Safe & Sound: A Trauma-Informed Approach to Care

The sensory processing system is greatly impacted by trauma and can be supported through trauma-informed parenting and the safe and sound protocol. It is essential as caregivers or as anyone who works with children to know what happens to children’s brains that have gone through trauma so we can support them in regaining proper regulation skills and neurological rewiring. We hope to break down this complex subject so it is easier to understand and increase your confidence in supporting your child.

The Impact of Trauma and Its Relationship to Sensory Processing

The effects of going through or being exposed to trauma in childhood can cause an inability to regulate and organize sensory responses. The brain's neurological wiring changes in the sensory cortex, which impacts the sensory and auditory parts of the brain and the areas responsible for reflexes (Joseph et al., 2021). This causes reactions and behaviors in children such as emotional eating or disinterest in eating, physical health-related symptoms, lack of sleep, acting out, fidgeting and inability to maintain focus, and risk-taking behaviors (Swift, n.d.). Child-appropriate sensory modulation intervention is a recommended approach from the occupational therapy world to treating children with trauma (Joseph et al., 2021). This intervention stems from the idea of supporting modulation (regulating yourself) with a focus on sensory experiences and their impacts, which is a common approach with many children in occupational therapy. It is helpful in circumstances where there is trauma because “the initial experience of trauma occurs on a somatosensory level” (Joseph et al., 2021). This means trauma impacts your senses and your perception of the world around you.

Trauma-Informed Parenting

Sensory experiences drive a child’s behaviors, leading to consequences often seen as “negative” and done by choice. However, children, when on high alert due to trauma, are hyper-vigilant about their outside world and the experiences going on around them (Reagan, 2022). What they pick up from their senses guides their reactions. Understanding a child’s actions may be due to a sensory instinct and trying to be compassionate is a great way to start. Research has found that cognitive behavioral therapy is an excellent way to help people going through trauma by teaching them skills to cope and problem-solve (Joseph et al., 2021). This is often done in the typical psychological therapy session. When a child is stressed, it is also found that dysregulation makes it hard to use cognitive approaches to shape and regulate behaviors (Warner et al., 2014). So it is important to have more than just the problem-solving approaches learned in CBT for a child who went through trauma to utilize for regulation. This is why, as parents, it is important to support your child with the understanding that they may not be able to control their reactions or use the skills they learned due to neurological brain changes. Using trauma-informed parenting is similar to trauma-informed care where you ensure the child feels safe, has trust, believes they have some say in choices made and that they are in it together with you, and lastly, that you recognize their strengths and are there to support them.

Safe and Sound Protocol

The Safe and Sound Protocol (SSP) follows the principle of neuroplasticity, believing that gently providing specific and gentle stimulation can activate neural pathways and build neural connections to support the appropriate processing of sensory information. Repeated sessions allow the nervous system to adapt and feel safe faster. The Polyvagal Theory is used in this protocol, which focuses on what is happening in both your body and your nervous system. It decides how our bodies sense safety, danger, or life threat, which can impact your behavior. In people who experience trauma, these three states are affected and don’t sense safety, danger, or life threat, the same as others who haven’t experienced trauma. These three states are parasympathetic, sympathetic, and dorsal vagal. Below they are explained, and this protocol is trying to rewire the neural connections so these signals are more accurate. You can find more on their website regarding their neurological approach to supporting a child’s healing from traumatic experiences.

Evidence Behind Safe and Sound

When looking at regulation and skill development in children utilizing traditional occupational therapy methods in conjunction with the safe and sound protocol, positive benefits can be found in both areas (Rogowski et al., 2024). A study reviewing these methods found increased attention and engagement with others, the environment, and tasks, which supports the development of new skills. This includes having the ability to support one's own regulation or find others to help regulate (Rogowski et al., 2024). Findings indicate positive impacts, specifically with children with ASD in an EI setting. More studies need to be done on other populations as this is a newer idea and not often used. Having traditional occupational therapy interventions and utilizing the safe and sound approach supports children in developing functional skills through increased nervous system regulation, which helps them feel safe (Rogowski et al., 2024). Combining therapeutic approaches allows for building typical coping skills, socialization skills, and functional independence while regulating the nervous system and neural connections.

Co-regulation is a crucial factor to consider when working with patients. As a therapist, it is important to be monitoring the patient's responses so you can respond with appropriate feedback. It is essential to monitor the patient's face, breathing, and movements. To help with co-regulation, you should allow restabilization of the body and emotions before starting again. Consider how long it takes them to recover and how long they can last before a break is needed. You want to support patients in gaining awareness of their control over stimuli so they can decrease the power a trigger has over them. 

References

Joseph, R. Y., Casteleijn, D., van der Linde, J., & Franzsen, D. (2021). Sensory modulation dysfunction in child victims of trauma: A scoping review. Journal of Child & Adolescent Trauma, 14(4), 455–470. https://doi.org/10.1007/s40653-020-00333-x

Rogowski, M., Damiao, J. A., Cavaliere, C., Rust, N., Lopez, A., Marash, R., & Zdrodowski, A. (2024). An exploratory study of the safe & sound protocol in young children with autism. The American Journal of Occupational Therapy, 78(S2), 7811500332-7811500332p1. https://doi.org/10.5014/ajot.2024.78S2-PO332

Reagan, L. (2022, April 23). Trauma, Attachment + Sensory Informed Parenting. Trauma Therapist Network. https://traumatherapistnetwork.com/trauma-informed-parenting/

Swift, M. S. (n.d.). Signs of Trauma. A Greater Hope. https://aghope.org/en/blog/signs-of-trauma?gad_source=1&gclid=Cj0KCQjw99e4BhDiARIsAISE7P_UAQMUvHV2WDVcKqMifgjx4gS8oYulTuKSbNifrFq31b1IdGvQqKYaAuSqEALw_wcB

Warner, E., Spinazzola, J., Westcott, A., Gunn, C., & Hodgdon, H. (2014). The body can change the score: Empirical support for somatic regulation in the treatment of traumatized adolescents. Journal of Child & Adolescent Trauma, 7(4), 237–246. https://doi.org/10.1007/s40653-014-0030-z