Trauma-informed care and preventing abuse in people with developmental disability

‘Trauma-informed care’ refers to practices that can guide safe and sensitive care for and with people with a history of trauma and abuse. This involves being aware and responding to the effects of abuse and trauma and should include a ‘whole of practice or service’ approach, from first contact with the person with developmental disability through to transfer of care or discharge.

A sensitive approach to questions and discussion can facilitate current and future disclosure; see How to ask about suspected abuse. Once aware of the trauma, or even an environment or relationship dynamics that may be suggestive of trauma, there is both an ethical and legal obligation to respond; see What to do if you suspect a person with developmental disability is being or has been abused.

Incorporating trauma-informed principles into clinical practice will help mitigate added trauma from medical care (eg re-living procedural trauma), as well as prevent abuse in that person and others by promoting awareness and identification of abuse and trauma. This may involve, for example, administrative and clinical staff training, or adapting physical environments such as waiting and treatment rooms.

Practical steps to incorporate trauma-informed principles in primary care include:

• promoting resilience, protective factors and positive relationships for people with developmental disability and their families and caregivers, including educating families and support workers about the impacts of abuse and trauma
• screening for possible abuse in people with developmental disability (see How to recognise abuse and trauma and How to ask about suspected abuse)
• being aware medical practice may ‘re-traumatise’ patients inadvertently (eg certain physical or social environments, procedures)—for practice measures to minimise distress and trauma throughout a medical consultation, see Making your practice disability friendly and Physical examination and investigations
• where possible, having a multidisciplinary approach that supports the person in their family and community as well as their learning and vocational environments.

Prevention of trauma extends to using trauma-informed practices when working with other services involved in supporting the person with a developmental disability (eg social services, child protection, justice systems), and advocating for that person.

Be mindful that abuse and trauma are often intergenerational or occur within families.

For more advice on the general practitioner role in prevention of abuse, see the Royal Australian College of General Practitioners (RACGP) guideline.