Implementing Trauma-Informed Care: Recommendations on the Process

  • Diane K. Yatchmenoff Portland State University
  • Stephanie A. Sundborg Portland State University
  • Mildred A. Davis Portland State University
Keywords: Trauma informed care, implementation, health and human services


The importance of trauma-informed care (TIC) is now recognized across most health and human service systems. Providers are calling for concrete examples of what TIC means in practice and how to create more trauma-informed organizations. However, much of the current understanding about implementation rests on principles and values rather than specific recommendations for action. This paper addresses this gap based on observations during the provision of technical assistance over the past decade in fields like mental health and addictions, juvenile justice, child welfare, healthcare, housing, and education. Focusing on the infrastructure for making change (the TIC workgroup), assessment and planning, and the early stages of implementation, the authors discuss barriers and challenges that are commonly encountered, strategies that have proven effective in addressing barriers, and specific action steps that can help sustain momentum for the longer term.

Author Biographies

Diane K. Yatchmenoff, Portland State University

Regional Research Institute for Human Services, School of Social Work

Adjunct Research Assistant Professor

Stephanie A. Sundborg, Portland State University
Regional Research Institute for Human Services, School of Social Work
Mildred A. Davis, Portland State University

Regional Research Institute for Human Services, School of Social Work

Associate Professor of Practice


ACE Interface. (2014). Laura Porter. Retrieved from
Armenakis, A. A., & Harris, S. G. (2009). Reflections: Our journey in organizational change and research. Journal of Change Management, 9, 127-142. doi:
Baker, C. N., Brown, S. M., Wilcox, P. D., Overstreet, S., & Arora, P. (2015). Development and psychometric evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) scale. School Mental Health, 8(1), 61-76. doi:
Berger, W., Coutinho, E. S. F., Figueira, I., Marques-Portella, C., Luz, M. P., Neylan, T. C., . . .Mendlowicz, M. V. (2012). Rescuers at risk: A systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology, 47(6), 1001-1011. doi:
Bloom, S. L. (2010). Organizational stress as a barrier to trauma-informed service delivery. In M. A. Becker & B. L. Levin (Eds.), A public health perspective of women’s mental health (pp. 295-311). Retrieved from doi:
Bloom, S. L. (2012). Trauma-organized systems. In C. R. Figley (Ed.), Encyclopedia of trauma (pp. 741-745). Retrieved from doi:
Bloom, S. L., & Farragher, B. (2011). Destroying sanctuary: The crisis in human service delivery systems. New York: Oxford University Press.
Burnes, B. (2011). Introduction: Why does change fail, and what can we do about it? Journal of Change Management, 11(4), 445-450. doi:
Choi, M. (2011). Employees' attitudes toward organizational change: A literature review. Human Resource Management, 50(4), 479-500. doi:
Clandinin, D. J., & Huber, J. (2010). Narrative inquiry. In B. McGaw, E. Baker, & P. P. Peterson (Eds.), International encyclopedia of education (3rd ed., pp. 436-441). New York, NY: Elsevier. doi:
Dube, S. R., Anda, R. F., Whitfield, C. L., Brown, D. W., Felitti, V. J., Dong, M., & Giles, W. H. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28(5), 430-438. doi:
Elliott, D. E., Bjelajac, P., Fallot, R. D. Markoff, L. S., & Reed, B. G. (2005). Trauma- informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461-477. doi:
Fallot, R. D., & Harris, M. (2006). Trauma-informed services: A self-assessment and planning protocol (Version 1.4). Washington, D.C: Community Connections. Retrieved from
Fallot, R. D. & Harris, M. (2009). Creating cultures of trauma-informed care (CCTIC): A self-assessment and planning protocol. Washington, DC: Community Connections. Retrieved from
Family Resources [famresmarketing]. (2013, June 12). Laura Porter - dealing with resistance to trauma informed care [Video file]. Retrieved from
Fowler, F. J., Jr. (2013). Survey research methods. Los Angeles, CA: Sage Publications.
Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67(2), 113-123. doi:
Guarino, K., Soares, P., Konnath, K., Clervil, R., & Bassuk, E. (2009). Trauma-informed organizational toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation. Retrieved from
Hall, D. J., (2016, May). What role did trauma-informed care play in alleged juvenile prison abuse? Retrieved from
Harris, M., & Fallot, R. D. (Eds). (2001). Using trauma theory to design service systems. San Francisco, CA: Jossey-Bass.
Hendricks, A., Conradi, L., & Wilson, C. (2011). Creating trauma-informed child welfare systems using a community assessment process. Child Welfare, 90(6), 187. Retrieved from
Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28(7), 679-692. doi:
Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(2), 80-100. doi:
Huang, M. C., Schwandt, M. L., Ramchandani, V. A., George, D. T., & Heilig, M. (2012). Impact of multiple types of childhood trauma exposure on risk of psychiatric comorbidity among alcoholic inpatients. Alcoholism, Clinical and Experimental Research, 36(6), 1099-1107. doi:
Hummer, V., & Dollard, N. (2010). Creating trauma-informed care environments: An organizational self-assessment (in Creating trauma-informed care environments curriculum). Tampa, FL: University of South Florida, The Department of Child & Family Studies within the College of Behavioral and Community Sciences. Retreived from
Institute for Health and Recovery. (2012). Developing trauma-informed organizations: A tool kit. Retrieved from
Institute for Healthcare Improvement. (2003). The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. Retrieved from
Jennings, A. (2004). Models for developing trauma-informed behavioral health systems and trauma-specific services. Alexandria, VA: National Association of State Mental Health Program Directors, National Technical Assistance Center for State Mental Health Planning. Retrieved from
Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., . . . & Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396-404. doi:
McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication II: Associations with persistence of DSM-IV disorders. Archives of General Psychiatry, 67(2), 124-132. doi:
Miller, N. A., & Najavits, L. M. (2012). Creating trauma-informed correctional care: A balance of goals and environment. European Journal of Psychotraumatology, 3, 1-8. doi:
Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. M. (2014). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56, 1213-1222. doi:
National Council for Behavioral Health. (2013). Trauma-informed care-top ten: A checklist for behavioral health organizations. Retrieved from
Oreg, S., Vakola, M., & Armenakis, A. (2011). Change recipients’ reactions to organizational change: A 60-year review of quantitative studies. The Journal of Applied Behavioral Science, 47(4), 461-524. doi:
Oregon Health Authority, Addictions and Mental Health Division. (2014). Trauma Informed Services (AMH-060-1607). Retrieved from
Patwardhan, A., & Spencer, C. H. (2012). Are patient surveys valuable as a service-improvement tool in health services? An overview. Journal Healthcare Leadership, 4, 33-46. doi:
Salazar, A. M., Keller, T. E., Gowen, L. K., & Courtney, M. E. (2013). Trauma exposure and PTSD among older adolescents in foster care. Social Psychiatry and Psychiatric Epidemiology, 48(4), 545-551. doi:
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014a). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from
SAMHSA. (2014b). Trauma-informed care in behavioral health services. Treatment improvement protocol (TIP) series 57 (HHS Publication No. SMA 13-4801). Rockville, MD: Author. Retrieved from
Trauma Informed Oregon. (2015). Standards of practice for trauma informed care. Retrieved from
Trauma Informed Oregon. (2016a). Roadmap to Trauma Informed Care. Retrieved from
Trauma Informed Oregon. (2016b) Trauma Informed Care Workgroup Meeting Guidelines. Retrieved from
U.S. Department of Health and Human Services, Office of Adolescent Health. (2015). A checklist for integrating a trauma-informed approach into teen pregnancy prevention programs. Retrieved from
Vivian, P., & Hormann, S. (2013). Organizational trauma and healing. North Charleston, SC: Create Space.