Trauma-Informed Care Principles and Practices

Core Definition and Framework

The American Academy of Pediatrics defines trauma-informed care as medical care in which all parties assess, recognize, and respond to the effects of traumatic stress on children, caregivers, and healthcare providers 1, 2, 3
Trauma-informed care is a public health approach involving specific beliefs and practices centered on safety, trust, and empowerment that are intended to prevent and mitigate the impact of trauma 4, 5, 6, 7, 8

A trauma-informed approach requires provision of five essential elements in every interaction: safety, trustworthiness, choice, collaboration, and empowerment 4, 5, 6, 7, 8
Creating both physical and emotional environments characterized by compassion, cultural humility, equity, and collaboration is essential for safety 9
Providing options whenever possible to restore a sense of control is an example of choice 10
Involving patients and families as key decision-makers is an example of collaboration 9, 10

Monitoring one's own response when difficult situations arise and resisting the urge to be angry or retaliate is crucial in trauma-informed care 10
Focusing on the emotion rather than the behavior is an effective way to communicate with patients 10
Creating warm, welcoming environments with clear communication of expectations and procedures is essential for patient comfort 10
Empowering all staff members to emphasize safety and patient self-efficacy is vital in trauma-informed care 10

Nearly half of American children (34 million under age 18) have faced at least one potentially traumatic early childhood experience 2, 3
Trauma exposure can have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the lifespan 2, 3

Failing to address secondary traumatic stress in healthcare providers who hear about firsthand trauma experiences of patients can have negative consequences 1, 2, 3
The American Academy of Pediatrics recognizes the importance of addressing secondary traumatic stress in healthcare providers 1

The American Academy of Child and Adolescent Psychiatry recognizes trauma-informed care as a public health approach involving specific beliefs and practices centered on safety, trust, and empowerment to prevent and mitigate the impact of trauma at individual, organizational, and systems levels 11

The American Academy of Child and Adolescent Psychiatry recommends building relationships through transparency and consistency in all interactions to establish trustworthiness in trauma-informed care 11
The American Academy of Child and Adolescent Psychiatry suggests that additional critical elements of trauma-informed care include cultural, linguistic, and gender competence, and the availability of peer support 11

The American Academy of Child and Adolescent Psychiatry states that understanding symptoms and manifestations of trauma exposure and the possible connection between past trauma and current behaviors is essential in trauma-informed care 11
The American Academy of Child and Adolescent Psychiatry notes that youth involved in systems of care have disproportionately high rates of trauma exposure and greater impairments at baseline compared to youth without such history 11

The American Academy of Child and Adolescent Psychiatry emphasizes that trauma-informed care requires ongoing efforts at the organizational level to avoid retraumatization and promote recovery 11
The American Academy of Child and Adolescent Psychiatry recognizes that both individuals and those working with them benefit from understanding the symptoms and manifestations of trauma exposure 11

The American Academy of Child and Adolescent Psychiatry distinguishes trauma-informed care from trauma-specific services, with the latter including intensive clinical interventions such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Child Parent Psychotherapy (CPP) 11, 12