Become a Trauma-Informed Community

Introductory Paragraph

Trauma is widespread and is an important component of understanding service delivery in behavioral health and substance use disorder. To become “Trauma Informed,” it’s necessary to first understand the root causes of trauma, such as Adverse Childhood Experiences, or ACEs. Then, it is possible to understand that trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation. This is the beginning of becoming a trauma-informed community. The next challenge is for a community to provide a trauma-informed service system.

Key Information

Root Causes of Trauma

Trauma is especially common in the lives of people with behavioral and/or substance use disorders. For this reason, the need to address trauma is increasingly viewed as a critical component of behavioral health care and part of the healing and recovery process. The American Psychological Association defines trauma “as an emotional response to a terrible event like an accident, rape or natural disaster. Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and has adverse effects on the individuals functioning and well-being. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives."

ACEs are potentially traumatic events that occur in childhood (0-17 years). The ACEs survey measures 10 types of childhood trauma; five are personal: physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect; five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma in the ACES survey counts as one. The higher the ACES score, the higher the risk of social and health issues -- including substance use disorder. Using the ACES survey as a foundation, communities can see how trauma can result from racism and discrimination, intergenerational poverty, lack of job opportunities, exposure to violence, substandard housing and education, and lack of access to key services. Some communities have developed expanded versions of the ACES survey to address issues specific to their region or city. For example, the city of Philadelphia’s Expanded ACE sub-scale has respondents answer six questions specific to experiences in their communities: witnessing violence, experiencing discrimination or food insecurity or racism, living in an unsafe neighborhood, being bullied, or living in foster care.

What Is a Trauma Informed Community? The Wilson Foundation of Rochester, NY describes the concept of trauma informed community as “...a strategic approach linking all community sectors together around the effects of trauma, while preventing gaps in services for clients. It is coordinated and collaborative; recognizes that the diversity of the population requires individual responses; uses a common language, measurements and accountability.” If a community works to identify the specific drivers of trauma in its own backyard, it can also identify the factors that influence substance use disorder, allowing them to create the appropriate community supports for behavioral health care, plus healing and recovery.

Trauma-Informed Systems. The National Child Traumatic Stress Network describes a trauma-informed service system as one where all agencies, programs, and service providers have a trauma-informed perspective, including the following:

• Routinely screen for trauma exposure and related symptoms.
• Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms.
• Make resources available to children, families, and providers on trauma exposure, its impact, and treatment.
• Engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma.
• Address parent and caregiver trauma and its impact on the family system.
• Emphasize continuity of care and collaboration across child-service systems.
• Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.

Child Welfare. Substance use disorders can affect parents’ ability to effectively care for their children, and is sometimes linked to rises in foster care placement and mistreatment cases. These parents are also a particularly vulnerable population. They benefit from a family-based approach to care which ensures that community services are tailored to children’s needs and are provided in tandem with those delivered to the whole family.

School Systems. For any community, schools may be the first resource for students coping with traumatic events. And it’s not just teachers in the classroom - it includes administrators, staff, and parents. The environment in a trauma-informed school supports all children to feel safe physically, socially, emotionally, and academically. When interviewed for a Washington State resource guide for creating trauma informed school settings, one teacher described the issue succinctly: a student who tries to focus on academics while struggling with trauma is like “trying to play chess in a hurricane."

Healthcare. Individuals who have experienced trauma are at an elevated risk for substance use disorders. A trauma-informed healthcare system understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize those seeking help.

Justice. In a law enforcement setting, a trauma-informed approach starts with the same premise: to understand the physical, social, and emotional impact of trauma on the individual involved in that system. It also requires the understanding that both police officers and other professionals may also be traumatized by a particular event or long-term history of or exposure to violence.

Ensuring Diversity in Trauma Informed Settings. It is vital that communities are inclusive in terms of both the populations affected by trauma and the functions of agencies that provides services, such as education, law enforcement, and the faith-based community.

Relevant Research

• Emerging research has documented the relationship among exposure to traumatic events, impaired neuro-development and immune system responses, and subsequent health risks resulting in chronic physical or behavioral health disorders. Research has also indicated that with appropriate supports and interventions, people can overcome traumatic experiences.

• A book by Gabor Maté, "In the Realm of Hungry Ghosts: Close Encounters with Addiction" and one co-written by Gabor Maté and his son, Daniel Maté, "The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture," blend research and personal history to reframe the relationships between trauma, addiction, and effective healthcare.

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Available Tools and Resources

SAFE Project:

• SAFE Veterans provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders.
• Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change. This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.
• "Lessons Learned: What are Adverse Childhood Experiences?" This SAFE Project article an overview on what ACEs are and how to use this knowledge to better care for someone who is experiencing or has experienced ACEs in their lifetime.
• See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse.

This ACEs Infographic provides a succinct method for communicating an overview of ACEs.

Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma. This report was published by the Prevention Institute and focuses on linking personal and community resiliency.

The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success. This report spans the needs of students and school staff and the responsibility of the community in fostering compassionate schools. It is a collaborative effort between staff in a public school, Western Washington University, and the Washington State Office of Superintendent of Public Instruction (OSPI) -- .

National Child Traumatic Stress Network Learning Center: Registering for this free online learning center provides access to several archived sessions of interest to education professionals. The Schools and Trauma Speaker Series has five archived sessions: (1) Trauma-informed IEPs (2) Evidence-based practices (3) Sudden death on a school campus (4) Trauma-informed understanding of bullying (5) School/mental health partnerships. More resources are also available.

PACEs Connection is a major resource for information exchange for local, state, and national ACEs initiatives. It also provides a Diversity, Equity & Inclusion Tool that helps communities organize their stakeholders and other contacts to make sure that every part of the community is included.

Trauma-Informed Care in Behavioral Health Services is a SAMHSA publication within its series of Treatment Improvement Protocols.

Trauma Informed Schools Resource Guide. This publication by the Wilson Foundation provides insight on how to relate increasing awareness of ACES to the film, "Paper Tigers, which documents the life of some students in one school year at a trauma-informed high school.

This documentary, "The Wisdom of Trauma," provides a video summary of many of the points brought forth in the work of Gabor Maté, discussed in the Relevant Research section of this article.

Promising Practices

Peace4Tarpon. Tarpon City, Florida, was the first city in the US to declare itself a trauma-informed community. Trauma-informed practices have been implemented in small and large ways in a variety of organizations, including an elementary school, an ex-offender re-entry program, and the local housing authority.

Compassionate Schools Program. This program in Washington State is an initiative that helps teachers to understand fundamental brain development and function and to correctly interpret behaviors, while engaging students, families, and the community. It simultaneously uses strategies that touch students daily -- through mindfulness activities in everyday teaching and learning, creating contracts with students for conflict resolution, and creating a culture that supports learning. The program resulted in dropping absenteeism rates, a decrease in disciplinary referrals, and improved engagement and achievement scores.