Implementation Of Trauma-informed Care Research Articles

Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review.

Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.

Trauma-Informed Care as a Universal Precaution: A Brief, Case-Based, Educational Primer Featuring Role-Playing and Individual Self-Reflection Exercises.

Despite its growing popularity, the implementation of Trauma-Informed Care (TIC) in standard medical practices remains insufficient. A workshop, featuring role-playing scenarios and individual self-reflection exercises, was developed to enhance compassion among health care providers. The workshop was created by a multidisciplinary team of community pediatricians, pediatric intensivists, psychologists, and palliative care physicians, was structured around key elements and principles of TIC, and was based on actual patient encounters. The 90-minute session included didactics, role-playing, writing and self-reflection exercises, and large-group debriefings, and it was presented at two academic meetings. It is currently available as an open-sourced, freely accessible website. The workshop was attended by individuals with varying levels of training and experience. Of approximated 80 participants, 39 responded to surveys about baseline knowledge and workshop satisfaction, and 24 completed self-perceived pre- and postknowledge surveys. Nearly 90% had limited prior exposure to TIC. All rated the workshop highly, with no significant differences based on workshop facilitation. Nearly 95% felt that they learned something that would impact their day-to-day practices. Self-perceived pre-post knowledge showed statistically significant improvements. This workshop is feasible and can potentially increase health care professionals' capacity to care, decrease moral injury, and alleviate burnout from difficult cases.

Youth, caregiver and healthcare professional perspectives on planning the implementation of a trauma-informed care programme: A qualitative study.

To explore youth, caregiver and staff perspectives on their vision of trauma-informed care, and to identify and understand potential considerations for the implementation of a trauma-informed care programme in an inpatient mental health unit within a paediatric hospital. We applied the Interpretive Description approach, guided by complexity theory and the Implementation Roadmap, and used Applied Thematic Analysis methods. Twenty-five individuals participated in individual or group interviews between March and June 2022, including 21 healthcare professionals, 3 youth and 1 caregiver. We identified two overarching themes. The first theme, 'Understanding and addressing the underlying reasons for distress', related to participants' understanding and vision of TIC in the current setting comprising: (a) 'Participants' understanding of TIC'; (b) 'Trauma screening and trauma processing within TIC'; (c) 'Taking "a more individualized approach"'; (d) 'Unit programming'; and (e) "Connecting to the community". The second theme, 'Factors that support or limit successful TIC implementation' comprises: (a) 'The need for a broad "cultural shift"'; (b) 'The physical environment on the unit'; and (c) 'Factors that may limit successful implementation'. We identified five key domains to consider within trauma-informed care implementation: (a) the centrality of engagement with youth, caregivers and staff in trauma-informed care delivery and implementation, (b) trauma-informed care core programme components, (c) factors that may support or limit success in implementing trauma-informed care within the mental health unit and (d) hospital-wide and (e) the importance of intersectoral collaboration (partnering with external organizations and sectors). When implementing TIC, there is an ongoing need to increase clarity regarding TIC interventions and implementation initiatives. Youth, caregiver and healthcare professional participants shared considerations important for planning the delivery and implementation of trauma-informed care in their setting. We identified five key domains to consider within trauma-informed care implementation: (a) the centrality of relational engagement, (b) trauma-informed care programme components, (c) factors that may support or limit successful implementation of trauma-informed care within the mental health unit and (d) hospital-wide and (e) the importance of intersectoral collaboration. Organizations wishing to implement trauma-informed care should consider ongoing engagement with all relevant knowledge user groups throughout the process. Standards for Reporting Qualitative Research (SRQR). The local hospital research institute's Patient and Family Advisory Committee reviewed the draft study methods and provided feedback.

Education for Health Care Providers on Implementation of Trauma-Informed Care in Practice.

Traumatic experiences can adversely affect a child's health. These effects often continue into adulthood, especially when trauma is not addressed. Although the evidence shows benefits with addressing trauma earlier in life, trauma-informed care of children is underused in primary care. Health care providers (nurses, nurse practitioners, physicians) report gaps in knowledge of trauma-informed care and in their comfort level addressing trauma in primary care. This project investigated the use of continuing education sessions to increase health care providers' knowledge and readiness to implement trauma-informed care into their practice. The education sessions improved health care providers' knowledge and comfort with trauma-informed care. This intervention improved providers' readiness to implement trauma-informed care into their primary care practice. [J Contin Educ Nurs. 2024;55(5):246-252.].

Application of the Adverse Childhood Experiences Framework to the NICU.

Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

“. . .We’re Not Doing Enough:”: Trauma-Informed Care in an Early Childhood Special Education Center

Young children with disabilities experience trauma at high rates. To mitigate and address the negative effects of trauma on young children’s development, systematic implementation of trauma-informed care is needed. In schools, it is important that all staff members at every level are trained to implement trauma-informed care. In this qualitative study, we explored the experiences of ECSE professionals in one center, including administrators, teachers, paraprofessionals, and related service providers, as they planned and implemented trauma-informed care. We used Bronfenbrenner’s ecological systems theory to guide the design of the study. Our findings suggest that ECSE professionals are impacted by factors at the micro-, meso-, exo-, and macrosystem level of the environment, which influenced the extent to which they were able to successfully implement trauma-informed care.

Trauma-informed care within residential aged care settings: A systematic scoping review.

The importance of trauma-informed care (TIC) within residential aged care (RAC) settings has been increasingly recognised. TIC would ensure that older people who have experienced trauma over their lifetime have their needs better understood and accommodated. This scoping review examined the extent to which TIC has been applied within RAC settings. A scoping review was conducted according to Cochrane recommendations and the PRISMA-ScR checklist. A systematic search of six databases (Embase, Emcare, CENTRAL, CINAHL, PsychInfo and Medline) was performed in July 2022 and March 2023 and peer-reviewed primary research, in English and involved RAC staff or residents (aged 65years and over) providing or receiving TIC were eligible for inclusion. Studies focused on trauma intervention, assessment, screening, or treatment were excluded. Thematic synthesis was performed to extract themes relating to trauma-informed practice, barriers and enablers to TIC, and outcomes from the application of TIC approaches. Five articles were included. There was little evidence of the implementation of TIC interventions in RAC settings. Only one study examined the application of a TIC framework in a RAC setting. However, there was some evidence that approaches that consider resident's experience of trauma have emerged from practice experience and been used in RAC as an extension of person-centred care. Whilst trauma-informed approaches to resident care are emerging through practice experience, and despite policy recommendations to do so, there is little evidence that formal TIC interventions or frameworks have been applied to RAC internationally. This study highlights a gap in research and practice and makes several recommendations for further research and implementation of TIC in RAC.

What is known about the application of trauma-informed care within services for people with intellectual and/or development disabilities?

Trauma-informed care (TIC) is gaining momentum in various health, social, and educational settings globally in response to the widespread pervasiveness of adverse experiences and resultant psychological trauma. Given that people with intellectual and/or developmental disabilities (IDD) are more likely to experience traumatic life events than the general population, it makes sense that TIC should be in place within services supporting individuals with IDD. Yet there is a dearth of empirical research exploring the integration of TIC in such organisations and the spread of limited available literature is diverse. Thus, this paper aimed to scope and synthesise the emerging literature to elucidate what is known -regarding TIC in the context of IDD. A scoping review was conducted using the Arksey & O’Malley (2005) guidelines. Three databases, PsycINFO, Web of Science, and PubMed, were searched using relevant search terms to retrieve 69 papers published since 2000, which were systematically screened for eligibility. Twenty-three papers comprising a range of source types met inclusion criteria and were reviewed rigorously, with included empirical studies appraised using the mixed methods appraisal tool (MMAT; Hong et al., 2018). The PAGER framework (Bradbury-Jones et al., 2022) was followed to generate four patterns from the findings: (1) Opportunities for Embedding TIC within IDD Contexts, (2) Incorporating TIC Principles into Specific IDD Service Models, (3) Implementing TIC across Micro, Meso, and Macro Levels, and (4) Challenges and Barriers to Implementing TIC in IDD Organisations. There is a growing body of literature exploring the implementation of TIC within IDD organisations, including newly emerging TIC training programmes for staff. Yet there remains a lack of empirical implementation research examining outcomes for service providers and recipients. Tentative evidence for clinical practice and research recommendations from each pattern of findings are discussed, along with strengths and limitations of this review.

Brief trauma-informed care training to enhance health care providers' knowledge, comfort, and implementation of trauma-informed care in primary care clinics: A pilot effectiveness study.

Trauma-informed care (TIC) training may be valuable for patient-facing health care providers within primary care in urban health care settings serving patients with high levels of trauma exposure. This study tested the pilot effectiveness of a clinic-wide TIC initiative to enhance providers' knowledge, comfort in caring for trauma-exposed patients, and implementation of TIC within a primary care clinic of an urban safety net hospital using a single-arm longitudinal within-subjects design. Measures were obtained at baseline (T1), posttraining (T2), 1-month (T3), and 6-months (T4). Twenty-nine providers who completed TIC training were included in study analyses. Twenty-one completed T2 and 14 completed T3 and T4. Knowledge was measured with the Providers' Knowledge Regarding Injury-Related Posttraumatic Stress, comfort with a researcher-generated two-item measure, and TIC implementation with an eight-item binary scale from the Trauma Provider Survey. Repeated-measures general linear model examining within-subjects change over time in knowledge was significant (n = 8; F₃ = 4.74, p = .01, ηp² = .40); the model measuring change in comfort was not significant but trending (n = 9; F₃ = 4.56, p = .06). The model examining change in TIC implementation from T1 to T4 was not significant (n = 14; F3 = 4.32, p = .21). This pilot study demonstrated the preliminary effectiveness of a brief TIC training on improving health care provider knowledge and comfort working with trauma-exposed patients that sustained through 6-months posttraining. The findings indicate that additional support is needed to change behaviors in provider implementation of TIC in primary care clinic settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Experiences of gender-responsive trauma-informed care among female youth in deep-end residential group care facilities

Over the past two decades, research on trauma and adversity and the implementation of trauma-informed care (TIC) has become established in social work, psychiatry, and other helping professions. Girls assigned to restricted out-of-home placements by legal order who use social services frequently have a history of childhood trauma. Whereas the extant literature has examined gender-responsive TIC among victimized women, it has barely addressed educational-rehabilitative work with girls placed in deep-end juvenile facilities. The present study aims to fill this gap by responsive gender-responsive practices of a unique gender-responsive and trauma-informed placement for adolescent girls.The research method was based on threefold database including observations, semi-structured interviews with girls and staff, and drawing data from ongoing documentation of the work in the placement as was documented by the staff.Findings refine eight principles of gender-responsive TIC: relationships, safety, empowerment and voice, trustworthiness, and transparency, perceiving maladaptive behaviors as useful survival skills, peer support, removing social barriers, and reducing re-traumatization.The article proposes a framework set of principles for gender-responsive trauma-informed care and discusses theoretical and practical implementations that are essential for future policies regarding professional work with adolescent girls in deep-end placements. Discussion rises the need for a new refining of guidelines coherent and holistic model for creating gender-sensitive trauma-informed care when working with adolescent girls who experienced adverse childhood events. Studies using controlled designs might examine the effects of such a framework by developing guidelines and action principles as a basis for fostering standardized training for professionals who work with adolescent girls in extreme social exclusion.

Implementing the NCTSN Trauma-Informed Organizational Assessment (TIOA) for Improving Trauma-Informed Care in Inpatient Child Psychiatry.

Children and adolescents receiving inpatient psychiatric services have disproportionately high levels of exposure to trauma and adversity. The National Child Traumatic Stress Network Trauma-Informed Organizational Assessment (TIOA) is a comprehensive tool intended to guide implementation of trauma-informed care, but it has not yet been applied in inpatient settings. The purpose of this quality improvement project was to describe trauma-informed care in inpatient child/adolescent psychiatry with the TIOA, examine relatedness among trauma-informed care domains, and explore barriers or facilitators to applying trauma-informed care. This quality improvement project used mixed methods. We conducted a web-based survey in Summer 2022 with staff members (clinical and administrative) at two inpatient child/adolescent psychiatric units in California to assess trauma-informed care practices with the TIOA (87 items). Qualitative follow-up interviews were offered to interested participants. A correlation matrix and cluster analyses were used to examine relationships among TIOA domains; qualitative data were analyzed thematically. There were 69 survey respondents and seven qualitative interviews. TIOA domain scores ranged from a low of 2.3 to a high of 3.2, indicating that practices were occurring only "rarely" to "sometimes." There were two major themes identified from qualitive interviews: (a) barriers to trauma-informed care in an inpatient context that can be resource-constrained or coercive; and (b) discovering strategies to provide trauma-informed care despite structural barriers. Organizational interventions targeting any domains of trauma-informed care are needed in inpatient settings given limited uptake of trauma-informed care.

Implementation of trauma-informed care and trauma-responsive services in clinical settings: a latent class regression analysis.

Engagement and retention in health care is vital to sustained health among people living with HIV (PLWH), yet clinical environments can deter health-seeking behavior, particularly for survivors of interpersonal violence. PLWH face disproportionate rates of interpersonal violence; clinical interactions can provoke a re-experiencing of the sequalae of trauma from violence, called re-traumatization. Trauma-informed care (TIC) is a strengths-based approach to case that minimizes potential triggers of re-traumatization and promotes patient empowerment, increasing acceptability of care. Yet, Ryan White HIV/AIDS clinics, at which over 50% of PLWH received care, have struggled to IMPLEMENT TIC. In this analysis, we sought to (1) identify unique sub-groups of HIV clinics based on clinical attributes (i.e., resources, leadership, culture, climate, access to knowledge about trauma-informed care) and (2) assess relationships between sub-group membership and degree of implementation of TIC and trauma-responsive services offered. A total of 317 participants from 47 Ryan White Federally-funded HIV/AIDS clinics completed a quantitative survey between December 2019 and April 2020. Questions included assessment of inner setting constructs from the Consolidated Framework for Implementation Research (CFIR), perceived level of TIC implementation, and trauma-responsive services offered by each respondent's clinic. We employed latent class analysis to identify four sub-groups of clinics with unique inner setting profiles: Weak Inner Setting (n = 124, 39.1%), Siloed and Resource Scarce (n = 80, 25.2%), Low Communication (n = 49, 15.5%), and Robust Inner Robust (n = 64, 20.2%). We used multilevel regressions to predict degree of TIC implementation and provision of trauma-responsive services. Results demonstrate that clinics can be distinctly classified by inner setting characteristics. Further, inner setting robustness is associated with a higher degree of TIC implementation, wherein classes with resources (Robust Inner Setting, Low Communication) are associated with significantly higher odds reporting early stages of implementation or active implementation compared to Weak class membership. Resourced class membership is also associated with availability of twice as many trauma-responsive services compared to Weak class membership. Assessment of CFIR inner setting constructs may reveal modifiable implementation setting attributes key to implementing TIC and trauma-responsive services in clinical settings. Introduction.

Trauma-Informed Care Approach in Family Practice: Steps to Implementing

Traumatic experiences can have a lasting effect on children’s mental and physical well-being. The short- and long-term benefits of addressing trauma earlier in life is evidenced in the literature. Trauma-informed care (TIC) is the framework used to guide those who seek to help others who have experienced trauma in life. TIC has long been utilized by multiple disciplines such as mental health care, social services, and substance use services with success. Even with the present evidence, TIC is underutilized in the care of children in the family practice primary care setting. Providers cite lack of knowledge on how to address trauma and how to implement a trauma-informed care approach with children in the primary care family practice setting. The implementation of TIC in family practice primary care, where many children are cared for, has the potential to impact the health outcomes of children in the short term and as they move into adulthood. TIC helps support children and family’s mental and physical well-being, thus reducing much suffering. This article presents best practices to implementing a universal TIC approach in family practice primary care setting in a step-by-step approach.

Trauma Informed Care in the Neonatal Intensive Care Unit

Parents who have a baby receiving care in the Neonatal Intensive Care Unit (NICU) likely all experience emotional distress and are at elevated risk of experiencing trauma. The NICU environment is a potential source of traumatic stress for parents and often the risk for neonatal death is substantial. While the stressors facing parents are considerable, the effects can be minimized through implementation of trauma-informed care. The Family Guidance Tool was developed to help parents and healthcare professionals in a NICU setting utilize a strengths-based approach to create an atmosphere of mutual trust and understanding while encouraging the family to be the guide. This practical tool shows promise to mitigate stress often experienced by parents in a NICU setting.

Factors that influence interprofessional implementation of trauma-informed care in the emergency department.

To describe factors that influence interprofessional staff decisions and ability to implement trauma-informed care (TIC) in a level-one emergency department (ED) trauma center. This qualitative research study consisted of semi-structured interviews and quantitative surveys that were conducted between March and December 2020 at an urban trauma center. Eligible participants were staff working in the ED. Interview questions were developed using the Theoretical Domains Framework (TDF), which is designed to identify influences on health professional behavior related to implementation of evidence-based recommendations. Interview responses were transcribed, coded using Atlas software, and analyzed using thematic analysis. Key themes identified included awareness of TIC principles, impact of TIC on staff and patients, and experiences of bias. Participants identified opportunities to improve care for patients with a trauma history, including staff training, more time with patients, and efforts to decrease bias toward patients. Most participants (85.7%) felt that a TIC plan, tiered trauma inquiry, and warm handovers would be easy or very easy to implement. We identified key interprofessional staff beliefs and attitudes that influence implementation of TIC in the ED. These factors represent potential individual, team-based, and organizational targets for behavior change interventions to improve staff response to patient trauma and to address secondary trauma experienced by ED staff.

Research note reliability and validity of Japanese version of the trauma-informed care provider survey (TIC provider survey)

ObjectiveRobust instruments to evaluate the ability of trauma-informed care among healthcare workers need to be developed, as this would help the implementation of trauma-informed care to prevent re-traumatization of patients. This study aims to assess the reliability and validity of the Japanese version of the Trauma-Informed Care (TIC) Provider Survey. A total of 794 healthcare workers were surveyed using a self-administered questionnaire, including the TIC Provider Survey, and six measures that were considered to be correlated with it. We calculated the Cronbach’s alpha coefficient to investigate the internal consistency of each category of the TIC Provider Survey (knowledge, opinions, self-rated competence, practices, and barriers). Spearman’s rank correlation coefficients were used to investigate the correlation between each category of the TIC Provider Survey, and other measures of construct validity.ResultsCronbach’s alpha coefficients of each category of the TIC Provider Survey were 0.40 (Knowledge), 0.63 (Opinions), 0.92 (Self-rated competence), 0.93 (Practices), and 0.87 (Barriers). The Spearman’s rank correlation coefficients were small. We confirmed the reliability of the acceptable levels and examined the validity of modest or unacceptable levels of the Japanese version of the TIC provider survey among Japanese workers in a healthcare setting.

Trauma-Informed Care: The Professional Development Needs of Early Childhood Special Education Teachers

It has been well documented that experiencing trauma impacts all aspects of child development. Young children experience trauma at high rates, and children with disabilities are at an increased risk of experiencing trauma. One way to mitigate the effects of trauma is through the implementation of trauma-informed care, which requires a well-trained workforce. Yet, to date, minimal research has been conducted about the professional development needs of early childhood special education (ECSE) teachers related to trauma. The purpose of this qualitative study was to understand ECSE teachers’ professional development needs related to trauma and trauma-informed care. Eighteen ECSE teachers participated in interviews. Results indicate that while ECSE teachers are familiar with the basics of trauma-informed care, more training is needed, specifically in the areas of working with families, implementing trauma-informed classroom strategies, and supporting children with disabilities who have experienced trauma.

Implementing a trauma-informed system of care: An analysis of learning collaborative outcomes.

Trauma exposure can negatively impact health. Trauma-informed care implementation within health care systems may improve the identification and treatment of trauma-related illness on a population health level. The current study investigated outcomes of a multiagency implementation of trauma-informed care for Medicaid-enrolled adults and children in 23 rural Pennsylvania (United States) counties. Changes in trauma symptom screening, the number of staff trained in trauma-informed care, and clinician confidence in using trauma-informed care were assessed in participating treatment agencies (N = 22) over the course of a 15-month trauma-informed care learning collaborative (TLC). Data included monthly agency-reported screening, training, and confidence outcomes, which were analyzed using repeated-measures analyses of variance. Trauma symptom screening rates improved from 41.1% (SD = 43.0%) to 93.3% (SD = 12.0), p < .001; ηp 2 = .30. The average number of cumulative staff members trained in trauma-informed care per agency increased from 24.43 (SD = 42.22) to 140.00 (SD = 150.87), p < .001, Kendall's W = .09. The percentage of agencies that reported high confidence in delivering trauma-informed care increased from 15.8% (SD = 15.5%) to 80.5% (SD = 17.7%), p < .001; ηp 2 = .45. Pairwise comparisons revealed both screening rates and confidence ratings reached significant improvement in Month 11 of the TLC, suggesting that these processes may be related. A total of 2,935 staff members were trained during the TLC. The immediate impact of system-level implementation of trauma-informed care was evident for agency processes and staff confidence, with support provided by multiple stakeholders.

‘You Say One Thing Wrong, and Your Children Are Gone’: Exploring Trauma-Informed Practices in Foster and Kinship Care

Abstract Trauma-informed care is a growing practice approach in child and family social work. Current policy directions in out-of-home care (OOHC) in Victoria, Australia show an interest in further implementation of trauma-informed care, particularly through training for foster and kinship carers. Drawing upon findings from grounded theory research with sixteen foster and kinship carers, this article considers the application of trauma-informed practices in home-based care in the Central Highlands region of Victoria, Australia. The research reveals that whilst carers utilise principles of trauma-informed care to support children and young people, they do not always experience trauma-informed support from the wider OOHC system. This discrepancy suggests that the implementation of trauma-informed care has the potential to increase pressure on home-based carers if it is only encouraged at the interpersonal level between carers and children, without incorporating associated systems-level change. These findings propose that whilst micro-level support and training for carers are necessary and useful, it is crucial for OOHC systems to move beyond such initiatives to plan and enact macro-level reforms.

Trauma-informed care in the emergency department: concepts and recommendations for integrating practices into emergency medicine

ABSTRACT The experience of psychological trauma is common and has become even more prevalent during the COVID-19 pandemic for both health care workers and the general population [1–3]. Traumatic experiences can have varied and lasting physical and mental health effects on patients, beyond what we are privy to in the acute environment of the emergency department. The effects of these prior traumatic experiences can be exacerbated by interaction with the healthcare system, and yet emergency medicine physicians have no standardized methods for working with patients in a trauma-informed way. The systematic implementation of trauma-informed care (TIC) practice requires the cooperation of multiple domains within the health care system, including focus on the physical environment, direct care, and administrative practices. Here we provide recommendations specific to emergency medicine for the development and implementation of TIC in the regular patient-clinician interaction, situated within the context of the TIC framework as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) [4].