Trauma Informed Care – A Collaborative Approach

What is Trauma Informed Care (TIC)?

Trauma Informed Care seeks to incorporate existing, evidence-based knowledge of trauma into all aspects of treatment in order to offer sensitive care and minimize re-victimization. Trauma’s effects can be pervasive and touch on multiple domains in one’s life. The effects run deep and are often self-perpetuating—trauma leads to more trauma or improper coping mechanisms, which compound the pre-existent trauma. Trauma affects the way people seek help and what kind of help they will seek.

Trauma Informed Care Principles

Trauma Informed Care is based on several key principles:

(1) Self-Direction – clients lead, control, and exercise choice over their path to recovery.

(2) Individualized and Person-Centered – there are multiple paths to recovery based on the individual.

(3) Empowerment – clients have the right to choice and participation in decisions that affect their lives and should be educated and supported in this empowerment.

(4) Holistic – recovery encompasses mind, body, spirit, and community.

(5) Non-Linear – recovery is a process of growth, some set-backs, and learning from experience.

(6) Strengths-Based – recovery relies on building strengths and coping abilities, as well as recognition of the inherent worth of individuals.

(7) Peer Support – sharing knowledge, experience, and skills to expedite recovery through mutual support.

(8) Respect – acceptance at many levels—communal, familial, social, and self—are essential to full participation in the various aspects of life.

(9) Responsibility – individuals are to take charge of their own recovery and identify coping strategies to promote their own wellbeing.

(10) Hope – essential to overcoming barriers that one will face in trauma recovery, and should be fostered at every level of the recovery process, whether in therapy, amongst peers, or amongst family. [1]

The History of TIC

William Steele began to approach Posttraumatic Stress Disorders (PTSD) in children in 1990, before they were ever included within the PTSD diagnostic category. Over the years, TIC has undergone extensive field-testing and evidence-based research to locate and integrate new knowledge into trauma informed approaches. Concurrently in the 1990s, greater attention was paid to women’s issues and gender specific treatment for those affected by trauma and violence.

In 1998 the National Association of State Mental Health Program (NASMHP) directors issued a Position Statement on Services and Supports to Trauma Survivors. That same year, the Adverse Childhood Experience Study was published. In 2001 the National Child Traumatic Stress Network was created ( In 2002, NASMHP launched an initiative to track best practices in trauma care. The following year the National Trauma Consortium organized in order to track best practices, and share data and knowledge around the impact of trauma. In the 2000s, numerous national conferences were held, as the field grew extensively. [2]

Uses and Effectiveness

In a study of 9,282 Americans aged 18 to 54, 60% of men and 51% of women in the United States had experienced at least one traumatic event in their lives, while 17% of men and 13% of women had experienced three or more such events (Kessler, Sonnega, Bromet, Hughes, & Nelson). [3] In light of the number of people touched by trauma, an approach that offers attentiveness to the kinds of challenges related to trauma is absolutely necessary. [4]

What has occurred in the past twenty-five years in trauma-related care is nothing short of monumental. Instead of asking a question of the form, “what’s wrong with you,” therapists have started asking, “what’s happened to you?” The whole approach of TIC is broad and reaches all levels of a client’s experience with therapists.

Data and testing inform Trauma Informed Care and make it consistently adaptive to new research. The national organizations, conferences, and networks providing care for those with trauma further enhance the success of TIC.

Applications for Teens and Families

Trauma Informed Care is especially important for teens and families as a collaborative approach can used to identify areas in which teens may be at risk for substance use or dependency, family dysfunction and re-traumatization. The team can then work on building skills, more effective styles of communication and resiliency both within the teen and within the family.

At The Center for Success and Independence, trauma is worked through in a multitude of ways, with integrated modalities including Cognitive Behavioral Therapy, Trauma-Focused Cognitive Behavioral Therapy and Dialectical Behavior Therapy. Through psychoeducation, teens are educated on what constitutes as trauma, the different types of trauma and abuse, as well as different styles of abuse and grooming techniques, in order to bring more awareness of triggering situations. Teens are also educated on the symptoms of trauma, adaptive coping skills for distress tolerance and emotion regulation, as well as consequences and risks of using maladaptive coping mechanisms. Teens are also encouraged to write out their trauma narratives and share them within a group setting, allowing for a shared learning experience and normalization so they know they are not alone.

Often, family members or caregivers are unaware of how trauma can affect a family system or even some of the traumatic experiences their teen has endured. Teens are encouraged to share their trauma narratives with their caregivers in family therapy to allow for systemic healing.

[1] Fallot and Harris, 2009; / programs / samh / mentalhealth/ training/ ba/ Trauma%20Web%20Event/ Informed/ Trauma_Informed_care.pdf

[2] programs/ samh/ mentalhealth/ training/ ba/ Trauma%20Web%20Event/ Informed/ Trauma_Informed_care.pdf

[3] archive/ exc_012014.shtml

[4] William Steele, “Trauma Informed Care: A History of Helping: A History of Excellence Lessons Learned Since 1990,” The National Institute for Trauma and Loss in Children, July 2009.

Steele, Raider & Kuban, 2009; Steele, Raider, Delillo, Jacobs & Kuban, 2008

Steele, W., Kuban, C. and Raider, M. (2009). Connections, Continuity, Dignity, Opportunities Model: Follow-up of Children Who Completed the I Feel Better Now! Trauma Intervention Program. School Social Work Journal. 33:2, 98-111.

Steele, W., Raider, M., Delillo, M., Jacobs, J. and Kuban, C. (2008). Structured Sensory Therapy (SITCAP-ART) For Traumatized Adjudicated Adolescents in Residential Treatment. Residential Treatment for Children and Youth. 25:2, 1-17.