Trauma Informed Care

Aka: Trauma Informed Care, Trauma-Informed Care

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II. Definitions

  1. Trauma Informed Care
    1. Medical approach with consideration of prior Trauma
    2. Clinician recognizes signs of prior Trauma and avoids retraumatization

III. Approach: Trauma Informed Care

  1. Empowerment, Voice and Choice
    1. Information is provided in simple, relatable and understandable terms
    2. Patients have the autonomy to refuse certain procedures, or to take breaks during the assessment
  2. Peer Support
    1. Patient may be accompanied for support (e.g. family members, community health workers)
    2. Specific peer support specialists may be available for patient's needs (e.g. Domestic Violence survivor)
  3. Collaboration and Mutuality
    1. Patients as partners in their own care including the evaluation and treatment plan
  4. Safety
    1. Clinical team provides an emotionally and physically safe environment for the patient
    2. Avoiding retraumatization helps to keep patient calm and cooperative in a chaotic environment (e.g. ED)
    3. Reduce light intensity and sound intensity (e.g. decrease alarm frequency and loudness)
    4. Employ alternatives to restraints
  5. Trust and Transparency
    1. Keep patients informed with complete transparency, and with privacy maintained
    2. Consult with patients on exams and procedures that may cause retraumatization
  6. Cultural, Historical and Gender Issues
    1. Marginalized groups (e.g. LQBTQ, people of color, Refugees) are at higher risk of prior Trauma

IV. Technique: History and Exam

  1. See Agitation Management (includes Verbal Deescalation)
  2. Perform evaluation in a private space (and as quiet as possible)
  3. Introduce yourself and maintain a welcoming, positive and nonjudgemental approach
  4. Identify how patient would like to be referred (e.g. name pronunciation)
  5. Use an Interpreter for non-english speaking patients
  6. Maintain adequate Analgesics
  7. Allow for questions and clarification throughout the evaluation

V. Evaluation

  1. See Post-Traumatic Stress Disorder Screening Tool

VI. Management: Models

  1. Creating Cultures of Trauma Informed Care (CCTIC)
    1. Organizational and administrative recognition and committment to addressing the special needs of Trauma survivors
  2. Collaborative Care Model (CoCM)
    1. https://www.psychiatry.org/psychiatrists/practice/professional-interests/collaborative-care/learn
    2. Patient centered care team
      1. Includes primary care and behavioral health providers
    3. Population-based care
      1. Registry of shared patients
    4. Measurement based treatment to target
      1. Care plan focused on personal goals and clinical outcomes
      2. Evidence based tools are used to evaluate treatments for efficacy in clinical outcomes
      3. Ineffective treatments for a specific patient are modified
      4. Reimbursement is based on care quality and clinical outcomes
  3. National Child Traumatic Stress Network (NCTSN)
    1. https://www.nctsn.org/audiences/healthcare-providers
    2. Routine Trauma screening
    3. Evidence-based, assessment and treatment (in context of culture)
    4. Trauma-related resources are made available to providers, patients, families
    5. Increase Trauma effect awareness, resilience and protective factors in children and their families
    6. Maintain care continuity and collaboration across health systems caring for children
    7. Support clinical staff in the secondary Trauma that occurs in their treatment of patients

VII. References

  1. Mhonda and Fisher (2025) Crit Dec Emerg Med 39(3): 25-34
  2. Nguyen-Feng (2025) Am Fam Physician 112(5): 474-7 [PubMed]

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