Implementing Trauma-Informed Care (TIC) Across Agency Settings: A TIC checklist

Trauma-Informed Care (TIC) is a proactive approach to reduce potentially traumatic interactions across all stages of the individual's treatment in various practice settings. Whether at a behavioral health agency, a primary care clinic, an integrated care practice center, or a residential facility, TIC must be implemented across all services and levels of care to better treatment engagement and outcome. Elements to assess include not only those involved in the engagement, care management and treatment of the client with each service encounter, but also those that include the actual physical functionality and atmosphere of the waiting room, the treatment room, and residential facility. It is important to assess whether the practice, policy and protocol support a physically, as well as emotionally, safe space for the person coping with both the emotional and physical effects of trauma. For example, a person living in a supported housing setting will be more responsive to treatment if she/he feels safe in the residential environment. It impacts the therapeutic interactions with staff, supports resiliency and positive coping in the residential community, and highlights the stimulus in the environment that can be controlled or changed to decrease retraumatization.

Therefore, it is essential that organizations have a fundamental understanding and implementation of TIC. An organization with a trauma-informed approach has TIC inculcated in its practice and organizational culture, values, norms and beliefs. To determine whether there is such an awareness, and whether it is integrated into the culture of the organization, review and respond to the following list of principles promulgated by SAMHSA:  

  • Promote Trauma Awareness and Understanding
  • Recognize that Trauma-Related Symptoms and Behaviors Originate from Adapting to Traumatic Experiences
  • View Trauma in the Context of Individuals' Environments
  • Minimize the Risk of Retraumatization or Replicating Prior Trauma Dynamics
  • Create a Safe Environment
  • Identify Recovery from Trauma as a Primary Goal
  • Support Control, Choice, and Autonomy
  • Create Collaborative Relationships and Participation Opportunities
  • Familiarize the Client with Trauma-Informed Services
  • Incorporate Universal Routine Screenings for Trauma
  • View Trauma Through a Sociocultural Lens
  • Use a Strengths-Focused Perspective: Promote Resilience
  • Foster Trauma-Resistant Skills
  • Demonstrate Organizational and Administrative Commitment to TIC
  • Develop Strategies to Address Secondary Trauma and Promote Self-Care
  • Provide Hope -- Recovery is Possible

Once TIC is implemented across all elements of the service agency, evidence-based practice (EBP) models can be selected and matched against the unique characteristics of the treatment needs and demographic parameters of the populations of focus. Then, outcome data must be captured to study impact and improvement. However, a trauma-informed EBP platform cannot be substituted for an agency's full-scale commitment to the principles of TIC. Agency recognition of, commitment to, and implementation of the principles of TIC are necessary first steps toward implementing a trauma-informed EBP approach to care.

The TIC goal of your organization must be to inculcate, at all levels, a commitment to every patient that "Our goal is for you to feel secure throughout your entire experience while in our care".

Additional Resources