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Trauma

This webpage, focused on trauma and trauma-informed approaches, is geared towards health, behavioral health and integrated care leadership, staff, and patients/consumers. The information and resources listed here can be easily adapted to other groups and settings such as schools. Three important areas of health: trauma, Intimate Partner Violence (IPV), and suicide are interrelated as trauma is a major risk factor for IPV and suicide.  It is vital for all leadership and staff of health, behavioral health, and integrated care organizations to understand the nature and impact of trauma and how to use principles and practices that can promote recovery and healing: Trauma-Informed Approaches. In addition to information and resources on Trauma and Trauma-Informed Approaches, you will find links to IPV as well as Suicide Prevention webpages that we encourage you to explore.

Trauma is highly prevalent, can impact a person at any time during their lifespan and may present as mental health, substance use or physical health conditions.

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. (SAMHSA)

Since trauma can have serious effects on health, behaviors, relationships, work, school, and other aspects of life, it is important for behavioral health, health care, and other providers to gain the knowledge and skills needed to promote healing, recovery, and wellness. A Trauma-Informed Approach, often referred to as trauma-informed care (TIC), is a promising model for organizational change in health, behavioral, health, and other settings that promotes resilience in staff and patients. Key principles of this approach include organizational safety, trustworthiness, transparency, cultural sensitivity, collaboration, and empowerment among and between staff and patients. This approach recognizes the role trauma plays in the lives of patients/consumers and seeks to shift the clinical perspective from “what’s wrong with you” to “what happened to you” by recognizing and accepting symptoms and difficult behaviors as strategies developed to cope with childhood trauma.

The Adverse Childhood Experiences Study (ACEs) by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC), illuminates a strong link among trauma and health, mental health, substance use, and other social and behavioral difficulties, including suicidal ideations and behaviors and IPV. This study 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. The ACE study also demonstrates that nearly every school has students who have been exposed to overwhelming experiences. To ensure that all students feel safe to learn, an increasing number of school districts are working to implement trauma-sensitive approaches. A trauma-sensitive school prioritizes development of trusting relationships, teaches students social and emotional skills, and addresses behavior with positive and compassionate approaches. It is a place where an ongoing, inquiry-based process allows for teamwork, coordination, creativity, and sharing of responsibility for all students, and support is focused on “what do you need” rather than “what is wrong with you?” 

A trauma-informed approach (the 4 R’s):

  1. Realizes the widespread impact of trauma and understands potential paths for recovery
  2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system
  3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices
  4. Resists re-traumatization 

    (SAMHSA)

Using a trauma-informed approach to care can create a safe, accepting, and respectful environment which is often needed to reveal thoughts or behaviors associated with trauma, suicide, or IPV. It is not always necessary for a person to disclose past painful experiences. Through education about the impact of adverse experiences along with teaching healthy coping skills within a trauma-informed culture, staff can promote positive health and behavioral health outcomes. It is important to note that exploring traumatic experiences requires sensitivity, skills, and training. Building resilience is a valuable way to respond to trauma as individuals can be taught skills that assist them to improve coping; manage emotions; connect with others; and find hope, purpose, and meaning.  

Staff may also come to this work with histories of trauma that may, at times, impact their ability to explore the traumatic experiences of their patients/consumers. Staff may also be impacted by repeatedly listening to the painful experiences of others. For this reason, a trauma-informed culture considers and responds to the needs of staff as well.
 
Below are resources to help you better understand and address trauma, including related areas of suicide prevention and IPV, as well as trauma-informed approaches, resilience, and staff self-care. These resources are arranged by audience.



Trauma

Resources for Clinicians/Staff

Trauma, Trauma Types, and Impact

SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach introduces the 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.

The ACEs Study found that survivors of childhood trauma are at risk for physical health, mental health, substance use, suicide, Intimate Partner Violence (IPV), and other types of behavioral and social conditions. The ACE Survey is featured on the ACEs Too High website. The survey measures 10 types of childhood trauma.

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.

Learn about the different types of trauma and violence that can impact the health and behavioral health of individuals, families, and communities. The U.S. Department of Health and Human Services provides information and resources related to the many types of trauma experienced by youth and families.

Substance Use

Data from the most recent National Survey of Adolescents and other studies indicate that one in four children and adolescents in the United States experiences at least one potentially traumatic event before the age of 16, and more than 13 percent of 17-year-olds — one in eight — have experienced posttraumatic stress disorder (PTSD) at some point in their lives. Read about the connection between childhood trauma and substance use in Making the Connection: Trauma and Substance Abuse from the National Child Traumatic Stress Network (NCTSN).

Substance Use, Childhood Traumatic Experience, and Posttraumatic Stress Disorder in an Urban Civilian Population, examines the relationship between childhood trauma, substance use, and PTSD in a sample of urban primary care patients.

National Institute on Drug Abuse: Women's Treatment for Trauma and Substance Use Disorders highlights the importance of finding effective treatments for this high-risk population. For additional resources on this topic, please visit the CIHS Substance Use webpage.

Post-Traumatic Stress Disorder (PTSD)

Although trauma may present as various types of physical health, mental health, substance use and other behavioral and social conditions, exposure to traumatic events may also present as Post-traumatic Stress Disorder (PTSD) which is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event, as per the National Institute for Mental Health (NIMH). For a DSM-V definition of PTSD and a PTSD Treatment Decision Aid Tool that can help you learn about and compare effective treatments, go to the Department of Veterans' Affairs National Center for PTSD (NCPTSD). NCPTSD 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 National Institute on Mental Health (NIMH) has produced a number of publications about post-traumatic stress disorder to guide a variety of care providers in their work with different populations

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

At-Risk Populations

Children and Youth

Zero to Three aims to promote healthy early childhood development and provides resources on shielding infants or toddlers from trauma and stress to promote their health.

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

The National Technical Assistance Center for Children’s Mental Health, within the Georgetown University Center for Child and Human Development (GUCCHD), supports federal, state, and local systems in increasing awareness of the impacts of trauma on children's lives and the importance of trauma-informed services. NTACC created a web-based toolkit to support leaders and decision makers at all levels in taking steps to implement trauma-informed services in their systems. 

Childhood Trauma, Changing Minds is an interactive evidence-based website about transforming public attitudes about children’s exposure to violence and the corrosive effects of trauma on healthy brain development. The U.S. Department of Justice, Futures Without Violence, and the Ad Council developed this site to raise awareness about the prevalence and impact of children’s exposure to violence and the trauma that may result; motivate adults to be more caring, concerned, and supportive figures to the children around them; and support programs and practices that help make homes, schools, and communities safer for children and youth. 

The ACEs Study demonstrates that nearly every school has students who have been exposed to overwhelming experiences. To ensure that all students feel safe to learn, an increasing number of school districts are working to implement trauma-sensitive approaches.

trauma-sensitive school is a place where an ongoing, inquiry-based process allows for teamwork, coordination, creativity and sharing of responsibility for all students, and where continuous learning is available for students, staff, and educators.

The Child Welfare Trauma Training Toolkit 2nd Edition is designed to teach basic knowledge, skills, and values about working with children who are in the child welfare system and who have experienced traumatic events.

The Office of Juvenile Justice and Delinquency Prevention, a component of the US Department of Justice, supports states and local communities in implementing programs that address the needs of youth and their families. It provides specific information on the impacts of trauma on children, especially those exposed to violence.

SAMHSA's National GAINS Center for Behavioral Health and Justice Transformation 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 Family and Youth Services Bureau supports the organizations and communities that work every day to put an end to youth homelessness, adolescent pregnancy and domestic violence. 

StopBullying.gov is a government resource managed by the U.S. Department of Health and Human Services (HHS) in partnership with the CDC, SAMHSA, and others dedicated to prevention, identification, and response to bullying. The website includes resources on talking to children about bullying, cyber bullying, and specific tools for schools, families, and communities. 

Individuals with Intellectual Disabilities

The Developmental Disabilities Administration Health Initiative at the Georgetown University Center for Child and Human Development – University Center for Excellence in Developmental Disabilities has introduced a trauma-informed care initiative. This initiative provides training and technical assistance on trauma care to service agencies that serve people with intellectual and developmental disabilities.

Older Adults

Many older adults experience psychiatric and mental health difficulties, and there are numerous reasons why the symptoms of PTSD can increase with age. The Department of Veterans' Affairs National Center for PTSD has dedicated resources for addressing PTSD in older adults.

Researchers at Memphis University have published the findings of their work exploring the efficacy of Cognitive Behavioral Interventions in the Treatment of PTSD in Older Adults

LGBTQ Populations

The Fenway Institute at Fenway Community Health Center provides information and resources related to making life healthier for those who are lesbian, gay, bisexual, and transgender (LGBT), people living with HIV/AIDS, and the larger community. 

HIV/AIDS

There is a high prevalence of trauma, particularly child sexual abuse, among individuals living with 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).

The National Alliance of State & Territorial AIDS Directors has released an issue brief titled A Health Systems Approach to Trauma-Informed Care. The brief includes an overview of trauma responses and the role of public health, information regarding programmatic changes to enable trauma-informed care (TIC), videos describing the impacts of implementation, and recommended actions for health department.

Homeless Populations

The prevalence of trauma in the lives of individuals and families experiencing homelessness is extraordinarily high due to various forms of past and on-going adverse events. Understanding trauma and its impact is essential to providing quality care in shelters and housing programs, as well as in behavioral health and integrated care settings. The Trauma-Informed Organizational Toolkit for Homeless Services was created by the National Center on Family Homelessness in partnership with HHS and is intended to provide a roadmap for organizations that are seeking to become trauma-informed.

Cultural Considerations

SAMHSA Tip 59 is a guide to help providers and administrators understand the role of culture in the delivery of mental health and substance use services. It describes cultural competence and discusses racial, ethnic, and cultural considerations.

The American Psychological Association (APA) explains that "Given the complexity of multiculturalism, it is beneficial to understand cultural competency as a process rather than an end product." To this end, the APA provides the concept of cultural humility as a framework for developing a process-oriented approach to competency. 

SAMHSA’s Center for the Application of Prevention Technologies (CAPT) describes cultural competence as the ability to interact effectively with people of different cultures and helps to ensure the needs of all community members are addressed. 

When considering culture, particularly for African Americans, Native American populations and others, it is important to understand the concept of historical trauma. SAMHSA defines historical trauma as a form of trauma that impacts entire communities. It refers to the cumulative emotional and psychological wounding, because of group traumatic experiences, that is transmitted across generations within a community. 

Screening and Assessing for Trauma

Trauma screening tools can be found in the SAMHSA publication, TIP 57. These tools may be used to screen and assess for the presence of adverse or traumatic life experiences. However, it is not necessary to use a formal tool to screen for trauma and exploration of trauma should be done by trained, experienced, and skilled staff. This process requires a safe, comfortable, and respectful environment and a trusting, caring relationship. As mentioned previously, it is not necessary for an individual to disclose painful experiences to be helped. By using universal precautions and treating all people as if they have been exposed to trauma and by using trauma-informed approaches, healing and recovery can be promoted. 

SAMHSA has created A Guide to GPRA Data Collection Using Trauma-Informed Interviewing Skills, that provides insights on the application of a trauma-informed approach to the data collection interview processes that programs may implement. The information in this guide can be adapted to different types of settings and uses.

Trauma-Informed Approaches

Trauma-informed care (TIC) is the adoption of principles and practices, as well as organizational culture change, that promotes 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 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 proposes a number of trauma-specific treatment models and provides behavioral health professionals with patient assessments, treatment planning strategies that support recovery, and information on building a trauma-informed workforce.  

Guide for Providing a Trauma-Informed Approach in Human Services from the Administration for Children and Families, SAMHSA, the Administration for Community Living, and the Offices of the Assistant Secretary for Health and the Assistant Secretary for Planning and Evaluation at HHS is intended to provide an introduction to the topic of trauma, a discussion of why understanding and addressing trauma is important for human services programs, and a “road map” to find relevant resources.

SAMHSA’s National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC) offers training and technical assistance (TTA) to publicly funded agencies, organizations, and systems. NCTIC works to eliminate the use of seclusion, restraints, and other coercive practices and to promote the implementation of trauma-informed approaches. 

Trauma-Informed Dental and Primary Care

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.

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 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 re-traumatization and promote emotional well-being.

This Curbside Consultation article by the American Academy of Family Physicians on providing trauma-informed care offers information on how physicians can effectively provide trauma-sensitive services in primary care settings.

Resilience

Administration for Children and Families defines resilience as the ability of individuals to not succumb to adverse experiences and is the typical response to adversity. Resilience is a skill set that can be learned and developed over time. 

SAMHSA provides multiple resources related to trauma and resilience.

The APA defines resilience in simple terms as, "bouncing back from difficult experiences." Its Road to Resilience toolkit offers strategies for the continued development of resilience and resources to support individuals on their journeys to resilience.

Resources for Organizations

Education and Training

To find opportunities in education and training, visit the following websites:

SAMHSA's National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC) provides technical assistance (TA) and consultation to publicly funded systems, agencies, and organizations to (1) reduce and ultimately eliminate the use of seclusion, restraints, and other coercive practices; (2) further develop the implementation science and measurement strategy for trauma-informed approaches; and (3) further the effective involvement of trauma survivors and peers in all aspects of trauma-informed change.

SAMHSA's 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. 

SAMHSA's National GAINS Center for Behavioral Health and Justice Transformation helps expand access to community-based services for adults with co-occurring mental and substance use disorders in the justice system, and 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. 

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

The U.S. Department of Veterans Affairs's National Center for PTSD (NCPTSD) 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 Coldspring Center for Social and Health Innovation is a nonprofit organization that provides knowledge and practical implementation processes that facilitate healing and growth at all levels of society. Their Trauma Informed Excellence Series encompasses research on trauma’s impact on the brain and human development, self-care, and leadership.

The Developmental Disabilities Administration Health Initiative at the Georgetown University Center for Child and Human Development – University Center for Excellence in Developmental Disabilities has introduced a trauma-informed care initiative. This initiative provides training and technical assistance on trauma care to service agencies that serve people with intellectual and developmental disabilities.

Five Key Elements is part of a series of Relias Learning tools and training available to help an organization understand and adopt a trauma-informed framework. 

The Practical Strategies for Creating Trauma-Informed Services and Organizations webinar series from the National Center on Domestic Violence, Trauma, and Mental Health, focuses on practical strategies and tools for creating accessible, culturally attuned, domestic violence- and trauma-informed services and organizations including information on agency self-assessment tools, self-care and sustaining advocacy work, reflective supervision, and trauma-informed peer support, among other related topics. 

Staff Self-Care

The importance of understanding and addressing burnout, vicarious trauma, and compassion fatigue among behavioral health providers is essential to providing effective care for people served in behavioral health and integrated care settings. The American Institute of Stress lists a myriad of symptoms of compassion fatigue, which it defines as, "The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events."

The ProQOL is the most commonly used tool to measure staff burnout as it relates to the effects of helping others who experience suffering and trauma. The ProQOL has sub-scales for compassion satisfaction, burnout, and compassion fatigue.

In its guide, The Road to Resilience, the APA describes the importance and applications of resilience identifies 10 strategies individuals can employ to strengthen resilience and address staff burnout.

This webinar from the National Resource Center on Domestic Violence, Keeping Your Cup Full: Self-Care is Essential to Trauma Informed Advocacy, offers strategies for dealing with daily work-related stress, increases awareness of the issue of vicarious trauma, and provides ideas in order to gain organizational support to help sustain and support those working with survivors of trauma.

Resources for Patients/Consumers and Families

The CDC has published a number of resources for Coping with a Disaster or Traumatic Event, including the following tip sheets: Coping with a Traumatic Event and Coping with Stress After a Traumatic Event.

Youth MOVE National created a guide to assist youth in understanding trauma. The aim of this interactive and accessible guide is to help youth make connections between stressful events and their potential lasting impacts and provides a framework for processing and asking for help. 

The National Child Traumatic Stress Network (NCTSN) strives to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events. Their website has resources dedicated to parents/caregivers.

The National Alliance on Mental Illness (NAMI) is an advocacy organization dedicated to increasing knowledge about mental health conditions, reducing stigma, and providing support to families and consumers.

Resources for Policymakers and leadership

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 proposes a number of trauma-specific treatment models and provides behavioral health professionals with patient assessments, treatment planning strategies that support recovery, and information on building a trauma-informed workforce.  

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).

The National Alliance of State & Territorial AIDS Directors released an issue brief titled A Health Systems Approach to Trauma-Informed CareThe brief includes an overview of trauma responses and the role of public health, information regarding programmatic changes to enable TIC, videos describing the impacts of implementation, and recommended actions for health departments.

National Resource Center on Domestic Violence (RCDV) is supported by HHS, with supplemental funds from the CDC and others to provide technical assistance, resources, and an online learning center. 

The Centers for Disease Control and Prevention's infographic depicts the impact of trauma on behavior, health, and society. 

Suicide Prevention

Suicide is highly prevalent among those experiencing IPV. For additional information and resources on Suicide Prevention, please visit the CIHS Suicide Prevention webpage.

Intimate Partner Violence

IPV is highly prevalent and preventable, therefore It is important that providers screen for and address issues of intimate partner violence (IPV). For information and resources on IPV, please visit the CIHS Intimate Partner Violence (IPV) webpage.

Call Our Helpline: 202-268-7457

This webpage, focused on trauma and trauma-informed approaches, is geared towards health, behavioral health and integrated care leadership, staff, and patients/consumers. The information and resources listed here can be easily adapted to other groups and settings such as schools. Three important areas of health: trauma, Intimate Partner Violence (IPV), and suicide are interrelated as trauma is a major risk factor for IPV and suicide.  It is vital for all leadership and staff of health, behavioral health, and integrated care organizations to understand the nature and impact of trauma and how to use principles and practices that can promote recovery and healing: Trauma-Informed Approaches. In addition to information and resources on Trauma and Trauma-Informed Approaches, you will find links to IPV as well as Suicide Prevention webpages that we encourage you to explore.

Trauma is highly prevalent, can impact a person at any time during their lifespan and may present as mental health, substance use or physical health conditions.

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. (SAMHSA)

Since trauma can have serious effects on health, behaviors, relationships, work, school, and other aspects of life, it is important for behavioral health, health care, and other providers to gain the knowledge and skills needed to promote healing, recovery, and wellness. A Trauma-Informed Approach, often referred to as trauma-informed care (TIC), is a promising model for organizational change in health, behavioral, health, and other settings that promotes resilience in staff and patients. Key principles of this approach include organizational safety, trustworthiness, transparency, cultural sensitivity, collaboration, and empowerment among and between staff and patients. This approach recognizes the role trauma plays in the lives of patients/consumers and seeks to shift the clinical perspective from “what’s wrong with you” to “what happened to you” by recognizing and accepting symptoms and difficult behaviors as strategies developed to cope with childhood trauma.

The Adverse Childhood Experiences Study (ACEs) by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC), illuminates a strong link among trauma and health, mental health, substance use, and other social and behavioral difficulties, including suicidal ideations and behaviors and IPV. This study 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. The ACE study also demonstrates that nearly every school has students who have been exposed to overwhelming experiences. To ensure that all students feel safe to learn, an increasing number of school districts are working to implement trauma-sensitive approaches. A trauma-sensitive school prioritizes development of trusting relationships, teaches students social and emotional skills, and addresses behavior with positive and compassionate approaches. It is a place where an ongoing, inquiry-based process allows for teamwork, coordination, creativity, and sharing of responsibility for all students, and support is focused on “what do you need” rather than “what is wrong with you?” 

A trauma-informed approach (the 4 R’s):

  1. Realizes the widespread impact of trauma and understands potential paths for recovery
  2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system
  3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices
  4. Resists re-traumatization 

    (SAMHSA)

Using a trauma-informed approach to care can create a safe, accepting, and respectful environment which is often needed to reveal thoughts or behaviors associated with trauma, suicide, or IPV. It is not always necessary for a person to disclose past painful experiences. Through education about the impact of adverse experiences along with teaching healthy coping skills within a trauma-informed culture, staff can promote positive health and behavioral health outcomes. It is important to note that exploring traumatic experiences requires sensitivity, skills, and training. Building resilience is a valuable way to respond to trauma as individuals can be taught skills that assist them to improve coping; manage emotions; connect with others; and find hope, purpose, and meaning.  

Staff may also come to this work with histories of trauma that may, at times, impact their ability to explore the traumatic experiences of their patients/consumers. Staff may also be impacted by repeatedly listening to the painful experiences of others. For this reason, a trauma-informed culture considers and responds to the needs of staff as well.
 
Below are resources to help you better understand and address trauma, including related areas of suicide prevention and IPV, as well as trauma-informed approaches, resilience, and staff self-care. These resources are arranged by audience.



Trauma

Resources for Clinicians/Staff

Trauma, Trauma Types, and Impact

SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach introduces the 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.

The ACEs Study found that survivors of childhood trauma are at risk for physical health, mental health, substance use, suicide, Intimate Partner Violence (IPV), and other types of behavioral and social conditions. The ACE Survey is featured on the ACEs Too High website. The survey measures 10 types of childhood trauma.

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.

Learn about the different types of trauma and violence that can impact the health and behavioral health of individuals, families, and communities. The U.S. Department of Health and Human Services provides information and resources related to the many types of trauma experienced by youth and families.

Substance Use

Data from the most recent National Survey of Adolescents and other studies indicate that one in four children and adolescents in the United States experiences at least one potentially traumatic event before the age of 16, and more than 13 percent of 17-year-olds — one in eight — have experienced posttraumatic stress disorder (PTSD) at some point in their lives. Read about the connection between childhood trauma and substance use in Making the Connection: Trauma and Substance Abuse from the National Child Traumatic Stress Network (NCTSN).

Substance Use, Childhood Traumatic Experience, and Posttraumatic Stress Disorder in an Urban Civilian Population, examines the relationship between childhood trauma, substance use, and PTSD in a sample of urban primary care patients.

National Institute on Drug Abuse: Women's Treatment for Trauma and Substance Use Disorders highlights the importance of finding effective treatments for this high-risk population. For additional resources on this topic, please visit the CIHS Substance Use webpage.

Post-Traumatic Stress Disorder (PTSD)

Although trauma may present as various types of physical health, mental health, substance use and other behavioral and social conditions, exposure to traumatic events may also present as Post-traumatic Stress Disorder (PTSD) which is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event, as per the National Institute for Mental Health (NIMH). For a DSM-V definition of PTSD and a PTSD Treatment Decision Aid Tool that can help you learn about and compare effective treatments, go to the Department of Veterans' Affairs National Center for PTSD (NCPTSD). NCPTSD 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 National Institute on Mental Health (NIMH) has produced a number of publications about post-traumatic stress disorder to guide a variety of care providers in their work with different populations

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

At-Risk Populations

Children and Youth

Zero to Three aims to promote healthy early childhood development and provides resources on shielding infants or toddlers from trauma and stress to promote their health.

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

The National Technical Assistance Center for Children’s Mental Health, within the Georgetown University Center for Child and Human Development (GUCCHD), supports federal, state, and local systems in increasing awareness of the impacts of trauma on children's lives and the importance of trauma-informed services. NTACC created a web-based toolkit to support leaders and decision makers at all levels in taking steps to implement trauma-informed services in their systems. 

Childhood Trauma, Changing Minds is an interactive evidence-based website about transforming public attitudes about children’s exposure to violence and the corrosive effects of trauma on healthy brain development. The U.S. Department of Justice, Futures Without Violence, and the Ad Council developed this site to raise awareness about the prevalence and impact of children’s exposure to violence and the trauma that may result; motivate adults to be more caring, concerned, and supportive figures to the children around them; and support programs and practices that help make homes, schools, and communities safer for children and youth. 

The ACEs Study demonstrates that nearly every school has students who have been exposed to overwhelming experiences. To ensure that all students feel safe to learn, an increasing number of school districts are working to implement trauma-sensitive approaches.

trauma-sensitive school is a place where an ongoing, inquiry-based process allows for teamwork, coordination, creativity and sharing of responsibility for all students, and where continuous learning is available for students, staff, and educators.

The Child Welfare Trauma Training Toolkit 2nd Edition is designed to teach basic knowledge, skills, and values about working with children who are in the child welfare system and who have experienced traumatic events.

The Office of Juvenile Justice and Delinquency Prevention, a component of the US Department of Justice, supports states and local communities in implementing programs that address the needs of youth and their families. It provides specific information on the impacts of trauma on children, especially those exposed to violence.

SAMHSA's National GAINS Center for Behavioral Health and Justice Transformation 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 Family and Youth Services Bureau supports the organizations and communities that work every day to put an end to youth homelessness, adolescent pregnancy and domestic violence. 

StopBullying.gov is a government resource managed by the U.S. Department of Health and Human Services (HHS) in partnership with the CDC, SAMHSA, and others dedicated to prevention, identification, and response to bullying. The website includes resources on talking to children about bullying, cyber bullying, and specific tools for schools, families, and communities. 

Individuals with Intellectual Disabilities

The Developmental Disabilities Administration Health Initiative at the Georgetown University Center for Child and Human Development – University Center for Excellence in Developmental Disabilities has introduced a trauma-informed care initiative. This initiative provides training and technical assistance on trauma care to service agencies that serve people with intellectual and developmental disabilities.

Older Adults

Many older adults experience psychiatric and mental health difficulties, and there are numerous reasons why the symptoms of PTSD can increase with age. The Department of Veterans' Affairs National Center for PTSD has dedicated resources for addressing PTSD in older adults.

Researchers at Memphis University have published the findings of their work exploring the efficacy of Cognitive Behavioral Interventions in the Treatment of PTSD in Older Adults

LGBTQ Populations

The Fenway Institute at Fenway Community Health Center provides information and resources related to making life healthier for those who are lesbian, gay, bisexual, and transgender (LGBT), people living with HIV/AIDS, and the larger community. 

HIV/AIDS

There is a high prevalence of trauma, particularly child sexual abuse, among individuals living with 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).

The National Alliance of State & Territorial AIDS Directors has released an issue brief titled A Health Systems Approach to Trauma-Informed Care. The brief includes an overview of trauma responses and the role of public health, information regarding programmatic changes to enable trauma-informed care (TIC), videos describing the impacts of implementation, and recommended actions for health department.

Homeless Populations

The prevalence of trauma in the lives of individuals and families experiencing homelessness is extraordinarily high due to various forms of past and on-going adverse events. Understanding trauma and its impact is essential to providing quality care in shelters and housing programs, as well as in behavioral health and integrated care settings. The Trauma-Informed Organizational Toolkit for Homeless Services was created by the National Center on Family Homelessness in partnership with HHS and is intended to provide a roadmap for organizations that are seeking to become trauma-informed.

Cultural Considerations

SAMHSA Tip 59 is a guide to help providers and administrators understand the role of culture in the delivery of mental health and substance use services. It describes cultural competence and discusses racial, ethnic, and cultural considerations.

The American Psychological Association (APA) explains that "Given the complexity of multiculturalism, it is beneficial to understand cultural competency as a process rather than an end product." To this end, the APA provides the concept of cultural humility as a framework for developing a process-oriented approach to competency. 

SAMHSA’s Center for the Application of Prevention Technologies (CAPT) describes cultural competence as the ability to interact effectively with people of different cultures and helps to ensure the needs of all community members are addressed. 

When considering culture, particularly for African Americans, Native American populations and others, it is important to understand the concept of historical trauma. SAMHSA defines historical trauma as a form of trauma that impacts entire communities. It refers to the cumulative emotional and psychological wounding, because of group traumatic experiences, that is transmitted across generations within a community. 

Screening and Assessing for Trauma

Trauma screening tools can be found in the SAMHSA publication, TIP 57. These tools may be used to screen and assess for the presence of adverse or traumatic life experiences. However, it is not necessary to use a formal tool to screen for trauma and exploration of trauma should be done by trained, experienced, and skilled staff. This process requires a safe, comfortable, and respectful environment and a trusting, caring relationship. As mentioned previously, it is not necessary for an individual to disclose painful experiences to be helped. By using universal precautions and treating all people as if they have been exposed to trauma and by using trauma-informed approaches, healing and recovery can be promoted. 

SAMHSA has created A Guide to GPRA Data Collection Using Trauma-Informed Interviewing Skills, that provides insights on the application of a trauma-informed approach to the data collection interview processes that programs may implement. The information in this guide can be adapted to different types of settings and uses.

Trauma-Informed Approaches

Trauma-informed care (TIC) is the adoption of principles and practices, as well as organizational culture change, that promotes 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 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 proposes a number of trauma-specific treatment models and provides behavioral health professionals with patient assessments, treatment planning strategies that support recovery, and information on building a trauma-informed workforce.  

Guide for Providing a Trauma-Informed Approach in Human Services from the Administration for Children and Families, SAMHSA, the Administration for Community Living, and the Offices of the Assistant Secretary for Health and the Assistant Secretary for Planning and Evaluation at HHS is intended to provide an introduction to the topic of trauma, a discussion of why understanding and addressing trauma is important for human services programs, and a “road map” to find relevant resources.

SAMHSA’s National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC) offers training and technical assistance (TTA) to publicly funded agencies, organizations, and systems. NCTIC works to eliminate the use of seclusion, restraints, and other coercive practices and to promote the implementation of trauma-informed approaches. 

Trauma-Informed Dental and Primary Care

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.

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 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 re-traumatization and promote emotional well-being.

This Curbside Consultation article by the American Academy of Family Physicians on providing trauma-informed care offers information on how physicians can effectively provide trauma-sensitive services in primary care settings.

Resilience

Administration for Children and Families defines resilience as the ability of individuals to not succumb to adverse experiences and is the typical response to adversity. Resilience is a skill set that can be learned and developed over time. 

SAMHSA provides multiple resources related to trauma and resilience.

The APA defines resilience in simple terms as, "bouncing back from difficult experiences." Its Road to Resilience toolkit offers strategies for the continued development of resilience and resources to support individuals on their journeys to resilience.

Resources for Organizations

Education and Training

To find opportunities in education and training, visit the following websites:

SAMHSA's National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC) provides technical assistance (TA) and consultation to publicly funded systems, agencies, and organizations to (1) reduce and ultimately eliminate the use of seclusion, restraints, and other coercive practices; (2) further develop the implementation science and measurement strategy for trauma-informed approaches; and (3) further the effective involvement of trauma survivors and peers in all aspects of trauma-informed change.

SAMHSA's 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. 

SAMHSA's National GAINS Center for Behavioral Health and Justice Transformation helps expand access to community-based services for adults with co-occurring mental and substance use disorders in the justice system, and 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. 

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

The U.S. Department of Veterans Affairs's National Center for PTSD (NCPTSD) 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 Coldspring Center for Social and Health Innovation is a nonprofit organization that provides knowledge and practical implementation processes that facilitate healing and growth at all levels of society. Their Trauma Informed Excellence Series encompasses research on trauma’s impact on the brain and human development, self-care, and leadership.

The Developmental Disabilities Administration Health Initiative at the Georgetown University Center for Child and Human Development – University Center for Excellence in Developmental Disabilities has introduced a trauma-informed care initiative. This initiative provides training and technical assistance on trauma care to service agencies that serve people with intellectual and developmental disabilities.

Five Key Elements is part of a series of Relias Learning tools and training available to help an organization understand and adopt a trauma-informed framework. 

The Practical Strategies for Creating Trauma-Informed Services and Organizations webinar series from the National Center on Domestic Violence, Trauma, and Mental Health, focuses on practical strategies and tools for creating accessible, culturally attuned, domestic violence- and trauma-informed services and organizations including information on agency self-assessment tools, self-care and sustaining advocacy work, reflective supervision, and trauma-informed peer support, among other related topics. 

Staff Self-Care

The importance of understanding and addressing burnout, vicarious trauma, and compassion fatigue among behavioral health providers is essential to providing effective care for people served in behavioral health and integrated care settings. The American Institute of Stress lists a myriad of symptoms of compassion fatigue, which it defines as, "The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events."

The ProQOL is the most commonly used tool to measure staff burnout as it relates to the effects of helping others who experience suffering and trauma. The ProQOL has sub-scales for compassion satisfaction, burnout, and compassion fatigue.

In its guide, The Road to Resilience, the APA describes the importance and applications of resilience identifies 10 strategies individuals can employ to strengthen resilience and address staff burnout.

This webinar from the National Resource Center on Domestic Violence, Keeping Your Cup Full: Self-Care is Essential to Trauma Informed Advocacy, offers strategies for dealing with daily work-related stress, increases awareness of the issue of vicarious trauma, and provides ideas in order to gain organizational support to help sustain and support those working with survivors of trauma.

Resources for Patients/Consumers and Families

The CDC has published a number of resources for Coping with a Disaster or Traumatic Event, including the following tip sheets: Coping with a Traumatic Event and Coping with Stress After a Traumatic Event.

Youth MOVE National created a guide to assist youth in understanding trauma. The aim of this interactive and accessible guide is to help youth make connections between stressful events and their potential lasting impacts and provides a framework for processing and asking for help. 

The National Child Traumatic Stress Network (NCTSN) strives to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events. Their website has resources dedicated to parents/caregivers.

The National Alliance on Mental Illness (NAMI) is an advocacy organization dedicated to increasing knowledge about mental health conditions, reducing stigma, and providing support to families and consumers.

Resources for Policymakers and leadership

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 proposes a number of trauma-specific treatment models and provides behavioral health professionals with patient assessments, treatment planning strategies that support recovery, and information on building a trauma-informed workforce.  

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).

The National Alliance of State & Territorial AIDS Directors released an issue brief titled A Health Systems Approach to Trauma-Informed CareThe brief includes an overview of trauma responses and the role of public health, information regarding programmatic changes to enable TIC, videos describing the impacts of implementation, and recommended actions for health departments.

National Resource Center on Domestic Violence (RCDV) is supported by HHS, with supplemental funds from the CDC and others to provide technical assistance, resources, and an online learning center. 

The Centers for Disease Control and Prevention's infographic depicts the impact of trauma on behavior, health, and society. 

Suicide Prevention

Suicide is highly prevalent among those experiencing IPV. For additional information and resources on Suicide Prevention, please visit the CIHS Suicide Prevention webpage.

Intimate Partner Violence

IPV is highly prevalent and preventable, therefore It is important that providers screen for and address issues of intimate partner violence (IPV). For information and resources on IPV, please visit the CIHS Intimate Partner Violence (IPV) webpage.

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