Trauma-informed Practices Research Articles

Toward a Trauma-Informed Comprehensive School Physical Activity Program: Specifying Feasible Practices Across the School Day.

Many students would benefit from trauma-informed physical activity (PA); however, there is a lack of systematic guidance on incorporating trauma-informed practices across school-based PA opportunities. The purpose of this study was to generate a feasible framework for trauma-informed school-based PA. Framework development was guided by a modified Delphi approach, including an exploration phase and an evaluation phase. First, a multidisciplinary working group reviewed extant literature, mapping trauma-informed practices onto the domains and components of the Comprehensive School Physical Activity Program (CSPAP). Subsequently, experts (n = 14) provided quantitative feedback on the utility and feasibility of these practices. Thirty-three practices met pre-determined thresholds for utility and feasibility. Across CSPAP domains, this included attending to: (a) safety; (b) positive communication and relationships; (c) empowerment, choice, and voice; (d) emotion management and skill building; (e) instructor competencies and support; and (f) cultural, historical, and gender issues. Incorporating trauma-informed practices into existing frameworks and approaches to school-based PA may promote uptake of practices that help meet the social and emotional needs of trauma-exposed youth. The present output provides a foundation for generating tools and supports for incorporating trauma-informed practices into school-based PA promotion efforts.

Defining Trauma-Aware Voice Pedagogy with Recommendations for Practice

Abstract: There is increasing interest in how to define and practice trauma-informed voice pedagogy. Voice teachers sometimes feel a need to react to trauma-related responses during lessons or to contextualize interactions between trauma experience and voice use, yet clear guidance on defining and implementing trauma-informed voice teaching is not routinely available. This paper includes an overview of trauma-informed practice and discusses implications for voice pedagogy, specifically singing teaching. It offers recommendations for singing teacher practice, with the aim of identifying and underlining teacher responsibilities regarding reasonable and ethical trauma-aware approaches to voice pedagogy.

Childhood Adversity and Engagement in Adulthood: The Role of Attachment as a Mediator.

A key assumption of occupational therapy is that engagement in meaningful activities is fundamental to one's health and well-being. Preliminary findings suggest a link between childhood adversity and engagement in meaningful activity. Childhood adversity is also linked to attachment insecurity in adulthood, and both represent barriers to health and well-being. It is unknown whether attachment insecurity is associated with meaningful activity engagement or how attachment insecurity influences the relationship between childhood adversity and meaningful activity engagement. To investigate the association between attachment insecurity and meaningful activity engagement and the role of attachment insecurity in the relationship between childhood adversity and engagement in meaningful activities in adulthood. Cross-sectional online survey. Community. Community-dwelling adults ages 18 yr or older, healthy, and able to understand standard English to complete the questionnaires. Participants were recruited through snowball sampling. Participants answered demographic questions and completed three questionnaires: the Engagement in Meaningful Activities Survey, Risky Families Questionnaire, and Experiences in Close Relationships-Short Form. Participants (N = 329) completed at least two of the three surveys, with most (n = 312) completing all three. More insecurely attached participants reported less engagement in meaningful activities. Both attachment avoidance and attachment anxiety mediated the relationship between childhood adversity and meaningful activity engagement. The findings offer support for interrelations among childhood adversity, attachment insecurity, and engagement in meaningful activity. Further research is required to support the application of these findings in clinical settings. Plain-Language Summary: To our knowledge, this is the first study to establish a connection between attachment insecurity in adults and lower levels of engagement in meaningful activities during adulthood. The findings highlight the heightened vulnerability of adults who have a history of childhood adversity. The findings also emphasize the significance of (1) considering clients' childhood adversity and attachment patterns when assessing for and providing occupational therapy services and (2) advocating for the inclusion of trauma-informed practices for those with lower levels of meaningful occupational engagement.

Integrating trauma-informed practices in U.S. educational systems: Addressing behavioral challenges in underserved communities

Integrating trauma-informed practices in U.S. educational systems: Addressing behavioral challenges in underserved communities

Empowering Future Bilingual Educators: Integrating Trauma-Informed Approaches in Bilingual Teacher Education

The impact of trauma on children's social, emotional, and academic growth is profound, yet teacher preparation programs, particularly in bilingual and multicultural contexts, often lack comprehensive training in trauma-informed practices. This qualitative study investigates the integration of trauma-informed approaches into a bilingual teacher education course at a university in West Texas. The study included 59 undergraduate pre-service teachers enrolled in a course on bilingual and multicultural education. Data were collected through preliminary and concluding written interviews, alongside ongoing instructional interventions, including discussions, case analyses, and trauma-informed strategies. Initially, participants demonstrated a limited understanding of trauma, associating it primarily with extreme events such as accidents or death. Post-course assessments, however, revealed a broadened understanding, recognizing everyday traumas like poverty, bullying, and family instability. Findings suggest that integrating trauma-informed approaches significantly enhances pre-service teachers' ability to identify and apply practical strategies to support trauma-affected students. The study introduces the Trauma-Informed Bilingual Teacher Preparation Model, focusing on key components such as foundational trauma knowledge, recognizing trauma symptoms, culturally responsive teaching, creating supportive environments, and fostering teacher resilience. By embedding trauma-informed practices in teacher education, this model prepares future educators to cultivate compassionate, inclusive classrooms, particularly in bilingual and multicultural settings. The study emphasizes the importance of curriculum reform to equip teachers with the necessary skills to support both students' emotional well-being and academic success.

Study tours as strategy in building multi-level public health system transformation in Ukraine (UA)

Abstract With 14 million Ukrainians in need of psychological aid (UNDP) and a strained health system, UA urgently requires mental health and psychological support services (MHPSS). As a TA partner on the USAID funded Public Health System Recovery and Resilience project in UA, the Philadelphia (PHL) team supports capacity building for population-based MHPSS at the community level with a study tour strategy. Such approaches apply to other countries interested in remodeling public health systems. The strategy aims to advance community based MHPSS through in person tours in PHL with remote follow up to stimulate vision, exchange ideas and accelerate action among governmental, community, and academic partners. The study tours presented overviews on health policy, system development, program services delivered to children and adults, community interventions, and workforce development of professionals and paraprofessionals. All included the foundational principles of trauma-informed practice. The June 2023 tour hosted 11 decision makers and regional officials who embraced the vision for system development and endorsed further engagement. The December 2023 tour hosted 13 practitioners and coordinators of health and social services to observe community programs. Results include development of PHL NGOs and UA social service hub partnerships to implement train the trainer programs for peers/people with lived experience and for mural arts programs to promote community engagement and empowerment. The September 2024 tour involves university partners from nursing, social work and psychology and PHL counterparts to strengthen curricula to include mental health competencies, support faculty development with potential for collaborative research and student exchange, and design post-graduate continuing education courses for upskilling the incumbent workforce. Study tours and direct exchange are an effective strategy for capacity building for MHPSS in Ukraine to address population health needs. Key messages • The sequenced study tour strategy affects distinct levels of change makers in UA. The results are governmental buy-in, partnerships for programmatic development, and academic advancement. • The study tour model promotes systematic change and offers solutions to MHPSS workforce shortages through information exchange, relationship building, and capacity development.

Shifting focus - the need to prioritise an inclusive public health approach to trauma

Abstract Since 2017, the Welsh government has prioritised the development of a Public Health Approach to understanding the impact of Adverse Childhood Experiences. Taking the work of Bellis et al, and the population level research to understand the prevalence of ACEs, and associated risks (Bellis etc al, 2015), the ACE Hub Wales was established to coordinate a multi-agency, cross sector approach to preventing, tackling and mitigating the impact of adversity in childhood. The Hub developed its approach to advocate for more public awareness of the life course risks to health if the right support was not accessed or available to children, such as poor mental health and chronic conditions such as type 2 diabetes and heart disease in adulthood. From 2021 there has been a dramatic shift to attempting to understand the experiences, and unmet needs, of children and people who have come to Wales to seek sanctuary, migrant women who have no recourse to public funds, and people experiencing racism and discrimination. In 2021, the ACE Hub Wales co-produced a Wales national trauma-informed practice framework including a set of principles placing inclusion at the heart of the approach in Wales; shining a light on the need to have a cultural, intergenerational and gender-based understanding of adversity and trauma which links directly to, informs and supports the government’s ambitions to be a nation of sanctuary and to be anti racist by 2030. To continue to ignore the experiences of adversity and trauma by people of colour, and Gypsy, Roma and Traveller people; is to perpetuate the health inequity experienced in healthcare, and justice systems. Wales has committed to developing wisdom, not just knowledge, that means that a public health approach is inclusive of all of our communities in Wales. Key messages • The experiences of racialised ad minoritised communities from population studies of adversity and trauma is traumatizing. • Understanding the life course impact of adversity and trauma must include the experiences of racism and discrimination to be inclusive and trauma-informed.

School Social Workers’ Reports of Differences in Policies and Practices in Trauma-Informed and Non-Trauma-Informed Schools

This study explored trauma-informed schools from the perspective of social workers, documenting the reported practices and policies associated with trauma-informed approaches in U.S. schools. Survey data from 538 school social workers were analyzed to investigate the differences in policies and practices between schools identified as trauma informed and not. Logistic regression analyses examined whether the presence of specific school practices and policies was associated with the identification of a school as trauma informed. Of a wide array of programs and policies that may be present in trauma-informed schools, only the presence of trauma training and resources for secondary traumatic stress were key predictors of social workers’ identification of a school as trauma informed. The implementation of trauma training has long been the primary focus of trauma-informed approaches in schools. Should commitment to trauma-informed approaches endure, we recommend moving beyond training and secondary traumatic stress resources to deepen the field’s focus on implementing trauma-informed practices and policies at all organizational levels. We also recommend that future research looks carefully at how some school safety and trauma-informed approaches may be incompatible and the extent to which trauma-informed approaches improve or detract from children’s educational experiences and outcomes.

Children’s Experiences of Police Custody and the Implications for Trauma-Informed Policing

The development of a trauma-informed Scotland is an ambitious and important agenda, but not without its challenges and limitations. In restrictive settings that rely on the application of power and control as part of their modus operandi, genuinely trauma-informed practice may be difficult to achieve. Drawing on interviews with 11 children, this article maps their experiences of police custody to trauma-informed practice principles. The gap between the espoused policies and the realities of custom and practice outlines the boundaries of trauma-informed practice in justice settings. The article concludes that police custody is antithetical to the concept of trauma-informed practice.

The impact of trauma-informed practices on academic outcomes of First Nations children: a pilot study of culturally responsive supports in Australia

This pilot observational study examined the effectiveness of trauma-informed and culturally responsive behavior support practices on the academic outcomes of predominantly First Nations children in an Australian primary school. The research supports integrating culturally relevant ways of knowing, being and doing into prevalent pedagogical and behavior support practices. The cohort study found that the co-designed, multi-tier Trauma-informed Behaviour Support program improved students’ literacy and numeracy scores over 2 years. The findings highlight the complex relationship between behavioral difficulties and academic abilities. Changes in numeracy scores were significantly higher for students with improved teacher-reported rates of disruptive behaviors. In contrast, changes in literacy scores were equivalent between students with and without such improvements. The findings suggest that educators can improve academic outcomes by promoting cultural safety across the school and making the curriculum more flexible, engaging, and relevant. Further implications for educators, policymakers, and researchers working with First Nations students are discussed.

Effectiveness of a multidimensional collaborative approach versus usual care in the treatment of adult depression in primary care in Chile: study protocol for a single blinded cluster randomized controlled trial.

Major depression (MD) is a prevalent and disabling condition in Chile, with most cases being treated at the primary care level. In Chilean primary care, the authors have identified key factors associated with more complex presentations of MD and a poorer prognosis, such as a history of childhood trauma, suicidality, and comorbidities. These findings underscore the need for a multidimensional, trauma-informed, and interprofessional approach to the treatment of depression. This protocol is a two-arm, single-blinded, cluster RCT to compare the effectiveness of a collaborative multidimensional approach for depression (CMAD) versus usual care to treat MD in primary care clinics in Chile. In total, 394 depressed adults from 18 to 65 years of age in twelve clinics located in Chile's Maule Region will be consented to participate in the study. Patients and care teams from each clinic will be randomized to the intervention or to the control arm.Interprofessional teams in the intervention arm will attend 27 hours of didactic and active learning sessions focused on clinical competences to effectively engage, treat and follow up patients with the factors associated to the complex presentation of MD. Team in the control arm will receive 27 didactic sessions on current clinical guidelines for MD.Patients of both arms will be blindly assessed at baseline, three months, and six months. The primary outcome will be the reduction in depressive symptoms, with secondary outcomes including improvements in anxiety symptoms, interpersonal and social functioning, and treatment adherence. This protocol proposes the evaluation of an intervention designed to improve depression symptoms by enhancing the clinical competencies of primary care teams. These competencies are structured around collaborative care and trauma-informed practices. NCT05016388, registered on 16 August 2021 at ClinicalTrials.gov.

Supporting Law Student Wellbeing: Integrating Trauma-Informed Practices in Legal Education

Sensitive course content pervades all courses in a law degree and is one of many diverse and complex factors impacting law student wellbeing. This article defines sensitive course content and examines its effects through the lens of trauma, particularly vicarious and collective trauma. It explores two examples from Australian universities where trauma-informed practices were integrated into the legal curriculum. Incorporating trauma-informed practices offers numerous benefits: it supports the mental wellbeing of law students, enhances their employability and destigmatises conversations around this critical issue. However, implementing these practices in legal education faces challenges, such as the diversity of legal practices, institutional constraints and law school culture. Legal education providers must lead the way in mitigating the impacts of sensitive course content by integrating trauma-informed practices and conducting further research to support law student wellbeing.

The Contactful Quad: An Effective Tool for Working With Trauma

The purpose of this paper is to explore the potential and development of the drama triangle, the winner’s triangle, and the trauma quadrangle in trauma work and to offer a tool to help identify the roles/patterns replayed when caught in drama. This fosters moving into a more active (winner’s) space and retaining a more integrated position. The authors draw on trauma-informed practices and transactional analysis (TA). They propose that the bystander position in response to trauma can be both an internal and external process. As a tool for working with developmental trauma, the authors offer the contactful quad, which through empowerment and witness aims to support the process of decontamination and deconfusion, to aid the healing process, and to support integration of the unresolved somatic experience of trauma responses. Using clinical vignettes, the authors demonstrate the power of the Actively Courageous position of the contactful quad as an antidote to the Bystander position.

Trauma-informed practice as a component to improve student wellbeing

Trauma-informed schools are deeply responsive to the trauma experiences of students and address their primary need for safety and connection as a foundation for emotional, social, and cognitive wellbeing. Trauma-informed schools have systems in place that provide trauma awareness, knowledge, and skills as part of their school culture, practices, and policies. This article draws on a literature base to explore what it means to be trauma-informed and shows ways that schools can play a key role in addressing the effects of traumatic stress on students.

A Trauma-Informed Approach for Care of a Postpartum Patient With Provoked-Localized Vulvodynia: A Case Report

Introduction: Vulvodynia is a chronic pelvic pain condition affecting at least 10% of individuals with a vulva. Its complex and multifactorial etiology can be exacerbated by adverse childhood events (ACEs), which intensify pain symptoms and complicate treatment. This case report outlines a comprehensive trauma-informed treatment strategy for addressing persistent vulvodynia in a patient with a history of traumatic ACEs. Case Description: This case report describes a 30-year-old female with provoked localized vulvodynia, and a history of multiple ACEs. A trauma-informed plan of care was created which emphasized consent, control, emotional safety, and compassionately listening to avoid re-traumatization. The patient was seen for 15 physical therapy visits over six months. Her pain reduced from 9/10 to 3/10 on the NRPS, exceeding the minimally clinically important difference. The Marinoff dyspareunia scale reduced from 3 to 1. She was able to return to previously painful activities, such as wearing underwear and blue jeans, and unlimited sitting, standing, and walking. Discussion: ACEs can adversely affect the pelvic floor and the nervous system. Adopting trauma-informed practices can assist patients in overcoming effects of trauma, and improve communication, plan of care adherence, and overall outcomes. Trauma-informed practice should be standard of care with all patients, as it encourages empowerment, choice, collaboration, and safety.

An evaluation of Barnardo’s trauma-informed policing training

This paper presents an evaluation of Trauma-Informed (TI) training for police officers in the West Midlands Police from November 2022 to February 2023. The West Midlands Violence Reduction Partnership has commissioned and delivered bespoke TI training since 2020, which aimed to deepen the understanding of adverse childhood experiences (ACEs) and trauma within the Police and, in turn, to create meaningful changes in everyday policing practice. Pre- and post-training surveys were conducted with 230 frontline officers and new recruits, as well as semi-structured interviews with 14 police officers and sergeants. Statistically significant improvements were found across all seven factors measured by the Trauma Aware Policing Attitudinal Survey (TAPAS). These findings indicate the efficacy of the training in improving police officers’ knowledge, responses, behaviours, self-efficacy, reactions to work, and personal and system-wide support for trauma-informed care. The qualitative results indicate a positive influence of the TI training on police practice overall. However, the quantitative data have limitations in drawing conclusions regarding long-term knowledge retention and the integration of trauma-informed practices, as well as the lack of robustness of the TAPAS tool. This highlights the necessity for further efforts to assess TI attitudes and providing TI training to police officers and senior management, promoting ongoing professional development and the wider implementation of trauma-informed approaches.

Health and wellbeing of survivors of sexual violence and abuse attending sexual assault referral centres in England: the MESARCH mixed-methods evaluation.

One million people in England and Wales experience sexual violence and abuse each year, with nearly half experiencing serious sexual offences; around 30,000 survivors access sexual assault referral centres. This research was commissioned by National Institute for Health and Care Research to evaluate access, interventions and care pathways for survivors, especially those provided through sexual assault referral centres. The sexual assault referral centres care pathway was investigated through six sub-studies. There were two Cochrane Reviews (4274 participants). Seventy-two providers and 5 survivors were interviewed at eight sites; the children and young people study involved 12 participants from two sexual assault referral centres. A cohort study involving three-wave data collection over 1 year (21 sites; 2602 service users screened, 337 recruited) used a multilevel modelling framework to explore risk factors for burden of post-traumatic stress disorder symptoms at baseline and change at 1 year. We analysed costs and outcomes and conducted a narrative analysis (41 survivors). We worked closely with survivors and prioritised the safety/welfare of participants and researchers. Cochrane Reviews identified large effects from psychosocial interventions for post-traumatic stress disorder and depression. Sexual assault referral centres delivered a high-quality frontline service for survivors but groups experiencing domestic abuse and some ethnic and cultural minorities were under-represented. The qualitative research emphasised inter-agency collaboration for survivor benefit. The cohort study identified a risk 'triad' of adverse childhood experiences, poor mental health and economic deprivation, which was associated with baseline trauma burden. There were important improvements in trauma symptoms a year later. These improvements were unrelated to different sexual assault referral centre models. Costs and other outcomes were also similar across models. Harmful policing and justice practices/procedures were identified by 25% of participants. In this context, trauma-competent interviewing techniques, regular/timely updates and conveying case decisions with care signalled good practice. The cohort study lacked a comparison group, reducing confidence in the finding that access to sexual assault referral centres explained the reduction observed in post-traumatic stress disorder. Barriers to access call for concerted efforts to implement trauma-informed universal health services. The risk 'triad' underscores the value of holistic approaches to care at sexual assault referral centres and timely follow-on care. Poor mental health was the main barrier to service access beyond sexual assault referral centres. The persistence of trauma symptoms a year after accessing sexual assault referral centres signals urgent need for tackling counselling wait-lists, expanding support options and commitment to lifelong care. Multidisciplinary evaluation of sexual assault referral centres for better health provides a foundation for advancing trauma-informed practices in the context of sexual violence and abuse. This study is registered as ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/117/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 35. See the NIHR Funding and Awards website for further award information.

Using natural language processing approaches to characterize professional experiences of child welfare workers

High turnover rates among child welfare workers, including caseworkers and supervisors, are associated with negative attitudes and perceptions about work (NAPW). Our study aimed to (a) explore how child welfare workers’ demographic characteristics, professional attributes, and their work narratives are related to NAPW and (b) extract themes from these narratives to understand their professional needs and concerns. In 2022, a statewide online survey was administered to active child welfare caseworkers and supervisors in a large Midwestern state. This survey, combining standardized scales and an open-ended question about work experiences, yielded numeric (N = 551 survey respondents) and text data (N = 2,193 words). We analyzed the numeric data using general linear modeling and the text data using natural language processing (NLP) techniques. Results showed that workers associated with higher NAPW were female, younger, from racial and ethnic minority backgrounds, less tenured, and more likely to be employed in public agencies and to work longer hours. They are predominantly caseworkers rather than supervisors. Worker role and agency affiliation had the largest effect sizes. NLP analysis showed that workers with more NAPW frequently used third-person pronouns and emotionally negative language, suggesting a disconnection from colleagues and job dissatisfaction. Caseworkers often used first-person singular pronouns, indicating feelings of isolation. Two key themes emerged: a) the need for better agency support during home visits and b) concerns over traumatic experiences and ineffective trauma-informed practices. The findings suggest that future interventions should prioritize the well-being of caseworkers in public agencies and consider language patterns in workers’ narratives to understand their vulnerability to NAPW.

A Primer on Trauma-Informed Practice in Refugee Law

This article is intended as a primer on trauma-informed practice for professionals working in the area of refugee law. Refugees and asylum seekers are amongst the most vulnerable groups in the community, and the process of seeking asylum itself can intensify stress. Trauma-informed practice is founded on ‘safety first’ and ‘do no harm’. It reflects adherence to core principles, rather than a prescribed set of practices and procedures. The core principles of trauma-informed practice include safety, trust, choice, collaboration and empowerment. This article primarily focusses on professional applications of trauma-informed practice at an individual level. By taking steps to integrate these principles into interpersonal interactions with refugees and asylum seekers, professionals can better support their needs in the refugee law context.

The Impact of Trauma-Informed Training for a Youth Residential Center on Staff Attitudes and Behavior

ABSTRACT Purpose Children with behavioral issues in residential care settings have high rates of trauma, with a range of trauma experiences such as abuse and neglect, issues with attachment, and multiple disruptions in placements. Staff in these settings should have an understanding of trauma, its impact, and how to engage in trauma-informed practice. The purpose of this study was to examine whether a trauma-informed training, developed specifically based on the identified needs of a residential group care facility, had an impact on future staff attitudes and behaviors. Materials and methods A 3-h training was delivered by the researchers. Three identical sessions were provided to all 48 staff, regardless of education and role, across a 3-day period. Prior to the training, staff were given a pretest survey measuring components of trauma-informed (TI) practice that indicated how often the staff members engaged in TI practice. Thirty days later, the same participants completed a posttest survey to gauge if the training had an impact on their subsequent attitudes and behavior. Results There were improvements in many of the trauma-informed practice areas on the posttest survey. T-test analysis revealed five trauma-informed practice areas had improvements that were statistically significant from the pretest survey. Discussion The findings present the opportunity for recommendations for trauma-informed training development and delivery, as well as providing implications for the field of social work. Conclusion This study demonstrates the feasibility of administering a trauma-informed training program and observing relatively rapid improvements in future attitudes and behavior among staff.