Video: Trauma Informed Care

This video will discuss the topic of trauma informed care and the impact of trauma on women’s health.

About this video

Production date: February 9, 2011
Length: 1 hour, 50 minutes
Presenter: Nancy Poole
Download slide notes for this video (PDF, 32 pages)

Nancy Poole is known for her collaborative work in FASD research, training and policy initiatives with local, provincial and national organizations. Since 1996, her work at the British Columbia Women’s Hospital and the BC Centre of Excellence for Women’s Health has focused on policy and service provisions for women with substance use problems.

Nancy is the co-editor of ‘Highs and Lows: Canadian Perspective on Women and Substance Use’ published by the Centre for Addiction and Mental Health in Ontario. She has also co-chaired the Prevention Action Team of the Canada Northwest FASD Research Network.


This video will help you understand:

  • results of recent research for the impact of trauma on women’s health
  • differences between ‘trauma informed’ and ‘trauma specific’ care
  • approaches to service delivery that prevent re-traumatization
  • key educational resources for professional development


  1. Defining trauma (1:24)
  2. Impact of trauma (6:50)
  3. Implications for FASD prevention (24:49)
  4. Resources (1:09:00)

Defining trauma

Trauma is a reaction to experiencing, witnessing or being threatened with an event or events involving serious injury or threat of serious injury to self or others.

The reaction can include intense fear, helplessness and horror.

The terms trauma, violence, abuse and post-traumatic stress are often used to mean the same thing. While they can be related, they are very different.

  • trauma is the reaction
  • abuse or violence is the event that causes the trauma.

Interpersonal trauma refers to experiences involving disruption in trusted relationships. It’s usually the result of violence and abuse.

Trauma can also come from other forms of oppression or forced uprooting from one’s family, community, heritage or culture.

Impact of trauma


  • extreme emotionality or withdrawal
  • sense of hopelessness
  • guilt and shame
  • fear or anxiety
  • anger
  • grief


  • internalized pattern of self-injurious behaviour
  • externalized pattern of violence or abuse of others
  • flashbacks
  • panic attacks


  • loss of trust
  • fear of closeness
  • impaired sexual functioning
  • isolation
  • poor judgement
  • avid need for reassurance
  • rescue
  • unhealthy sexual relationships


  • physical memory of the event
  • re-experiencing the physical and emotional sensations and images
  • physical complaints
  • disrupted sleep patterns
  • exhaustion

A history of abuse and trauma has been linked to problems with:

  • central nervous system
  • sleep
  • cardio-vascular system
  • gastrointestinal system
  • urinary system
  • reproductive systems
  • immune system
  • substance use and abuse

A number of studies about women who abuse substances show a strong link between substance use and a history of having been abused.

  • study results range from 90% to 100% of women studied for substance abuse had a history of abusive experiences

The impact varies with intensity and length of time of events.

  • more chronic experiences (such as prolonged abuse or exposure to violence) result in deeply rooted impact
  • results in changes in brain functioning
  • impact varies with cause or source of trauma
  • impact of abuse from a trusted loved one is greater than if abuse comes from stranger
  • social expression of the emotional, psychological, physical and interpersonal impacts adds to violence in families and communities
  • physical symptoms add to costs of health care

Implications for FASD prevention

Mainstream health and social services are often not gender or trauma informed, so the phenomena is either reinforced or lengthened.

  • there aren’t special systems for substance use and abuse, violence, trauma and mental illness
  • many service providers are not informed about how these issues interact
  • can result in intervention that’s insensitive to the other issues and in worst case may cause other problems to worsen
  • often results in client refusal of or failure to seek services and supports

This is also true for mainstream services for First Nations communities. However, care providers are getting educated about the role that trauma can play in physical and mental health.

Trauma-informed care

In trauma-informed care:

  • knowledge is combined into all parts of service delivery
  • users are most likely to have history of violence
  • includes child protection, substance abuse and mental health
  • design service delivery to avoid re-traumatizing
  • ensure service providers are skilled at trauma-awareness and screening
  • person doesn’t have to disclose trauma history to get trauma-sensitive services
  • trauma-specific services are offered for those who need and want them

Trauma-specific services

  • services directly address impact of trauma and facilitate trauma recovery and healing

Trauma informed techniques

  • therapeutic relationship: establish trust and safety
  • gender informed
  • Motivational interviewing (MI): be sensitive to readiness for change and gauge process

Trauma-specific techniques

  • create therapeutic alliance
  • promote safety
  • address most pressing needs
  • normalize and validate experiences
  • educate about post-traumatic stress and treatment
  • enhance the person’s sense of control and influence
  • promote awareness of how trauma has affected or is affecting daily living and relationships
  • model relationship skills; problem solve

Study of women, co-occurring disorders and violence

  • USA study of specific programming used in study sites:
    • ATRIUM (Addictions And Trauma Recovery Integration Model)
    • HWR (Helping Women Recover)
    • Seeking Safety
    • TREM (Trauma, Recovery and Empowerment)
    • Triad

Study conclusions

Those in combined care saw major reductions in symptoms of mental illness, alcohol and drug use compared to women in regular services. Service costs stayed the same.

Jean Tweed Centre study

  • centre undertook shift to trauma-informed mental health and substance use services
  • strengthened their capacity for trauma-informed work through:
    • broad needs assessment
    • staff training: mindfulness and seeking safety
    • trauma specific programming
    • all programs trauma informed
    • service providers were well supervised and supported
    • program evaluations for quality improvement

Trauma informed community support

A British Columbia study showed major declines in use of alcohol and illicit drugs following a stay in a transition house. This was the case whether the house provided a large or a small amount of substance use intervention.

Women and Co-occurring Disorders study

  • need sustained buy-in from broad range of stakeholders
  • relationships are key
  • strong leadership vital
  • consumer input crucial
  • planning and training vital
  • expect resistance to the paradigm shift
    • cross train staff
    • ensure ongoing suitable supervision
    • management and support


CAMH – Highs & lows: Canadian perspectives on women and substance use (PDF, 6 pages)

Centre for Addiction and Mental Health

Klinic’s Trauma Toolkit (PDF, 152 pages)

Coalescing on Women’s SU

Modified: 2015-09-09
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