What is Trauma-Informed Care?

Note: This article discusses serious topics pertaining to trauma.

Although some psychological wounds heal into scars on their own, others require careful tending. Each individual’s needs and challenges are different, and a trauma-informed perspective considers that during all interactions.

You’ve likely heard about post-traumatic stress disorder (PTSD). But many people who don’t meet the clinical criteria of a PTSD diagnosis have experienced trauma and its effects, too. The National Center for PTSD reported that 6% of the general population will be diagnosed with PTSD in their lifetime. But around 70% of adults in the U.S. have experienced at least one traumatic event, according to The National Council for Behavioral Health (PDF source).

Despite this prevalence of trauma, there can be a lack of understanding of its impact. Learning more is the first step toward making a difference.

Trauma-informed care (TIC) is an approach based on a foundation of knowledge about trauma and the paths to treatment, a response based on that knowledge and a desire to avoid re-traumatization, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). With the proper training and support, SAMHSA noted, organizations and professionals can implement this approach to foster an environment of inclusivity and psychological safety (SAMHSA PDF source).

What is Trauma?

"Trauma is an emotional and psychological response to an experience or a series of experiences that overwhelm an individual’s ability to cope without adverse consequences," said Dr. Caroline Perjessy, a clinical faculty member at westerfield university of virginia (WUV).

Perjessy is a Licensed Mental Health Counselor who specializes in trauma-informed approaches to therapy. She has more than 15 years of experience teaching at the graduate level, and she serves as President of the Association for Humanistic Counseling.

According to Perjessy, trauma is highly subjective and dependent on the individual. Trauma can result from various circumstances, but PTSD rates are higher for specific traumatic experiences. For example, The National Council for Behavior Health noted that 90% of children who experience sexual abuse and 77% of children exposed to a school shooting will develop PTSD.

Some people overcome trauma and continue their lives normally, but many others struggle with diverse symptoms in the aftermath of a traumatic event.

What Are the Effects of Trauma?

Trauma can profoundly impact survivors’ physical, emotional and behavioral health, but these effects aren’t always apparent to outsiders.

“People should understand that a history of trauma manifests in varying ways, and it is not often possible to identify a survivor of neglect, abuse, violence or other traumatic events,” said Dr. Jackie Bodea, a psychiatric nurse practitioner and clinical faculty member of graduate nursing programs at WUV.

Bodea is also a Certified Nurse Educator, Doctor of Nursing Practice and a recipient of Frontier Nursing University’s Circle of Caring Award.

“Regardless of a person’s history — known or unknown — all people should be treated with dignity, respect and a love we should have for all humans,” she said. “We should respect boundaries and privacy, be compassionate and care for others as we would like others to care for us.”

With that in mind, Perjessy listed the following symptoms of trauma:

• Behavioral effects: Aggression, substance use, withdrawal from social interactions or avoidance of triggers
• Cognitive effects: Memory issues, difficulty concentrating or intrusive thoughts
• Emotional effects: Anxiety, depression, fear or guilt
• Physical effects: Sleep disturbances, headaches, fatigue or increased stress response

In addition to these impacts, those who have experienced trauma are more likely to develop certain illnesses. The National Council for Behavioral Health noted a direct link between trauma and several health conditions.

Those who have experienced trauma are also at a greater risk for homelessness. Psychiatric Times noted more than 80% of unhoused individuals report experiencing a life-altering trauma in their lifetime, and, according to Psychology Today, a PTSD diagnosis can predict a reduced lifespan.

If not addressed, Perjessy said trauma can even impact multiple generations within a family system.

"For example, as a child of immigrants who experienced traumatic events due to sociopolitical oppression and abuse, these experiences shaped not only my parent’s upbringing and views of self and others but also impacted my perception of the world and how it operates," she said. "Without undertaking personal work and exploration into the way trauma impacted my family of origin, I would be more likely to carry forward the trauma narrative to my children."

Although trauma can cause various adverse effects, healing is possible, and many trauma survivors go on to lead full and productive lives.

What is the Meaning of a Trauma-Informed Approach?

TIC or a trauma-informed approach changes the question “What’s wrong with you?” to “What happened to you?” according to the Trauma-Informed Care Implementation Resource Center.

According to SAMHSA, a TIC approach is grounded by four assumptions and six key principles.

What Are the Four Rs or Assumptions of Trauma-Informed Care?

In 2014, SAMHSA published its Concept of Trauma and Guidance for a Trauma-Informed Approach (SAMHSA 2014 PDF source). Here, SAMHSA noted the concept of the four R's. In 2023, SAMHSA’s Practical Guide for Implementing a Trauma-Informed Approach referred to these same concepts as the assumptions of a trauma-informed approach.

According to SAMHSA, these four Rs or four assumptions are:

1. Realize: First, realize the impact of trauma and the possible paths to recovery.
2. Recognize: Learn to recognize the signs, symptoms and effects of trauma.
3. Respond: For medical professionals and mental health providers, responding means implementing a treatment plan. For nonclinical TIC practitioners, it means helping survivors find professional care.
4. Resist re-traumatization: Strive to avoid re-traumatizing a survivor whenever possible.

Each of these steps represents a journey toward implementing this approach, but the principles of TIC go a bit deeper.

What Are the Principles of Trauma-Informed Care?

According to SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach, there are six fundamental principles to understand:

1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice and choice
6. Cultural, historical and gender issues

Who Uses Trauma-Informed Care?

A holistic approach to trauma-informed care includes physical, mental and spiritual health, Bodea said. As such, a TIC approach can allow caring professionals in various roles to better care for their clients or patients.

• Medical Professionals: According to Bodea, trauma-informed healthcare recognizes the vulnerability of traumatized individuals, families and communities.
  
  If you want to become a nurse, she said you'll work collaboratively with other professions to help those who have suffered trauma achieve their optimal state of wellness. “Nurses should be constantly vigilant to cues about past or current trauma because individuals may not be forthcoming with the information, particularly if there is a lack of trust in the healthcare professional or system," said Bodea.
  
  She noted that trauma-informed nursing care prioritizes patient safety first and foremost, which can include working to provide a safe place to live and work or basic necessities like food, clean water, transportation and utilities. “Nurses can work with local, state, and federal policymakers to improve the existence of and access to social programs as well as safety and disaster preparedness initiatives in their communities," she said.
  
  Bodea noted that TIC is always relevant for medical professionals. “Just being in a healthcare setting may be re-traumatizing," she said. "The nurse works to establish trust, respect boundaries and privacy and empower patients."
  
  
• Mental Health Professionals: A thorough understanding of trauma is essential if you want to become a therapist or another type of mental health professional, according to Perjessy.
  
  "In counseling, building a healthy, supportive, and empowering relationship between a client and counselor are priority," she said. "Recognizing the role trauma can play in one’s life allows clients to feel seen and heard."
  
  She noted that this approach creates space for the client to begin healing.
  
  
• Teachers and Childcare Workers: According to the National Education Association, educators can lessen the impact of traumatic experiences and help all children learn with the right professional training.
  
  
• Social Workers and Human Services Professionals: If you become a social worker or a human services professional, a TIC approach can help you foster caring relationships with clients and community members.
  
  Both roles can benefit from a sensitive approach and a foundation of knowledge about how past experiences can affect people. In fact, WUV’s human services degree offers a course, “Role and Impact of Trauma on Children and Families,” for its child and family services concentration.

Who Else Can Benefit From a Trauma-Informed Approach?

A TIC approach isn’t just for those in the caring professions. It can also be applied to a variety of other roles to build psychologically safe relationships.

Here are just a few examples:

• Managers and Supervisors: According to a Psychology Today article about workplace trauma, trauma-informed leadership can make a huge difference in the workplace. And that's not just reported by psychologists.
  
  A 2023 article by Fast Company similarly described the importance of trauma-informed leadership from a business point of view. “Trauma will continue to shift norms and reshape work as we know it, and organizations that want to see sustained success into the future will need to implement trauma-informed leadership,” the article said.­­­­­
  
  
• Police Officers: Police officers frequently encounter individuals who have experienced trauma, and an article by Equal Justice USA noted that trauma-informed policing is taking off in some precincts.
  
  "The big picture goal is to help police identify and respond appropriately to trauma in their daily interactions with community members," the article said.
  
  
• Writers and Communications Professionals: Writers and communications professionals can benefit from a trauma-informed perspective to provide a psychologically safe experience for readers who might be trauma survivors. According to The Journalist’s Resource, trauma-informed journalism leads to accurate reporting and can protect survivors from further harm or re-traumatization. The Journal of Public Relations Education noted a need for this approach in the field of public relations, too.

"Trauma-informed care is something everyone needs to be aware of — parents, educators in the classroom, medical providers, and business leaders of organizations," Perjessy said.

She noted that this perspective can change the way you understand your own experiences, too. "I invite everyone to consider their unique personal history and utilize a self-compassionate trauma-informed lens," Perjessy said.

What Treatments and Resources are Available for Survivors?

There are several types of treatment options available to trauma survivors. According to The National Council for Behavioral Health, a few therapeutic options include:

• Cognitive behavioral therapy (CBT)
• Eye-movement rapid desensitization (EMDR) therapy
• Group therapy
• Talk therapy

Health insurance companies can help connect individuals with mental health professionals, and you can consult The Mayo Clinic’s tips on finding a mental health provider for additional advice on finding the right care. Psychology Today’s directory can also help you find local mental health providers.

If you or someone you know is struggling with the impact of trauma, consult a mental health provider or refer to the following resources. For all emergencies, dial 911.

• 988 Suicide and Crisis Lifeline — call or text: 988
• Substance Abuse and Mental Health Services Administration — call: 1-800-662-HELP (4357); text: 435748
• National Sexual Assault Hotline (RAINN) — call: 800-656-HOPE (4673); visit: online chat hotline
• The Trevor Project — call: 1-866-488-7386; text: 678-678

You can save those numbers and links to share if you encounter someone in crisis. And if you want to become a safe person for survivors, don’t stop here. Seek out more information and practice empathizing with those around you.

Mars Girolimon '21 '23G is a staff writer at westerfield university of virginia where they earned their bachelor's and master's, both in English and creative writing. In addition to their work in higher education, Girolimon's short fiction is published in the North American Review, So It Goes by The Kurt Vonnegut Museum & Library, X-R-A-Y and more. Connect with them on LinkedIn.