What is Trauma-Informed Care?

Note: This article discusses serious topics pertaining to trauma.

Although some psychological wounds heal into scars on their own, others require careful tending. Each individual’s needs and challenges are different, and a trauma-informed perspective considers that during all interactions.

You’ve likely heard about post-traumatic stress disorder (PTSD). But many people who don’t meet the clinical criteria of a PTSD diagnosis have experienced trauma and its effects, too. The National Center for PTSD reported that 6% of the general population will be diagnosed with PTSD in their lifetime. But around 70% of adults in the U.S. have experienced at least one traumatic event, according to The National Council for Behavioral Health (PDF source).

Despite this prevalence of trauma, there can be a lack of understanding of its impact. Learning more is the first step toward making a difference.

Trauma-informed care (TIC) is an approach based on a foundation of knowledge about trauma and the paths to treatment, a response based on that knowledge and a desire to avoid re-traumatization, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). With the proper training and support, SAMHSA noted, organizations and professionals can implement this approach to foster an environment of inclusivity and psychological safety (SAMHSA PDF source).

What is Trauma?

As a counselor and faculty member of the master’s in clinical mental health counseling program at Southern New Hampshire University (SNHU), Dr. Matt Glowiak has over a decade of experience working with clients who have experienced trauma.

Glowiak gained a deeper understanding of this subject in his first full-time clinical counseling role at a methadone clinic. He observed that many patients who progressed to a heroin addiction had experienced significant trauma in their lifetime. Later, he co-founded a group counseling practice and continues to use his understanding of trauma and mental health to treat clients.

According to Glowiak, trauma refers to an overwhelming experience or event that exceeds one’s ability to cope, often resulting in intense fear, helplessness or horror. He said trauma can be caused by a single incident, like an accident or assault, or it can result from ongoing experiences, such as abuse or neglect.

“In defining trauma, it is important to note that all individuals perceive and respond to the world differently in accordance with their genetic predisposition, environmental influences, lived experiences and otherwise,” Glowiak said.

He said a key to understanding trauma is realizing it isn't the stressor that defines trauma but a person's interpretation of and reaction to the stressor. That means experiences that might not significantly affect you could still be a source of trauma for someone else.

Although trauma can result from various circumstances, PTSD rates are higher for specific traumatic experiences. For example, The National Council for Behavior Health noted that 90% of children who experience sexual abuse and 77% of children exposed to a school shooting will develop PTSD.

Some people overcome trauma and continue their lives, but many others struggle with diverse symptoms in the aftermath of a traumatic event.

What are the Effects of Trauma?

Trauma can profoundly impact survivors’ physical, emotional and behavioral health, but these effects aren’t always apparent to outsiders.

“People should understand that a history of trauma manifests in varying ways, and it is not often possible to identify a survivor of neglect, abuse, violence or other traumatic events,” said Dr. Jackie Bodea, a psychiatric nurse practitioner and clinical faculty member of graduate nursing programs at SNHU. She’s also a Certified Nurse Educator, Doctor of Nursing Practice and a recipient of Frontier Nursing University’s Circle of Caring Award.

“Regardless of a person’s history — known or unknown — all people should be treated with dignity, respect and a love we should have for all humans,” she said. “We should respect boundaries and privacy, be compassionate and care for others as we would like others to care for us.”

With this in mind, Glowiak noted several symptoms and effects of trauma:

Behavioral effects: According to Glowiak, behavioral changes are common. He said these can include isolation, changes in appetite and sleep difficulties. "Given the vulnerable state that many individuals suffering trauma find themselves in, high rates of substance abuse, suicidality and otherwise high-risk behavior may be common," he said.

Cognitive effects: Memory, attention, concentration, and decision-making abilities may be impacted, too, Glowiak noted. “Individuals may experience difficulties with problem-solving and have negative beliefs about themselves or the world,” he said. “Hypervigilance or paranoia are common here as well.”

Emotional distress: Glowiak reported heightened emotional sensitivity as another symptom. “Trauma can lead to intense emotions such as fear, sadness, anger, guilt or shame,” he said. “Emotional dysregulation and mood swings are also common.”

Flashbacks and triggers: Trauma survivors may experience intrusive memories, nightmares or flashbacks that make them feel as if they are reliving the traumatic event, Glowiak said. He noted that these aren't typical memories or recollections. 

"The experience is so intrusive that people truly feel as though they are reliving the experience and may do so among any or all the five senses,” he said. “Certain triggers, such as sights, sounds or situations resembling the trauma, can evoke intense emotional or physical reactions."

Many people who are aware of their triggers will go through great lengths to avoid them, Glowiak said. While experiencing these flashbacks or intrusive memories, a survivor’s trauma response may be activated. This is often referred to as “fight or flight,” but other reactions can include freeze, fawn and flop, according to Medical News Today.

Physical symptoms: Trauma can also manifest in physical symptoms like fatigue, headaches, gastrointestinal problems, sleep disturbances and increased vulnerability to illnesses, according to Glowiak.

“Given that individuals may find themselves more regularly in a state of fight, flight or freeze than others, the consistent release of cortisol may compromise one’s immune system — leading to them becoming sicker quicker and staying that way for an extended duration or perhaps permanently,” he said.

Relationship and social challenges: Glowiak also said trauma can impact one’s ability to form and maintain healthy relationships. “Survivors may have difficulties with trust, intimacy, and may isolate themselves from others,” he said. “They might also experience a sense of detachment or estrangement from the world.”

Other risk factors: In addition to these impacts, those who have experienced trauma are more likely to develop certain illnesses. The National Council for Behavioral Health noted a direct link between trauma and several health conditions, including:

• Cancer
• Diabetes
• Heart disease
• High blood pressure

Those who have experienced trauma are also at a greater risk for homelessness. Psychiatric Times noted more than 80% of unhoused individuals report experiencing a life-altering trauma in their lifetime, and, according to Psychology Today, a PTSD diagnosis can predict a reduced lifespan.

Although trauma can cause various adverse effects, healing is possible, and many trauma survivors go on to lead full and productive lives.

What is the Meaning of a Trauma-Informed Approach?

TIC or a trauma-informed approach changes the question “What’s wrong with you?” to “What happened to you?” according to the Trauma-Informed Care Implementation Resource Center.

From a mental health perspective, Glowiak said it's "an approach that recognizes the widespread impact of trauma on individuals’ mental well-being."

He noted that a TIC approach involves creating an environment that is sensitive to trauma survivors while promoting safety, trust and empowerment.

According to Glowiak, trauma-informed providers “prioritize understanding the potential effects of trauma, such as triggers and re-traumatization, and seek to avoid further harm.” He said that they emphasize collaboration, choice and autonomy while aiming to support healing, resilience and recovery.

“There is a common saying that in therapy, counselors meet their clients where their clients are at. In this respect, treatment is highly individualized and comprehensive,” said Glowiak. “Whatever the trauma experienced, providers are continually adapting to how the client expresses it.”

According to SAMHSA, a TIC approach is grounded by four assumptions and six key principles.

What are the Four Rs or Assumptions of Trauma-Informed Care?

In 2014, SAMHSA published its Concept of Trauma and Guidance for a Trauma-Informed Approach (SAMHSA 2014 PDF source). Here, SAMHSA noted the concept of the four R's. In 2023, SAMHSA’s Practical Guide for Implementing a Trauma-Informed Approach referred to these same concepts as the assumptions of a trauma-informed approach.

According to SAMHSA, these four Rs or four assumptions are:

1. Realize: First, realize the impact of trauma and the possible paths to recovery.
2. Recognize: Learn to recognize the signs, symptoms and effects of trauma.
3. Respond: For medical professionals and mental health providers, responding means implementing a treatment plan. For nonclinical TIC practitioners, it means helping survivors find professional care.
4. Resist re-traumatization: Strive to avoid re-traumatizing a survivor whenever possible.

Each of these steps represents a journey toward implementing this approach, but the principles of TIC go a bit deeper.

What are the Principles of Trauma-Informed Care?

According to SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach, there are six fundamental principles to understand:

1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice and choice
6. Cultural, historical and gender issues

Echoing these principles, Glowiak said emphasizing the importance of creating safe and supportive environments is essential. "This involves understanding the principles of trauma sensitivity, recognizing potential triggers and fostering physical and emotional safety for individuals who have experienced trauma," he said.

What Else Should You Know About Trauma?

It's vital to learn as much as you can about the physical, emotional, psychological and social impacts of trauma and the different types of trauma if you intend to practice TIC, according to Glowiak. One type is childhood trauma or adverse childhood experiences (ACEs), which the Center for Disease Control (CDC) reported can have tremendous and lifelong impacts on health, behavior and opportunity (CDC PDF source).

Trauma-informed communication is another crucial aspect of TIC to learn and practice, Glowiak noted. "This includes active listening, empathy, non-judgment and understanding the power dynamics that can be present in trauma-related interactions," he said.

Glowiak also reiterated SAMHSA's sixth principle and the importance of understanding trauma's intersection with diversity. "Recognizing that trauma intersects with various aspects of identity, such as race, gender, culture and socioeconomic status, is critical," he said.

He noted some marginalized and oppressed populations experience more pervasive forms of trauma in the form of intergenerational or generational trauma, which is passed down from one generation to the next.

"Understanding the unique experiences and specific needs of diverse populations is essential to provide culturally sensitive and inclusive trauma-informed care," said Glowiak.

Resilience is another key concept to explore. "Resilience is the ability for one to bounce back to various stressors, big and small, consistent and not," Glowiak said. "Trauma-informed care focuses on building resilience and enhancing coping skills."

You should also realize that you can experience the impacts of trauma secondhand as a TIC practitioner. This is often referred to as vicarious or secondary trauma, according to Glowiak.

"Recognizing the potential impact of working with trauma survivors is crucial for professionals," he said. "Understanding the concepts of vicarious trauma, compassion fatigue and burnout is important to prioritize self-care and prevent the negative effects of secondary trauma."

Finally, it's vital to keep learning. "Continuous learning, self-reflection and staying informed about current research and practices are also important in maintaining a trauma-informed approach," said Glowiak.

Who Uses Trauma-Informed Care?

A holistic approach to trauma-informed care includes physical, mental and spiritual health, according to Bodea. As such, a TIC approach can allow caring professionals in various roles to better care for their clients or patients.

Mental Health Professionals: A thorough understanding of trauma is essential if you want to become a therapist or another type of mental health professional, like a psychologist or psychiatrist.

"Trauma-informed counselors develop personalized treatment plans that consider the unique needs and goals of each client," Glowiak said. "They collaborate with clients to empower them in their healing journey and offer choices and options for their therapeutic process."

Counselors carefully assess a client's history and related symptoms while providing care, according to Glowiak. "They use trauma-informed assessment tools and techniques to gather information while being sensitive to potential triggers or re-traumatization," he said.

Medical Professionals: According to Bodea, trauma-informed healthcare recognizes the vulnerability of traumatized individuals, families and communities.

If you want to become a nurse, she said you'll work collaboratively with other professions to help those who have suffered trauma achieve their optimal state of wellness. “Nurses should be constantly vigilant to cues about past or current trauma because individuals may not be forthcoming with the information, particularly if there is a lack of trust in the healthcare professional or system," said Bodea.

She noted that trauma-informed nursing care prioritizes patient safety first and foremost, which can include working to provide a safe place to live and work or basic necessities like food, clean water, transportation and utilities.

“Nurses can work with local, state, and federal policymakers to improve the existence of and access to social programs as well as safety and disaster preparedness initiatives in their communities," she said.

Bodea acknowledged that TIC is always relevant for medical professionals. “Just being in a healthcare setting may be re-traumatizing," she said. "The nurse works to establish trust, respect boundaries and privacy and empower patients."

Teachers and Childcare Workers: According to the National Education Association, educators can lessen the impact of traumatic experiences and help all children learn with the right professional training.

Glowiak agreed. He said teachers, school counselors and administrators can all adopt trauma-informed practices in schools.

Social Workers and Human Services Professionals: If you become a social worker or a human services professional, a TIC approach can help you foster caring relationships with clients and community members.

Both roles can benefit from a sensitive approach and a foundation of knowledge about how past experiences can affect people. In fact, SNHU’s human services degree offers a course, “Role and Impact of Trauma on Children and Families,” for its child and family services concentration.

"Learning to recognize the signs and symptoms of trauma is important for early identification and appropriate support," said Glowiak. "This includes understanding trauma-related disorders, such as post-traumatic stress disorder (PTSD), and being able to distinguish between trauma reactions and other mental health conditions."

Who Can Benefit From a Trauma-Informed Approach?

A TIC approach isn’t just for those in the caring professions. It can also be applied to a variety of other roles to build psychologically safe relationships. Here are just a few:

Community Leaders:  "Nonprofit organizations, community centers and advocacy groups can adopt trauma-informed practices to better serve individuals impacted by trauma," Glowiak said. "This involves creating safe spaces, offering trauma-informed programs and support groups, and training staff on recognizing and responding to trauma."

Managers and Supervisors: According to a Psychology Today article about workplace trauma, trauma-informed leadership can make a huge difference in the workplace. And that's not just reported by psychologists.

A 2023 article by Fast Company similarly described the importance of trauma-informed leadership from a business point of view. “Trauma will continue to shift norms and reshape work as we know it, and organizations that want to see sustained success into the future will need to implement trauma-informed leadership,” the article said.­­­­­

Police Officers: Police officers frequently encounter individuals who have experienced trauma. “By implementing trauma-informed approaches, they can improve their interactions, communication and de-escalation techniques to minimize potential re-traumatization and provide more compassionate support,” Glowiak said. He added that it would be particularly helpful for law enforcement and first responders to consider the impact of cultural and intergenerational trauma.

An article by Equal Justice USA noted trauma-informed policing is taking off in some precincts. According to the article, "The big picture goal is to help police identify and respond appropriately to trauma in their daily interactions with community members."

Writers and Communications Professionals: Writers and communications professionals can benefit from a trauma-informed perspective to provide a psychologically safe experience for readers who might be trauma survivors. According to The Journalist’s Resource, trauma-informed journalism leads to accurate reporting and can protect survivors from further harm or re-traumatization.

On the flip side, the Science Fiction & Fantasy Writers Association also emphasized the value of trauma-informed writing — even in speculative fiction. Whether you’re a novelist, a journalist or a PR specialist, this sensitive approach can help you write about difficult topics with care.

What Treatments and Resources are Available for Survivors?

"Gaining knowledge about evidence-based trauma-informed practices and interventions is essential," Glowiak said. "This can include trauma-focused therapies, mindfulness-based approaches, self-regulation techniques and other strategies that promote healing, resilience and empowerment."

There are several types of treatment options available to trauma survivors. According to The National Council for Behavioral Health, a few therapeutic options include:

• Cognitive behavioral therapy (CBT)
• Eye-movement rapid desensitization (EMDR) therapy
• Group therapy
• Talk therapy

"Unless properly trained and qualified, do not attempt practicing these approaches. Rather, use this knowledge toward referral or providing general support," said Glowiak.

Health insurance companies can help connect individuals with mental health professionals, and you can consult The Mayo Clinic’s tips on finding a mental health provider for additional advice on finding the right care. Psychology Today’s directory can also help you find local mental health providers.

If you or someone you know is struggling with the impact of trauma, consult a mental health provider or refer to the following resources. For all emergencies, dial 911.

• 988 Suicide and Crisis Lifeline — call or text: 988
• Substance Abuse and Mental Health Services Administration — call: +1 800.662.HELP (4357); text: 435748
• National Sexual Assault Hotline (RAINN) — call: 800.656.HOPE (4673); visit: online chat hotline
• The Trevor Project — call: +1 866.488.7386; text: 678.678

You can save those numbers and links to share if you encounter someone in crisis. And if you want to become a safe person for survivors, don’t stop here. Seek out more information and practice empathizing with those around you.

Mars Girolimon’ 21’ 23G is a staff writer at Southern New Hampshire University, where they earned their bachelor’s and master’s, both in English and creative writing. In addition to their work in higher education, Girolimon’s short fiction is published in the North American Review, So It Goes by The Kurt Vonnegut Museum & Library, X-R-A-Y and more. They’re currently writing their debut novel, which was Longlisted for The First Pages Prize. Connect with them on LinkedIn and X, formerly known as Twitter.