Trauma-informed care

A stance, not a technique1

There is no single model; frameworks share principles and skills that individuals and whole organizations can apply.

Safety first1

The opposite of danger is safety, and most or all models put providing safety at the centre.

Do no more harm1

Harris and Fallot stressed screening for trauma and not re-traumatizing people through how services are delivered.

At reception2

"A receptionist quietly speaks a patient's name, rather than screaming it across the waiting room."

In the exam room2

"An examination table offers privacy by facing away from the door."

Asking before touching2

Wearing gloves, a primary care provider asks the patient, "May I touch your arm?" before doing so.

Asking about history2

One practitioner frames trauma screening around resiliency and family history, using words such as "ancestors".

Letting the patient set the pace3

A GP describes "seeking just what the patient is willing to acknowledge they need help with… just moving one step at a time."

Taking the time it takes3

In one clinic a nurse met with a woman with a history of child sexual assault for six months, "just talking about Pap smears", before she was ready for the test.

Noticing a reaction3

A practitioner describes a patient starting to cry during a pelvic exam and stopping to ask, realising "there's something really off here".

Collaboration, not status3

A provider says they try to make the patient feel "I am at the same level as they are", keeping any status of power minimal.

The three E's1

Trauma is defined by the Event, how it was Experienced, and its Effects.

Six principles1

Safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; cultural, historical and gender issues.

Ten implementation domains1

From governance and policy to physical environment, screening, training, financing and evaluation.

Presence before content1

Badenoch's first principle is nonjudgmental, agendaless presence to build safety and co-regulation.

Pace and follow-up1

Attune to what clients say and leave out; extensive trauma talk without follow-up support can re-traumatize.

Within therapy models1

TIC principles appear in psychodynamic, attachment-informed, trauma-focused CBT, feminist and EMDR-based work.

Hard to measure1

Wathen and colleagues (2020) found no measure fully assessed TIC implementation, and unclear links between theory and measures.

Blurry terms1

The same review found "trauma-focused" and "trauma-informed" often conflated.