Understanding Trauma-Informed Care and the Trauma Lens
Trauma-informed care is a fundamental shift from asking "What is wrong with you?" to "What happened to you?"—recognizing that problematic behaviors in the present often served a protective function in the past, and that without this lens, individuals with trauma histories may continue to feel misunderstood and isolated, seriously jeopardizing their behavioral health and well-being. 1
Core Definition and Framework
Trauma-informed care is a public health approach involving specific beliefs and practices centered on safety, trust, and empowerment that are intended to prevent and mitigate the impact of trauma at individual, organizational, and systems levels. 1, 2 This approach recognizes the pervasiveness of trauma—nearly half of American children (34 million under age 18) have faced at least one potentially traumatic early childhood experience. 2
The approach acknowledges that trauma exposure can have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the lifespan. 2
The Five Essential Interpersonal Principles
Every interaction in trauma-informed care must provide these five core elements: 1, 2
Safety: Creating both physical and emotional environments characterized by compassion, cultural humility, equity, and collaboration; establishing warm, welcoming environments with clear communication of expectations and procedures 2
Trustworthiness: Building relationships through transparency and consistency in all interactions 1
Choice: Providing options whenever possible to restore a sense of control for patients and families 2
Collaboration: Involving patients and families as key decision-makers in their care 2
Empowerment: Empowering all staff members to emphasize safety and patient self-efficacy 2
Additional critical elements include cultural, linguistic, and gender competence, and the availability of peer support. 1
Using the Trauma Lens in Clinical Practice
The trauma lens fundamentally changes how clinicians interpret behavior. When viewed through this lens, problematic behaviors in the present are understood to have served a protective function in the past. 1 This reframing is essential because if trauma is not recognized and addressed, other interventions—regardless of how well-intentioned—may be less effective. 1
Practical Implementation Strategies
Monitor your own response when difficult situations arise and resist the urge to be angry or retaliate 2
Focus on the emotion rather than the behavior when communicating with patients 2
Understand symptoms and manifestations of trauma exposure and the possible connection between past trauma and current behaviors 1
Recognize that youth involved in systems of care have disproportionately high rates of trauma exposure and greater impairments at baseline compared to youth without such history 1
Organizational Implementation
Trauma-informed care requires ongoing efforts at the organizational level to avoid retraumatization and promote recovery. 1 Both individuals and those working with them benefit from understanding the symptoms and manifestations of trauma exposure. 1
Critical Pitfall to Avoid
Without using a trauma lens, professionals risk having patients continue to feel misunderstood and isolated, with their behavioral health and sense of well-being seriously jeopardized. 1 This represents a fundamental failure in care delivery that perpetuates harm rather than healing.
Distinction from Trauma-Specific Services
Trauma-informed care is distinct from trauma-specific services. 1 While trauma-informed care is the universal approach to all interactions, trauma-specific services are intensive clinical interventions for those whose level of trauma exposure requires specialized treatment, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Child and Family Traumatic Stress Intervention (CFTSI), Child Parent Psychotherapy (CPP), and Parent Child Interaction Therapy (PCIT). 1
Addressing Secondary Traumatic Stress
Healthcare providers who hear about firsthand trauma experiences of patients can themselves experience secondary traumatic stress, which must be addressed to prevent negative consequences. 2 Failing to address this in providers undermines the sustainability of trauma-informed care delivery. 2