Trauma-informed Care Framework Research Articles

Leveraging Trauma Informed Care for Digital Health Intervention Development in Opioid Use Disorder.

Digital health refers to the use of information and communication technologies in medicine (including smartphone apps, wearables, other non-invasive sensors, informatics and telehealth platforms) to prevent illness, deliver treatment, and promote wellness. This rapidly proliferating group of technologies has the potential to reduce harm for people with opioid use disorder (OUD) and facilitate the recovery process; however, development in this space for OUD has been slower compared to that for other medical conditions. Unique issues with OUD management surrounding patient provider relationships, interaction with the healthcare system, autonomy and trust sometimes hinder care approaches, including those in digital health. The trauma informed care framework (TIC), developed for use by organizations to support individuals who have experienced trauma, has particular applicability for digital health interventions in OUD care. This manuscript will serve as a review of TIC principles and how they can be applied to digital health interventions to increase access, equity, and empowerment for people with OUD. We will highlight representative current and pipeline digital technologies for OUD, challenges with these technologies, TIC models for OUD, and the integration of TIC principles into digital technology development to better serve people with OUD. Finally, we will posit strategies to incorporate the aforementioned principles into future research efforts. We ultimately aim to use TIC as a lens through which to develop digital technologies to help individuals with OUD while minimizing harm.

Trauma-Informed Care Practices in a Forensic Setting: Exploring Health Care Professionals’ Perceptions and Experiences

The prevalence of trauma within secure forensic populations is widely acknowledged, yet the implementation of trauma-informed care (TIC) in secure forensic settings (SFS) remains in its infancy. This qualitative study delves into the perceptions and experiences of healthcare professionals (HCPs) adopting a TIC framework in SFS, examining associated barriers and facilitators. 15 participants engaged in semi-structured interviews, and results underwent thematic analysis, yielding five overarching themes and 15 sub-themes. Themes identified include: 1) understanding the TIC experience in SFS, 2) organizational and personal barriers in TIC implementation, 3) facilitators and reflections on TIC benefits, 4) barriers to specific TIC practices, and 5) practical recommendations. Participants emphasized the prevalent nature of trauma in SFS and underscored the perceived advantages of creating spaces for reflection and emotional well-being. Interviewees explored the impact of organizational culture, the demands of frontline roles and training accessibility. Practice implications highlight the need to involve key stakeholders (staff and SUs) in decision making and in assessing the feasibility of implementing TIC. SFS should prioritize TIC by addressing training needs, allocating time for TIC in supervision, providing specialist support for trauma-informed clinical work, and ensuring dedicated spaces for reflection. While the study highlights the power of incorporating HCP perspectives, limitations arise from findings drawn from a single forensic service, emphasizing the importance of further replication. This research contributes valuable insights into advancing trauma-informed care practices within secure forensic settings.

Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care?

IntroductionContinuing education is important to improve midwives’ attitudes to trauma-informed care in addressing the needs of women during the perinatal period. This study aimed to evaluate if there was a significant difference in attitudes towards trauma-informed care between midwives who participated in a 2-day trauma-informed care education program and those who did not. MethodA static group comparison design was adopted with a convenience sample of midwives to analyse differences in attitudes towards trauma-informed care between midwives who received a 2-day TIC education (n = 19, intervention group) and their peers who did not receive the education (n = 18, comparison group). ResultsThe results suggest that midwives who participated in a 2-day trauma-informed care education program had significantly higher scores for positive attitudes towards trauma-informed care compared to those who did not take part in the program and that this effect was sustained at 6 months. ConclusionTo minimise perinatal trauma for mothers and babies, midwives require specific trauma-informed care education. This study proposes that trauma-informed care education is a foundational pathway for implementing a trauma-informed care framework across a maternity service.

Using a trauma-informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings.

Tensions between therapeutic and security needs on forensic wards can create a social climate which is challenging for both mental health nurses and patients. Social climate refers to the physical, social and emotional conditions of a forensic ward which influence how these environments are experienced. For patients with borderline personality disorder (BPD), previous trauma means that the social climate of forensic settings may be experienced as retraumatising, negatively impacting the outcomes and wellbeing of both patients and mental health nurses. Trauma-informed care (TIC) has been offered as a contemporary framework for mental health nursing in inpatient units which aims to create a therapeutic social climate. In this critical review, we drew widely on literatures examining the social climate in forensic settings, the relationships between patients with BPD and staff (including mental health nurses), and the experiences of patients with BPD in forensic and inpatient settings to draw out the implications of scrutinising these literatures through the lens of TIC. Attending to the physical, social and emotional conditions of social climate in secure settings highlights how forensic wards can mirror trauma experiences for patients with BPD. Implementing TIC in these contexts has the potential to evoke positive shifts in the social climate, thus reducing the risk of retraumatisation and leading to improved outcomes for patients and staff.

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.

Untangling Intimate Care Experiences for Patients Admitted to Public Hospitals in South Africa

Background: Hospital admission can be a traumatic and humiliating experience for patients due to the institutionalised attire they must wear. Intimate care may trigger experiences of helplessness and disrespect due to exposure to their body parts and having to be touched by nurses. Objective: This research aimed to explore and describe patients’ perceptions of their bodies and their experiences of intimate care execution during their hospital stay. Methods: A qualitative explorative-descriptive design and Trauma-informed care framework were used to explore and describe the participants’ perceptions and experiences of intimate care execution during admission to the two sampled hospitals. Twenty participants admitted to medical and surgical units were purposively recruited. Data was collected using semi-structured interviews, and thematic analysis was used to give meaning to the data. Results: Three overarching themes emerged from the data: the sacredness of the human body; Patients want their dignity to be respected during intimate care and touch; and creating the nurse-patient intimate care relationship. Patients wish the nurses to maintain their dignity and privacy. Intimate care and touch should be initiated in a safe environment where patients can make informed decisions. Implications for Nursing: Declothing of personal attire during admission violates patients’ dignity and privacy and is dehumanising. During intimate care and touch, nurses should create a cultural, religious and gender safe environment, allowing inpatients to make informed decisions regarding the care provided to their bodies. Conclusion: Patients’ beliefs system should be incorporated into autonomy and informed decisions about the care to be provided to naked bodies. Hospitalisation should not reinforce physical and psychological trauma. Respect and dignity are paramount when caring for the patient’s body.

The development of a trauma informed care framework for residential services for adults with an intellectual disability: Implications for policy and practice

AbstractTrauma informed care has become an evidenced based approach for inpatient and residential services for people in the general population who are likely to have been impacted by trauma. Given the increased vulnerability to psychological trauma for adults with an intellectual disability, it should follow that residential services for adults with an intellectual disability would also benefit from a trauma informed care approach. Two focus groups and individual interviews with seven adults with an intellectual disability and six workshops with seven service providers were conducted to co‐produce a trauma informed care framework for residential services that was evidence‐based and guided by established models (MRC, Developing and evaluating complex interventions, London: MRC & NIHR, 2019; Wight et al., Journal of Epidemiology and Community Health, 70, 520–525, 2016). The framework was developed into four chapters: ‘Setting the context’; ‘Organisational change’; ‘Workforce development’; and ‘Trauma focussed services’. A logic model outlining the mechanisms of change was refined over the course of the co‐production workshops. This is the first study to develop and co‐produce a trauma informed care framework for residential and supported living accommodation for adults with an intellectual disability. The framework has implications for local policy and practice in its current cultural context. Future development is required to operationalise and test the framework and to explore its adaptability to international contexts.

Untangling Intimate Care Experiences for Patients Admitted to Public Hospitals in South Africa

Background: Hospital admission can be a traumatic and humiliating experience for patients due to the institutionalised attire they must wear. Intimate care may trigger experiences of helplessness and disrespect due to exposure to their body parts and having to be touched by nurses. Objective: This research aimed to explore and describe patients’ perceptions of their bodies and their experiences of intimate care execution during their hospital stay. Methods: A qualitative explorative-descriptive design and Trauma-informed care framework were used to explore and describe the participants’ perceptions and experiences of intimate care execution during admission to the two sampled hospitals. Twenty participants admitted to medical and surgical units were purposively recruited. Data was collected using semi-structured interviews, and thematic analysis was used to give meaning to the data. Results: Three overarching themes emerged from the data: the sacredness of the human body; Patients want their dignity to be respected during intimate care and touch; and creating the nurse-patient intimate care relationship. Patients wish the nurses to maintain their dignity and privacy. Intimate care and touch should be initiated in a safe environment where patients can make informed decisions. Implications for Nursing: Declothing of personal attire during admission violates patients’ dignity and privacy and is dehumanising. During intimate care and touch, nurses should create a cultural, religious and gender safe environment, allowing inpatients to make informed decisions regarding the care provided to their bodies. Conclusion: Patients’ beliefs system should be incorporated into autonomy and informed decisions about the care to be provided to naked bodies. Hospitalisation should not reinforce physical and psychological trauma. Respect and dignity are paramount when caring for the patient’s body.

Integration of Trauma-informed Care Into the Doctor of Pharmacy Curriculum

Trauma-informed care (TIC) is a framework based on understanding and responding to individuals’ experiences of psychological trauma (defined as harmful circumstances that have a lasting impact on emotional well-being), as well as fostering their sense of safety and empowerment. Health profession degree programs are increasingly integrating TIC training into their curricula. Although literature is scarce regarding TIC education in academic pharmacy, student pharmacists will likely encounter patients, co-workers, and peers who have experienced psychological trauma. Students may also have experienced psychological trauma themselves. Therefore, student pharmacists would benefit from TIC learning, and pharmacy educators should consider implementing trauma-informed education. This commentary defines the TIC framework, explores its benefits, and considers an approach to implementing the TIC framework in pharmacy education with little disruption to existing curricula.

Previous exposure to violence among emergency department patients without trauma-related complaints: A cross sectional analysis

IntroductionThe Emergency Department (ED) is a critical setting for the treatment of acute violence-related complaints and violent victimization is associated with numerous long-term negative health outcomes. A trauma-informed care framework can prevent re-traumatization of victims within the healthcare setting, but currently there are insufficient mechanisms to detect previous exposures to community violence within the ED. The current study sought to determine the prevalence of community violence and characterize the types of violence exposures among adult ED patients without trauma-related complaints to determine if there may be a need for expanded screening for previous exposure to violence for ED patients. MethodsThis was a prospective cross-sectional observational study of adult ED patients without a trauma-related chief complaint at an urban public hospital. Adult patients were approached by trained research staff and answered questions adapted from the Survey of Exposure to Community Violence (SECV), which measures lifetime exposure to community violence, including both witnessing and victimization. The SECV was modified for clarity, brevity, and to assess exposure to violence within the previous 3 months and 3 years from enrollment, in addition to lifetime exposure. Enrollment occurred from June 2019 to September 2022 with a 19-month gap due to the COVID-19 pandemic. Demographics and results within SECV domains were analyzed using descriptive statistics. Comparisons between males and females in types of violence experienced during one's lifetime were made by fitting logistic regression models adjusting for age. ResultsA total of 222 respondents completed some or all of the modified SECV. Ages ranged from 19 to 88, with 47.7% of respondents identifying as female and 50.9% as male. Of all respondents, 43.7% reported directly witnessing violence during their lifetime, 69.4% being personally victimized by violence, and 55.4% personally knowing someone killed by a violent act. Of those personally victimized, 47.4% occurred within the preceding 3 years and 20.1% within 3 months. Among all respondents, lifetime victimization was reported in the following domains: slapping, hitting, or punching (45.9%); robbings or muggings (33.8%); physical threats (28.8%); verbal or emotional abuse (27.5%); being shot at (18.0%); uncomfortable physical touch (15.3%); forced entry while home (14.4%); sexual assault, molestation, or rape (13.5%); or being attacked with a knife (13.5%). Comparing male and female respondents, 63.5% of females and 76.6% of males reported any violent victimization over their lifetime (aOR 1.88; 95% CI 1.04–3.43). Additionally, 31.7% of females and 56.3% of males reported witnessing violence (aOR 2.86; 95% CI 1.64–5.06). Males were more commonly exposed to physical violence, violence with weapons, and threats while females more commonly reported sexual assault, molestation, and rape. ConclusionBoth lifetime and recent exposure to community violence was common among adult ED patients without trauma-related complaints. Broader adoption of a trauma-informed care framework and the development of efficient ED screening tools for previous exposure to trauma is reasonable in areas where community violence exposure is highly prevalent.

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].

Validation of Trauma-Informed Care Instruments: Emergency Department Environment and Transitional Secondary Environment.

Trauma-informed care is a paradigm of care that requires health care practitioners to understand multiple types of traumas and their effects on the trauma survivor and then incorporate that knowledge into practice. However, there are few psychometrically robust instruments to evaluate trauma-informed care, and none have been applied in the trauma patient setting. The purpose of this article is to validate two trauma-informed care instruments in the trauma patient setting. Exploratory factor analysis and simultaneous pairwise marginal independence testing procedures were conducted on the "Emergency Department Environment" and the "Transitional Secondary Environment" instruments from September 2020 to November 2020. Descriptive statistics were reported for the content experts participating in the instrument validation. Exploratory data analysis results for each trauma-informed care statement in the tools indicate multidimensionality of trauma-informed care core values, with statistically significant (p < .05) overlap between two or more trauma-informed care core values. After accounting for item interdependence, the associations between the trauma-informed care core values do not appear to be spurious consequences of response interdependence. The two instruments showed high levels of internal consistency supporting the multidimensional models posited by the trauma-informed care framework. The findings will allow for routine monitoring and early detection of gaps in health care provider behaviors in the individualized care of trauma survivors. This will enable identification of trends in trauma care delivery and inform trauma-informed care education for health care providers, ultimately enhancing the healing of trauma survivors.

Expanding Neuroprotective Care: A Trauma-Informed Approach to Delivery of Services within Pediatric Inpatient Units.

Children with a history of trauma or adverse childhood experiences may be at higher risk for poor psychological and physical responses to medical experiences aimed at enhancing their well-being. Health care institutions are aware of the need for integration of trauma-informed care (TIC) practices yet struggle to find frameworks that promote resiliency to medical stress. An approach called neuroprotective care buffers the effects of toxic stress negatively affecting child health and well-being. Although often used in neonatal and cardiac intensive care units, the development and broad implementation of universal neuroprotective care measures across age groups and hospital settings has not been previously explored. An expanded neuroprotective care protocol takes a prevention approach to TIC. It fits a TIC framework, accounts for children's ecological, biological, and developmental needs, protects them against medical traumatic stress and retraumatization, and provides a tailored, measurable approach that systematically preserves child well-being within hospital settings.

Trauma-Informed Care for Hospitalized Adolescents.

Purpose of ReviewExposure to trauma accelerates during the adolescence, and due to increased behavioral and psychiatric vulnerability during this developmental period, traumatic events during this time are more likely to cause a lasting impact. In this article, we use three case studies of hospitalized adolescents to illustrate the application of trauma-informed principles of care with this unique population.Recent FindingsAdolescents today are caught in the crosshairs of two syndemics—racism and other structural inequities and the COVID-19 pandemic. Increased hospitalizations and mental health diagnoses during the past two years signal toxic levels of stress affecting this group. Trauma-informed care promotes health, healing, and equity.SummaryThis concept of the “trauma-informed approach” is still novel; through examples and practice, providers can learn to universally apply the trauma-informed care framework to every patient encounter to address the harmful effects of trauma and promote recovery and resilience.

Developing an Educational Website for Women With Endometriosis-Associated Dyspareunia: Usability and Stigma Analysis.

BackgroundEndometriosis is a chronic condition that affects approximately 10% of women worldwide. Despite its wide prevalence, knowledge of endometriosis symptoms, such as pelvic pain, and treatments remains relatively low. This not only leads to a trivialization of symptoms and delayed diagnosis but also fuels myths and misconceptions about pain symptoms. At the same time, the use of web-based platforms for information seeking is particularly common among people with conditions that are perceived as stigmatizing and difficult to discuss. The Sex, Pain, and Endometriosis website is an educational resource designed to provide evidence-based information on endometriosis and sexual pain to help people understand the condition, feel empowered, dispel myths, and destigmatize endometriosis-associated sexual pain.ObjectiveThe study objective is to evaluate the usability of the website and assess for destigmatizing properties of sexual health–related web-based resources.MethodsWe conducted a usability analysis by using a think-aloud observation, a postsystem usability questionnaire, and follow-up interviews with 12 women with endometriosis. The think-aloud data were analyzed using the framework by Kushniruk and Patel for analyzing usability video data, the questionnaire data were analyzed using descriptive statistics, and the follow-up interviews were analyzed using simple content analysis. We conducted a usability assessment by deductively analyzing the interview data via a trauma-informed care framework and a content analysis approach.ResultsThrough usability analysis, we found the website to be simple, uncluttered, satisfying, and easy to use. However, 30 minor usability problems related to navigation; website response; the comprehension of graphics, icons, and tabs; the understanding of content; and mismatch between the website and users’ expectations were reported. In our stigma analysis, we found the web content to be nonstigmatizing. The participants suggested ways in which websites could be designed to address stigma, including ensuring privacy, anonymity, inclusiveness, and factual and nonjudgmental content, as well as providing opportunities for web-based engagement.ConclusionsOverall, the participants found the website to be useful, easy to use, and satisfying. The usability problems identified were largely minor and informed the website redesign process. In the context of the limited literature on stigma and website design, this paper offers useful strategies on how sexual health–related websites can be designed to be acceptable and less stigmatizing to individuals with sensitive health issues.

Evaluating Trauma-Informed Care Practices in an Interdisciplinary Homeless Service Collaboration

ABSTRACT There are various barriers and challenges when delivering appropriate and evidence-based practices, such as trauma-informed care, within homeless service agencies. There is a need for coordinated, comprehensive, and trauma informed services for individuals experiencing homelessness or those at risk for homelessness. Purpose The purpose of this study was to examine the cooperative efforts of a cross-sector collaboration of social service providers who have come together to address the needs of individuals experiencing homelessness or those at risk of homelessness. Method The trauma-informed care framework was utilized as a method for evaluating and assessing the uniformity and baseline of service delivery across the providers. The staff of the four organizations involved with the project: a large behavioral health organization, a HIV/AIDS support service organization, a medical clinic, and a housing service organization were all given an online survey measuring the degree to which they were utilizing trauma-informed care practices. Results There were statistically significant differences found between organizations for several areas in the trauma-informed care. Regarding overall trauma-informed care practices, the domain rated highest among the organizations was assessing and planning services, while consumer involvement received the lowest ratings. Discussion These findings present the opportunity for several future recommendations, as well as provide implications for social work practice, research, policy, and education.

Field Note—Creating Trauma-Informed Library Spaces: Lessons Learned From a Pilot Program

ABSTRACT Public libraries play an increasingly vital role as a public hub and safe haven open to all, with innovative programming and services that increase literacy, access to resources, and capacity-building. This field note describes the implementation of a federally funded academic–community partnership integrating a trauma-informed care framework and social work field placements into a public library to address the needs of vulnerable patrons in accessing community resources. It describes the process of developing this pilot program, including placing MSW student interns, assessment, implementation, training, and community integration of services. It concludes by discussing implications, strategies and lessons learned from this innovative pilot project with attention to navigating the challenges of adapting services and field placements during a global pandemic.

A Universal, Trauma-Informed Approach to Pediatric Hospital Medicine.

Olivia, a 13-year-old neurologically intact patient with cerebral palsy, arrived from a routine abdominal procedure screaming in pain. The medical team was baffled as to why she experienced such agony despite receiving copious doses of morphine. We spoke with her adoptive parents to obtain more history. They revealed long-standing physical and sexual abuse before Olivia’s adoption 6 years ago and noted extreme distress to all medical procedures and prolonged surgical healing time. Although her parents hoped to give her a better life and ensure she received appropriate care for her condition, they felt helpless that Olivia was at risk for retraumatization (reexperiencing posttraumatic symptoms from her original traumas) each time she came to the hospital. The amplification of pain and delayed medical recovery secondary to a history of psychological trauma and adverse childhood experiences (ACEs) is well recognized.1–3 Health care institutions are aware of the need for the integration of trauma-informed care into practice, yet they struggle to find the right approach. Although screening for ACEs has been widely adopted as a trauma-informed practice, there are multiple concerns with ACEs screening, including operating from a deficit- versus strength-based model, risk for traumatization from screening, and limited follow-up resources.4 ACEs scores also do not fully capture trauma and posttraumatic stress symptoms, which may be better predictors of negative outcomes than ACEs alone. Many organizations have now implemented the Substance Abuse and Mental Health Services Administration guidelines of educating clinicians on realizing …

Reliability and construct validity of 3 psychometric trust scales for women seeking substance abuse treatment in a community setting

Background: Women with a history of substance use disorder (SUD) constitute a unique population with gender-specific needs in treatment. Most notable is high rates of prior trauma and the need for a trauma-informed care framework. Given theoretical links between trauma and interpersonal trust, understanding quantitatively how trust may impact outcomes for women in this population requires confirmation of validity of existing psychometric instruments. Objective: This study sought to confirm reliability and construct validity of the Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, and the Revised Health Care System Distrust Scale (RHCSDS) for use in women with a history of SUD seeking treatment in a community-based setting. Methods: A total of 301 participants were enrolled between August 2017 and March 2018 at an urban, community-based residential substance abuse treatment program in the mid-South. Participants were given an electronic survey containing questions about demographics/clinical characteristics, the Rotter, Wake Forest, and RHCSDS scales, Socially Desirable Response Five-Item Survey (SDRS-5), and the Adverse Childhood Experiences (ACEs) questionnaire. All participants also completed a modified protocol of the “Trust Game.” Statistical analysis was completed for each trust scale in regard to scale means and distribution, internal consistency, interscale correlation, and scale correlation to the ACE score. Results: Results confirm statistically significant (P < .001) differences in global trust and trust of health care providers compared with general population samples in prior studies. Internal consistency of scales is comparable to reliability testing in prior studies (α > .70 for all scales). Interscale correlation between individual scales is statistically significant, with the strongest relationship between the 2 health care–specific scales (r = −.740, P < .001). There was a weak, negative correlation between the ACE score and interpersonal trust (r = −.135, P = .019). Individual scales do not have statistically significant correlation with “Trust Game” scores. Discussion: Findings suggest reliability and construct validity of scales for use in this population.

Refining Trauma‐Informed Perinatal Care for Urban Prenatal Care Patients with Multiple Lifetime Traumatic Exposures: A Qualitative Study

Because lifetime trauma exposure has been linked to multiple adverse pregnancy outcomes, there is a need for all perinatal care providers to be versed in trauma-informed care practices. However, there are few data to guide trauma-informed practice during the perinatal period. The objective of this study was to refine ongoing development of a trauma-informed care framework for perinatal care by conducting a qualitative study of all trauma experiences and preferred screening practices of pregnant patients at an urban prenatal clinic. In this qualitative study, we conducted semistructured interviews with 30 women receiving prenatal care at an urban clinic. Participants also completed a trauma history questionnaire. Inductive coding was used to generate themes and subthemes. Participants described multiple lifetime traumatic exposures as well as background exposure to community violence. Not all participants desired routine trauma screening; factors limiting disclosure included fear of retraumatization and belief that prior trauma is unrelated to the current pregnancy. Strong therapeutic relationships were identified as critical to any trauma history discussion. This study supports a trauma-informed care approach to caring for pregnant women with prior traumatic exposures, including trauma screening without retraumatization and trusting patient-provider relationships.