Peer Perspectives

Trauma-Informed Approach Gains Traction in Care of Youth and Adults With Developmental Disabilities

By Lorraine McLarney, LMHC, and Mary Quinn, LICSW

While trauma-informed care has been an essential component within the mental health, education, and criminal justice fields for many years, the practice is finally gaining traction with caregiving agencies who work with individuals with developmental disabilities (DDs). It’s about time.

Research has shown that people with DDs experience alarmingly high rates of trauma and abuse. They are less likely to tell someone about the abuse or may be limited in their ability to process it. They’re likely to display more trauma-related behavior, with their disability often limiting the capacity to heal from it. They face immense stigma and marginalization by society at large, which may be traumatic in itself or make traumatic experiences worse.

The traditional approach to DD behavioral issues has been to deploy interventions designed to encourage these persons to “ask for what they want” in a more productive manner. This approach is ineffective with individuals with DDs in particular because their behavior is often an expression of emotion rather than a manipulative effort to get what they want. Focusing exclusively on the behavior can actually make the trauma—and thus the behavior—worse.

Being trauma-informed means understanding how trauma affects a person, and knowing effective ways to respond to someone who has experienced it. Trauma-informed care shifts the focus away from “what’s wrong with you” to “what has happened in your life to drive you to the behavior.” It involves understanding that our clients’ behaviors are often manifestations of how they’ve adapted to living their lives. Their reactions are normal reactions to the abnormal situations they’ve found themselves in.

Also, brain science has evolved to a point where we have a better understanding of the neurobiology of trauma. For example, our brains and bodies are wired for survival. Even though we’re not all necessarily facing predators in the wild, our brains respond the same way to other threats of real or perceived danger. When the brain is constantly in fight/flight/freeze mode, executive functioning skills are inaccessible. While traumatized clients may not have a clear memory of their trauma, their bodies remember and remain in a state of toxic stress. A healthy therapeutic relationship, however, has been shown to heal common trauma wounds, repair damaged neural pathways in the brain, and teach self-regulation skills.

A Success Story
American Training first incorporated a trauma-informed practice five years ago at two group homes for residents and clients between the ages of 17 and 22, and more recently we’ve implemented it at our adult DD group homes. We also began the practice within our day services, where we support and encourage our clients to participate in their communities, be a volunteer, find a job, or just be a valued neighbor, citizen, and contributor.

This new approach has led to a better understanding of those in our care and has positively enhanced our connections to them. Our understanding shifted from controlling or “fixing” their behavior to becoming more aware that the behavior is literally something their bodies and brains have absorbed. This has led to more compassionate interventions, ones where we let our residents and clients interact with us so we can meet them where they are.

Traditional approaches have often assumed that individuals with DD have limited capacity to engage in or benefit from relationships. Not so. Trauma-informed care begins with the assumption that everyone has endured some type of trauma and then works to create a trusted space and bond between the resident and caregiver. In fact, all of our treatment plans are based on our clients’ strengths and what they need from us, making our community a place where they can feel safer and become more responsive in the context of a therapeutic relationship.

It doesn’t have to be complicated. For example, whenever we had a fire drill at a group home, one of our residents, a young woman, would go into a full-fledged panic. It turns out she may have been in a fire when she was very young and likely preverbal. She has no conscious memory of it, but her body remembers it. Now, when we know there’s a fire drill planned, we make sure she’s out of the building. One of her trusted caregivers will walk with her and practice deep breathing until the drill is over.

Trauma-informed also means ensuring caregivers practice self-care. Often, trauma survivors can be retraumatized by well-meaning caregivers who are burnt out. Witnessing, hearing about, or experiencing traumatic events is a daily possibility for them. One could say the same about first responders or the police, but our exposures and our missions are quite different. As caregivers, we are in the relationship with our residents and clients for the long haul. The healing elements of our interventions have just as much to do with us as the technique we are using. If we aren’t in a healthy place, we can’t be nearly as effective in our practice.

Understanding the impact of trauma is an important first step in becoming a compassionate and supportive community. It’s about dignity and respect, it’s about acknowledging the choice of individuals with DDs and allowing them to guide us on their path to resilience.

— Lorraine McLarney, LMHC, is vice president of clinical service and quality management at American Training, which provides day habilitation and residential services for people with developmental disabilities in the Merrimack Valley in Massachusetts.

— Mary Quinn, LICSW, is a clinician at American Training.