The Substance Abuse and Mental Health Services Administration

SAMHSA Stakeholder Feedback

(CLOSED) Definition of and the Guiding Principles for a Trauma-Informed Approach

This forum serves as an opportunity for the public — including SAMHSA stakeholders — to provide feedback and ideas on: Definition of and the Guiding Principles for a Trauma-Informed Approach (http://www.samhsa.gov/traumajustice/traumadefinition/approach.aspx)

Current Working Definition of a Trauma-Informed Approach:

A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for healing; recognizes the signs and symptoms of trauma in staff, clients, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings.

Key Principles of a Trauma-Informed Approach:

1) Safety, 2) Trustworthiness and Transparency, 3) Collaboration and Mutuality, 4) Empowerment, 5) Voice and Choice, 6) Peer Support and Mutual Self-Help, 7) Resilience and Strengths Based, 8) Inclusiveness and Shared Purpose, 9) Cultural, Historical, and Gender Issues, 10) Change Process

For more information, please refer to the complete paper: SAMHSA’s Working Definition of Trauma and Principles and Guidance for a Trauma-Informed Approach (http://www.samhsa.gov/traumajustice/traumadefinition/index.aspx)

Help on using this tool is available in our FAQ section (http://www.samhsa.gov/about/feedback.aspx) and you can contact SAMHSA at newmedia@samhsa.hhs.gov for more assistance

This forum will close on Friday, December 21st at midnight Eastern Time.

Tell us your views on the definition of and the guiding principles for a trauma-informed approach. What do you like about the definition, and what changes do you suggest?

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  1. A trauma-informed approach must include psychoeducation on the physiological components of trauma, as a way of normalizing people's response

    The physiology and neurology of trauma and post-trauma responses are easily understood if they're explained in everyday language. Gaining a basic understanding of these things can be liberating, empowering, de-stigmatizing, and a source of immense relief. This kind of information answers the question on everyone's mind -- "am I crazy?" -- with a resounding "no." This kind of understanding also helps people integrate their emotional and physical experiences, and provides a context for the very important work of modulating their stress responses and emotional reactions. This, in turn can bring about much higher levels of psychological safety, whether people are…

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    • Some thoughts on Part Two from a peer working on the Mental Health Transformation Grant.

      1. It makes sense to me that SAMHSA is using the two terms trauma-informed care and trauma-informed approach synonymously. The example of the criminal and juvenile justice sectors using trauma-informed approach may suit their organizations better. While it may be ideal for there to be more "care" involved in corrections work, I think that issue is more complex than the scope of this paper.

      2. Many people who experience trauma do feel shame. And because our culture tends to shame trauma survivors, many people don't self-identify as trauma survivors. Also, I think there is a misconception in our culture that…

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      • Good Working definition, would adjust some key principles e.g. maybe #5, 7, 8 maybe captured in another principle.

        It is a good working definition. I don't fully agree with all of the the key principles in action at the sa realizing the widespread impact

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        • National Center on Domestic Violence, Trauma & Mental Health - comments on Part Two: A Trauma-Informed Approach

          The following comments are submitted by the National Center on Domestic Violence, Trauma & Mental Health. We are encouraged by SAMHSA’s ongoing work and interest in trauma and trauma-informed approaches, and we appreciate this opportunity to provide comment.

          Part Two: A Trauma-Informed Approach

          A trauma-informed approach includes avoiding retraumatizing those who seek assistance as well as ensuring that additional harm is not being done. Furthermore, facilitating participation and meaningful involvement of people receiving services and their families is also an important element of providing trauma-informed services. A trauma-informed approach also means actively supporting healing and well-being. We therefore suggest adding…

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          • Agenices helping inidividuials with trauma may intensify trauma,

            Some a agencies don't properly identify trauma then the aqppproaches may ggravate the trauma may causing the peron to relive truma or continue to not haver trrust or lose trust for people.I am further convinced that the Cognitive Behavioral appporaqch may not be the bes tapporach to trauma because it deals wwith behaviour rather than th cause and events of trakma and the continuingd the events of trauma and post traqumatic stree as well as not adress
            the trusat issues

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            • Key Trauma Informed Principles Applicable to Community Settings Also

              Add somewhere in the discussion of Part II:

              The key TI principles, particularly those that specific to an individual TI relationship, are aplicable to normative settings and relationships in the community -- and not just to care and service settings. Such normative settings and endeavors include parenting, the functioning of community teams and organizations, and the functioning of religious institutions, among others.

              3 votes
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              • Trauma Informed Approach is in the Eye of the Beholder

                Add at end of section on "What are the Key Principles of a Trauma-informed Approach?"

                A TI approach is concerned with the actual experience of the individual being served, not the intent of the professional or the rhetoric of the system. The fundamental issue involves whether or not the client, group of ndividuals in a milieu, or staff member experiences the support identified as comprising the key trauma-informed principles -- not what the professionals or administrators intend or claim. The individual served is the arbiter of whether or not a relationship or system is truly trauma-informed.

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                • Agree!

                  We fully agree with the proposed definition and commend SAMHSA for the comprehensive descriptions and explanations of the recommended approach in this section.

                  3 votes
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                  • Recommendations from The National Center on Family Homelessness on the guiding principles for a trauma-informed approach

                    •Principles not included in the current list that are critical for trauma survivors include: trauma-awareness (across organizations); consumer control; relationship-based; and integrated.
                    •The “change process” principle appears to be more of a guideline or practice related to making a commitment to change vs. a principle.

                    2 votes
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                    • Recommendations from The National Center on Family Homelessness on the definition of a trauma-informed approach

                      •The first “r”, “realizing the widespread impact of trauma” requires some clarification. It seems that this is about understanding the broader context of trauma and its’ impact in general.
                      •Including a general understanding of how to foster resilience and recovery as opposed to the more vague “potential paths for healing”, grounds the definition in trauma-related terms.
                      •Moving from realizing trauma in a broad sense, it seems that recognizing signs and symptoms should be further grounded to the particular system one is involved with vs. “the system” not clearly defined.
                      •The term “client” is not used in all settings. The term…

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                      • 2 votes
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                        • It seems more appropriate to use the language "trauma informed care" rather than "trauma informed approach".

                          It seems more appropriate to use the language ‘Trauma Informed Care’ instead of ‘Trauma Informed Approach.” Are these terms to be used interchangeably? Per the information that exists on the following link http://www.samhsa.gov/nctic/, the National Center for Trauma Informed Care (NCTIC) “seeks to change the paradigm from one that asks, "What's wrong with you?" to one that asks, "What has happened to you?" Is this the same paradigmatic shift that is being sought through the implementation of ‘Trauma Informed Approach?’ I am assuming so, but think it needs to be made clear whether or not Trauma Informed Approach and…

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                          • 2 votes
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                            • Feedback Received by NCTSI Evalaution on Trauma-informed Services Definition

                              For SAMHSA, the NCTSI evaluation team in FY 2006 and FY 2007 conducted key informant interviews and focus groups with 84 Network TIS-affiliated experts in the field of child trauma to evaluate SAMHSA’s definition of the Trauma Informed Services (TIS).
                              We recognize that the definition for trauma-informed services has been modified but we still think some of the comments made by the NCTSN experts are still relevant.
                              SAMHSA’s definition of Trauma-Informed Services in 2005:
                              Trauma-informed services are designed to 1) reduce the impact of trauma on children/adolescents through screenings, assessments, referrals, supportive services, outreach, crisis response; 2) train service providers…

                              2 votes
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                              • Solution based with strengths of a matrix of reactive and proactive.

                                Taking into consideration the whole person, place and event.

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                                • Trauma informed appraoches must be cross disciplinary

                                  Effective trauma informed approaches must be cross disciplinary. For example, juvenile justice, child welfare, mental health and other human servvice professionals should be working with a common set of language, resoureces and screening tools.

                                  5 votes
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                                  • Screening tools should be comprehensive and developmentally appropriate

                                    Tools to measure and screen for trauma should be comprehensivce, flexible and broad enough to capture a wide array of potentially traumatic expereinces and circumstances. Tools shouod also be developmentally specific as youth are exposed to, experience and manifest trauma in very different ways than adults.

                                    5 votes
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                                    • Scope of trauma informed approach needs to be expanded

                                      Although a trauma-informed approach is discussed in the context of what a program, agency, organization or community thinks abouts and responds to those who have experienced trauma, the focus of change seems to be limited to change in organizational culture and the people within an organization. While comprehensive organizational culture change that goes beyond those directly delivering services is essential, it is not sufficient to address a cross service systems response to trauma. Reference needs to be made to including public and private funders and public sector policymakers as key stakeholders who need an understanding of trauma and its effects.…

                                      6 votes
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                                      • The Psychophysiology of Trust, Rapport, and Attachment needs to be included in the framework.

                                        The Psychophysiology of Trust, Rapport, and Attachment needs to be included in the framework. Incorporate how the neurobiology of trust and arousal are intertwined and related to the psychophysiology of safety.

                                        6 votes
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                                        • Community Trauma: Include more examples regarding child ****** abuse

                                          Community trauma examples should include a child being medically examined improperly, questioned repeatedly, questioned by individuals who are not properly trained, etc. All of these actions in a community response to child ****** abuse can lead to further trauma formation.

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                                          (CLOSED) Definition of and the Guiding Principles for a Trauma-Informed Approach

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