In part 1 of this series on the need and value for expanding ED care to be trauma-informed, we explored how the core of trauma-informed care is the creation of a space in which one can feel safe. In this post, we will discuss how inclusive care works to make this space accessible and appropriate for anyone to explore in safety.
Trauma-Informed Care Reminders:
Empathizing
- Understanding where one is coming from, even if their journey has been very different.
Depersonalizing
- When someone is upset, angry, or reactive, expressing empathy can demonstrate an understanding as to why they might feel upset or angry and depersonalize any hostility.
Personalized Conversations
- Understanding and relating are crucial for building rapport and connecting in care. When rapport deepens over time, conversations become more personal to guide one’s growth.
Reducing the Fight, Flight, Freeze Response
- Creates a space where service users can think through a situation and their reactions; helps calm the flight, fight, or freeze response that can come if feeling disempowered.
Helps Reasoning
- Once a service user is no longer in trauma mode, they can process their reasons for engaging in effective behaviors and comfortably start to recognize the benefits of action.
Motivates Open Responses
- The goal is always to empower the service user to take steps toward healing; avoiding “retriggering” a person’s trauma to provide a safe space to open up and connect.
Inclusive care is meant to embody the “Health for All” ethos. It intends to build on a rights-based approach to health care and promote the idea of inclusion as a verb by prioritizing a proactive approach that addresses the barriers which make care inaccessible. Inclusive health refers both to who gets health care and to who provides it, and its ideal relates strongly to Plato’s assertion; ‘Nothing is more unequal than the equal treatment of unequal people’. In the context of health care, inequalities in service provision are abundant. Disparities exist due to a range of factors; including but not limited to lack of access to care and treatment, stigma and discrimination, cultural norms and expectations, and experiences of trauma. Notably, these experiences are exacerbated among marginalized identities; inclusive care must thus seek to understand and account for the factors influencing such discrepancies and their impact on health outcomes.
Eating disorders are complex and multifactorial disorders that can have a significant impact on an individual’s physical and mental health, quality of life, and social and economic well-being. Eating disorders can and do happen to everyone. When viewing disordered eating as a coping mechanism, rather than only an issue focused on food, body image and social pressure to meet stereotypic beauty ideals, it becomes clear how much more prone people who experience discrimination are to disordered eating as a result of being marginalized. The need to cope often arises from experiencing stress, and the prevalence and degree of stressors is higher amongst those of oppressed communities due to current systemic impacts on quality of living/opportunity.
Trauma is a constituent element of intersectional oppression stemming from and overlaid in conditions of colonial structures of power that hide and legitimize social inequalities, extreme poverty, malnutrition, violence, racism, and other ‘cultural’ traumas. The historical domination of the Eurocentric perspective on trauma has hidden the sustained and long processes of the trauma of colonialism’ and its disproportionate impacts among marginalized populations. Thus, a decolonized perspective on trauma aims to make visible the ‘collective’ and ‘chronic’ dimensions of trauma (cultural, political and historical contexts).Therefore, eating disorders should be viewed as a social justice issue because they are shaped by and perpetuate the inequalities and injustices existent in our eurocentric society and systems. Understanding the ways in which eating disorders intersect with social justice issues is vital to provide care that aims to create a more equitable and inclusive society by addressing these underlying factors.
Inclusivity Principles
Healthcare professionals who understand the principles behind inclusivity are more likely to understand why inclusivity leads to more accessible care. The principles of inclusivity include:
- Not only acknowledging that different people have different needs and capabilities, but understanding how such differences are often influenced by systems (to be discussed).
- Respecting the rights of all individuals to adequate health and social care.
- Focusing on what individuals are capable of without making assumptions.
- Including people of all backgrounds and communities in all services and provisions, including diversity representation in service providers.
- Treating all patients with respect and sensitivity.
Following these principles can help providers offer accessible care to service users from various backgrounds, with particular consideration and benefit to those who may have had negative experiences with providers in the past. In order to assist and ensure the establishment of these principles from providers, the following values should be prioritized in care settings;
- Safety
- Trustworthiness and Transparency
- Peer Support
- Collaboration and Mutuality
- Empowerment, Voice and Choice
- Cultural, Historical and gender Considerations
Safety
- The physical, psychological and emotional safety of service users is prioritized by asking what they need to feel safe and making efforts to prevent compromising these needs.
Trustworthiness
- Transparency exists with the object of building trust among staff, service users, and the wider community.
Choice
- Service users are supported in shared decision-making, choice and goal setting to determine the plan of action they need to heal.
Collaboration
- The value of staff and service user experience is recognized in overcoming challenges and improving the care provision experience.
Empowerment
- Efforts are made to share power and give service users and staff their own (equal) voice in decision-making.
Considerations
- Recognize and work with an understanding of cultural stereotypes and biases based on (including but not limited to) gender, sexual orientation, age, ability, race, and ethnicity.
Final Reminder: Safety is not told, it is felt. The aim of inclusive care is to create a space for this feeling to be experienced by all, increasing one’s confidence and capacity to do so in future life. If you would like to work one-on-one with a dietitian who offers a trauma-informed approach, contact us at info@sooma.ca or at (514) 437-4260, and we would be happy to chat!
By: Liam Fowler, McGill Dietetics Intern
Sööma est une entreprise bilingue qui fonctionne en anglais et en français. Nous fournissons des articles de blogue, des recettes et des articles de diverses sources qui sont parfois écrits en anglais et parfois en français. Si vous vous sentez incapable d’accéder à un article ou à un sujet spécifique en raison d’une barrière linguistique, veuillez nous contacter à info@sooma.ca et nous serons heureux de traduire le contenu pour vous.
Sööma is a bilingual company that operates in both English and in French. We will provide blog posts, recipes and articles from various sources that are sometimes written in English and sometimes in French. If you feel unable to access a specific article or topic due to a language barrier, please reach out to us at info@sooma.ca and we will be happy to translate the content for you.
References
- American Psychological Association. (n.d.). Trauma. American Psychological Association.
- Brewerton, T. D. (2018). An Overview of Trauma-Informed Care and Practice for Eating Disorders. Journal of Aggression, Maltreatment & Trauma, 28(4), 445–462.
- Center for Health Care Strategies. (2022). What is Trauma? Trauma-informed Care Implementation Resource Center. https://www.traumainformedcare.chcs.org/what-is-trauma/
- Eating Recovery Center Webinar (2023). Understanding the Impacts of Trauma on Eating Disorders with Landry Weatherston-Yarborough, LPC, CEDS-S, NCC, Kris Ramos, MSW, LCSW, and Eric Dorsa.
- NEDA (2023). National Eating Disorders Association; Social Justice. Retrieved from (database); https://www.nationaleatingdisorders.org/social-justice
