SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach.

This purpose of this paper is to develop a working concept of trauma and a trauma-informed approach and to develop a shared understanding of these concepts that would be acceptable and appropriate across an array of service systems and stakeholder groups. It begins by discussing the impact of trauma on behavioral health service delivery and the need to address trauma through a multi-pronged, multi-agency public health approach inclusive of public education and awareness, prevention and early identification, and effective trauma-specific assessment and treatment. The harmful impact of traumatic events on individuals, families, and communities, and the unintended re-traumatizing of individuals within public institutions and service systems is explained, and a framework for trauma and a trauma-informed approach is described. Following sections review the history of the concept of traumatic stress, federal, State, and local level trauma-focused activities. Trauma is then defined as resulting from an event, series of events or set of circumstance that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on functioning and mental, physical, social, emotional, or spiritual well-being. Key assumptions and principles in a trauma-informed approach are explained, and guidance is provided for implementing a trauma-informed approach that addresses ten domains: governance and leadership, policy, physical environment, engagement and involvement, cross sector collaboration, screening, assessments, and treatment services, training and workforce development, progress monitoring and quality assurance, financing, and evaluation. Finally, sample questions to consider when implementing a trauma-informed approach are offered. 41 references.


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