Trauma-informed Care For Marginalised and Low-income Communities

Trauma-informed care (TIC) is an essential framework in health services, designed to help care providers understand and recognise the profound effects of trauma on individuals. By adopting this approach, TIC fosters a culture of safety, empowerment, and healing. Central to this model is the creation of trust, collaboration, and shared power between consumers and practitioners (Levenson, 2020). Its primary aim is to transform the cultural and philosophical foundations of health services, equipping practitioners to manage traumatic stress effectively while addressing the complex dynamics of trauma (Mental Health Australia, 2014).

This integrative literature review seeks to examine the core components of trauma-informed care. It focuses on the practical application of these principles within health services. Through an analysis of diverse academic and policy resources, this review will critically evaluate the key barriers to implementing TIC, particularly concerning specific population groups and trauma types (Snyder, 2019). Additionally, it will explore strategies to overcome these barriers, with a focus on promoting recovery, minimising re-traumatisation, and supporting the long-term health and well-being of trauma-affected individuals.

Trauma-informed care (TIC) acknowledges the profound effects of trauma, particularly on marginalised and underserved populations (Sanders & Hall, 2018). These groups often face adversities such as violence, poverty, and systemic discrimination, which exacerbate trauma and result in complex health and behavioural outcomes. Marginalised communities, especially those in public housing or low-income areas, experience "community trauma" driven by systemic issues like racism and disenfranchisement. Chronic stressors, including substandard housing, violence, and limited healthcare access, worsen the impact of trauma (Falkenburger et al., 2018). Additionally, cumulative trauma from interpersonal and structural violence contributes to distrust in support systems, intensifying the sense of abandonment.

Trauma manifests through behaviours like hyper-vigilance, where prolonged exposure to stress leads to heightened alertness and anxiety. While protective in dangerous environments, this can strain relationships due to mistrust and defensiveness (Kira, 2022). Substance abuse is another prevalent response, often used as a coping mechanism in environments normalising drug use amidst pervasive trauma. This issue is further linked to inadequate mental health services in such communities (Rogers et al., 2020; Falkenburger et al., 2018).

These behavioural responses have significant health implications. Chronic stress often leads to conditions like cardiovascular disease and diabetes, while mental health disorders such as depression and anxiety are widespread due to ongoing trauma (Koury & Green, 2017). Trauma-informed care provides a framework to address these complex needs, recognising trauma's pervasive impact and fostering empowerment and healing through targeted interventions (Sanders & Hall, 2018). By addressing behavioural responses such as hyper-vigilance and substance abuse, TIC aims to improve long-term health and social outcomes.

TIC provides a critical framework for addressing trauma but faces challenges in real-world application due to systemic barriers. While proponents argue that TIC principles effectively address the trauma experienced by marginalised groups (Australian Psychological Society, 2021), skeptics highlight structural violence and underfunding as significant obstacles (Australian Institute of Health and Welfare, 2025). These barriers risk reducing TIC to aspirational ideals rather than practical solutions for promoting empowerment and choice.

Key impediments include underfunding and fragmented services, which hinder holistic, coordinated care. Resource constraints make it difficult to build safe environments and trusted relationships, while large caseloads and staff shortages limit consistency and responsiveness. Public housing residents often endure unsafe and underfunded living conditions that undermine feelings of safety. Policy-level drivers of trauma, such as racism, poverty, and oppression, are insufficiently addressed, leaving systemic disempowerment unchallenged. Additionally, poor cross-sector coordination fragments care, failing to address the complex, interconnected needs of these communities.

Overcoming these barriers requires sustainable funding to adequately resource services, hire more staff, and improve housing conditions. Policy changes targeting systemic drivers of trauma, like poverty and structural violence, are vital. Community engagement should shape care improvements, ensuring services empower residents and reflect cultural needs. Strengthening cross-sector coordination through formal agreements and protocols is crucial to providing integrated care. A multi-faceted approach addressing resources, systemic influences, and community partnerships is necessary to realise TIC principles that foster safety, empowerment, and healing for marginalised populations.

For individuals in marginalised, low-income communities, TIC must address both individual and community trauma stemming from systemic oppression, poverty, racism, and violence. Recognising trauma responses like hyper-vigilance and substance abuse as coping mechanisms helps build trust. Ensuring safe environments and culturally responsive care fosters healing, while empowering residents involves restoring control and dignity lost through systemic oppression. A holistic approach integrating mental health care, addiction support, and social services is essential, alongside coordinated care to meet multifaceted needs.

Sustainable funding for staff, safe spaces, and coordinated services (Australian Psychological Society, 2021).
Ongoing training for practitioners to recognise trauma responses and foster trust (Kira, 2022; Rogers et al., 2020).
Policy reforms targeting structural causes of trauma, such as racism and housing instability (Falkenburger et al., 2018).
Community co-design to ensure care is culturally safe and empowering (Levenson, 2020).
Integrated supports through cross-sector collaboration and wrap-around care (Falkenburger et al., 2018).

Zubaida Baher holds a Master of Science degree, along with qualifications in mental health and counselling. As an ACA-1 member transitioning to level 2, she has completed coursework through Monash University and BACB-certified behaviour therapy programs. Currently undergoing supervision in NDIS Positive Behaviour Support, Zubaida is committed to evidence-based strategies that empower individuals while maintaining their dignity and respect. Her published papers include “Carrier Identification of Thalassaemia” and “Mental Health Supports.” Passionate about expanding her work in mental health counselling and Positive Behaviour Support, she strives to contribute further through research and practice.