Trauma-Informed Care

by

Johanna Creswell Báez, M. Karen "Wren" Lichlyter-Klein, Maria O'Connell

• LAST REVIEWED: 23 June 2023
• LAST MODIFIED: 23 June 2023
• DOI: 10.1093/obo/9780195389678-0323

Introduction

Trauma-informed care (TIC) is a conceptual approach to client care that uses evidence-based knowledge to create environments and services that are engaging, welcoming, and supportive for individuals or groups. Substance Abuse Mental Health Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC) have collaborated on six primary practices that inform TIC praxis: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment voice and choice, and cultural, historical, and gender issues. These principles inform best practices for helping professionals to create an environment where individuals and groups can experience growth without re-traumatization. TIC is a proactive approach in caring that shifts the question from “What is wrong with you?” to ask instead, “What happened to you?” TIC understands that an individual’s behaviors occur within their environment and that trauma can present as maladaptive or, conversely, as adaptive growth behaviors. TIC helps the clinician understand and approach clients with curiosity and compassion, withholding judgment to support clients in their own unique growth process. The TIC principles can be applied to a wide range of settings, including clinical practice, organizations, and policymaking.

General Overviews

This section covers references that provide an overview of trauma-informed care (TIC). Trauma has been found to be widespread in childhood (Felitti, et al. 1998). Mental health, behavioral health, and medical fields are adapting to utilize models and interventions to properly understand, assess, and treat trauma-related symptoms in individuals seeking help. In the 1990s, the Substance Abuse Mental Health Administration (SAMHSA) in the United States moved toward understanding the intersection of trauma, mental health, and substance use, which resulted in National Association of State Mental Health Program Directors 1998 offering the first positional paper on trauma and treatment. SAMHSA and the Trauma-Informed Care Implementation Resource Center 2021 defines trauma-informed care as organizations and providers that seek to recognize the widespread impact of trauma; notice the symptoms of trauma in clients, patients, loved ones, and staff; integrate education and insight about trauma into policies, procedures; institute best practices for an organization; and actively avoid re-traumatization. Harris and Fallot 2001 offered the groundbreaking work regarding the utilization of a TIC approach in offering mental health and human services, followed by other work that focused TIC in areas of behavioral health by Bloom 2006, childhood welfare by Hodas 2006, homeless populations by Hopper, et al. 2010, and organizational systems by Blanch 2003. Finally, in terms of neuroscience, van der Kolk 2014 is a landmark book. The Body Keeps the Score offers a biological approach to understanding the long-term impacts of trauma on the brain, body, and an individual’s relationships.

• Blanch, A. 2003. Developing trauma-informed behavioral health systems. National Association of State Mental Health Program Directors, Alexandria, VA. Health Program Directors, National Technical Assistance Center for State Mental Health Planning.

  The report from the National Technical Assistance Center for State Mental Health Planning (NTAC) stated that the goals were to (1) review progress, noting successes and challenges to trauma informed behavioral health, (2) renew leadership interest throughout the country, (3) ensure cooperative trauma projects with national mental health priorities, (4) identify opportunities that have emerged since 9/11/01, and (5) make recommendations to NASMHPD and other groups regarding creating trauma-informed systems.

• Bloom, S. L. 2006. Organizational Stress as a Barrier to Trauma‐Sensitive Change and System Transformation. White Paper for the National Technical Assistance Center for State Mental Health Planning (NTAC), National Association of State Mental Health Program Directors.

  This article discusses organizations as living systems, vulnerable to trauma and stress, and calls for reinventing organizations to be trauma-informed, thereby increasing safety for employees and clients alike.

• Felitti, V. J., R. F. Anda, D. Nordenberg, et al. 1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 14.4: 245–258.

  DOI: 10.1016/s0749-3797(98)00017-8

  A groundbreaking work in the connection between childhood abuse and trauma with potential health complications later in life, this study makes healthcare workers and behavioral health professionals aware of the role of traumatic exposure and experience as a predictor for disease.

• Harris, M., and R. D. Fallot. 2001. Trauma-informed inpatient services. In Using trauma theory to design service systems. Edited by M. Harris and R. D. Fallot, 33–46. San Francisco: Jossey-Bass.

  As a seminal work in providing TIC services, this offers both community and consumer based initiatives to revamp delivery of medical care, with best practices in mind to avoid re-traumatization.

• Hodas, G. R. 2006. Responding to childhood trauma: The promise and practice of trauma informed care. Pennsylvania Office of Mental Health and Substance Abuse Services.

  With a clear focus on childhood and children, this paper presents symptomatology, personal characteristics of potential victims, and factors for traumatization, along with a strengths-based approach to intervention that is cognizant of trauma and its impacts.

• Hopper, E. K., E. L. Bassuk, and J. Olivet. 2010. Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal 3:80–100.

  DOI: 10.2174/1874924001003020080

  Narrowing the scope of focus to unhoused individuals, this article reveals the prevalence and risk of trauma in the population. It provides a framework for services to traumatized persons within a variety of settings with implications for practice.

• National Association of State Mental Health Program Directors. 1998. Position statement on services and supports for trauma survivors.

  NAMHPD’s unanimous statement on trauma-informed care for services and professionals.

• Trauma-Informed Care Implementation Resource Center. 2021.

  An excellent resource for definitions, resources, and policy for the trauma-informed practitioner.

• van der Kolk, B. A. 2014. The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.

  An excellent overview of how trauma impacts the entire person, particularly from a biological and neuroscientific perspective. This book focuses on the importance of attachment relationships and interpersonal theory for healing the person who has experienced trauma.