational support一staff need to feel safe as well. Recognition of caregivers’ personal trauma and its potential impact on children is also necessary. One study found that 73% of early childhood educators had experienced at least one ACE, 22% had experienced four or more ACEs and educators who reported higher numbers of ACEs contributed to lower social and emotional climate scores in classrooms (Hubel et al., 2020).
Cultural, historical and gender issues. The organization actively moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, religion, gender-identity, etc.,); incorporates policies, protocols and processes that are responsive to the racial, ethnic and cultural needs of the children and families and recognizes and addresses historical trauma. This principle requires child care programs to actively take steps to recognize the prevalence of trauma and its role in providing trauma-informed care to infants and toddlers and their families, as well as employed caregivers and staff. Institutional policies and protocols need to be established and supported, as well as everyday practices and processes between children, caregivers and families.

^{^[1]} Sanders & Hall (2018). Trauma-informed care in the newborn intensive care unit: Promoting safety, security and connectedness. Journal of Perinatology, 38(1), 3-10. CC by NC SA 4.0

^{^[2]} 6 Guiding Principles from a trauma-informed approach from the CDC is in the public domain.

^{^[3]} “Infographic: 6 Guiding Principles To A Trauma-Informed Approach” from the CDC is in the public domain.

^{^[4]} Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication. Located in the public domain.