1. Trauma-informed care and
practice - changing the lives of Australian adult
survivors of childhood trauma
Dr. Cathy Kezelman
CEO: Adults Surviving Child Abuse
www.asca.org.au

2. Failure of policy, systems and services
Exists as a result of many factors including
Collective denial about
- scale of the issue i.e. number of people affected
- severity of issue i.e. long-term complex needs
Stigma and taboo around legacy of abuse
Lack of investment in trauma informed approach

3. Trauma-informed Care
“Trauma-Informed Care is a strengths-based framework
that is grounded in an understanding of and
responsiveness to the impact of trauma, that
emphasizes physical, psychological, and emotional
safety for both providers and survivors, and that creates
opportunities for survivors to rebuild a sense of control
and empowerment.”
• Hopper, E.K., Bassuk, E. L., & Olivey, J. (2010). Shelter from the storm: trauma-informed care in homelessness services settings, The
Open Health Services and Policy Journal , 3, 80-100.

4. Trauma
Invokes
fear
Helplessness
Horror
Lack of control
Overwhelms
Coping mechanisms
Childhood trauma is often especially damaging

5. Childhood trauma
Rarely an isolated incident
Interpersonal
Intentional
Prolonged
Extreme
Repeated
Affects developing brain
- Disrupts attachment
- Affects template for development
- Impacts fundamental neuro-chemical processes
- Affects growth, structure and function of brain

6. Complex trauma
Sustained trauma exposure
• Causes complex trauma and often complex needs – more than
PTSD
• Often has global and pervasive consequences
PTSD - re-experiencing of traumatic memories, emotional
numbing/avoidance and hyperarousal
• Diagnosis of PTSD alone misses additional challenges of traumatic
stress resulting from childhood trauma

7. Child abuse - effects
• Lifetime patterns of fear and lack of trust
• Long-term difficulties with emotional regulation and stress
management
• Chronic feelings of helplessness
• Somatic symptoms
Child abuse impacts
• Sense of self
• Interpersonal relationships
• Behaviours
• Cognitions

8. Coping strategies
Extreme coping strategies are adopted in childhood to
manage overwhelming traumatic stress.
Many persist in adult life.
• Suicidality
• Self-harm
• Substance abuse
• Dissociation
• Re-enactments of abusive relationships
Behaviours are challenging but in context of trauma make
sense

9. Challenges of meeting needs of adult
survivors
• Deep feelings of insecurity
• Sensitivity to criticism
• Low self-esteem
• Difficulties with trust and interpersonal
relationships
• Substance abuse, self-harming, suicidal and
risk-taking behaviours

10. Challenges for survivors to seek help
• Shame
• Self-blame
• Fear about being unsafe
• Isolation and withdrawal
• Symptoms of PTSD – avoidance and
hyper-arousal

11. Recovery from childhood
trauma
Survivors can learn how to trust, feel safe, relate and self-
regulate
Neural pathways can repair themselves
However -
• Current systems of care often fail to acknowledge or
address underlying trauma
• Survivors often feel their issues are minimised,
dismissed or invalidated

12. Medical model
Labels a disease
Pathologises
Studies symptoms rather than people
Works on premise that something is wrong with a person
rather than something happened to the person
Mental health challenges are “normal” reactions to
extremely “abnormal circumstances”
We need to ask the question:
What happened to you?

13. Borderline Personality Disorder
Pathologising diagnosis
We need to understand behaviours in terms of
• traumatic stress
• personal invalidation
• disrupted attachment
• coping strategies

14. Responding to complex needs
Working through compounded impacts of complex trauma
can take a long time and go through a number of stages
e.g.
• Establishing safety
• Stabilisation
• Establishing therapeutic relationship
• Education and skill building
• Processing and integration
Adapted Christine Curtois http://drchriscourtois.com/default.aspx

15. Services
Mainstream services are not trauma-informed
Systems are overstretched
Few specialist trauma-specific services
Services are often crisis-driven and revictimising
Focus is on short term interventions and outcomes
Often experienced as disempowering, invalidating

16. Co-morbidity and life burdens
Trauma survivors with complex needs often experience co-
morbid mental health and substance abuse problems
and a range of life burdens.
Currently there is little to no co-ordination between services
along with poor referral and follow-up pathways.

17. Service delivery - What do adult survivors of
childhood trauma need?
Services where
trauma is acknowledged
particular vulnerabilities and sensitivities
are respected an understood
victims are not blamed or retraumatised

18. Supporting survivors
Understand symptoms as adaptations
Work collaboratively
Empower
Validate resilience
Enable understanding of the relationship between past abuse and
current feelings and behaviours
Establish trust and safety
Enable choice
Establish clear boundaries
Acknowledge strengths
Help survivors to embrace hope

19. Relationships
 Crucial to recovery
 Constructive
 Persuasion and not coercion
 Ideas and not force
 Mutuality and not authoritarian control
These new relationships need to challenge
the beliefs created by the original trauma

20. Trauma-informed System of
Care
• Sustained commitment and investment in trauma-
specific services and programs
• Philosophical and cultural shift
• Integrate awareness and understanding around
trauma and traumatic stress into work
• Always consider possibility of undisclosed or
unaddressed trauma
• Not limited to mental health but applies to all systems

21. Systems change
•Survivors conditions and behaviours are viewed
differently
•Staff respond differently
•Day-to-day delivery of services is conducted differently
•System understands the connection between past
trauma and current behaviours
•System develops strategies for responding to complex
trauma

22. Trauma informed system
Safety from physical harm and re-traumatization
Understand survivors and “symptoms” in context
Open collaboration between workers and those seeking help
Build on strengths and acquire skills
Understanding symptoms as attempts to cope
Perceive childhood trauma as a defining experience/set of
experiences that forms the core of an individual’s identity
focus on what happened to a person rather than what is wrong with
the person.
Harris, M., & Fallot, R. (2001). Using trauma theory to design service systems. New Directions for Mental Health
Services, 89. Jossey Bass.
Saakvitne, K., Gamble, S., Pearlman, S., & Tabor Lev, B. (2000). Risking connection: A training curriculum for working
with survivors of childhood abuse. Sidran Institute.

23. Improved outcomes for survivors
USA reports of a Trauma informed approach have included
 decrease in
• Psychiatric symptoms
• Substance use
• Trauma symptoms
• Hospitalisation and crisis care
 Improvement in consumers’ daily functioning
 Cost effective
Cited in Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings The Open Health
Services and Policy Journal, 2010, 3, 80-100 Elizabeth K. Hopper, Ellen L. Bassuk, and Jeffrey Olivet

24. ASCA – Adults Surviving Child Abuse
Trauma informed approach to care
1300 line – empathy, validation, safety, handling
disclosure and appropriate referral
Creating New Possibilities – psycho-educational
workshops for survivors
Education and training for health professionals and
community workers
Australian national day - Forget-me-knot Day for all
Australians to unite in support of adult survivors of
childhood trauma

25. ASCA quote – from workshop attendee
“Please, please educate counsellors, psychologists-anyone who comes
into contact with survivors of child abuse that it can have life-long
effects. We cannot move on until we have dealt with our baggage
and it takes a long time and endless patience and support. We don’t
want to wallow, however we need to deal with and express our pain
and anger and go through the stages of grief and loss for our lost
childhood. Counsellors etc need to understand the stages of
childhood development and realise the impact of not experiencing
these important developmental stages. I don’t believe there are any
quick fixes. We need to be listened to, have our experiences
validated. Counsellors with little experience, despite the best of
intentions can do more harm than good. Inappropriate ‘help’ kept me
in denial and isolation for many years.’

26. Adults Surviving Child Abuse
For more information go to www.asca.org.au
Contact: Dr. Cathy Kezelman, CEO ASCA
ckezelman@asca.org.au
Author of Innocence Revisited – a tale in parts
www.jojopublishing.com