Trauma-informed practice

SAMHSA describes individual trauma as coming from an event, series of events or set of circumstances that a person experiences as physically or emotionally harmful or life-threatening, with lasting effects on their wellbeing.

The three Es

• Event: what happened, once or many times
• Experience: how the person lived it, which can differ from one person to the next
• Effects: lasting changes in how a person feels, thinks, relates or copes

SAMHSA describes a trauma-informed program as one that realizes how widespread trauma is, recognizes how it affects everyone involved, including staff, responds by putting that knowledge into practice, and actively resists re-traumatization.

The Center for Health Care Strategies notes that front-desk staff, security staff and other non-clinical workers often shape whether people feel safe. A trauma-informed approach works best when it is part of the whole organization, not just clinical work.

A survey of 309 staff at a psychiatric center found that personal lifetime trauma was linked with more secondary traumatic stress and burnout. The authors called for trauma-informed approaches that protect all staff without requiring anyone to disclose their history.

SAMHSA notes that practices like seclusion and restraint should be a last resort when less restrictive measures have failed, and aims for coercion-free, violence-free treatment settings.

The Center for Health Care Strategies says trauma-informed care can help reduce provider burnout and may reduce staff turnover.

Ideas

• Clear signs so people know where to go
• Let people choose where to sit, including near the door
• Make sure waiting areas feel safe and visible
• Reduce noise and harsh lighting where you can
• Tell people who else is in the room or nearby

Ideas

• Ask before touching, even for routine tasks
• Explain what will happen before it happens
• Greet people by the name they prefer
• Let people take breaks or pause a hard conversation
• Use a calm, steady tone, even when you are rushed

Ideas

• Be clear about limits of confidentiality at the start, including reporting duties
• Explain why you are asking each question
• Share what notes say if people ask, where policy allows
• Tell people what happens next and when you will follow up

Calling back when you said you would, starting on time and explaining changes all add up. For someone whose trust was broken before, reliability can matter more than any technique.

Peer workers, advisory boards and service-user feedback bring the voices of people with lived experience into everyday decisions.

Helpers often hold power over services, records and decisions. You can’t erase that, but you can soften it by explaining your role, asking for the person’s view and making decisions together where possible.

Small shifts

• Ask “What would be most helpful today?”
• Invite people to correct your notes or summary
• Sit at the same level rather than across a big desk
• Use plain words instead of jargon

Examples

• Appointment times or formats (in person, phone, video)
• Door open or closed
• Order of topics in a meeting
• Whether a support person joins
• Who they would prefer to work with, where possible

Ask about what people are proud of and what has helped them cope. Behaviours that look like problems may have once been ways to stay safe.

Where you can, let people decline a question, a step or a referral without penalty. When something truly is required, explain why, and what choices remain.

Ideas

• Ask sensitive questions in private, not at a front desk
• Avoid making people repeat their story to many staff
• Explain why each sensitive question is asked and how answers are used
• Let people skip questions where possible

Try swapping

• “Attention-seeking” for “trying to get a need met”
• “Calm down” for “Let’s take a breath together”
• “Difficult” or “non-compliant” for “struggling with…” or “not ready yet for…”
• “You have to” for “Here’s what’s required, and here are your choices”

Searches, restraint, locked doors and sudden changes can bring back past trauma. SAMHSA describes seclusion and restraint as a last resort when less restrictive measures have failed.

If you must use a restrictive step

• Explain what is happening and why, in plain words
• Keep it as brief as possible
• Offer choices within it where you can
• Check in afterwards and repair the relationship

Ideas

• Agree on a “stop” word or signal
• Ask permission before each step
• Keep people covered as much as possible
• Say what you are about to do before you do it

Because many staff carry their own trauma, researchers recommend universal supports that protect everyone, rather than relying on people to reveal their histories.

Risk rises with your own past trauma, social isolation, little training or supervision, and constant exposure with little variety.

A systematic review of 27 studies found that leadership engagement, staffing and money, flexible policies, accessible training and feedback from service users helped. Resistance to change got in the way.

A 2025 federal evidence review found that existing studies were too limited to show clearly whether trauma-informed care improves client health outcomes. The authors stressed this does not mean it is not useful, only that research has not yet given clear answers.

It is not

• A checklist you finish once
• A reason to drop all limits or structure
• A replacement for trauma-focused therapy
• Asking everyone to tell their trauma story

The CDC notes the principles are not a single technique or checklist. They need ongoing attention and, often, a change in organizational culture.