Trauma Informed Care Principles: Facility Guide and FAQ

Every patient has a story. Although your healthcare facility can prepare for the illness or injuries that brought them through your doors, it’s impossible to predict the life experiences that shaped them. A trauma-informed approach to care allows healthcare providers and staff to see an individual for their holistic needs. Their health condition doesn’t define them, but knowing their story helps.

But how can adopting trauma-informed care principles at your facility improve patient outcomes? In this guide, we answer these and other questions and provide useful tips for implementing trauma-based policies and procedures into practice at your facility.

What Are Trauma-Informed Care Principles?

Trauma-informed care (TIC) is an approach to healthcare that considers patients’ past or present trauma as part of their whole-person needs. It takes into consideration how a person’s life experiences affect their health and the way they engage in care. Integrating this approach in a healthcare facility allows providers and staff to create a safe and healing environment for patients.

Having a trauma-informed care model allows healthcare facilities to:

• Appreciate the impact of trauma and the path to recovery.
• Spot the signs and symptoms of trauma in patients, families, and staff.
• Incorporate trauma-informed policies and procedures into practice.
• Prevent retraumatization.

It’s important to note that trauma awareness is just as important for improving patient outcomes as it is for staff wellness. While it informs interpersonal interactions between staff and patients, it also considers the experiences of staff and providers, who may experience trauma from the nature of their work or in their personal lives.

Recognizing trauma in staff is an important way for healthcare leaders to support bedside nurses by investing in their mental well-being. Doing so allows nurses to be more engaged in their work and provide better patient care.

By paying closer attention to nursing departments with high rates of PTSD, such as the intensive care unit, healthcare administrators can integrate knowledge about trauma to address caregiver strain. Nurses in the ICU consistently have higher rates of PTSD than those in other hospital departments due to working conditions such as higher numbers of adverse events, moral dilemmas, and adrenaline rushes.

Why Is Trauma-Informed Care Important?

Understanding trauma is essential to developing a successful trauma-informed care approach at your facility. The American Psychological Association (APA) defines trauma as “any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning.”

Individuals may experience trauma at any time in their life. Examples may include, but are not limited to:

• Natural disasters
• Sexual assault or violence
• Physical injury or illness
• Poverty and systematic discrimination
• Adverse childhood experiences (ACEs) such as abuse, neglect, or witnessing domestic violence as a child

Research from the U.S. Department of Veterans Affairs suggests everyone may experience trauma at some point in their lives. Shocking and dangerous situations may cause post-traumatic stress disorder (PTSD), which affects about 6% of the U.S. population.

Trauma-informed care asks the question, “What happened to you?” instead of, “What’s wrong with you?” Even if a patient isn’t diagnosed with PTSD, it’s safe to assume they’ve experienced trauma and could benefit from a thoughtful, targeted approach during interpersonal interactions. It considers how the effects of trauma impact a patient’s everyday life, inside and outside of a healthcare setting.

A trauma-informed approach to care should be implemented organization-wide, rather than being exclusive to one department. For example, integrating TIC in the emergency department may be as beneficial as applying it to pediatric units. A hospital serving a pediatric population can implement strategies like child life therapy for patients at risk of developing trauma from being hospitalized as a child, such as those with chronic illnesses.

The 6 Trauma-Informed Care Principles

The Center for Health Care Strategies (CHCS) established the Trauma-Informed Care Information Resource Center as a resource guide for facilities interested in implementing the framework. It recognizes the trauma-informed care principles established by the Substance Abuse and Mental Health Services Administration (SAMHSA). The six guiding principles of trauma-informed care are outlined and defined in the table below.

Many healthcare facilities are already implementing similar approaches to care in daily practice. Staff may wonder how trauma-informed care principles improve patient outcomes. These principles allow healthcare providers and other non-clinical staff to recognize the signs of trauma to minimize retraumatization and promote recovery.

How to Apply a Trauma-Informed Care Model at Your Facility

When applying a new framework at a healthcare organization, it’s crucial to follow a formal implementation plan. Within each phase, set goals to monitor progress and make changes along the way. In the sections below, you’ll get a chance to explore what is meant by trauma-informed care at each phase of program implementation. Check with your state’s department of health or mental health to find out which resources are available to support trauma-informed care training and implementation.

To get started, consider SAMHSA’s recommendations for the domains of implementation of a trauma-informed approach, which include:

• Governance and leadership
• Training and workforce development
• Cross-sector collaboration
• Financing
• Physical environment
• Engagement and involvement
• Screening, assessment, and treatment services
• Progress monitoring and quality assurance
• Policy
• Evaluation

So, what do trauma-informed care principles look like in practice? What can it look like at your facility? Here are some tangible steps that facility leaders can take to start infusing trauma-informed care into their workplace:

• Improving lighting in parking garages and walking paths to create a safer environment
• Delivering training about conflict resolution and compassionate communication to patient-facing staff, including ancillary staff and security guards
• Over-communicating online by anticipating patient questions, such as what to expect at an appointment, or sending scheduling reminders
• Employing nurse navigators at an oncology practice to guide patients with a new cancer diagnosis through the path to remission
• Educating caregivers at a long-term care facility that serves a high volume of war veterans about the impact of PTSD on geriatric behavioral health

Taking these actions shows how basic changes could go a long way to support patients and staff members who have undergone past trauma. But building a broader care system informed by TIC principles takes a more organizational approach which can be broken down into the following three phases.

Implementing a TIC Model: 3 Key Phases

Now that we’ve gone over the importance of creating an implementation plan, you’re likely looking for more detail on how to carry out each phase. We’ll outline the three key phases of implementing a TIC model and provide examples of what to consider during each phase below.

1. Planning Phase

To successfully implement trauma-informed care principles, facility leaders must first recognize how trauma might present at their facility. This helps you set measurable goals during the planning phase as you determine the desired outcomes. Start by gathering a baseline assessment of how your organization currently approaches trauma. You can collect data for key performance indicators using patient and staff surveys, incident reports, and objective clinical outcomes. Consider factors affecting patients, families, and staff, such as:

Population health. What are the common diseases or conditions affecting your community and how do they affect patients and their families? For example, a comprehensive stroke center may offer support groups for stroke survivors with life-changing conditions.

Secondary trauma. Healthcare providers and caregivers are susceptible to secondary traumatic stress disorder, also called compassion fatigue. It’s a reaction to working with individuals who’ve been traumatized and mirrors the symptoms of PTSD. Awareness of this risk is especially important in high-stress settings like a Level 1 trauma center — a successful TIC program teaches staff to recognize trauma in each other in addition to patients.

2. Implementation Phase

Once the program goals are set, facilities can implement the framework by following CHCS’s trauma-informed care intervention components. Take a look at these trauma-informed care examples for the recommended steps.

Staff training. Organization-wide staff trauma-informed care training should include clinical and non-clinical staff. This allows everyone to speak the same language and customize their interactions with a trauma-informed approach. It strengthens staff members’ ability to respond to patients with empathy, especially during outbursts or unexpected reactions.

Example: A patient curses out the unit secretary, stating they asked for ice chips and nobody brought them. The secretary calmly diffuses the situation by validating their concerns and reflecting on their traumatic experience instead of taking the situation personally.

Workforce wellness. Facilities should incorporate strategies to promote staff wellness to prevent secondary trauma and burnout. Examples include encouraging breaks, deep breathing exercises, and open dialogue between staff. For this to work, though, healthcare leaders should provide staff with adequate support and manageable workloads.

Example: A long-term acute care facility promotes workforce wellness by adding an additional nurse to the staffing grid to cover breaks. This ensures nurses get 30 minutes of uninterrupted rest on each shift.

Change in the environment. For trauma-informed care principles to work at your facility, change must begin at the organizational level. This starts with healthcare administrators who set the tone for company culture and values. Is a toxic workplace a result of your leadership style? Consider what culture changes need to shift as you work toward a goal of delivering holistic, person-centered care.

Example: During the planning phase of TIC program implementation, a healthcare facility incorporates shared governance. This allows nursing staff to participate in clinical practice decision-making and feel valued within the organization. During the implementation phase, the facility creates a patient advisory board made up of past and current patients or families with a vested interest in improving the patient experience at the facility.

3. Evaluation

During the evaluation phase of the program implementation, follow up on the measurable goals you set. Trauma can be difficult to measure objectively — and change doesn’t happen overnight. Your facility may need to take a long-term approach to this type of change. Ask yourself, What are your trauma-informed care principles seeking to improve? Potential goals may include:

• Improved patient satisfaction scores.
• Reduction of readmissions.
• Improved adherence to treatment guidelines.
• Reduced numbers of reported ACEs at facilities incorporating TIC in pediatric populations.

To gather evaluation data, facility leaders can conduct follow-up surveys related to those sent out during the implementation phase. If your facility has the resources, consider publishing and sharing the results both internally and externally. This can help other healthcare facilities figure out how to incorporate trauma-informed care principles for continuous quality improvement.

Learn More Ways to Elevate the Care Your Facility Provides

What are trauma-informed care principles able to do for your facility? By providing high-quality, holistic, and more focused care you’ll forge stronger patient-provider relationships and generate better patient outcomes. Find more ways to improve care at your facility with the latest evidence-based insights and resources from the field.