Trauma-informed care is a framework for human service providers created to recognize trauma's prevalence and widespread impact. Given that people with intellectual and developmental disabilities (I/DD) disproportionately experience traumatic events, taking a trauma-informed approach is crucial for human service providers. Yet, as researchers Jade Presnell, John Keesler, and Jen Thomas-Giyer highlight in their recent study, Assessing Alignment Between Intellectual and Developmental Disability Service Providers and Trauma-Informed Care: An Exploratory Study, this practice has yet to be implemented comprehensively across the nation’s human services sector. To learn more about the importance of trauma-informed care and paths forward for the I/DD field, we sat down with The Guild’s Jennifer Magnuson, MA, BCBA, Chief Clinical Officer, and Michelle McGonagle, LICSW, Director of Mental Health Services.
Can you start by defining trauma-informed care and explaining why, in your mind, it’s an important framework when working with I/DD populations?
Michelle: We define trauma as an overwhelming, subjective experience that leads to a sense of vulnerability or loss of control. It can be experienced as one large event or multiple smaller events over time. Taking a trauma-informed approach to care acknowledges the research demonstrating that most people have been impacted by the effects of trauma in their lives. This framework is of particular importance for us at The Guild because those in our care have already faced extraordinary circumstances just by having a disability in an ableist community and, at times, failing to receive proper services and supports. Caregivers also tell us that having a child in residential care, no matter how beneficial, can be experienced as a traumatic event.
Jen: Right, and the first step is acknowledging the prevalence of trauma not only in those we serve but also within their families, our community, and our staff members. With this in mind, we can pay attention to common caregiver responses to working with people with trauma, such as becoming overly permissive, feeling ineffective, or withdrawing. Helping staff recognize these patterns allows them to respond better to those in their care. Implementing trauma-informed care practices across our community helps us fulfill The Guild’s mission of increasing the quality of life of individuals and their families.
You mention the importance of implementing trauma-informed care to create safe environments. What does this look like in practice at The Guild?
Jen: From a trauma-informed standpoint, we start with an understanding that all behavior is communication. This means that our role is to understand what the people we serve are trying to tell us, not only through their words but also their actions. Unsafe behaviors result from how an individual has learned to navigate their world and get their needs met. Our objective is to create safe environments and teach new skills so individuals feel comfortable participating in therapy sessions and can meet their goals. To do this, we build opportunities for meaningful engagement and social interaction, provide consistency by following familiar routines, and teach communication and emotional regulation skills.
Michelle: We create that safe environment for people we serve within the counseling session by letting them know their needs will be met, and their ideas are worth communicating. We all want to trust that the person we’re communicating with will understand us, but this is especially important for Guild students and residents who might have had multiple traumatic or adverse experiences. After building this trust, we can work with behavior analysts, speech language pathologists, and occupational therapists to help them find more successful ways to communicate and meet their needs.
The article establishes that trauma-informed care "provides a foundation for practices grounded in safety, choice, collaboration, empowerment, and trustworthiness." How does this approach relate to The Guild's values?
Jen: I think a lot about that word “empowerment.” Empowerment is central to The Guild’s mission and is grounded within the trauma-informed care framework. Empowering those we serve means providing them with a sense of safety and control over decisions that impact their lives. We also help students and residents to create the connections they need to build resiliency and self-advocacy skills. To do this, we emphasize an individualized and strengths-based approach to treatment planning, understanding that each individual has unique responses to the adverse and traumatic events that they may have experienced.
Michelle: Right, and as the article highlights, individuals in residential care are more prone to abuse and neglect, so there’s a real need to foster a sense of empowerment. We use expressive arts therapy as a therapeutic modality in counseling as it allows students to explore their emotions and show us what they need without necessarily relying on words. Play is the language of children, so our counselors highlight that the playroom is a special place where students can explore and be heard. For the adults in our program, we emphasize the teaching and modeling of self-advocacy skills and healthy relationships. Giving individuals unconditional positive regard is the first step in empowerment and provides the foundation for growth. Recovery happens within the context of safe relationships.
What avenues for growth do you see in the I/DD field with relation to trauma-informed care?
Michelle: We must keep the momentum going at The Guild around trauma-informed care and focus on sustainability. We are developing programs that teach all staff skills grounded in the trauma-informed care framework. We are expanding our pool of “trainers” to ensure that this work continues to move forward. Also, The Guild has been part of initiatives with state agencies to increase the awareness and focus on trauma-informed work across providers in the Commonwealth of Massachusetts.
Jen: Part of building on that momentum means committing our time, attention, and resources to the development and dissemination of trauma-informed practices, specifically when developed for individuals with intellectual disabilities. Many trauma-informed care practices are developed for people who communicate using verbal language. There is a need to understand further the therapeutic modalities that will appropriately serve individuals with I/DD, especially those who may be non-speaking or have limited verbal communication skills. From my vantage point, it is encouraging to see trauma-informed work gain recognition and adoption across multiple clinical disciplines outside the counseling and social work fields. Our goal is to improve those modalities to increase their effectiveness for people with intellectual disabilities.