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Trauma

Trauma

Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. 

In the United States, 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event, and 90 percent of clients in public behavioral health care settings have experienced trauma. If trauma goes unaddressed, people with mental illnesses and addictions will have poor physical health outcomes and ignoring trauma can hinder recovery. To ensure the best possible health outcomes, all care — in all health settings — must address trauma in a safe and sensitive way.

Providing care in a trauma-informed manner promotes positive health outcomes. A trauma-informed approach is defined by SAMHSA as a program, organization, or system that realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.

Learn more about trauma at www.samhsa.gov/trauma-violence

resources



ADVERSE CHILDHOOD EXPERIENCES (ACEs), TRAUMA, & POST TRAUMATIC STRESS DISORDER (PTSD)

The Adverse Childhood Experience Study (ACES) found that survivors of childhood trauma are up to 5,000 percent more likely to attempt suicide, have eating disorders, or become IV drug users. Watch this video from Dr. Vincent Felitti, the study's founder, which details this remarkable and powerful connection.

The ACE Survey featured on the ACE’s Too High website shares the ACE questionnaire. The survey measures 10 types of childhood trauma; five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect; five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma counts as one. 

ACEs Connection is a social network that accelerates the global movement toward recognizing the impact of adverse childhood experiences in shaping adult behavior and health, and reforming all communities and institutions to help heal and develop resilience.


Post-traumatic Stress Disorder (PTSD) – once a person screens positive, receives a thorough assessment exploring the nature and impact of the trauma, it is important to screen and assess for signs of PTSD so these can be treated and re-traumatization prevented. Not all persons with a history of trauma exhibit symptoms of PTSD; however many people who have a history of trauma experience signs and behaviors related to toxic stress such as depression, anxiety, somatic complaints, and use/abuse of illegal substances; therefore universal screening and assessment of trauma is necessary.  

The Department of Veterans' Affairs National Center for PTSD is dedicated to research and education on trauma and PTSD. The center works to assure that the latest research findings help those exposed to trauma.

PTSD Coach is a mobile app, created by the National Center for PTSD and the Department of Defense’s National Center for Telehealth and Technology, to help individuals learn about and manage trauma symptoms.

TRAUMA-INFORMED CARE

Trauma-Informed Care (TIC) – adoption of principles and practices that promote a culture of safety, empowerment, and healing. Based on what we know about the prevalence and impact of trauma, it is necessary to ensure widespread adoption of trauma-informed care.

SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach introduces a concept of trauma and offers a framework for how an organization, system, or service sector can become trauma-informed. This document includes a definition of trauma, a definition of a trauma-informed approach, six key principles, and 10 implementation domains.

SAMHSA's TIP 57 on Trauma-Informed Care in Behavioral Health Services assists behavioral health professionals in understanding the impact and consequences for those who experience trauma. It includes patient assessments, treatment planning strategies that support recovery, and information on building a trauma-informed care workforce.  

The National Council for Behavioral Health offers learning communities, consultation, and training and technical assistance for providers and systems of care in the areas of Trauma-informed Care and Integration of Behavioral Health and Primary Care Services. This trauma-informed care checklist allows organizations to determine their commitment to providing trauma-informed services.

 The National Council magazine issue on trauma contains more than 20 articles from leading researchers, policy specialists, administrators, clinicians, and peer representatives as well as interviews and case studies from organizations and communities seeking to make the transition to a trauma-informed culture of care.

Leaving The Door Open: Alternatives to Seclusion and Restraint DVD trains mental health services direct care staff, administrators, and consumers on alternative approaches to seclusion and restraint in the treatment of people with serious mental illness. An section of the video addresses the trauma informed approach and explains how people with trauma backgrounds are especially triggered by the use of seclusion and restraint.

The Trauma Survivors in Medical and Dental Settings pamphlet, developed by the Western Massachusetts Training Consortium, describes issues trauma survivors may have in medical and dental settings, and provides suggestions to avoid common problems and promote emotional well-being.

The Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse helps health care practitioners be sensitive to the needs of adult survivors of childhood sexual abuse and other types of interpersonal violence. The handbook also includes information on examinations and procedures that health care providers might consider innocuous or routine but can be distressing for survivors. 

The Trauma Toolbox for Primary Care, from the American Academy of Pediatrics, is a six-part series designed to increase primary care practices' understanding of adverse childhood experiences and their impact on health. It provides suggestions for talking with families, identifying ways to prepare the medical home to address ACEs and other traumatic events, and more.

SAMHSA TECHNICAL ASSISTANCE CENTERS 

Centers funded by SAMHSA with a focus on promoting TIC principles and practices.

SAMHSA Promoting Alternatives to Seclusion and Restraint through Trauma-Informed Practices & National Center for Trauma Informed Care (NCTIC) promotes trauma-informed practices in services delivery for people who have experienced violence and trauma and seek support for recovery and healing.

The Disaster Technical Assistance Center (DTAC) supports SAMHSA's efforts to prepare states, territories, tribes, and local entities to deliver an effective mental health and substance abuse (behavioral health) response to disasters. 

The National GAINS Center helps expand access to community-based services for adults with co-occurring mental and substance use disorders in the justice system, as well as promotes communities’ integrated systems of behavioral healthcare for people in contact with the justice system.

The Suicide Prevention Resource Center (SPRC), supported by SAMHSA, promotes a public health approach to suicide prevention. Their website contains important information and numerous resources, including the Framework for Suicide Prevention, a Best Practice Registry and a section for providers. 

OTHER TRAUMA RELATED CENTERS 

The Anna Institute is a resource, research, and informational website developed by Ann Jennings, PhD, and named for her daughter Anna who was a victim of child sexual abuse and spent her last years of life in a psychiatric institution.

The National Child Traumatic Stress Network strives to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events.

The National Center for PTSD is dedicated to research and education on trauma and PTSD. The center works to assure that the latest research findings help those exposed to trauma.

The Child Trauma Academy is a not-for-profit organization based in Houston, Texas working to improve the lives of high-risk children through direct service, research, and education. They recognize the crucial importance of childhood experience in shaping the health of the individual, and ultimately, society. By creating biologically-informed child and family respectful practice, programs, and policy, CTA seeks to help maltreated and traumatized children.

The Trauma Center at the Justice Resource Institute presents a wealth of information on clinical services, training, consultation, and education programs.

Federal Resources on HIV/AIDS

There is a very high prevalence of trauma with people with HIV/AIDS, particularly child sexual abuse in women and men who have sex with men with HIV/AIDS. The following are general resources on HIV/AIDS. 

The Health Resources and Services Administration (HRSA) HIV/AIDS Programs provides extensive information, resources and tools related to HIV/AIDS including contact information on the Ryan White Technical Assistance Center-TARGET.

AIDS.gov features information on federal HIV policies, programs, funding, and other activities. The website includes information on the National HIV/AIDS Strategy (NHAS), Presidential Advisory Council on HIV/AIDS (PACHA) and the President’s Emergency Plan for AIDS Relief (PEPFAR).

SCREENING TOOLS

Trauma screening tools can be used to screen for the presence of adverse or traumatic life experiences. Once a person reveals that they are experiencing or have had adverse or traumatic life experiences, it would be appropriate to use an assessment tool that could uncover signs of related stress, functional difficulties and or PTSD. Two factors are very important when screening for trauma: one, in order to reveal such experiences, the person must be engaged in a sensitive and caring process that allows them to feel safe and comfortable and two, screening for trauma is a process that may not be revealed during intake; therefore a system should be in place to screen for trauma post intake and following the development of a trusting relationship with the clinician.

The Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD) Screen is a 4-item screen that was designed for use in primary care and other medical settings. 

WEBINARS

Recordings (synched audio and slides) remain in our archive for one year. For webinar recordings more than one year old, contact us at Integration@TheNationalCouncil.org. 

Improving Health through Trauma-Informed Care
July 28, 2015
Presented by: Leah Harris, Trauma Informed Care Specialist and Coordinator of Consumer Affairs for the National Association of State Mental Health Program Directors (NASMHPD), Eddy Machtinger, MD, Professor of Medicine and Director of the Women’s HIV Program at the UCSF, and Mary Blake, CRE, ITE, Public Health Advisor at SAMHSA
Slides and Recording 

It's Just Good Medicine: Trauma-Informed Primary Care
August 6, 2013
Presented by Larke Huang, Cheryl Sharp, and Tara Gunther
Slides 

Call Our Helpline: 202-268-7457

Trauma

Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. 

In the United States, 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event, and 90 percent of clients in public behavioral health care settings have experienced trauma. If trauma goes unaddressed, people with mental illnesses and addictions will have poor physical health outcomes and ignoring trauma can hinder recovery. To ensure the best possible health outcomes, all care — in all health settings — must address trauma in a safe and sensitive way.

Providing care in a trauma-informed manner promotes positive health outcomes. A trauma-informed approach is defined by SAMHSA as a program, organization, or system that realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.

Learn more about trauma at www.samhsa.gov/trauma-violence

resources



ADVERSE CHILDHOOD EXPERIENCES (ACEs), TRAUMA, & POST TRAUMATIC STRESS DISORDER (PTSD)

The Adverse Childhood Experience Study (ACES) found that survivors of childhood trauma are up to 5,000 percent more likely to attempt suicide, have eating disorders, or become IV drug users. Watch this video from Dr. Vincent Felitti, the study's founder, which details this remarkable and powerful connection.

The ACE Survey featured on the ACE’s Too High website shares the ACE questionnaire. The survey measures 10 types of childhood trauma; five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect; five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma counts as one. 

ACEs Connection is a social network that accelerates the global movement toward recognizing the impact of adverse childhood experiences in shaping adult behavior and health, and reforming all communities and institutions to help heal and develop resilience.


Post-traumatic Stress Disorder (PTSD) – once a person screens positive, receives a thorough assessment exploring the nature and impact of the trauma, it is important to screen and assess for signs of PTSD so these can be treated and re-traumatization prevented. Not all persons with a history of trauma exhibit symptoms of PTSD; however many people who have a history of trauma experience signs and behaviors related to toxic stress such as depression, anxiety, somatic complaints, and use/abuse of illegal substances; therefore universal screening and assessment of trauma is necessary.  

The Department of Veterans' Affairs National Center for PTSD is dedicated to research and education on trauma and PTSD. The center works to assure that the latest research findings help those exposed to trauma.

PTSD Coach is a mobile app, created by the National Center for PTSD and the Department of Defense’s National Center for Telehealth and Technology, to help individuals learn about and manage trauma symptoms.

TRAUMA-INFORMED CARE

Trauma-Informed Care (TIC) – adoption of principles and practices that promote a culture of safety, empowerment, and healing. Based on what we know about the prevalence and impact of trauma, it is necessary to ensure widespread adoption of trauma-informed care.

SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach introduces a concept of trauma and offers a framework for how an organization, system, or service sector can become trauma-informed. This document includes a definition of trauma, a definition of a trauma-informed approach, six key principles, and 10 implementation domains.

SAMHSA's TIP 57 on Trauma-Informed Care in Behavioral Health Services assists behavioral health professionals in understanding the impact and consequences for those who experience trauma. It includes patient assessments, treatment planning strategies that support recovery, and information on building a trauma-informed care workforce.  

The National Council for Behavioral Health offers learning communities, consultation, and training and technical assistance for providers and systems of care in the areas of Trauma-informed Care and Integration of Behavioral Health and Primary Care Services. This trauma-informed care checklist allows organizations to determine their commitment to providing trauma-informed services.

 The National Council magazine issue on trauma contains more than 20 articles from leading researchers, policy specialists, administrators, clinicians, and peer representatives as well as interviews and case studies from organizations and communities seeking to make the transition to a trauma-informed culture of care.

Leaving The Door Open: Alternatives to Seclusion and Restraint DVD trains mental health services direct care staff, administrators, and consumers on alternative approaches to seclusion and restraint in the treatment of people with serious mental illness. An section of the video addresses the trauma informed approach and explains how people with trauma backgrounds are especially triggered by the use of seclusion and restraint.

The Trauma Survivors in Medical and Dental Settings pamphlet, developed by the Western Massachusetts Training Consortium, describes issues trauma survivors may have in medical and dental settings, and provides suggestions to avoid common problems and promote emotional well-being.

The Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse helps health care practitioners be sensitive to the needs of adult survivors of childhood sexual abuse and other types of interpersonal violence. The handbook also includes information on examinations and procedures that health care providers might consider innocuous or routine but can be distressing for survivors. 

The Trauma Toolbox for Primary Care, from the American Academy of Pediatrics, is a six-part series designed to increase primary care practices' understanding of adverse childhood experiences and their impact on health. It provides suggestions for talking with families, identifying ways to prepare the medical home to address ACEs and other traumatic events, and more.

SAMHSA TECHNICAL ASSISTANCE CENTERS 

Centers funded by SAMHSA with a focus on promoting TIC principles and practices.

SAMHSA Promoting Alternatives to Seclusion and Restraint through Trauma-Informed Practices & National Center for Trauma Informed Care (NCTIC) promotes trauma-informed practices in services delivery for people who have experienced violence and trauma and seek support for recovery and healing.

The Disaster Technical Assistance Center (DTAC) supports SAMHSA's efforts to prepare states, territories, tribes, and local entities to deliver an effective mental health and substance abuse (behavioral health) response to disasters. 

The National GAINS Center helps expand access to community-based services for adults with co-occurring mental and substance use disorders in the justice system, as well as promotes communities’ integrated systems of behavioral healthcare for people in contact with the justice system.

The Suicide Prevention Resource Center (SPRC), supported by SAMHSA, promotes a public health approach to suicide prevention. Their website contains important information and numerous resources, including the Framework for Suicide Prevention, a Best Practice Registry and a section for providers. 

OTHER TRAUMA RELATED CENTERS 

The Anna Institute is a resource, research, and informational website developed by Ann Jennings, PhD, and named for her daughter Anna who was a victim of child sexual abuse and spent her last years of life in a psychiatric institution.

The National Child Traumatic Stress Network strives to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events.

The National Center for PTSD is dedicated to research and education on trauma and PTSD. The center works to assure that the latest research findings help those exposed to trauma.

The Child Trauma Academy is a not-for-profit organization based in Houston, Texas working to improve the lives of high-risk children through direct service, research, and education. They recognize the crucial importance of childhood experience in shaping the health of the individual, and ultimately, society. By creating biologically-informed child and family respectful practice, programs, and policy, CTA seeks to help maltreated and traumatized children.

The Trauma Center at the Justice Resource Institute presents a wealth of information on clinical services, training, consultation, and education programs.

Federal Resources on HIV/AIDS

There is a very high prevalence of trauma with people with HIV/AIDS, particularly child sexual abuse in women and men who have sex with men with HIV/AIDS. The following are general resources on HIV/AIDS. 

The Health Resources and Services Administration (HRSA) HIV/AIDS Programs provides extensive information, resources and tools related to HIV/AIDS including contact information on the Ryan White Technical Assistance Center-TARGET.

AIDS.gov features information on federal HIV policies, programs, funding, and other activities. The website includes information on the National HIV/AIDS Strategy (NHAS), Presidential Advisory Council on HIV/AIDS (PACHA) and the President’s Emergency Plan for AIDS Relief (PEPFAR).

SCREENING TOOLS

Trauma screening tools can be used to screen for the presence of adverse or traumatic life experiences. Once a person reveals that they are experiencing or have had adverse or traumatic life experiences, it would be appropriate to use an assessment tool that could uncover signs of related stress, functional difficulties and or PTSD. Two factors are very important when screening for trauma: one, in order to reveal such experiences, the person must be engaged in a sensitive and caring process that allows them to feel safe and comfortable and two, screening for trauma is a process that may not be revealed during intake; therefore a system should be in place to screen for trauma post intake and following the development of a trusting relationship with the clinician.

The Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD) Screen is a 4-item screen that was designed for use in primary care and other medical settings. 

WEBINARS

Recordings (synched audio and slides) remain in our archive for one year. For webinar recordings more than one year old, contact us at Integration@TheNationalCouncil.org. 

Improving Health through Trauma-Informed Care
July 28, 2015
Presented by: Leah Harris, Trauma Informed Care Specialist and Coordinator of Consumer Affairs for the National Association of State Mental Health Program Directors (NASMHPD), Eddy Machtinger, MD, Professor of Medicine and Director of the Women’s HIV Program at the UCSF, and Mary Blake, CRE, ITE, Public Health Advisor at SAMHSA
Slides and Recording 

It's Just Good Medicine: Trauma-Informed Primary Care
August 6, 2013
Presented by Larke Huang, Cheryl Sharp, and Tara Gunther
Slides 

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Email: integration@thenationalcouncil.org

Phone: 202-684-7457