What are the best practices for conducting trauma-informed interviews?

Trauma-Informed Interviewing: Best Practices

Begin every trauma-informed interview by greeting the patient warmly, being fully present, and establishing both physical and emotional safety through clear communication of expectations, procedures, and offering choices whenever possible. 1

Core Interviewing Principles

Establish Safety and Trust First

• Create an emotionally safe environment by maintaining a balance between professionalism and friendliness while being fully present in the moment 1
• Provide a warm, welcoming setting with clear communication about what will happen during the interview 1
• Offer choices throughout the interaction (e.g., "Would you prefer to sit here or there?") to restore a sense of control 2
• Ensure physical and emotional safety characterized by compassion, cultural humility, equity, and collaboration 2

Interview Structure and Technique

Start with open-ended questions, then progress to more specific probing questions based on the patient's responses 1. This approach allows the patient to guide the narrative initially.

• Begin by asking about strengths and resilience factors before discussing trauma or difficulties, framing the conversation positively 1
• Ask questions like: "How does your family cope with stress?" or "What does your child do well?" 1
• Listen in an active, nonjudgmental, attuned way without allowing implicit bias to affect your neutrality 1

Essential Communication Skills

• Reflect back what you hear for clarification and confirmation 1
• Paraphrase and summarize what is discussed 1
• Attend to and reflect on the emotions that accompany the information, not just the content 1
• When patients become distressed, focus on the emotion rather than the behavior: "I can see that you are angry, worried, sad, upset" 1, 2

Critical Trauma-Sensitive Considerations

Separate Interviews When Appropriate

Always ask children if they want to be interviewed separately from their parents or caregivers 1. Children who have experienced trauma may not feel comfortable discussing events with parents present 1.

• Failure to separate children from caregivers can limit disclosure and facilitate ongoing harm 1
• Children often have unique asylum or safety concerns they won't share in front of parents 1

Avoid Re-traumatization

• Never ask the same question multiple times, as this causes confusion and distress 1
• Recognize that children exposed to trauma are more susceptible to changing their responses under pressure, especially those with prior violence exposure 1
• Avoid using social pressure or repeated questioning, which comprised 5% of problematic interviewer statements in research 1
• Do not use inconsistencies to challenge credibility - trauma affects the ability to provide coherent, consistent accounts 1

Address Power Dynamics

• Monitor your own response when difficult situations arise and resist the urge to be angry or retaliate 1, 2
• Involve patients and families as key decision-makers throughout the interaction 2
• Be transparent about power dynamics and maintain flexibility 3
• Recognize that empowering patients while maintaining safety requires careful balance 3

Specific Interview Content Areas

Assess Through Routine History

Much of the trauma assessment can be integrated into routine evaluation 1:

• Social history: Identify risks, stressors, and strengths 1
• Developmental history: Assess resilience factors, social connectedness 1
• Review of systems: Screen for trauma symptoms using the FRAYED framework 1:
  • Frets (anxiety, fears)
  • Regulation difficulties (behavioral/emotional disorders)
  • Attachment challenges
  • Yawning (sleep problems) and yelling (aggression)
  • Educational/developmental delays
  • Defeated (hopeless), depressed, or dissociated

Essential Safety Screening

Always screen for immediate safety concerns including suicidality, self-harm, or intent to harm others 1. Have clear protocols for positive responses 1.

• Assess whether the child is in an unsafe setting due to abuse, neglect, or impaired caregiving 1
• Ask directly about fear of return in relevant contexts - this is frequently omitted but critical 1

Cultural Considerations

• Cultural awareness can ease difficult conversations about trauma 1
• Culture affects how trauma is experienced and understood by families 1
• Ensure interpreters are trained in neutrality with regular oversight of interpretation quality 1

Common Pitfalls to Avoid

• Never assume mature-appearing youth are less credible - this is a documented bias 1
• Do not expect trauma survivors to fit a stereotypical profile 1
• Avoid making statements made during crisis (e.g., border crossing without interpreter) invalidate later testimony 1
• Recognize that functional complaints (sleep difficulty, appetite changes, toileting concerns, school problems) may be early manifestations of trauma 1
• Do not overlook that attachment trauma represents the greatest threat and may be most challenging to explore 1

Two-Generation Approach

Address caregiver trauma history when relevant, as parental adverse childhood experiences affect child health and development 1:

• Caregivers may have their own trauma histories, mental health struggles, or substance use issues affecting parenting 1
• Exploring parenting stressors and strengths creates opportunities for caregiver reflection 1
• Assume all caregivers love their children and are doing their best 1

Protecting the Interviewer

Recognize that listening to trauma narratives can trigger secondary traumatic stress (STS) in providers 1, 2, 4:

• Listening to trauma stories may take an emotional toll that compromises professional functioning 1
• Trauma narratives are particularly distressing when they challenge the listener's basic assumptions of safety and justice 4
• Strong empathic responses and operating outside one's "window of tolerance" increase distress 4
• Ensure adequate supervision, peer support, and self-care including rest, exercise, and mindfulness practices 1