Proactive Strategies for Implementing Trauma-Informed Care

Wajdi Akef Fakhoury, LMFT 148333

Trauma-informed care is not just about responding to moments of distress—it’s about creating environments and relationships that reduce the likelihood of distress occurring in the first place. For individuals with intellectual and developmental disabilities (IDD), this approach is especially critical. Proactive strategies help establish safety, promote emotional regulation, and build resilience. Caregivers, educators, and professionals can use these strategies to reduce both the impact of trauma and the likelihood of re-traumatization.

Key Principles of Trauma-Informed Care

To effectively implement trauma-informed care, it’s important to follow guiding principles that prioritize safety, trust, and empowerment. The Substance Abuse and Mental Health Services Administration (SAMHSA) emphasizes six key concepts in trauma-informed care:

• Safety: Ensuring physical and psychological safety.

• Trustworthiness and Transparency: Building trust through consistent and predictable practices.

• Peer Support: Collaborating with others who understand similar experiences.

• Collaboration and Mutuality: Engaging as equal partners in care and decision-making.

• Empowerment, Voice, and Choice: Fostering strengths and encouraging self-determination.

• Awareness of Cultural, Historical, and Gender Issues: Addressing systemic barriers and respecting individual identities (SAMHSA, 2014).

Using these principles as a foundation, trauma-informed care can be implemented through practical, proactive strategies tailored to the needs of individuals with IDD.

Proactive Strategies for Trauma-Informed Care

1. Create Predictable Routines

For individuals with IDD, unpredictability can heighten feelings of stress or anxiety, particularly if they already struggle with executive functioning. Using consistent routines reduces uncertainty and builds a sense of safety.

How to Apply This:

• Use visual schedules with pictures, symbols, or written steps.

• Provide advance warnings for upcoming changes using timers or verbal prompts (e.g., “Two more minutes before lunch”).

• Prepare individuals for big transitions, such as starting school or a new therapy program, with social stories or practice runs.

2. Promote Emotional Regulation Skills

Trauma often disrupts the brain’s ability to regulate emotions, making it harder for individuals to manage feelings of anger, fear, or frustration. Building emotional regulation skills empowers individuals to respond to stress in healthier, more adaptive ways.

How to Apply This:

• Integrate calming activities into daily routines, like deep breathing, progressive muscle relaxation, or guided imagery.

• Use sensory tools, such as fidget items, weighted blankets, or noise-canceling headphones, to help individuals self-soothe.

• Model emotional regulation by naming and expressing feelings in a calm, validating way (e.g., “It’s okay to feel upset. I can help you work through it.”).

3. Highlight Strengths and Interests

A trauma-informed approach emphasizes recognizing and building upon an individual’s strengths. Focusing on strengths not only boosts self-esteem but also fosters trust and engagement.

How to Apply This:

• Incorporate preferred activities or interests into learning and therapy sessions. For instance, if the individual loves music, introduce songs that teach coping skills.

• Celebrate successes, no matter how small, to reinforce a positive sense of self.

• Help individuals build on their strengths to achieve goals, like using a passion for drawing as a way to express emotions.

  
  

4. Adapt Communication Approaches

Many individuals with IDD face challenges expressing themselves or understanding others, which can create stress and miscommunication. Trauma-informed care requires communication to be accessible, respectful, and supportive.

How to Apply This:

• Use simple, concrete language and avoid abstract phrases.

• Provide options for nonverbal communication, such as gestures, pictures, or devices.

• Allow extra processing time after asking a question or giving an instruction.

• Validate emotions by actively listening and acknowledging the individual’s feelings (e.g., “It sounds like you’re frustrated. I understand it’s hard to wait.”).

  
  

5. Foster Safe Spaces

Physical environments play an important role in reducing stress for individuals with IDD. Trauma-informed spaces should promote a sense of calm and minimize sensory triggers.

How to Apply This:

• Create quiet areas where individuals can retreat to self-regulate. These might include beanbags, soft lighting, or calming visuals.

• Minimize loud noises, crowded environments, or abrupt lights.

• Consider individual sensory preferences and adjust the environment accordingly (e.g., dimmer lights for someone sensitive to brightness).

Responding When Something Goes Wrong

Even with the best proactive strategies, stressful moments can’t always be avoided. However, trauma-informed care emphasizes meeting individuals where they are and responding with understanding.

Steps to Take in the Moment:

1. Regulate: Focus on helping the individual calm down. Offer grounding activities like rhythmic movements, deep breathing, or sensory tools.

2. Relate: Use an empathetic, calm tone to build connection. Avoid assigning blame or discussing consequences until the individual feels regulated.

3. Reason: Once calm and connected, engage in problem-solving together. Offer tools like visual aids or step-by-step options to help them reframe the experience or transition back to routine.

Why Proactive Strategies Matter

Proactive strategies transform trauma-informed care from a reactive to a preventative approach. By creating safe, structured, and empowering environments, we can reduce triggers and reinforce the protective factors that promote healing and resilience. Trauma-informed care isn't just about addressing moments of crisis—it’s about building a foundation that allows individuals with IDD to thrive.

Next in this series, we’ll focus on in-the-moment strategies for effectively supporting individuals during times of distress or crisis through a trauma-informed lens.

References

• Mevissen, L., & de Jongh, A. (2010). PTSD and its treatment in people with intellectual disabilities: A review of the literature. Clinical Psychology Review, 30(3), 308-316.

• Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. U.S. Department of Health and Human Services.

• Fletcher, R. (2011). Psychotherapy for Individuals with Intellectual Disability. Kingston, NY: NADD Press.