The Substance Abuse and Mental Health Services Administration

SAMHSA Stakeholder Feedback

(CLOSED) Suggested Guidelines for Implementing a Trauma-Informed Approach

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

Suggested Guidelines for Implementation of a Trauma-Informed Approach:

1. Governance and leadership: the leadership and governance bodies of the organization support and invest in implementing and sustaining a trauma-informed approach; there is an identified point of responsibility within the organization to lead and oversee this work.

2. Policy : there is a written policy establishing a trauma-informed approach as an important part of the organizational mission.

3. Engagement and involvement of people in recovery, trauma survivors, consumers, and family members in services : these groups have significant involvement, voice, and meaningful choice at all levels and in all areas of organizational functioning (e.g., program design, implementation, service delivery, quality assurance, cultural competence, access to peer support, workforce development, and evaluation.)

4. Cross sector collaboration : there is collaboration between adult and children’s services, prevention and treatment, different health and human service sectors, education, legal, child welfare, criminal justice, peer support and community-based organizations representing the diversity of populations served, and military and veterans systems.

5. Services and Interventions: all services and interventions, including screening and assessment, are based on the best available empirical evidence, are culturally appropriate, and reflect principles of a trauma-informed approach; a trusted and effective referral system is in place; and trauma-specific services/interventions are acceptable, effective, and available for individuals and families seeking services.

6.Training and workforce development: training on trauma and how to respond to it is available for all staff; a human resource system incorporates trauma-informed principles in hiring, supervision, staff evaluation; procedures are in place to support staff with trauma histories and/or those experiencing significant secondary traumatic stress from vicarious exposure to highly stressful material.

7. Organizational and community multiagency protocols: organizational procedures and community cross agency protocols reflect trauma-informed principles, including collaborations with other agencies.

8. Quality assurance: there is ongoing assessment, tracking, and monitoring of trauma-informed principles and effective use of evidence-based trauma specific interventions.

9. Financing: financing structures are designed to support a trauma-informed approach (e.g. staff training, appropriate facilities) and evidence-based trauma-specific services.

10. Evaluation: measures used to evaluate service or program effectiveness reflect an understanding of trauma.

11. Physical environment of the organization: investments should be made to ensure that the physical environment promotes a sense of safety.

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 suggested guidelines for implementation of a trauma-informed approach. What do you like about the definition, and what changes do you suggest?

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  1. Feedback from a Mental Health Transformation Grant Peer

    I am wondering if the Suggested Guidelines for Implementation of a Trauma-Informed Approach include peer support. I work in a community mental health agency where there are employed peers and this is very helpful for the people receiving services. In my state, peer counselors are accepted in our organizations and our co-workers value our lived experience. How will other organizations that want to become trauma-informed integrate this?

    In regards to #6, I think training on trauma-informed priciples be mandatory for all staff. This is important for every person in the organization. In my professional and personal life, the first person…

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      0 comments  ·  Flag idea as inappropriate…  ·  Admin →
    • 1 vote
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        1 comment  ·  Flag idea as inappropriate…  ·  Admin →
      • National Center on Domestic Violence, Trauma & Mental Health - comments on Part Three: Suggested Guidelines for Implementation

        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 Three: Suggested Guidelines for Implementation of a Trauma-informed Approach

        With regard to Paragraph 2, “Policy,” we note that it is important to not only have a policy stating the agency’s commitment to trauma-informed principles, but also to integrate a trauma-informed approach into all of the agency policies.

        With regard to Paragraph 5, “Services and interventions,” we recommend deleting the word “empirical”…

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          0 comments  ·  Flag idea as inappropriate…  ·  Admin →
        • What guidelines can you suggest that will help break the established professional culture that is resistant to TIC?

          I live in a state that is STRONGLY advocating trauma-informed protocols across all human services systems. We have poured hundreds of thousands of dollars into professional training for a couple years and the state government is proposing over a million dollars more for just the upcoming year. I can tell you that the facilities that have been the primary focus of this vast support and funding effort have not embraced TIC. If there are national-level trainers, performance evaluators, contract assessment reviewers or anyone else present that is "watching" the staff complies- demonstrating they know what to do and what it…

          5 votes
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            1 comment  ·  Flag idea as inappropriate…  ·  Admin →
          • SAMHSA and all government should understand that forced drugging and forced electroshock are the **** of the brain and traumatizing for life

            Any government website talking about trauma should not hide from the elephant in the room, VIOLENT atrocities in the form of forced psychiatry laws allow countless to be traumatized by government "mental health services".

            How can a government that is guilty of traumatizing innocent people and torturing them really claim to be having a serious conversion about trauma?

            More government lies, more government workers with their head in the sand.If SAMHSA cared about people who have had traumatic lives it would move to outlaw all forced psychiatry so as to ensure people no longer had to live in fear of…

            7 votes
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              1 comment  ·  Flag idea as inappropriate…  ·  Admin →
            • Poeple who suffer trauma wshouold be included int the treatment of trauma

              It is very important that people who have suffered trauma and post traumat ic stress nsot only be involved in the di9scussion of implementationof policies, services a nd community action but be active participaticiapants oin delevery of service s upports and policy malking as thoisewho have experexiened czn better understand and hlelp in suppoprting aand treating trauma and post traumtic stress

              2 votes
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                0 comments  ·  Flag idea as inappropriate…  ·  Admin →
              • Validate form the Individual that TI Principles are Being Followed

                An addition to #3 (Engagement and Involvement), at the end of the discussion of this point:

                In addition, there are ongoing efforts to determine and validate, from the target population, if each person is actually experiencing the origanization and relationships within it as being trauma informed, consistent with the identified key principles, on a day-to-day basis in relationships and decision-making.

                3 votes
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                  0 comments  ·  Flag idea as inappropriate…  ·  Admin →
                • Requirements for healthcare systems for identification and referrals to treatment

                  We fully support the proposed guidelines and propose adding either an additional guideline or a statement for healthcare systems (rather than organizations) that service systems across the country should be encouraged to promote early identification and treatment of trauma in medical settings. To the extent possible, healthcare systems should train their primary care physicians, hospital emergency room and urgent care personnel on trauma informed care and encourage referrals to mental health professionals as appropriate.

                  3 votes
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                    0 comments  ·  Flag idea as inappropriate…  ·  Admin →
                  • Recommendations from The National Center on Family Homelessness on suggested guidelines for implementing a trauma-informed approach

                    •The “Policy” domain can be expanded to include the practice of using knowledge of trauma and recovery to inform the creation and review of all policies and procedures.
                    • “Services and interventions” domain should include language around providing services and interventions in a flexible manner to ensure that trauma survivors receive supports that are tailored to individual needs.
                    •The “Training and workforce development” domain should include training on development and the needs of children and youth, in addition to adults. Traumatic experiences and impact should be placed in the context of development. Staff self-care should not only be a topic…

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                      0 comments  ·  Flag idea as inappropriate…  ·  Admin →
                    • The magnitude of implementation of a trauma-informed approach is not recognized.

                      The guidelines provide an excellent framework for beginning the assessment process for the development of an organizational change strategy to support a trauma informed approach. The key domains to be considered are very comprehensive and relevant. However, the focus is solely on assisting organizations to identify strengths and weakneses in order to provide milestones for measuring implementation progress. One key variable omitted is assessment of resources needed by an organization to do this. Domain # 9 references designing financing structures to support a trauma-informed approach which is absolutely critical. However, nowhere in the guidelines is there an acknowledgement that government…

                      4 votes
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                        0 comments  ·  Flag idea as inappropriate…  ·  Admin →
                      • Within #1, include concept of 'parallel process' as described by Bloom's sanctuary model, e.g., hurt people, hurt people.

                        A trauma-informed approach requires governing bodies to adequately assess the 'health' of the organization as a first step in TIC transformation. An organization that is crisis-driven, deficit-based, punitive in approach (to staff and clients), without adequate resources, maginalized by society, and led by people who have been promoted without appropriate leadership skills/competence has much work to prio, or in tandem with, staff training.

                        3 votes
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                          0 comments  ·  Flag idea as inappropriate…  ·  Admin →
                        • This is very broad and overwhelming for many organizations.

                          There need to be concrete examples and suggestions to assist those interested in adopting this approach.

                          4 votes
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                            1 comment  ·  Flag idea as inappropriate…  ·  Admin →
                          • The guidelines must include the training and understanding of existing cultural differences in order to better respond to individual needs.

                            It is important to understand that the conceptualization of “Trauma” and any treatments or principles are founded on cultural beliefs and general premises that may not relate across all cultural groups. A Trauma-Informed Care organization must acknowledge and be prepared to acknowledge the impact of trauma depending on the cultural context in which it happens and the responds to individuals or community impacted by threatening or traumatic events may differ based on their cultural beliefs. An organization who will effectively engage their consumers and their workforce must have an understanding of the cultural differences related to trauma. For example the…

                            2 votes
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                              1 comment  ·  Flag idea as inappropriate…  ·  Admin →
                            • The guidelines need to include normalizing trauma responses

                              Stress responses to trauma are well documented and can be seen as adaptive to the trauma. These reactions do not need to be medicalized and medicated. Early intervention with psychopharmacology truncates the natural healing response and causes chronicity.

                              One of these reactions is one of loss and grief that many times is expressed in anger. Allowing this expression is important in the healing process. Having a guideline that implements services that allow for the stages of healing is imperative. All human behavior does not need to be catagorized as a symptom.

                              2 votes
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                              • What is a safe environment? This needs elaboration

                                If a safe environment means having the reception staff and the nursing staff behind glass in a protedted station, a armed police officer or security guard in the wainting room, and cameras everywhere, then this place is not safe. This is the description of the average public mental health clinic in many communities.

                                What is considered a safe environment? Guidelines are required for this as people will interpret this in their own context, which unfortunately is becoming more forensic in natures even in community settings.

                                1 vote
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                                • 1 vote
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                                  • Just including peer support in itself is not a trauma informed approach, peer support training must be trauma informed.

                                    Too many view peer support as about telling a a story versus a relationship of learning and growing. Many think peer support is about "I help you" versus "we are here to help each other learn and grow". You can say mutuality, but until mutual help is widely accepted and understood- people will continue to be stifled in relationships and further traumatized by thier inability to connect to the community with real realationships based on mutuality.

                                    13 votes
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                                      0 comments  ·  Flag idea as inappropriate…  ·  Admin →
                                    • This approach means we ask, "what has happened to you" rather than "what's wrong with you?"

                                      Trauma informed approach is an approach to engaging people with histories of trauma that recognizes the presence of trauma and acknowledges the role that trauma has played in people's lives. One of the key components of builidng organizational capacity for trauma informed care is professional education and development. Staff need education on how traume affects people seeking services, what trauma-informed care is, how to create safe environments for person's served, and ways to aviod retraumatizing.

                                      3 votes
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                                      • EmotionalCPR is a trauma informed

                                        eCPR is a public health approach, can be learned by any member of the community to help others in community after trauma and therefore prevents crises and builds healthy communities

                                        12 votes
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                                        • Empowerment is a central factor in prevention and healing from trauma

                                          all services need give maximal control and choice to the consumer, be as voluntary as possible and present alternatives to involuntary treatment, such as peer-run respites

                                          6 votes
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                                          (CLOSED) Suggested Guidelines for Implementing a Trauma-Informed Approach

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