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RESOURCES GUIDE

Trauma-Informed
Care for Health
Care Professionals
WHAT’S INSIDE

Key Trauma-Related 6 Guiding Principles Tips to Prevent De-Escalation

Concepts to a Trauma-Informed Vicarious Trauma Preferences Form
Approach

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Resources Guide: Trauma-Informed Care for Health Care Professionals

A trauma-informed
health care team
makes your
facility safer for
all patients.

Trauma can come in many forms, and whether caused by a

single event or by a repeated exposure, the way a person feels,
thinks, and behaves is shaped by that experience. As health care
professionals, you may encounter both patients and colleagues
that have been impacted.

Understanding the definition of trauma This guide will give you:

and increasing your awareness of the
• A deeper awareness of key
specific trauma a person has experienced
trauma-related concepts.
will help you better understand not only
how they’ve been impacted, but how to • A greater understanding of
respond appropriately to their behavior trauma’s effects on behavior.
as well. • 6 Guiding Principles to a
Trauma-Informed Approach.
As you sharpen your understanding of
their experience, you are strengthening • Tips for understanding and
your relationship and making future preventing vicarious trauma.
interventions that much more successful. • A De-Escalation Preferences Form
That level of trust is critical to trauma- to use with patients and colleagues.
informed care—in and out of the
• Resources to explore
workplace—and allows you to respond
trauma-informed care further.
efficiently while calming escalating
behaviors.

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Resources Guide: Trauma-Informed Care for Health Care Professionals

Trauma Terminology Defined

Trauma Triggers
An emotional response to a terrible Signals that act as signs of possible
event like an accident, rape or natural danger, based on historical traumatic
disaster. Immediately after the event, experiences which lead to a set of
shock and denial are typical. Longer term emotional, physiological, and behavioral
reactions include unpredictable emotions, responses that arise in the service of
flashbacks, strained relationships and even survival and safety (e.g., sights, sounds,
physical symptoms like headaches smells, touch).
or nausea.
Triggers are all about a person’s
Trauma-Informed Care perceptions experienced as reality. The
mind/body connection sets in motion a
A framework of thinking and
fight, flight, or freeze response. A patient or
interventions that are directed by a
colleague who is triggered will experience
thorough understanding of the profound
fear, panic, upset, and agitation.
neurological, biological, psychological,

mental
and social effects trauma has on an
individual—recognizing that person’s
constant interdependent needs for

trauma
safety, connections, and ways to manage
emotions/impulses.

is one of the most-common

psychological health conditions.

61% of men and 51%

of women report at
least one traumatic
event in their lifetimes.
This would put mental
trauma at the top
of the list of most-
common psychological
health conditions.

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Resources Guide: Trauma-Informed Care for Health Care Professionals

Types of Trauma
Acute trauma results from exposure to a Complex trauma results from a single
single overwhelming event. traumatic event that is devastating enough
• Examples: Rape, death of a loved one, to have long-lasting effects.
natural disaster. • Examples: Mass casualty school shooting,
• Characteristics: Detailed memories, car accident with fatalities involved,
omens, hyper-vigilance, exaggerated refugee dislocation.
startle response, misperceptions or • Characteristics: Perpetual mourning or
overreactions. depression, chronic pain, concentration
problems, sleep disturbances, irritability.
Chronic trauma results from extended
exposure to traumatizing situations.
• Examples: Prolonged exposure to violence
or bullying, profound neglect, home Traumatization occurs
environment, or abrupt removal from an when internal and external
environment with friends or colleagues. resources are inadequate
• Characteristics: Denial and psychological for coping.
numbing, dissociation, rage, social
withdrawal, sense of foreshortened future.

The Effects of Trauma on Behavior

Think about the distinct types of trauma Let’s look at the patient or colleague’s
noted above, and the characteristics behavior through a trauma-informed lens.
commonly associated with each. As
a health care professional, you may Questions to ask yourself include:
encounter patients or home care residents
• What type of trauma could be at
who become easily startled, begin
play here?
withdrawing, or even show uncharacteristic
outbursts. You may also notice a colleague • What are some possible triggers?
exhibiting similar behaviors. They could be obvious or subtle.
• How could you respond in a
Modeling a person-centered, trauma-informed way?
strength-based approach
creates a cultural shift in how
health care professionals and
patients interact.
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Resources Guide: Trauma-Informed Care for Health Care Professionals

Guiding Principles to a
Trauma-Informed Approach
The CDC’s Office of Public Health Preparedness and Response
(OPHPR), in collaboration with SAMHSA’s National Center for
Trauma-Informed Care (NCTIC), has developed six principles that
help guide a trauma-informed approach.

CPI Nonviolent Crisis Intervention® 2nd Edition: Trauma Training provides a

deeper dive into each of these concepts as it relates to the trauma-impacted
individuals in your care.

1 Safety 5 Empowerment and Choice

The physical setting provided is safe, A focus on recognizing, empowering,
and the interpersonal interactions and building upon the strengths and
further promote that sense of safety. experiences of trauma-impacted
individuals.
2 Trustworthiness and Transparency
The organization’s operations and 6 Cultural, Historical, and
decisions are made based on trust and Gender Issues
transparency. The trust of individuals The organization makes an effort to
served is built and consistently move past cultural stereotypes and
maintained. biases; utilizing policies, protocols, and
processes that respond to racial, ethnic,
3 Peer Support and cultural needs.
Peer support is a key vehicle for
establishing safety, building trust,
enhancing collaboration, and utilizing
lived experience to promote recovery “Adopting a trauma-informed
and healing. approach is not accomplished
through any single particular
4 Collaboration and Mutuality
technique or checklist. It requires
The effectiveness of mutual decision-
constant attention, caring awareness,
making and sharing of power is
sensitivity, and possibly a cultural
harnessed. This concept highlights the
change at an organizational level.”
role everyone in an organization plays
(Source: CDC)
in providing trauma-informed care.

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Resources Guide: Trauma-Informed Care for Health Care Professionals

Health Care Workers Impacted

by Vicarious/Secondary Trauma
Also known as compassion fatigue, vicarious/secondary
trauma is a process through which one’s own experience
becomes transformed through engagement with
an individual’s trauma.

If your role finds you regularly interacting with patients or

colleagues impacted by trauma, such as that of a nurse
or hospital social worker, you may be at a higher risk of
compassion fatigue—that is, experiencing an impact from the
trauma those in your care have experienced. It’s important to Oftentimes, the
be self-aware of the signs of compassion fatigue in your own person affected
behavior, but also in the behavior of your colleagues. is the last to
recognize what
Signs of Risk Factors is happening. If
Compassion Fatigue: for Compassion Fatigue: you are a friend,
• Reduced sense of efficacy • Being new to the field. family member,
at work. • Having a history of or a colleague
• Concentration and focus personal trauma. to someone who
problems. • Working long hours and you feel may be
• Apathy and emotional experiencing sleep exhibiting signs
numbness. deprivation. of compassion
• Isolation and withdrawal. • Having inadequate fatigue, bringing it
• Exhaustion. support systems.
to their attention
• Difficulty communicating
• Jaded, bitter pessimism. is critical to their
emotions.
• Secretive addictions and mental well-being.
self-medicating.

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Resources Guide: Trauma-Informed Care for Health Care Professionals

7 Tips for Preventing

Re-Traumatization
1. Learn as much as you can. 5. Provide consistency, predictability,
Collect data and screen for trauma and choice-making opportunities.
histories. Use the De-Escalation Meet the person where they are, in
Preferences Form on the a way they understand. Consistency
following pages. and predictability provide feelings
of safety for the individual, helping
2. Grow your skill of attunement. to reduce anxiety. And by providing
That is, develop your capacity and choice-making opportunities, you
the capacity of staff and clients to allow that person to have control. All
accurately read each other’s cues and of this can go a long way to empower
respond appropriately. the person.

3. Look for the causes of behaviors. 6. Always weigh the physiological,

psychological, and social risks of
Seek to understand the function of
any physical interventions.
behaviors and what the behaviors are
communicating. What you might view Be sure to choose the least-restrictive
as a frustrating behavior may actually option possible in every situation.
be a coping mechanism attempt. If
your response is not trauma-informed, 7. Debrief.
it could play right into causing the Prioritize debriefing after any crisis.
individual to feel less safe and even This will help you find patterns and
more disconnected. triggers—and prevent crises from
reoccurring. It will also help you
4. Use person-centered, strength- help the person foster resilience and
based thinking and language. develop successful coping skills.
Help staff shift from a deficit-based
mindset to a strength-based mindset.
Instead of looking at how a person is Common functions of
“a victim” or “damaged,” we can view behavior include access,
them as a survivor. Focus on what
they can do, and not on what they
avoidance, and meeting a
cannot do. sensory or emotional need.

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Resources Guide: Trauma-Informed Care for Health Care Professionals

De-Escalation Preferences Form

This form is a guide to help you gather information and
develop personalized de-escalation strategies. Person-
centered, trauma-informed de-escalation strategies are
powerful prevention tools to help you avert difficult behaviors,
and avoid restraint and seclusion. Use this form to develop
strategies that are unique to your environment and to the
patients and colleagues you’re surrounded by.

Name:

Date:

1. It’s helpful for us to be aware of the things that can help you feel better when you’re having a
hard time. Have any of the following ever worked for you? We may not be able to offer all these
alternatives, but I’d like us to work together to figure out how we can best help you.

q Listening to music. q Playing a computer game.

q Reading a newspaper/book. q Using ice on your body.
q Sitting by the nurses’ station/ q Breathing exercises.
waiting room, lobby, chapel, etc.
q Putting your hands under
q Watching TV. running water.
q Talking with a peer. q Going for a walk with staff.
q Walking the halls. q Lying down with a cold facecloth.
q Talking with staff. q Wrapping up in a blanket.
q Calling a friend. q Using a weighted vest.
q Having your hand held. q Voluntary time out in a quiet room.
q Calling your therapist. q Voluntary time out (anywhere specific?):
q Getting a hug.
q Pounding some clay.
q Punching a pillow. q Other:
q Physical exercise.
q Writing in your diary/journal.

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Resources Guide: Trauma-Informed Care for Health Care Professionals

2. Is there a person who’s been helpful to you when you’ve been upset?

q Yes q No

If you are not able to give us information, do we have your permission to call and speak to:

Name: ____________________________________________ Phone: _____________________________________

q Yes q No

If you agree that we can call to get information, sign below:

Signature: ______________________________________________________________________________________

Date: __________________________________________________________________________________________

Witness:________________________________________________________________________________________

Date: __________________________________________________________________________________________

3. What are some of the things that make it more difficult for you when you’re already upset?
Are there particular “triggers” that you know will cause you to escalate?
q Being touched.

q Being isolated.

q Door open.

q People in uniform.

q Loud noise.

q Yelling.

q A particular time of day (when?): _______________________________________________________________

q A time of the year (when?): _____________________________________________________________________

q Specific scents (please explain): ________________________________________________________________

q Not having control/input (please explain): ________________________________________________________

q Others (please list):

________________________________________________________________________________________________

________________________________________________________________________________________________

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Resources Guide: Trauma-Informed Care for Health Care Professionals

4. Have you ever been restrained?

q Yes q No

When:

Where:

Please describe what happened:

5. Do you have a preference regarding the gender of staff assigned to respond during a crisis?

q Female staff q Male staff q No preference

6. Is there anything that would assist you in feeling safe here? Please describe:

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 Resources Guide: Trauma-Informed Care for Health Care Professionals

Additional Trauma Resources

At Crisis Prevention Institute, the Care, Welfare, Safety, and SecuritySM
of your patients and colleagues is our top priority. Beyond our training
programs for health care professionals, we want to ensure you’re armed
with the knowledge and confidence you need to handle any challenges that
come your way in the safest, most effective way possible. The following
resources will help you learn more about trauma-informed practices.

BOOKS
The Comfort Garden: Tales From the Trauma Unit Treating Traumatic Stress in Children and Adolescents:
By Laurie Barkin, RN, MS. A personal account of working How to Foster Resilience Through Attachment, Self
as a psychiatric nurse at San Francisco General Hospital. Regulation, and Competency
By Margaret E. Blaustein and Kristine M. Kinniburgh. Provides a
Managing Change With Personal Resilience flexible framework for working with kids and their caregivers.
By Mark Kelly, Linda Hoopes, and Daryl Conner. Outlines
21 keys to being resilient in turbulent organizations.

WEBSITES AND ARTICLES

3 Keys to Help Staff Cope with Secondary Trauma Personal Resilience: How to Be Resilient When
Hearing the shocking stories of our clients can have a You’re a Caregiver
devastating effect. This article offers antidotes. Dr. Linda Hoopes of Resilience Alliance on how to flex
your seven resilience muscles.
12 Ways to Help a Developmentally Traumatized Child
When a kid with trauma explodes like the Tasmanian Devil, How to Help People Handle Trauma
here’s how to get them back on track. Strategies for attuning your own emotions can help
you care for people who carry the weight of trauma.
CDC’s Adverse Childhood Experiences (ACEs)
Study Info on the landmark study that measures 10 types of How Therapeutic Writing Can Help Crisis Workers
childhood traumas and their effects on health. One night, unable to sleep, a psych nurse found catharsis
from the intensity of her patients’ tragedies.
Compassion Fatigue: Could It Be Compromising
Your Professionalism? Is Trauma-Informed Care Just Another Buzzword?
For those who excel at taking care of others but put A movie about a doctor in 1980s East Germany shows
themselves last on the priority list. how important trauma-informed care is.

National Center for Trauma-Informed Care and

Alternatives to Seclusion and Restraint
Offers resources to help health care workers develop
trauma informed practices.

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Resources Guide: Trauma-Informed Care for Health Care Professionals

A Safer Health Care

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