Trauma can come in many forms. One form is what The Mandt System® terms “acute episodic trauma,” which is the result of some type of disaster over which the person has no control. Natural disasters, automobile accidents and fires are examples of this type of trauma.
“Betrayal Trauma” is the term applied to interpersonal violence, such as abuse and neglect. The National Association of State Mental Health Program Directors (NASMHPD) and the National Technical Assistance Center (NTAC) have studied this form of trauma for over 15 years and are the leading experts in North America on the prevention of trauma. A study was published by the Centers for Disease Control in 2000 called the Adverse Childhood Experiences (ACE) study. As overwhelming as the study is, more overwhelming is data from NTAC indicating over 85% of all patients in psychiatric hospitals have experienced some form of interpersonal violence.
“Observer violence” is the term used to describe what happens when people see harm being done to others. One individual in a developmental center saw his best friend die as a result of a restraint. He ran away from the center, and when he was “caught” was placed in seclusion. One woman reported that when she was restrained, it felt to her as if she was being “raped again.” The interventions we use to keep people safe can, in fact, re-traumatize individuals.
Addressing the core issues of trauma requires that organizations create systems of care that are “trauma informed” (which means that all of the services provided by an organization recognize the potential of those services to re-traumatize individuals.) Services that are informed by the trauma histories of individuals served, as well as staff, are hospitable and engaging. (Fallott, 2011) The word “hospitable has the same root as the word “hospital” – an hospitable environment is one in which people feel safe emotionally, psychologically, and physically. At the same time, they are “engaging” which means that service users direct the process of their own recovery. Person Centered Planning, the Recovery Model, Client Directed Services, are all examples of “engagement”.
The Mandt System® not only has a separate chapter on Trauma Informed Services, the concepts Trauma Informed Services are integrated into all the work we do, as our entire program “trauma informed.” Louise Hopkins, a clinical social worker at Sheppard-Pratt Psychiatric Hospital, writes:
Before I started my current job, as a clinical educator, I had spent years in the trenches as a clinician. I saw again and again, trauma survivors being restrained by well meaning staff, with the result that they made a bad situation much worse by triggering flash backs, and by making kids who already felt hopeless, powerless and alone, feel these ways only more so. I very much wanted to address this, and designed a training program using my own experience and reading, including parts of the Sanctuary Model, and parts of the trauma chapter of SAMHSA’s “Road Map to Seclusion and Restraint Free Mental Health.” My training was then adding to our system-wide aggression management training.
Then we discovered Mandt. It wasn’t aggression management plus trauma informed care. It was a truly integrated trauma informed aggression management system. (I am sure the Mandt folks would not consider themselves an aggression management system. They are very careful about language. However, this is a view from the trenches. For years restraint training was called aggression management training, or on a good day aggression prevention and management training.) Mandt does teach restraint, but the focus is on numerous interventions to avoid or contain without restraint. Since the vast majority of our kids are receiving our services because they are survivors of trauma, this is pretty important. As a Licensed Certified Social Worker (Clinical) I consider myself to be above average in my sophistication in childhood trauma theory and research, and have in fact been invited to teach a doctorate level social work course in treatment of traumatized children, despite having only a master’s degree myself. Therefore, I think I know what I am talking about when I say Mandt integrates “state-of the art” research on trauma. It also integrates “state of the art” positive behavioral support research, and a great deal concerning the theories about and research on communication.