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Trauma-Informed Care Collection

Trauma-Sensitive Healthcare Practices


  • Pay attention to body cues (trembling, flinching, flushing, crying). Many survivors are conditioned to be passive and defer to authority. 
  • Use Grounding Techniques-
    • Share where they are, why they are here
    • Take time to familiarize patient with physical environment
  • Remember difficult or angry persons are often scared or putting up a tough front. "This is BS!...I'm leaving...Leave me alone." Recognize function behind the behavior. 
  • For medical appointments, meet before they disrobe, explain reasons for change of clothing, get consent from patient. 
  • When safe, leave room while patient is changing.
  • Provide a variety of sizes if using gowns and discuss whether opening is to be in the front or back. 
  • Do not assume all males are comfortable bearing their chests. 
  • Environment-Remember high anxiety while waiting for health care appointments can occur due to triggers of past abuse experiences. 
    • Create waiting areas that are warm and welcoming
    • Consider how to create safe movement, i.e. rocking chairs
    • Signage for Safety (brochures, posters)
    • Signage to educate and normalize emotional health needs
    • Post policies in language that is simple and succinct


  • Recognize your role and speak to your plan to listen
  • Explain why you are doing what you are doing
    • Tell patient what to expect and how long it will take
    • Explain everything in simple terms, use open ended questions to check
    • Tell when you will be back and how to reach you
  • When upset, clarify, "It seems like you might be having a rough time...I am so glad you are talking...We are here to help."
    • Explain strong feelings (i.e. fear, anger, sadness) are okay/normal
  • Clear and consistent rules for behavior and setting limits
  • Recognize behaviors not as pathology but rather as attempts to cope or survive
  • If patient/family displays shame or embarrassment, speak to that, "You don't need to worry about anything you say here. We want you to be healthy and safe."
  • Don't assume sexual orientation/gender
  • When screening for safety concerns remember... Disclosure is NOT the key. The key is risk assessment.
    • Has  anyone ever asked you to...?
    • has anyone ever taken photos of you when...?

Cultural Humility

  • Infused into all Key Principles-We don't know what we don't know


  • Consider all options for providing choice. Only limit when necessary. 
  • Explain rationale for what you are doing and obtain consent. 
  • Ask before you invite others in the room. 
    • Explain reasons for medical or other students. 
    • Let patient or family know they can change their mind at any time. 
  • When a third party must be in the room for medical or legal reasons, ensure understanding and consent. 
  • Ask before you close the door, curtain.
  • Ask permission to screen for traumatic histories & symptoms
    • Explain that often there are related factors between adverse experiences and health
    • Explain referrals for support are available. 
  • Share power
    • When possible, ask before you touch them. 
    • Offer a choice of where to sit in examination, treatment, and waiting rooms
  • Because some survivors are strongly affected by lighting and views of floor and ceilings, ask about their comfort level with position and lighting. 


  • Flatten the hierarchy. Encourage a collaborative relationship between the patient and staff (patient and family seen as experts)
  • Encourage the person to make decisions about their care. 
    • Co-create solutions when possible
    • Foster a sense of investment
  • Knowledge is power. Share what you know. 
    • Why are you making referrals?
    • Have kids gotten help before?
  • When they share something won't work, 
    • Empathic listening
    • Ask for suggestions. 
  • Late arrivals-First tell them you are glad they are here!
    • Can you offer a shorter slot?
    • Is there a possibility of being seen?
    • What can be completed?


  • Ask "What happened to you," not "What is wrong with you?"
  • Support parents in comforting their child
  • Identify strengths/build on skills. 
  • Use Person First Language
    • She has autism (or a diagnosis of ...)
    • Does not have stable or secure housing
    • It is hard for them to be calm right now...
    • He shares a struggle with opioid abuse...


  • Gallo-Silver L, Anderson CM, Romo J. Best clinical practices for male adult survivors of childhood sexual abuse: "do no harm". Perm J. 2014;18(3):82-87. doi:10.7812/TPP/14-009
  • Schachter, C.L., Stalker, C.A., Teram, E., Lasiuk, G.C., Danilkewich, A. (2008). Handbook on sensitive practice for health care practitioner: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada. Accessed: 
  • Hodas, GR. (2006). Responding to childhood trauma: the promise and practice of trauma informed care.  Pennsylvania Office of Mental Health and Substance Abuse Services. Accessed:
  • Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117-125. doi:10.1353/hpu.2010.0233
  • Greenbaum, J. (2018), Responding to Human Trafficking,  AAP-Trauma-Informed Pediatric Provider Course Addressing Childhood Adversity and Building Resilience.