How a Child’s Bedtime Routine Led to Trauma-Informed Care Approach

I fell in love with trauma-informed care because I wasn’t doing my job very well.

I was trying to reduce restraints in the psychiatric treatment facility I oversaw, and was having marginal success. We tried everything we knew at the time: more activities, more staff, more staff training, different staff, different policies — and the results were marginal.

The burden was substantial; there were external demands from regulators to reduce the numbers and internal pressure to have fewer patients in restraints that we knew were psychologically and occasionally physically harmful. And yet, despite our multitude of committees, performance improvement, program adjustments, children (and staff) did not experience less restraints.

One child in particular had difficulty at bedtime. The doors to the rooms are shut at bedtime, ‘for their safety,’ and she had ingenious ways of avoiding bedtime or simply starting fights as ‘holds’ were not done in rooms.

I finally spoke with her about it. She told me, “I hate my door’s sound.” After a bit of discussion, I realized she hated the click the doors made as they shut.

In staffing the case the next day, a wise mind brought up that she had been found in a closet when she was removed from her home. The closet was not locked just as her bedroom door was not, and who knows what terrors kept in her there.

This was my first experience in realizing that her story mattered much more than all of our analytics, practices and procedures. What we — what I — had seen as damaging, dangerous and annoying were keeping her safe. It was far preferable to her to be in a restraint, to be in close, albeit violent, contact with adults, than to be abandoned in a small, dark, shut space again.

We changed after that. A staff member went in her room with her at bedtime, left the door open a crack and rubbed her feet until she fell asleep. We worked up to closing her door, by having someone staying in there, by letting her close it, by letting her choose.

She did much better when we did better.

I could tell you about her improvement, but the point is that it was our viewpoint that was wrong. If I tell you that the restraints went down and she was eventually discharged to a foster family (they did and she did), it implies she got better. But she was never the problem. What happened to her and our lack of listening was the problem. She was doing what made sense; we were trying to make well at the expense of what kept her sane. The two were at odds.

Trauma-informed care believes that what has happened helps tell us about what is happening now; that often what we call “symptoms” are stories, a way to bear the intolerable. Past trauma has a profound effect on a person’s ability to cope but awareness of that trauma has a profound impact on recovery.

I had not heard of trauma-informed care when we changed the way we interacted with that 8-year-old girl, but she was my first introduction to it. Knowing her story, understanding that it was intolerable to relive those traumatic memories, changed everything about the way I viewed her behavior. I became trauma informed.

Trauma-informed care is a paradigm shift.

The numbers are incredibly compelling: an adult male with an adverse childhood experience score of 6 is 4600 percent more likely to use intravenous drugs; Trauma-informed care is the number one (some argue the only) intervention shown to reduce restraints in inpatient facilities. The allure of measurements, evidence-based practices and neuroscience are now part of my trauma-informed care knowledge base.

But at the heart of it all, true to the foundation of trauma-informed care, I remember the story of a scared little girl that changed everything for me.

Trauma Matters KC is a coalition of more than 30 Kansas City metro area social service agencies, behavioral health centers, philanthropies, institutions and individual providers dedicated to raising awareness about trauma sensitive practices. Trauma Matters KC meets on the second Monday of every month from 2-3:30pm at MARC. Learn more about how you can be trauma informed or join our group,

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