New SAMHSA Publication: Concept of Trauma and Guidance for a Trauma-Informed Approach

In July 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) released SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.

As described, “The purpose of the paper is to develop a working concept of trauma and a trauma-informed approach and to develop a shared understanding of these concepts that would be acceptable and appropriate across an array of service systems and stakeholder groups.”

SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

The paper describes the importance of a trauma-informed approach to services:

Trauma researchers, practitioners and survivors 
have recognized that the understanding of trauma and trauma-specific interventions is not sufficient
 to optimize outcomes for trauma survivors nor to influence how service systems conduct their business.

The context in which trauma is addressed or treatments deployed contributes to the outcomes for the trauma survivors, the people receiving services, and the individuals staffing the systems. Referred 
to variably as “trauma-informed care” or “trauma-informed approach” this framework is regarded as essential to the context of care [citations omitted].

The paper defines trauma using “the three E’s,” describing it as an event of actual or extreme threat of physical or psychological harm, which an an individual experiences as traumatic, and which causes long-lasted effects. It also discusses “the three R’s,” or the key assumptions in a trauma-informed approach, as follows: “A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies , procedures, and practices, and seeks to actively resist re-traumatization.”

The paper then goes on to provide 10 implementation domains, including governance and leadership, policy, and physical environment, along with sample organizational evaluation questions. The paper cites Becoming a Trauma-Informed Peer-Run Organization: A Self-Reflection Tool, adapted by Darby Penney and Cathy Cave from the National Center on Domestic Violence, Trauma and Mental Health’s popular tool, Creating Accessible, Culturally Relevant, Domestic Violence- and Trauma-Informed Agencies, as a source used in the creation of these domains.

Click here to access a PDF version of the paper, SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach:

Also from SAMHSA is TIP 57: Trauma-Informed Care in Behavioral Health Services, available here:



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