The RRN (Restraint Reduction Network) Training Standards
state that training curricula must have content that enables participants to understand the meaning of ‘trauma’ and how it can impact on people’s experience of restrictive interventions.
CPI’s specific trauma element within our core training programmes
covers how trauma impacts people and how to be trauma-responsive in your daily practice.
CPI Global Professional Instructor Francis Florencio
takes a deeper look into the impact of trauma.
Trauma is all around us. We may not see it with our eyes but the impacts of trauma are far-reaching and significant. A survey by the World Health Organization [WHO] in 2017, found that 70.4% of respondents from across 24 countries have experienced at least one traumatic event (Kessler et al., 2017).
As people working on the frontline, either in education, health or in any other social fields, we have already been with someone with trauma. Our approach has the capacity to either heal and nurture or disempower and re-traumatise. We have the power to positively impact the life of a person who experienced trauma.
In general terms, trauma can be used to describe either a severe physical injury or confronting experiences that triggers physical, emotional and mental distress to a person resulting in deterioration and suffering in the person’s wellbeing (Rossiter & Scott, 2017).
Experiences such as loss of a loved one, being critically injured after an accident, disasters and wars, domestic violence and abuse can lead to a person developing trauma. Being restrained is also a very traumatic experience for a person. The practice of restraining, though could be necessary to maintain safety for serious events, always needs to be proportionate, reasonable and used as last resort to minimise the risk of traumatising a person.
Furthermore, the younger the person is who experiences traumatic events, the greater the person’s risk of developing ongoing and long-lasting physical and mental illnesses. An event may happen repeatedly or even just once for the person to develop trauma (Werry Workforce Whāraurau, 2020).
Physical and emotional symptoms
There are physical and emotional symptoms to trauma. The symptoms of trauma are related to the body’s ‘fight or flight’ response which is also known as the stress response. Emotional responses to trauma can be feeling on edge, irritable, hypervigilance and rapid mood swings. Physical symptoms can be in form of feeling fatigue, palpitations, increased blood pressure, restlessness, having difficulty sleeping and repeated nightmares (Ministry of Health, 2016; Rossiter & Scott, 2017). The symptoms may present immediately after the trauma or could take weeks or months to manifest.
These symptoms may last for a few days, months or even years after the trauma. Each a person’s response to trauma is unique and different. When a person’s symptoms of trauma become debilitating and hinder the person from participating in their daily living, the person could have developed post-traumatic stress disorder (Rossiter & Scott, 2017).
Due to feelings of physical and emotional vulnerability that comes with trauma, people with traumatic experiences may present with crisis. Crisis is a situation that is difficult and dangerous that requires immediate attention and support
. Crisis is characterised by instability and chaos in the person’s life. In acute state of crisis, there is severe dysfunction in the person’s emotion, cognition and behaviour that can lead to a person becoming a risk to themselves or others, or have reduced capacity to care for themselves (Rossiter & Scott, 2017).
To minimise crisis situations from happening, the WHO recommends psychological first aid, stress management and working with the person to identify and strengthen coping skills and social supports as appropriate interventions (WHO, 2013).
In addition to the interventions recommended by WHO, trauma-informed approach underpins the values of practice when working with people with trauma. Trauma-informed approach is a philosophy that recognises the strength of the person with trauma. When working with people with trauma, the person is and remains at the centre of their recovery (Rossiter & Scott, 2017). Trauma-informed approach outlines key values one must practice to work therapeutically with people with trauma. These values are safety, trustworthiness, choice, collaboration and empowerment.
is about nurturing the person’s sense of physical and emotional wellbeing.
is building mutual trust and respect.
is recognising the person’s autonomy.
is working with the person alongside their goals and aspirations.
is acknowledging and utilising the person’s resources and resilience (Rossiter & Scott, 2017)
The following are practical ways a person with experience of trauma can be supported within a trauma-informed approach (Ministry of Health, 2016):
- Spend time and be present. This is about listening with empathy and providing affirmations. There is healing in being present with the person.
- Give time, space and patience. Recovery from traumatic events take time. There will be times the person may be irritable, angry or want to be alone.
- Affirm the emotions and reactions are true for the person. Avoid minimizing the event but rather be with them as they navigate and make sense of their experiences.
- Know that specialist and professional help is available. There is always help available and this would be more warranted if the person starts to present with risk behaviour to self and or others, or start losing capacity to take care of themselves in an adequate standard (for example, refusing to eat and drink and not sleeping).
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., . . .
Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8
(sup5), 1353383. doi:10.1080/20008198.2017.1353383
Ministry of Health. (2016). When someone you know has been through a traumatic
. Retrieved May 20, 2021, from
Rossiter, R., & Scott, R. (2017). Trauma, crisis, loss and grief In K. Evans, D. Nizette, & A.
O'Brien (Eds.), Psychiatric and Mental Health Nursing
(4th ed.). New South Wales, Australia: Elsevier.
Werry Workforce Whāraurau. (2020). Trauma-informed healthcare: A resource for health
practitioners supporting children and whānau in primary care settings
. New Zealand LeVa, Te Pou & Werry Workforce Whāraurau. Retrieved from https://werryworkforce.org/sites/default/files/pdfs/Trauma/2020-Trauma_IC_A5_web-with%20insert.pdf
World Health Organization. (2013). WHO releases guidance on mental health care after
. Retrieved May 20, 2021, from https://www.who.int/mediacentre/news/releases/2013/trauma_mental_health_20130806/en/