What Does it Mean to Be Trauma-Informed?

In health care and education, being “trauma-informed” has become a popular aspiration. As leaders, providers, educators, and individuals, to be "trauma-informed" is to recognize the pervasiveness of trauma in the world and seek to be responsive to this unfortunate reality. It means becoming aware of trauma's many personal and societal consequences, anticipating how trauma survivors may respond to our words and actions, and doing our part to create a world that does not cause further harm. Even more, being trauma-informed means helping to create a world that can foster growth, resiliency, and healing as well.

Merely stating the intention to be trauma-informed is not enough to guarantee good outcomes. Further, given the diversity of traumatic experiences and trauma survivors, it is hard to land on a narrow set of behaviors that will be appropriate in all circumstances. A better approach is to use a set of guiding principles which can be flexibly applied to unique situations and people.

Understanding the importance of this topic, the Substance Abuse and Mental Health Service Association (SAMHSA) has created guidance for a trauma-informed approach to care (2014). Their work provides some key definitions as well as a set of core principles, including Safety; Trustworthiness and Transparency; Collaboration and Mutuality; Empowerment, Voice, and Choice; Peer Support; and Cultural, Historical, and Gender Issues.

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The principle of Safety encourages people to pay attention to whether those under their care feel both physically and emotionally protected from danger. It is particularly important to understand what makes the people you serve feel unsafe, as it can be quite different across cultures and contexts. Safety does not always mean that everything will feel easy or comfortable, and it can be useful to make this distinction at times. Instead, this principle is built on the understanding that many trauma survivors lack a basic sense of safety that others take for granted in their lives. In applying this principle, the goal is to level the playing field so that all individuals under your care can enjoy a basic sense of safety. An individual might report feeling safe when they are able to stop scanning their environment for threat or danger, or when they are no longer preoccupied with having to defend or protect themselves.

Trustworthiness and Transparency is an approach to leadership or service delivery that can help people feel more willing to engage with you or your organization. Being trustworthy means keeping your promises, being reliable, and demonstrating this clearly. For instance, you might verbally state what you intend to do, then follow up with clear evidence of having done what you promised. Transparency helps people better understand your priorities and intentions and know where they stand with you or your organization. It is akin to “showing your work” when doing math problems; you might tell people your thought process, and what factors were given weight in an important decision.

Collaboration and Mutuality go even further, encouraging people to pay attention to who wields power and who might be vulnerable to its misuse. Embodying collaboration and mutuality, you can seek to reduce this power differential and its risks by engaging in more active collaboration across levels of leadership, and between staff and clients or students. For instance, you might seek input from patients (Collaboration and Mutuality) when considering an important new initiative, then share how that information was used when making your final decision (Transparency).

Empowerment, Voice and Choice continues to expand on this idea by further emphasizing the need to actively encourage people to use their power and voice. People who have been disempowered or victimized in the past may be understandably fearful and reluctant to step forward, so active efforts may need to be made to help people develop skills (e.g., self-advocacy, assertiveness) in this area. Further, the more you are able to embody other core principles (e.g. Safety or Trustworthiness), the more likely people will be to feel empowered as well.

Understanding the Cultural, Historical, and Gender Issues that impact the people in your world are also essential to being trauma-informed. Paying attention to culture can help us see strengths, social connections, core values, and resources that might otherwise go ignored. Understanding historical context or ways a person might have experienced discrimination can also help us better guess how our actions or policies may be received, or what concerns they might elicit. By understanding these issues, we can also better implement the other principles on this list.

Finally, providing opportunities for Peer Support can help people with lived experience of trauma learn and grow together. Helping peers come together also enhances the likelihood that people will feel safe due to the stronger sense of belonging that comes with having peers. Bringing peers together can also support empowerment, as it’s often easier to speak up as a group than as an individual.

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A truly trauma-informed approach remembers that it’s not just the clients or students we work with, but members of our staff and leadership, and perhaps even ourselves, who are trauma survivors. Thus, there is no setting or context that would not likely be improved by considering these principles. Some situations may call for one or more to be at the foreground or background, and there might be tremendous diversity in what it looks like to apply these across contexts. Over time, in our own unique situations and lives, these core principles can transform and heal our relationships, our organizations, and perhaps even ourselves.