The purpose of this paper is to develop a working concept of trauma and a trauma-informed approach and to develop a shared understanding of these concepts that

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AcknowledgementsThis publication was developed under the leadership of SAMHSA™s Trauma and Disclaimer Public Domain NoticeAll materials appearing in this volume except those taken directly from copyrighted sources are in the public domain and may be reproduced or copied without permission Human Services.Electronic Access and Copies of Publication Web page at Recommended CitationSubstance Abuse and Mental Health Services Administration. SAMHSA™s Concept of Trauma and Guidance for a Trauma-Informed Approach

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page 1ContentsIntroduction 2 and a Trauma-Informed Approach ..3 Background: Trauma Š Where We Are and How We Got Here . SAMHSA™s Concept of Trauma 7 9 Guidance for Implementing a Trauma-Informed Approach .12 Next Steps: Trauma in the Context of Community .17 Conclusion 17 ..

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page 2Introduction traumatic experiences. without these services and supports. Unaddressed emotionally harmful experiences. Trauma has no and substance use disorders and chronic physical diseases. It is an almost universal experience of people with mental and substance use disorders. The need to address trauma is increasingly viewed as an important component of effective behavioral health multi-agency public health approach inclusive of assessment and treatment. In order to maximize the impact of these efforts, they need to be provided in an organizational or community context that is trauma-informed, that is, based on the knowledge and understanding of trauma and its far-reaching implications.The effects of traumatic events place a heavy create challenges for public institutions and service systems. Although many people who experience a traumatic event will go on with their lives without neurodevelopmental and immune systems responses and subsequent health risk behaviors resulting in chronic physical or behavioral health disorders.With appropriate supports and intervention, people can overcome traumatic experiences.Individuals with experiences of trauma are found substance use disorders and personal histories of trauma. Children and families in the child welfare system similarly experience high rates of trauma and associated behavioral health problems. Young people bring their experiences of trauma into the success. And many patients in primary care similarly on their health and their responsiveness to health interventions. that are intended to provide services and supports to individuals are often themselves trauma-inducing. removal of a child from an abusing family in the child for individuals who already enter these systems or system practices and policies often interfere with achieving the desired outcomes in these systems. The need to address trauma is increasingly viewed as an important component of effective behavioral health service delivery.

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page 4of traumatic experiences who have had involvement in multiple service sectors. It was expected that knowledge would generate a framework for improving the capacity of our service systems and public institutions to better address the trauma-related issues of their constituents. of trauma informed care. SAMHSA convened a group of national experts who had done extensive work in this area. This included trauma survivors who had been recipients of care in multiple service work focused on trauma and the development of document summarizing the discussions among these experts. The document was then vetted among made revisions to the document and developed the framework and guidance presented in this paper. The key questions addressed in this paper are: implementing a trauma-informed SAMHSA™s approach to this task has been an attempt to integrate knowledge developed through research and clinical practice with the voices of trauma survivors. This also included experts funded through such as SAMHSA™s National Child Traumatic Stress other grant programs that did not have a primary focus

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page 5 The concept of traumatic stress emerged in the movement has provided another perspective on the understanding of traumatic experiences. Trauma in recognizing the need to address trauma as a fundamental obligation for public mental health and substance abuse service delivery and has supported documented their paths to recovery. Traumatic the development and promulgation of trauma-informed experiences complicate a child™s or an adult™s capacity to make sense of their lives and to create meaningful consistent relationships in their families and communities. conference in which women trauma survivors talked about their experiences and ways in which standard and Violence Study to generate knowledge on the development and evaluation of integrated services approaches for women with co-occurring mental and substance use disorders who also had histories of funded the National Child Traumatic Stress Initiative to increase understanding of child trauma and develop effective interventions for children exposed to different types of traumatic events. traumatic stress disorders have been debated through several iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM) with a new National trauma research and practice centers have effective trauma assessments and treatments. approach to traumatic experiences has begun to interact and contribute to mental and substance use disorders across the life-span.Trauma survivors have powerfully and systematically documentedtheir paths to recovery. The convergence of the trauma survivor™s perspective with research and clinical work has underscored the central role of traumatic experiences in the lives of people with mental and substance use conditions. The connection between trauma and these conditions offers a potential explanatory model for what has who come to the attention of the behavioral health and other service systems. to these experiences often manifest in behaviors or conditions that result in involvement with the child on individuals in the military and increasing rates of posttraumatic stress disorders.

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page 6With the growing understanding of the pervasiveness number of clinical interventions for trauma responses academic institutions and practice-research partnerships have generated empirically-supported treatment or screening for trauma.These interventions have been integrated into the become clear that these clinical interventions are not enough. Building on lessons learned from SAMHSA™s and SAMHSA™s National Center for Trauma-Informed clear that the organizational climate and conditions role in maximizing the outcomes of interventions and contributing to the healing and recovery of the people being served. SAMHSA™s National Center for Trauma-Informed Care has continued to advance this but increasingly responding to technical assistance requests for organizational change in the criminal FEDERAL, STATE AND LOCAL LEVEL TRAUMA-FOCUSED ACTIVITIESThe increased understanding of the pervasiveness of trauma and its connections to physical and behavioral number of organizations and service systems to explore ways to make their services more responsive to people who have experienced trauma. This has been happening in state and local systems and federal agencies. Oregon Health Authority is looking at different types of trauma across the age span and different population groups. Maine™s fiThrive Initiativefl incorporates a trauma-informed care focus in their children™s systems of care. New Y ork is introducing a trauma-informed exploring a trauma-informed approach for their adult care statewide in child welfare practice. In Connecticut the Child Health and Development Institute with the a trauma-informed system of care throughout the state through policy and workforce development. SAMHSA has supported the further development of trauma-informed approaches through its Mental Health Transformation Grant program directed to State and local governments. Increasing examples of local level efforts are being a trauma-informed community. The city made it its mission to promote a widespread awareness of the costly effects of personal adversity upon the wellbeing Washington State convened groups to focus on the impact of adverse childhood experiences on the health and well-being of its local communities and tribal its understanding of the impact of trauma and violence on the psychological and physical health of its communities. SAMHSA continues its support of grant programs that treatment and recovery from trauma.

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page 7Other federal agencies have increased their focus primary care on how to address trauma issues in on trauma. The Administration on Children Youth health care for women. The Department of Labor is examining trauma and the workplace through a federal trauma of children in the child welfare system and interagency workgroup. The Department of Defense is how screening and assessing for severity of trauma honing in on prevention of sexual violence and trauma and linkage with trauma treatments can contribute in the military. As multiple federal agencies representing varied sectors have recognized the impact of traumatic agencies developed and issued through the CMS SAMHSA in addressing these issues. The widespread recognition of the impact of trauma and the burgeoning Single State Agency Directors for Substance Abuse interest in developing capacity to respond through trauma-informed approaches compelled SAMHSA to revisit its conceptual framework and approach treatment interventions and strategies for paying has developed a curriculum to train providers in SAMHSA™s Concept of Trauma Desiring a concept that could be shared among its to help craft a concept that would be relevant to public health agencies and service systems. SAMHSA aims to provide a viable framework that can be used to stakeholders in the work they do. A review of the generated the following concept:Individual trauma results from an event, series of events, or set of circumstances that is experiencedby an individual as physically or emotionally harmful or life threatening and that has lasting adverse effectson the individual™s functioning and mental, physical, social, emotional, or spiritual well-being.

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