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6 Principles of Trauma-Informed Care

Trauma-informed care is an approach to health and social services that recognizes the impact of trauma on people’s lives. Its aim is to create a safe, respectful, and empowering environment for healing. Many people who seek help have experienced some form of trauma, such as abuse, violence, neglect, loss, or oppression, and these experiences can affect their physical, mental, emotional, and spiritual well-being. Trauma-informed care acknowledges the resilience and strength of people who have survived trauma and honors their diverse coping strategies and preferences to provide more effective care. In this article, we’ll cover six principles of trauma-informed care that form the foundation of this approach.

Why is trauma-informed care needed?

Trauma-informed care can help resolve the lasting and pervasive effects of trauma on people’s health and well-being, remove barriers to care, and improve the efficacy of other care practices. Trauma can increase the risk of chronic diseases, mental health disorders, substance use, and suicidal behavior. It can also impair people’s ability to trust, communicate, and form healthy relationships, affecting their sense of identity, belonging, and purpose. Trauma-informed care can help people heal from trauma by providing them with a safe, respectful, and empowering environment that supports their overall recovery and growth.

A Native American teacher explains the importance of culture and history to her students.

What are the 6 principles of trauma-informed care?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), six key principles guide trauma-informed care. They are:

1 – Safety

In the context of trauma-informed care, safety means ensuring that people feel physically and emotionally safe in the care setting and that their privacy and confidentiality are protected.

2 – Trustworthiness and transparency

Trust is critical for effective care. It includes providing clear and consistent information about services, policies, and procedures, and maintaining honesty and accountability in all interactions.

3 – Peer support and self-help

Support from others with similar experiences is important, especially for individuals from marginalized communities. Facilitating connections and relationships among people who have shared experiences of trauma and recovery fosters a sense of hope and empowerment.

4 – Collaboration

Everyone has a role to play in the healing process. Minimizing power differences by sharing decision-making and responsibility creates a partnership that increases individuals’ commitment to their own care.

5 – Empowerment

Honoring and building on people’s strengths, skills, and preferences provides the support they need to take control of their recovery and goals.

6 – Cultural and historical awareness

Respecting and addressing cultural and historical factors that may have created people’s trauma responses, and ensuring that services are culturally responsive and inclusive, is of primary importance to trauma-informed care.

Assumptions behind the 6 principles of trauma-informed care

SAMHSA outlines four key assumptions that underlie trauma-informed care. These assumptions form the basis of how a care provider operates within a trauma-informed framework. They are:

  • Realization: Understanding how trauma affects individuals, families, and groups and acknowledging that trauma can obstruct desired outcomes and impact all types of care (physical, behavioral, social).
  • Recognition: Identifying the signs of trauma through screening and assessment and while working with others — whether they may be clients, patients, employees, or others.
  • Response: Applying trauma-informed principles to all operational areas of an organization, building psychologically and physically safe environments, and working to promote a trauma-informed approach through training, leadership support, mission, and messaging.
  • Resisting re-traumatization: Knowing how policies and practices can affect the well-being of staff and clients and re-trigger trauma. Acknowledging trauma in all operations to avoid reinforcing or repeating it.

How to provide trauma-informed care for marginalized populations

Trauma-informed care is especially important for marginalized communities and populations — including Native American nations, people of color, LGBTQ+ people, immigrants, refugees, and people with disabilities — who have experienced historical and intergenerational trauma, as well as ongoing discrimination, oppression, and violence. These groups may face barriers to accessing and receiving culturally appropriate care and may mistrust and fear mainstream health and social systems. To provide trauma-informed care for these communities, it is essential to:

  • Acknowledge historical and intergenerational trauma and its impacts on the health and well-being of these communities, and the need for healing and reconciliation.
  • Engage and collaborate with community members, leaders, and organizations, and respect their wisdom, knowledge, and values.
  • Provide culturally responsive and inclusive services honoring the diversity and uniqueness of each person and community and incorporate their cultural, spiritual, and traditional practices and beliefs.
  • Address the social and structural determinants of health and well-being, such as poverty, racism, sexism, homophobia, and other forms of oppression and injustice, and advocate for social change and equity.

What are the benefits of applying the 6 principles of trauma-informed care?

Trauma-informed care has many benefits for Native American communities and other marginalized populations. By applying the six principles of trauma-informed care, providers can:

  • Improve access to care and care quality by creating a safe, respectful, and empowering environment that meets the needs and preferences of the people and communities.
  • Enhance the outcomes and satisfaction of individuals and communities by supporting their recovery and growth and by addressing the root causes and consequences of trauma.
  • Reduce the stigma and discrimination associated with trauma and mental health issues by raising awareness and understanding of trauma experiences and responses.
  • Strengthen the resilience and empowerment of people and communities by honoring their strengths, skills, and coping strategies, and by fostering a sense of hope and purpose.
  • Build trust and collaboration among care providers, people, and communities by sharing decision-making and responsibility and by respecting and valuing the diversity and uniqueness of individuals and the community.

Building a trauma-informed organization and practice

After integrating a trauma-informed approach into your own work, you may be ready to help others adopt this approach. All individuals who seek help should benefit from the improved care outcomes that the six principles of trauma-informed care can bring, and this can only happen if entire organizations and health systems adopt this approach.

Trauma-informed care aligns with the healthcare motto, “do no harm.” An awareness of trauma and the need for informed approaches can help ensure that individuals do not experience further trauma from their interactions with healthcare providers.

The National Council for Mental Wellbeing provides resources such as its Organizational Self-Assessment (OSA) tool, which assesses an organization’s readiness to adopt a trauma-informed care approach. The OSA spans seven domains of trauma-informed care:

  1. Early screening and comprehensive assessment
  2. Consumer-driven care and services
  3. Trauma-informed, educated, and responsive workforce
  4. Trauma-informed, evidence-based, and emerging best practices
  5. Safe and secure environments
  6. Community outreach and partnership building
  7. Ongoing performance improvement and evaluation

Healthcare leaders should evaluate each of these seven domains to determine where their organization stands. Where possible, integrate the six principles of trauma-informed care into each area.

For successful adoption, your staff needs education on trauma-informed care approaches and techniques tailored for their specialty or area of practice. Tactics will vary depending on care settings and the needs of individuals and communities.

How Relias can help

Relias can help educate your staff about trauma-informed care so they can better serve clients or patients and more effectively manage employees who may be affected by trauma. Addressing trauma is a first step that enhances the success of other areas of care.

It is important to understand that health disparities, such as those that exist in marginalized communities, often stem from historical trauma and inequities. Ensure that your staff is well-informed and trained so they are equipped to serve those who may not even realize they have experienced trauma.


5 Key Elements to Trauma-Informed Care

Download our research brief to learn how to integrate trauma-informed care into your practice. Create an integrated, whole health system of care that provides more effective treatment by addressing the impacts of trauma. Avoid retraumatizing staff, clients, or patients and position your organization to meet their needs, leading to higher efficacy and better outcomes.

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