Avoid Simplistic Thinking About Trauma-informed Care, Some Say

trauma: A very grumpy young girl with green eyes

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As the effort to be trauma informed sweeps across youth-serving agencies, some who research and treat trauma are urging people to think more carefully and critically about it.

The word trauma is used too loosely, said Michael S. Scheeringa, author and vice chair of research for psychiatry at Tulane University School of Medicine. For more than two decades, he has researched, treated and taught about stress, trauma and post-traumatic stress disorder (PTSD).

Stress is not trauma, he said.

“Of the people who experience life-threatening trauma, only about 30% develop PTSD,” he said.

As for schools and youth-serving organizations that are trying to implement trauma-informed practices, “people are trying to figure out what it means. … they don’t really know,” Scheeringa said.

The traditional work of screening children and referring them for services or treatment is the right type of practice, he said. “If they start giving kids messages that trauma permanently damages the brain” that’s wrong.

[Related: How One Philadelphia After-school Program Works to Be Trauma-informed]

[Related: LA’s Best Sees Increase in Mental Health Issues, Responds with a Focus on Trauma]

Scheeringa said the work around trauma is being seen as a panacea — a way to address wide-ranging social problems that cannot be solved that way.

“A lot of people have been looking for ways to improve the world … and they want to get the attention of policymakers.” As a result, the language around trauma has gotten overblown, he said.

Consequences or coping strategies?

Child psychiatrist David Rettew has another concern. It’s the risk of moving too far away from behavioral approaches, he wrote in a blog for Psychology Today.

A behavioral approach with kids involves explaining consequences to problematic behavior, while a solely trauma-centered approach is about offering support, comfort and coping strategies, according to the blog.

What adults need to do is make a choice about which approach is best in the moment, he wrote.

“Institutions may do well to mirror the approach of astute parents who recognize that, even within the same individual, there are times when a behavioral outburst is under a child’s control and instances when no amount of incentives or consequences are going to bring a child back to baseline,” Rettew wrote.

The point is to avoid dogmatic thinking about any one approach: “When cornered, most mental health professionals will acknowledge that the behavioral versus trauma-informed debate is a false dichotomy, with both approaches having value,” he wrote.

Other thinkers have criticized a culture of “safetyism,” which they describe as an overfocus on emotional fragility, particularly on college campuses. Social psychologist Jonathan Haidt and fellow author Greg Lukianoff make this case in their book “The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure.” They also point to “concept creep around ideas such as trauma, which has shifted from a clear definition “to mean almost anything one experiences that is physically or emotionally harmful.”


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