Most of us aren’t sure what exactly trauma-informed care means. It turns out that as a profession, we are woefully uninformed on this topic. Those of us who have had some training often lack confidence in our skills and the support we have to implement it. Below, we’ll review the basics and share resources, based on research and expert commentary from scientists in our field. 

So what does it mean to be trauma-informed? 

It means critically reframing your perspective of the world around you. 

Champine and colleagues found that trauma-informed individuals: 

• have greater awareness and understanding of the potential signs of traumatic stress in the people around them (watch this 2-minute video for an overview)
• have a deeper understanding of their own past adverse experiences, and how they may have impacted their thoughts and interpersonal interactions in life; and
• gain skills that allow them to thoughtfully respond to trauma in others.

Check out their paper for focus group responses on what it means to be trauma-informed. 

To understand how this looks on a larger scale, Gayaldo and Gladfelter’s commentary directs us to resources outside of our field, such as the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA describes trauma as a pervasive public health problem resulting from adversity. Because trauma is ubiquitous, SAMHSA proposes a trauma-informed approach that would be appropriate to use in behavioral health systems, child welfare systems, medical and educational systems, and the criminal justice system. 

According to SAMHSA, a program, organization, or system that is trauma-informed:

• realizes the widespread impact of trauma and understands potential paths for recovery;
• recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
• responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
• seeks to actively resist re-traumatization.

How do SLPs fit in? 

Rupert and Bartlett recognize the important role that SLPs play in the lives of children experiencing maltreatment and trauma. First, we are mandated reporters. Additionally, in our scope as communication specialists, we work to strengthen child and caregiver interactions and attachment—protective factors for children experiencing trauma—through the improvement of social-emotional, executive function, and communication skills. Rupert and Bartlett note that many SLPs lack education and training on trauma and attachment, and don’t have access to evidence-based recommendations regarding trauma inquiry or screening. In their survey study, they found that most of our understanding of trauma is limited to maltreatment such as neglect or abuse. We also tend to think of attachment in a binary way; either it is or isn’t there, when in fact, attachment can be secure, avoidant, ambivalent/anxious, or disorganized, with all types having implications for a child’s development. 

Download a printable PDF version of this graphic here. 

The good news is that SLPs want to understand how trauma affects communication development and understand the relevance of trauma to our work. This is a challenge, according to Gayaldo and Gladfelter, because although one in seven children are exposed to maltreatment, our literature has very little evidence base on the subject. Keep in mind that the aforementioned prevalence means that maltreatment is a risk factor for communication disorders more common than autism spectrum disorder and developmental language disorder. It also pretty much guarantees that SLPs will have students on their caseloads who have been exposed to maltreatment or trauma. 

So what should we do?

1. Get trained: In their survey study on school-based SLPs attitudes and knowledge about TIC, Roberson and Lund suggest that SLP participation in trauma-informed training programs could improve clinical practice by providing tools for behavior management that are less likely to escalate dysregulated behavior.
2. Switch up your assumptions: After the foundation of TIC is established, Gayaldo and Gladfelter urge SLPs to practice under the assumption that every child intends to do their best but may demonstrate fight-or-flight responses due to their trauma exposure. This may be a shift away from a traditional behaviorist mindset that would respond to challenging behaviors with reprimands, verbal reinforcement, and removal from settings. Instead, a trauma-informed approach responds relationally by assisting children with emotion identification, processing, and regulation. 
    

Note: Be on the lookout for another deep dive into trauma-informed care and implications for dismantling ableism! In the meantime, members can look back at other research reviews on childhood trauma (here and here), trauma-response behaviors (here), and coaching caregivers to find opportunities for responsiveness and attunement (here and here).

Champine, R. B., Hoffman, E. E., Matlin, S. L., Strambler, M. J., & Tebes, J. K. (2022). “What does it mean to be trauma-informed?”: A mixed-methods study of a trauma-informed community initiative. Journal of Child and Family Studies https://doi.org/10.1007/s10826-021-02195-9 [open access]
 

Gayaldo, S., & Gladfelter, A. (2022). 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. American Journal of Speech-Language Pathology. https://doi.org/10.1044/2022_ajslp-21-00380 [available to ASHA members] 
 

Roberson, M. M., & Lund, E. (2022). School-based speech-language pathologists’ attitudes and knowledge about trauma-informed care. Language, Speech, and Hearing Services in Schools https://doi.org/10.1044/2022_lshss-21-00172 [available to ASHA members] 

Rupert, A., & Bartlett, D. (2022). The childhood trauma and attachment gap in speech-language pathology: Practitioner's knowledge, practice, and needs. American Journal of Speech-Language Pathology. https://doi.org/10.1044/2021_ajslp-21-00110 [available to ASHA members]