SAMHSA Suggested Guidelines for Trauma-Informed Care

Introduction

Interest in the impact of trauma on behavioral health has been steadily increasing since the 1970’s. Models for the treatment of trauma have been developed and tested and a growing number of organizations have explored ways to make their services more responsive to people who have experienced trauma.¹ Recently, multiple federal agencies representing varied sectors, including child welfare, primary health care, criminal justice, education, and labor have recognized the impact of trauma on the children, adults, and families they serve, and have requested assistance from SAMHSA in addressing these issues. This has compelled SAMHSA to revisit trauma-related concepts and their applicability not only to behavioral health but to other related fields.

In 2011, SAMHSA designated Trauma and Justice as one of its key strategic initiatives. Research has highlighted the central role of trauma in mental and substance use disorders and the linkage between trauma experiences and other chronic physical diseases.² Trauma survivors, family members, advocates, researchers, and practitioners have stressed the need to address trauma in order to promote recovery and resilience for people with behavioral and other chronic physical health conditions.

Promoting recovery and resilience for those individuals and families impacted by trauma involves developing and implementing interventions specific to the trauma experienced by them and examining ways to reduce re-traumatizing people through their experiences in services and systems. Consistent with SAMHSA’s definition of recovery, services and supports that are trauma-informed build on consumer and family choice, empowerment, and collaboration.

To advance this work, SAMHSA embarked on a process to develop a working definition of trauma and key operating principles and guidance for a trauma-informed approach that can be applied across multiple service sectors. While much work has already been done in this area, there still is confusion and ambiguity regarding what is meant by trauma and trauma-informed approaches.

In May 2012, SAMHSA convened a group of national experts to address the following questions:

• What do we mean by trauma?
• How do we understand trauma in the context of community?
• What do we mean by a trauma-informed approach?
• What is the difference between trauma-specific interventions and services, trauma-informed care, and a trauma-informed approach?
• What are the key principles of a trauma-informed approach?
• What are suggested guidelines for implementing a trauma-informed approach?

This working document summarizes the discussions among these experts which included trauma survivors, practitioners from multiple fields, researchers, and policy makers. The next step in this process is to gather comments on this document from the public. For the purposes of public comment, this document is divided into three parts:

• Part One: Defining Trauma provides a working definition of trauma. This section also begins to address the role of communities in the context of trauma; however, a definition or conclusive discussion of community trauma is beyond the scope of this document (Tell us your views on the working definition of trauma.);
• Part Two: A Trauma-Informed Approach provides a definition and a list of the key principles of a trauma-informed approach. This section also differentiates the trauma-informed approach from commonly confused terms such as trauma-specific interventions and services and trauma-informed care (Tell us your views on the definition of and the guiding principles for a trauma-informed approach.);
• Part Three: Suggested Guidelines for Implementing a Trauma-Informed Approach is a description of guidelines for systems and organizations to follow when implementing a trauma-informed approach. These suggested guidelines will be incorporated into a matrix worksheet for organizations to use when planning and assessing the implementation of a trauma-informed approach (Tell us your views on suggested guidelines for implementation of a trauma-informed approach.).
• Conclusion
  1. Huang, L.N., Pau, T., Flatow, R., DeVoursney, D., Afayee, S., & Nugent, A., 2012. Trauma-Informed Care Models Compendium; Jennings, A. (2008). Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services.
  2. Felitti. V., Anda, R., Nordenberg, D. et al., (1998) Relationship of child abuse and household dysfunction to many of the leading cause of death in adults: The Adverse Childhood Experiences Study; Green, J.G., McLaughlin, K.A., Kessler, R.C., et al., (2010). Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) III: associations with functional impairment related to DSM-IV disorders; McLaughlin, K.A., Green, J.G., Kessler R.C., et al., (2010). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey; Saxe, G.N., Ellis, B.H., & Kaplow, J.B. (2009). Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems Therapy Approach; Mollica, R.F. (2006). Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World.

   

  Last updated: 12/10/2012