Trauma-Informed Practice and Its Four Levels

by | Nov 21, 2023 | Blog, Coaching, SBMC

Have you noticed the word “trauma-informed” is popping up in the news a lot these days? It’s not hard to understand why it has become such a buzzword. There’s been a significant shift in both how we think about trauma, seemingly the amount of trauma around us, and a growing readiness to talk openly about how it affects and shapes our lives. Best-selling books and ongoing research are expanding our knowledge of what it truly means to have a trauma-informed practice. In this article, we will break down the four fundamental levels of trauma practice, helping you to better assess your current level of trauma understanding and also charting a course for where you may want to go.

Trauma-Informed Practice Levels Infographic - Understanding the four levels from Trauma-Aware to Trauma-Specific

Trauma-Aware

Being Trauma-Aware simply means that a person recognizes the widespread prevalence of trauma and its impacts on humans and other living creatures.  Yes, trauma is far more common than most people think with experts telling us that 90% of people have experienced at least one significant traumatic stress-inducing event in their life, which has the potential to impact their nervous system for an extended period of time.  These nervous system impacts might include things like anxiety, depression, and poor health-related behavioral choices.  The key takeaway from the Trauma-Aware level is understanding that people experience traumatic events far more often than we realize and those experiences affect people for prolonged periods of time.

Trauma-Informed

Firstly, anyone can be trauma-informed.  You don’t have to be a healthcare professional, or even a trauma professional to have a trauma-informed practice.  While receptionists, bus drivers, cashiers, bankers, and a host of other people can become trauma-informed, my personal belief is that certain people should and must have a  trauma-informed practice.  Those people include anyone working in healthcare, teachers and school administrators, coaches, and holistic and wellness professionals.   

When someone’s trauma-informed, at a minimum they recognize the widespread prevalence of trauma and its impact on health and behavior.  Next, being trauma-informed requires that someone implements the 5 Principles of Trauma-Informed Practice in their daily actions, policies, and procedures.  

The 5 Principles of Trauma-Informed Practice include:

  • Safety
  • Trustworthiness
  • Choice
  • Collaboration
  • Empowerment
Coaches Implementing Trauma-Informed Principles

Someone who has a trauma-informed practice ensures the safety of everyone they come in contact with including a person’s physical, emotional, psychological, racial, cultural, and gender-related safety.  They develop trustworthiness through communicating clear parameters, expectations, and boundaries.  This person prioritizes and honors other peoples’ choices as well as acts as a co-collaborator in supporting their goals.  Finally, a trauma-informed person consistently empowers others through strength-based development and feedback.  

Adherence to the 5 Trauma-Informed Practice Principles drastically reduces the chance of retraumatization while simultaneously recognizing that eliminating retraumatization is likely not possible.  It is important to know that while retraumatization is almost always unintentional, at the same time, it’s always hurtful. So even if we’re not intending to say something, or do something, or be in a certain way, that reactivates trauma for somebody doesn’t mean that it’s not hurtful to the person.  By following the trauma-informed practice principles we make room for both reducing unintentional retraumatization while at the same time having compassion for ourselves and others.

Trauma-Sensitive

Trauma-sensitive work ideally includes and builds upon the previous levels of trauma-informed practice and trauma-aware.  Trauma-sensitive practice is where we’re really starting to work more specifically in and with the body and the nervous system itself.  We have more enhanced awareness around trauma and there is an honoring of the bodyminds deep survival mechanisms. At this level, we are practicing with the 4 R’s of Trauma-Informed practice, which include:

  • Realizing the widespread nature of trauma
  • Recognizing the signs and symptoms of trauma
  • Responding by integrating trauma knowledge into practice 
  • Reducing Retraumatization 

In our opinion, anyone who works directly with another person’s bodymind like, yoga, Tai Chi, and meditation teachers, rehabilitation professionals, psychologists and social workers, and of course, somatic professionals absolutely need to be trained in trauma-sensitive practices.  We must remember that while trauma happens in a person’s past it more importantly lives presently in their body.  Current research shows that body-based therapies, teaching a person how to regulate their post-traumatic nervous system, may be more effective for trauma than currently used cognitive therapies.  

Someone who is trauma-sensitive is able to identify when someone is experiencing nervous system dysregulation and in turn, respond with appropriate tools for helping that person co-regulate and eventually self-regulate.  The ability to self-regulate is the central feature of being a resilient and centered person.  A trauma-sensitive professional is also knowledgeable and proactive in setting up environments and conditions that effectively reduce client retraumatization.  

Trauma-Sensitive Workshop for Healthcare Professionals - Practical exercises for understanding nervous system dysregulation and trauma-sensitive approaches

Trauma-Specific

The deepest level of trauma practice is that of being trauma-specific.  The trauma-specific level of care encompasses all of the preceding levels and aims to work more directly with a person’s trauma content, including their trauma memories.  At this level of care, professionals are employing psychodynamic modalities, teaching processing skills, and working to integrate a person’s trauma narrative.  There is deep work happening at this level and it requires a significant amount of training, practice, and self-awareness to do well and safely.

Interestingly, one of the most important things to happen in trauma-specific training in the past twenty years has been the growing adoption of trauma-sensitive, somatic practices such as mindfulness, Qigong, and yoga.  What experts and researchers have discovered is that the act of recalling past trauma often causes significant nervous system dysregulation including things like hypervigilance, flashbacks, and/or dissociation.  Using trauma-sensitive methods in order to help a person stabilize their nervous system before trauma-specific work, as well as help them return to a more regulated state if dysregulation occurs, is fast becoming the standard of care in trauma-specific practice.  

In a world where understanding and addressing trauma is more important than ever, this article explored the four essential levels of trauma-informed practice. From here, you will be able to determine your current level of understanding and determine where you aspire to grow in your own practice. Whether you are interested in becoming a certified trauma-aware practitioner or are ready to dive into trauma-sensitive training, the Somatic Coaching Academy is your trusted partner in cutting-edge, research-supported techniques that can be implemented easily and effectively. Your first step is to visit our website where you can explore our programs and the extensive free resource library we’ve created just for you. 

As society increasingly acknowledges the prevalence and nuances of trauma, you can become the sought-after change agent who easily connects with ideal clients, receives better rates, and can differentiate yourself in the market by providing the most transformational, high-integrity client results. 

The Author

Brian Trzaskos, PT, LMT, CSCS, CMP, MI-C, is a co-creator of Sensation-Based Motivation Coaching, a somatic, trauma-sensitive methodology, and has extensive experience in diverse clinical settings ranging from “cutting his teeth” at the world-renowned Craig Hospital for TBI and SCI Rehabilitation, to operating his own integrative wellness center in Upstate New York. As a practicing physical therapist and student of Eastern movement and meditation practices for 30 years, Brian is a nationally recognized expert for his work in training health and wellness leaders how to successfully address mental wellness, burnout, and chronic pain challenges with trauma-sensitive, somatic coaching practices. Brian is currently the President of NEW Health Inc. and director of education at the Somatic Coaching Academy.  He earned his degree in Physical Therapy and Trauma Informed Organizations certificate from the State University of New York at Buffalo.

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