How to Address Trauma and Facilitate Healing: Trauma-Informed Principles
In 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) outlined a series of strategies and principles for trauma-informed approaches. With the assistance of the TIA Toolkit Advisory Panel and other resources, NASTAD developed the following examples of how to incorporate these principles in your agency. The reflection questions in NASTAD’s Trauma-Informed Principles in Practice tool can help organizations operationalize these principles in their program.
A program, organization, or system that is trauma-informed:
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;
RESPONDS by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively RESIST re-traumatization.
Staff and clients feel physically and emotionally safe. Environments are safe and welcoming, and privacy and confidentiality are ensured.
- Crisis protocols are in place and practiced.
- Adequate lighting and safe parking are provided.
- Trauma-informed design and architecture are utilized, such as natural light, art, plants, cool colors (blue, green and purple), clear signage, and intentional furniture arrangement.
- Building is compliant with Americans with Disabilities Act (ADA) regulations and accessibility is addressed (e.g., in literature and other agency materials) to accommodate people with disabilities.
- When on site, security is dressed in plain clothes (instead of in uniform) with clear security identification.
- Trigger warnings are provided when discussing trauma so that clients/staff can opt out of conversations and content that may elicit unwanted emotions for them.
- Time is dedicated in meetings or supervision to discuss safety with staff.
- Crisis response scenarios are created and practiced. Staff receive training in de-escalation techniques and mediation. The agency has identified a shared, neutral alert word or phrase (e.g., “Can you bring me the blue file?”) for when staff need assistance.
Recognition that healing happens in relationship and that power and decision-making responsibilities are to be shared at all levels of an organization. Staff and clients work in partnership. Everyone has a role to play in a trauma-informed approach, from reception to direct medical care to partner organizations.
- Compensate clients in ways that are allowable (e.g., gift cards) for their participation in agency planning, evaluation, and decision making through a client advisory board.
- Include staff from all positions in agency and program planning, evaluation, and decision making.
- Provide training about trauma, resilience, and healing for clients, staff and volunteers.
- Engage referral sources and partner organizations in commitment to the use of trauma-informed approaches.
- Believe stories that are shared with you, particularly about traumatic events.
- Ensure care and treatment plans are co-created with the client.
- As desired by clients, foster the inclusion of family (chosen and biological), support networks, and community at large.
Trustworthiness and Transparency
Program policies and procedures are conducted with transparency with the goal of building trust among staff and clients, while maintaining professional boundaries. There are clear expectations about what happens and why.
- Explain the intent and rationale behind questions and processes used in intake, screening, and assessment. Explain how information is used and kept confidential and the limits of confidentiality.
- To the greatest extent possible, reduce and simplify forms, procedures, policies, and required documentation. Advocate to funders about the importance of low-barrier services and burdens of unnecessary data collection.
- Use visuals and plain language when communicating with clients – speak slowly and clearly, avoid jargon and complex medical terminology.
- Provide multiple ways for clients and staff to provide feedback about providers, services, and systems; use feedback to make improvements.
- Maintain predictive schedules – provide adequate notice and explanation when hours or services are changed.
- Apply the rule of seven (seven different times using seven different methods) when communicating about changes in policy or procedures.
Empowerment, Voice, and Choice
Decisions are made with, instead of for, people. Client and staff experiences and choices are honored and respected. Services are customized for the individual and validate strengths and assets. Self-determination is valued and radical empathy is practiced.
- Center clients and their family (both chosen and biological) in the treatment and care planning process.
- Inform clients of their autonomy during the intake process. Clients always have the option to decline questions, examinations, procedures, and treatments. Help clients make informed decisions about their care.
- Include questions about resilience in screening and assessment.
- Distribute HIV self-testing kits as part of prevention programming.
- Provide low-barrier services and programs, such as housing first models.
- Practice radical empathy.
Individuals with lived experience are part of all aspects of the organization (e.g., leadership, administration, and direct services). Inclusion of peers builds trust, establishes safety, and empowers staff and clients. Sharing of lived experience promotes recovery and healing.
- Provide peer support programs for clients.
- Hire people with lived experience.
- Ensure adequate support and supervision for staff with lived experience.
- Provide peer support and mentorship for staff.
- Create space for family, partners, and friends to support clients in their care.
- Incorporate the client’s supportive community (e.g., ballroom culture and community, and partner with houses for programming.)
- Utilize group supervision for staff to work through difficult situations together and share resources and information.
Cultural, Historical and Gender Considerations
Program offers culturally and linguistically responsive services, attends to implicit biases, recognizes and repairs historical (e.g., trans-Atlantic slave trade, Indigenous erasure, Holocaust) and current harms, and celebrates culture.
- Provide gender-affirming restrooms.
- Participate in or implement LGBTQ Pride activities.
- Incorporate pronoun identification and ask for a chosen name in all processes and procedures.
- Practice visual descriptions when meeting remotely or working with someone who’s visually impaired.
- Practice bystander interventions for microaggressions and harassment.
- Invite staff to take and discuss results of implicit bias tests.
- Provide culturally and linguistically responsive services.
- Name and dismantle systemic racism.
- Commit to operating through an intersectionality lens.
- Utilize targeted universalism frameworks in program planning.
- Ask staff to develop and share positionality statements.
- Trauma-Informed care for Trans and Gender Diverse Individuals
- CDC Toolkit for Providing HIV Prevention Services to Transgender Women of Color
- National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care
- Meaningful Involvement of People with HIV/AIDS
- Evidence-Informed Interventions (E2i)