Archived 02/02/2017

The recently released Treatment Improvement Protocol (TIP) 57, Abstract colors in a jaded pattern with straight lines, with TIP 57 in large letters.Trauma-Informed Care in Behavioral Health Services (Trauma TIP), offers behavioral health service providers and program administrators information and practices to assist people who have experienced repeated, chronic, or multiple traumas. People who experience trauma are more likely to exhibit pronounced symptoms and consequences, including substance misuse, mental illness, and other health problems. For this reason, addressing trauma is a public health priority under the SAMHSA Trauma and Justice Strategic Initiative.

Trauma and “Trauma-Informed” Care

Trauma results from an event or a series of events that subsequently causes intense physical and psychological stress reactions. The individual’s functioning and emotional, physical, social, and spiritual health can be affected. Some of the most common traumatic experiences include violence, abuse, neglect, disaster, terrorism, and war. People of all ages, ethnic backgrounds, sexual orientations, and economic conditions may experience trauma. Trauma can affect a person’s functional ability – including interacting with others, performing at work, and sleeping – and contribute to responses – including isolation, anxiety, substance misuse, and overeating or under eating – that can increase health risks. Behavioral health service providers can benefit greatly from understanding the nature and impact of trauma and the benefits of a trauma-informed approach.

Adopting trauma-informed policies may require a fundamental cultural shift within organizations intended to promote a greater sense of equality and safety. This may lead to changes in governance and leadership; organizational policy; engagement and involvement of people in recovery, trauma survivors, consumers, and family members; cross-sector collaboration; services and interventions; training and workforce development; protocols and procedures; quality assurance; budgeting and financing; evaluation; and the physical environment of the organization.

Trauma TIP Recommendations

The Trauma TIP provides evidence-based and best practice information for behavioral health professionals working with people who have been exposed to acute and chronic traumas and/or are at risk of developing detrimental reactions to traumatic experiences. Using key trauma-informed principles, this TIP addresses trauma-related prevention, intervention, and treatment issues and strategies in behavioral health services (services that focus on the prevention and treatment of substance use and mental illness). The content can be adapted across behavioral health settings that serve individuals, families, and communities – underscoring the importance of coordinating and integrating services.

The Trauma TIP endorses a trauma-informed care (TIC) model. This model emphasizes the need for behavioral health practitioners and organizations to recognize the prevalence of trauma and its pervasive impact on the lives of the people they serve and to develop trauma-sensitive or trauma-responsive services. It provides key information to help behavioral health practitioners and program administrators become trauma aware and trauma informed, improve screening and assessment processes, and use science-informed intervention strategies across settings. Trauma-informed services may include trauma-specific services and may involve trauma specialists (individuals with advanced training and education to provide specific treatment interventions to address traumatic stress reactions). TIC anticipates the role that trauma can play across the continuum of care-actively establishing integrated and/or collaborative processes to address the needs of traumatized individuals and communities.

Trauma TIP Concepts

Main concepts from the Trauma TIP include:

  • Becoming trauma aware and knowledgeable about the impact and consequences of traumatic experiences for individuals, families, and communities.
  • Evaluating and initiating use of appropriate trauma-related screening and assessment tools.
  • Approaching interventions from a collaborative strengths-based approach that acknowledges the resilience of trauma survivors.
  • Learning the core principles and practices that reflect TIC.
  • Anticipating the need for specific trauma-informed treatment planning strategies that support the individual’s recovery.
  • Decreasing the inadvertent retraumatization that can occur from using standard organizational policies, procedures, and interventions with individuals, including clients and staff members, who have experienced trauma or are exposed to secondary trauma.
  • Building a trauma-informed organization by incorporating specific strategies across each level of the organization, including universal screening and assessment procedures for trauma; interagency and intra-agency collaboration to secure trauma-specific services as appropriate; referral agreements and networks to match clients’ needs; mission and value statements endorsing the importance of trauma recognition; consumer- and community-supported committees and trauma response teams; and program policies and procedures that ensure trauma recognition and secure trauma-informed practices, trauma-specific services, and prevention of retraumatization.
  • Building a trauma-informed workforce that includes in-depth training to enhance understanding of the impact of trauma on individuals and among providers (i.e., secondary traumatization); screening, assessment, and referral processes; and other trauma-specific counselor competencies and ethics.

“It’s hard to believe that when I worked in mental health crisis centers we rarely inquired about trauma,” said Larke N. Huang, Ph.D., Director of SAMHSA’s Office of Behavioral Health Equity and SAMHSA’s lead for the Strategic Initiative on Trauma and Justice. “Now we better understand the centrality of trauma in behavioral health conditions. We recognize the need for a workforce trained in trauma-specific interventions that can be offered in settings that are grounded in a trauma-informed approach and guided by the voices of people with lived experiences of trauma. ”

References

Hopper, E. K., Bassuk, E. L., and Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3, 80-100.

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