Trauma Informed Care for Institutions

What Is Trauma Informed Care?. GettyImages

An awakening has occurred over the past few decades in our understanding of trauma and how it affects well-being.

We now understand that trauma is widespread and the impact of trauma runs deep.

Across the health care and social welfare fields, people are beginning to adjust their practices, so they do not re-traumatize their clients and instead are part of the healing process. The movement is called trauma-informed care.

If you’re among the many persons who have experienced trauma and feels it is impacting your day to day life, seeking out caregivers and institutions that are trauma-informed may help your healing process. Understanding the tenets of trauma-informed care can give you language for advocating for the best care.

If you or a loved one are struggling with mental health issues due to trauma, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.


Once you are introduced to the implications of trauma, it is hard to imagine mental health care without this verbiage and framework. Looking back at history you may see classic examples of PTSD in stories of soldiers or family members.

It wasn’t until 1980 that post-traumatic stress disorder was included in the third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

That was the official mental health first diagnosis related to trauma. It marked the beginning of a much broader movement. In 1994, The Substance Abuse and Mental Health Services Administration (SAHMHSA) held the Dare to Vision Conference, which brought the discussion of trauma to the foreground. At this landmark conference, trauma survivors shared how standard practices in hospitals re-traumatized and often triggered memories of previous abuse.

Since then the clinical research on trauma has grown rapidly.

Like the Recovery Model, the trauma-informed care movement has grown largely in part due to advocacy and systematic documentation by survivors of trauma.

What Is the Working Definition of Trauma?

Unfortunately, the avenues for trauma are broad and can affect people in all walks of life. Released in 2014, SAMHSA gave this definition of trauma:

Trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening and has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

Long-Term Implications 

Trauma can affect almost everything about a person: their physical health, their brain development, their relationships, and their coping abilities. The research in this area continues to grow. We are now beginning to understand that the stage of development your brain is in when the trauma is experienced can impact how it will affect you. For example, if you undergo a trauma at age seven then the impact will likely be different from if you were 17.

As we continue to learn more about the deep-seated effects of trauma, there is also good news. Research shows us that the impact of trauma is not written in stone. Your brain can continue to evolve and heal after trauma. 

How Can Care Be Trauma-Informed?

SAMHSA argues that a general understanding of trauma by some professionals is not sufficient to improve outcomes for trauma survivors.

Trauma-informed care must be built into the fabric of company culture and recognized at all organizational levels. SAMHSA lays out four assumptions in this type of trauma informed care.

  1. Members of a trauma-informed system know that trauma is widespread, but there is potential for recovery.
  2. Individuals can be taught to recognize the signs and symptoms of trauma.
  3. Policies, procedures, and practices should be set with the trauma in mind.
  4. A trauma-informed system should resist inflicting re-traumatization.

Instead of prescribing set policies, SAMHSA advocates that these six principles guide care:

  1. Safety
  2. Trustworthiness and Transparency
  3. Peer Support
  4. Collaboration and Mutuality
  5. Empowerment, Voice, and Choice
  6. Cultural, Historical, and Gender Issues 
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Article Sources
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  1. Pai A, Suris AM, North CS. Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual ConsiderationsBehav Sci (Basel). 2017;7(1). doi:10.3390/bs7010007

  2. National Center on Substance Abuse and Child Welfare. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Published July 2014.

  3. Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma.

  4. Dunn EC, Nishimi K, Powers A, Bradley B. Is developmental timing of trauma exposure associated with depressive and post-traumatic stress disorder symptoms in adulthood?J Psychiatr Res. 2017;84:119-127. doi:10.1016/j.jpsychires.2016.09.004

  5. National Institute of Mental Health (NIMH). Coping with Traumatic Events. Updated  January 2020.