Trauma-Informed Care

Nearly one in three adult women experience at least one physical assault by a partner during adulthood. 

One out of every 6 American women has been the victim of an attempted or completed rape in her lifetime

By the age of 13… at least one out of every five girls are sexually abused

Trauma is a widespread, harmful and costly public health problem. It occurs as a result of violence, traumatic experiences, abuse, neglect, loss, disaster, war and other emotionally harmful experiences. Traumatic exposure cuts across age groups, gender, socioeconomic status, race, ethnicity, geography and sexual orientation. Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being.[i]

Exposure to traumatic events in the lives of women such as Intimate Partner Violence (IPV), Military Sexual Trauma (MST), rape and other forms of sexual assault, child abuse and neglect, terrorism, natural disasters, and street violence, all predispose affected individuals to poor health outcomes in part through high risk behaviors such as smoking, drinking, illicit drug use, and risky sex, as means to cope with trauma.  As a function of both engaging in high risk behaviors and the trauma itself, survivors are at increased risk of poor physical and mental health outcomes.

Recognizing the substantial prevalence of traumatic exposure and that the impact on health and well-being is dramatically underestimated, health and social service providers are gradually recognizing the value of adopting Trauma-Informed Care (TIC) principles into their practice.

Trauma-informed care and trauma-informed systems function according to at least four basic principles:

1) Realize the prevalence of traumatic events and the widespread impact of trauma;

2) Recognize the signs and symptoms of trauma;

3) Respond by integrating knowledge about trauma into policies, procedures, and practices; and

4) seek to actively Resist Re-traumatization.

These are often referred to as the “Four R’s.”[ii]

Trauma-informed care is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. The TIC pyramid (below)  helps practitioners to visualize TIC and how to apply the principles to practice.

Pyramid showing elements of Trauma-Informed Care: Base level (purple) is labeled 'Patient-Centered Communication Skills'; Second level from bottom (green) is labeled 'Understanding the Health Effects of Trauma'; Third level from bottom (orange) is labeled 'Collaboration and Understanding Your Professional Role'; Fourth level from bottom (turquoise) is labeled 'Understanding Your Own History'; and Top level (red) is labeled 'Screening.'

[iii] Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S.,Rajagopalan, C. & Kruthoff, M.

For more information

Substance Abuse and Mental Health Services Administration's (SAMHSA) National Center for Trauma-Informed Care

Center for Disease Control and Prevention’s (CDC) Injury Prevention & Control : Division of Violence Prevention: ACE Study

The Adverse Childhood Experiences Study

ACEs Connection

ACES Too High


[ii] TIP 57 (PDF, 5 MB)
[iii] Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S.,Rajagopalan, C. & Kruthoff, M. Trauma Informed Care in Medicine: Current Knowledge and Future Research Directions. Family and Community Health. 2015 Jul-Sep;38(3):216-26.
Page last reviewed April 2016
Page originally created April 2015
Internet Citation: Trauma-Informed Care. Content last reviewed April 2016. Agency for Healthcare Research and Quality, Rockville, MD.
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