This document provides an overview of trauma-informed care (TIC). It defines TIC as a strengths-based approach grounded in an understanding of trauma that prioritizes safety, empowerment and resilience. The document outlines key objectives of TIC such as recognizing the prevalence of trauma, understanding how it affects people, and responding with trauma-sensitive practices. It also discusses the impact of trauma, characteristics of resilient individuals and trauma-informed organizations, and the importance of a strengths-based approach to treatment.

1. Module 1
Tippi Watson. MPH, BCHS
2014

2. Objectives
By the end of this class students will be able to
recognize:
 The prevalence of trauma
 Identify the key steps to TIC
 Define trauma and identify the types of trauma
 Understand the concept of resiliency and its importance
 Identify the characteristics of a trauma informed
organization
 Identify the three R’s of TIC

3. Overview
 Trauma-informed care is…..
 Strengths based approach
 Based on an understanding of the impact of trauma
 Responsive to the impact of trauma
 Creates opportunities for individual control and
empowerment.
 Addresses service provision on all levels of safety
 Physical
 Psychological
 emotional

4. What is Trauma Informed Care?
SAMHSA defines trauma informed care as “a
strengths based service delivery approach
that is grounded in an understanding of and
responsiveness to the impact of trauma, that
emphasizes physical, psychological, and
emotional safety for both providers and
survivors to rebuild a sense of control and
empowerment.” (SAMHSA, 2014, p.xix)

5. Trauma Informed Care
“It involves diligence in anticipating and avoiding
institutional processes and individual practices that
are likely to retraumatize individuals who already have
histories of trauma, and it upholds the importance of
consumer participation in the development, delivery,
and evaluation of services.” (SAMHSA, 2014, p.xix)

6. Why is TIC important?
Many individuals who seek treatment
in a behavioral health setting have a
history of trauma.
Most of those people do not draw a
connection between the trauma and
their maladaptive behavior.

7. SAMHSA endorses adherence to 6
key principles in a trauma
informed approach
 Safety
 Trustworthiness and Transparency
 Peer support
 Collaboration and mutuality
 Empowerment, voice and choice
 Cultural, Historical, and Gender Issues

8. Statistics…..
 In surveys of adolescents receiving treatment for substance abuse,
more then 70% of patients had a history of trauma exposure. (NCTSN.org,
2014)
 NCS data shows that 60.7% of American males and 51.2% of females
age 15 – 24 reported exposure to one or more traumatic events (Kessler et al.,
1995).
 GSMS found that by age 16 - 67.8% of the children studied were
exposed to one or more traumas (Copeland et al., 2013)
 Up to two thirds of men and women in substance use disorder
treatment report childhood abuse and neglect (SAMSHA, CSAT, 2000).
 Study of male veterans in an inpatient unit found that 77% were
exposed to severe childhood trauma and 58% had a history of lifetime
PTSD (Triffleman et al., 1995).

9. Key elements of TIC
 Meet clients needs in a safe, compassionate, and
collaborative manner.
 Prevent treatment practices that re-traumatize people
 Treatment is built on the strengths and the resilience
of the client
 Treatment is transferable to the community setting.
 Support the ideas of TIC in agencies through support,
consultation, and supervision of staff.

10. What is trauma?
 SAMHSA defines trauma as:
“trauma results from an event, series of events, or
set of circumstances that is experienced by an
individual as physically or emotionally harmful or
threatening and that has lasting adverse effects in the
persons functioning and physical , social, emotional or
spiritual well being.”
(SAMHSA, 2012, p.2)

11. How are we traumatized?
Direct experience of the trauma
Witness the event
Feel threatened by someone or
something
Hear about an event that effects
someone you know

12. What kind of events?
Human made wide scale disasters
(World Trade Center Bombing,
Oklahoma City Bombing, Roswell
school shooting).
Human made individual events (sexual
assault, mugging, domestic violence.)
Natural disasters (flood, tornados,
hurricanes)

13. Why do some people develop maladaptive
behaviors and not others?
 Resiliency - The ability to rise above the
circumstances or to meet the challenges with
fortitude.
 Stage of development when the trauma occurred.
 Support system in place
 Trauma experience
 Previous outcomes that were successful

14. Characteristics of a Trauma
Informed Organization
 Invested in their staff and its development
 Promote TIC in training of all staff
 Adopt trauma informed principles of care
 Address secondary trauma issues
 Implement processes that reinforce the safety of their
staff.

15. Resiliency and its impact
Resiliency - The ability to thrive despite negative life
experiences and heal from traumatic events. It is directly
related to the internal strengths and environmental
supports of an individual.
We must make a shift from a ‘pathology’ mindset to one of
resilience… a mindset that views clients’ presenting
difficulties, behaviors, and emotions as responses to
surviving trauma.
We must view traumatic stress reactions as normal
reactions to abnormal situations.

16. Factors that contribute to
resilience include….
 Close relationships with family and friends
 A positive view of yourself and confidence in your strengths and
abilities
 The ability to manage strong feelings and impulses
 Good problem-solving and communication skills
 Feeling in control
 Seeking help and resources
 Seeing yourself as resilient (rather than as a victim)
 Coping with stress in healthy ways and avoiding harmful coping
strategies, such as substance abuse
 Helping others
 Finding positive meaning in your life despite difficult or
traumatic events

17. Key Elements to a Trauma-
Informed Approach
1. Realizing the prevalence of trauma
2. Recognizing how trauma affects all
individuals involved with the program,
organization, or system including its own
workforce.
3. Responding by putting this knowledge
into practice.
(SAMHSA, 2012, p.4)

18. 1. Realizing the prevalence of trauma
 According to the National Comorbidity Study 61% of
men and 51% of women report experiencing at least one
traumatic event in their lifetime.
 Wave 2 of the National Epidemiological Survey on
Alcohol and Related Conditions 71.6% of the sample
reported witnessing trauma, 30.7 % experienced a
trauma that resulted in injury, and 17.3 % experienced
psychological trauma.
(SAMHSA, Tip 57: Trauma-Informed Care in Behavioral Health Services, 2014)

19. Prevalence of Trauma
 American study of adolescent inpatients found that 93% had
histories of trauma and 32% had PTSD (Lipschitz et al, 1999)
 According to the National Survey of Adolescents, (1997) 8% of all
children age 12 to 17 report a lifetime prevalence of sexual
assault, 17% reported physical assault, and 39% reported
witnessing violence.
 Gabby et al, (2004) reports from review of research that up to
63% of survivors of childhood abuse, 53% of the children who
were medically ill, and 95% of disaster survivors suffered from
PTSD.
 97% of homeless women with SMI have experienced severe
physical and sexual abuse – 87% experience this abuse both in
childhood and adulthood (Goodman et al, 1997).

20. Prevalence continued….
 Up to two-thirds of men and women in substance use disorder
treatment report childhood abuse and neglect (SAMHSA. CSAT, 2000)
 55-99% of women with substance abuse disorders have a lifetime
history of trauma; 50% of women in treatment have a history of rape or
incest (Navjatis et al., 1997; Gov. Commission on Sexual and Domestic Violence, Commonwealth of MA, 2006)
 Being abused or neglected as a child increases the likelihood of arrest
as a juvenile by 59% (widom, 1995).
 70% - 92% of incarcerated girls reported sexual, physical, or severe
emotional abuse in childhood. (DOC, 1998, Chesney & Sheldon, 1997).
 Studies suggest that 49 percent of people with intellectual disabilities
will experience 10 or more sexually abusive incidents in their
lifetime(Sobsey & Doe, 1991).
 Between 75 and 95% of people with an intellectual or developmental
disability will be sexually assaulted in their lifetime (ADC, Rights and Advocacy,
1996).

21. 2. Recognizing how trauma affects
all individuals involved.
 The consumer of services
 The family of the person receiving services
 The staff members supporting the person
receiving services.
 The community service providers
 Schools, employers, and other agencies

22. 3. Responding
 Using this knowledge to create individualized services
 Acting on the needs of the individual
 Strengths based approaches are vital to success
 Consumer driven care
 Quality services
 TIC begins with the first contact a person has with an
agency.

23. Recognizing that Trauma-Related Symptoms and
Behaviors Originate from Adapting to Traumatic
Experiences
 Trauma related symptoms and behaviors are an
individuals best and most resilient attempt to manage,
cope with, and rise above his/her experience of
trauma.
 Individuals do the best they can with what they have.
 Traumatic stress reactions are individual specific
reactions. No two people will be the same.
 People do not wake up and say “I am going to be
dysfunctional today.”
 Trauma is never and excuse, but it is an explanation.

24. Universal Precautions
Treat individuals with care and
assume that trauma may have likely
happened in their lives. Just as you
would treat all biological fluids as
if they contained a contagion.

25. What is a strengths based
approach?
Strengths based approach is based on six key principles according
to the research of Saint-Jacques (2009):
 Every individual, family, group and community has strengths.
Focusing on these strengths instead of the pathology is of prime
importance.
 The community is a rich source of resources
 Interventions are consumer driven and self–determination is
respected.
 Collaboration is the central goal between the practitioner and
the client and is primary and essential.
 Outreach is the preferred mode of intervention. Treatment in
the community should be the goal. Providing that support is
critical for sustained success.
 All people have an inherent capacity to learn, grow and change.

26. What is different about a Trauma
Informed Program?
 Program policies, procedures and practices protect the
vulnerabilities of the trauma survivor.
 Program policies, procedures and practices protect the
vulnerabilities of the support staff.
 Practices are designed with consumer input.
 First do no harm is at the core of TIC.
 The organization is committed to building
competence among staff.
 Establishes program standards and clinical guidelines
that support delivery of trauma sensitive services.

27. What questions
do you have?

28. References
 SAMHSA, Trauma Informed Care in Behavioral Health
Services, Tip 57, 2014.
 Turner, T. National Association of State Mental Health
Program Directors, SAMHSA, retrieved June 2014.
 Journal of Family Violence, ISSN 0885-7482.