Social work theory · Volume H: Integrative & Practice-Oriented
Trauma-informed practice
Trauma-informed practice is a framework for organising services and relationships around an understanding of how trauma affects people's lives. It is a way of working that applies across a whole service, from first contact to policy and staff support.
1. What it is
Trauma-informed practice is a framework for organising services and relationships around an understanding of how trauma affects people’s lives. It is a way of working that applies across a whole service, from first contact to policy and staff support. Its starting point is that many people who use social, health and justice services have experienced trauma. Services can support their recovery, or they can unintentionally repeat the dynamics of the original harm (Harris & Fallot, 2001). Trauma-informed practice is distinct from trauma-specific treatment, which refers to therapies designed to treat trauma symptoms directly (Knight, 2015). In social work, it draws together trauma theory, attachment and neurobiological research, and the profession’s commitment to empowerment and social justice.
SAMHSA’s concept of trauma. The United States Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) defines individual trauma through three elements, known as “the three E’s”. These are an event or circumstances, experienced as harmful or life-threatening, with lasting adverse effects on functioning and wellbeing. The definition places weight on how an event is experienced, which explains why the same event can be traumatic for one person and not another. SAMHSA describes a trauma-informed approach through “the four R’s”. A program realises the widespread impact of trauma, recognises its signs, responds by integrating this knowledge into policy and practice, and seeks actively to resist re-traumatisation.
The six principles. SAMHSA (2014) sets out six key principles: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and attention to cultural, historical and gender issues. Safety covers physical and emotional safety for clients and staff. Trustworthiness means decisions are made openly and boundaries are clear. Peer support recognises the value of people with lived experience. Collaboration levels power differences between staff and clients. Empowerment builds on strengths and supports choice. The final principle asks services to move past stereotypes and to recognise historical trauma, including colonisation.
Harris and Fallot. Maxine Harris and Roger Fallot (2001) argued that trauma-informed services require a change in organisational culture, a “paradigm shift” in how services understand the people they serve. Fallot and Harris identified five core values: safety, trustworthiness, choice, collaboration and empowerment. These values informed SAMHSA’s later principles. They also proposed that services audit everyday practices, such as waiting areas, intake questions and rules, for their potential to re-traumatise.
Herman’s stages of recovery. Judith Herman (1992a) described recovery from trauma as occurring in three stages. The first, establishing safety, focuses on stabilisation, self-care and a safe environment. The second, remembrance and mourning, involves telling the trauma story and grieving its losses. The third, reconnection with ordinary life, involves rebuilding relationships and a sense of self and future. Herman (1992b) also proposed the concept of complex post-traumatic stress disorder for survivors of prolonged, repeated interpersonal trauma. In later work, Herman (2023) added justice, understood as acknowledgement and repair by the community, as a further stage of recovery.
Blue Knot Foundation guidelines. In Australia, the Blue Knot Foundation (formerly Adults Surviving Child Abuse) published practice guidelines for the treatment of complex trauma and for trauma-informed care and service delivery (Kezelman & Stavropoulos, 2012). The updated guidelines (Kezelman & Stavropoulos, 2019) adopt a phased approach consistent with Herman’s stages. They also draw on neurobiological research on stress and integration. The guidelines are widely used in Australian mental health, community and child protection services.
Vicarious trauma. Vicarious traumatisation describes the cumulative changes in a worker’s beliefs about safety, trust, esteem, intimacy and control that arise from empathic engagement with clients’ trauma (McCann & Pearlman, 1990). It is related to secondary traumatic stress and compassion fatigue, which describe trauma-like symptoms in helpers (Figley, 1995). Pearlman and Saakvitne (1995) argued that vicarious trauma is an occupational hazard and that supervision, workload management and organisational support are responsibilities of the employer as well as the worker.
Organisational trauma-informed care. Trauma-informed care applies the same principles to organisations. Bloom’s (1997) Sanctuary Model proposed that organisations under chronic stress can reproduce the features of traumatised individuals, such as hypervigilance, authoritarian control and loss of collective memory. A trauma-informed organisation attends to leadership, policy, physical environment, staff wellbeing, workforce training and the involvement of people with lived experience (SAMHSA, 2014; Bloom & Farragher, 2013).
2. Historical development
| Period | Development |
|---|---|
| 1980 | Post-traumatic stress disorder enters DSM-III, following advocacy by Vietnam veterans and the women’s movement |
| 1990–1995 | McCann and Pearlman (1990) define vicarious traumatisation; Figley (1995) describes compassion fatigue |
| 1992 | Herman’s Trauma and Recovery proposes stages of recovery and complex PTSD |
| 1997 | Bloom’s Sanctuary Model applies trauma theory to organisations |
| 1998 | The Adverse Childhood Experiences (ACE) study links childhood adversity to adult health (Felitti et al., 1998) |
| 2001 | Harris and Fallot set out trauma-informed service systems |
| 2012–2019 | Blue Knot Foundation practice guidelines published and updated in Australia |
| 2014 | SAMHSA publishes its concept of trauma and six principles |
| 2017 | Royal Commission into Institutional Responses to Child Sexual Abuse final report highlights institutional re-traumatisation |
Trauma-informed practice grew from clinical trauma research, feminist work on violence against women and children, and the community mental health and consumer movements. Herman (1992a) linked the study of trauma to political movements that made violence visible. The ACE study gave public health weight to the idea that trauma is common and has lifelong effects (Felitti et al., 1998). Trauma-informed practice became an independent approach once the focus moved from treating individual disorder to redesigning whole services.
Social work adopted trauma-informed practice readily because its principles align with the profession’s values of empowerment, self-determination and attention to context (Knight, 2015). In Australia, Atkinson (2002) documented the transgenerational effects of colonisation on Aboriginal families and communities, extending trauma thinking to collective and historical trauma. Royal Commissions into child sexual abuse, family violence and disability have since reinforced the need for trauma-informed service systems.
3. Practical guidance
Trauma-informed principles apply to every client interaction, whether or not trauma has been disclosed.
- Assume trauma may be present. Practise “universal precautions”: treat every client as someone who may have a trauma history, without requiring disclosure (Harris & Fallot, 2001).
- Prioritise safety and predictability. Explain what will happen, why and for how long. Avoid surprises, and offer the client control over seating, breaks and pace.
- Offer genuine choice. Give options about the order of topics, who is present and what information is shared. Choice restores a sense of agency that trauma often removes (SAMHSA, 2014).
- Ask what happened to the person. Move from asking what is wrong with someone to asking what happened to them. Reframe behaviours such as aggression, dissociation or missed appointments as possible survival responses (Sweeney et al., 2018).
- Work in phases. Follow Herman’s (1992a) sequence. Stabilisation and safety come before detailed trauma processing, which belongs with qualified clinicians.
- Attend to culture and history. Recognise collective and intergenerational trauma, including the effects of colonisation and child removal for Aboriginal and Torres Strait Islander peoples, and support culturally led healing (Atkinson, 2002).
- Look after the worker. Use regular supervision, peer debriefing and reasonable caseloads to manage vicarious trauma (Pearlman & Saakvitne, 1995).
4. Critical evaluation
Strengths. Trauma-informed practice gives services a shared language and set of principles that apply across sectors. It reframes distress and challenging behaviour in non-blaming terms and reduces practices, such as restraint or coercive intake, that may re-traumatise. Its organisational focus recognises that individual workers cannot provide safe care in unsafe systems (Bloom & Farragher, 2013). Its attention to worker wellbeing is important in high-risk fields such as child protection.
Limitations. The term is used loosely, and services can adopt the label without changing practice (Becker-Blease, 2017). The evidence base for whole-of-organisation models is still limited, and few outcome studies isolate the effects of trauma-informed care (Hanson & Lang, 2016). Critics also note that an emphasis on individual trauma can medicalise responses to structural harms such as poverty, racism and colonisation. Universal screening for trauma has been questioned when services lack the capacity to respond.
Overall importance. Trauma-informed practice is now a core expectation across Australian health, human services and justice settings. Its value lies in combining clinical knowledge of trauma with social work’s concern for power, choice and context. Used with attention to evidence and to structural causes of harm, it supports safer services for clients and workers.
5. References
- Atkinson, J. (2002). Trauma trails, recreating song lines: The transgenerational effects of trauma in Indigenous Australia. Spinifex Press.
- Becker-Blease, K. A. (2017). As the world becomes trauma-informed, work to do. Journal of Trauma & Dissociation, 18(2), 131–138. https://doi.org/10.1080/15299732.2017.1253401
- Bloom, S. L. (1997). Creating sanctuary: Toward the evolution of sane societies. Routledge.
- Bloom, S. L., & Farragher, B. (2013). Restoring sanctuary: A new operating system for trauma-informed systems of care. Oxford University Press.
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
- Figley, C. R. (Ed.). (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner/Mazel.
- Hanson, R. F., & Lang, J. (2016). A critical look at trauma-informed care among agencies and systems serving maltreated youth and their families. Child Maltreatment, 21(2), 95–100. https://doi.org/10.1177/1077559516635274
- Harris, M., & Fallot, R. D. (Eds.). (2001). Using trauma theory to design service systems (New Directions for Mental Health Services, No. 89). Jossey-Bass.
- Herman, J. L. (1992a). Trauma and recovery. Basic Books.
- Herman, J. L. (1992b). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. https://doi.org/10.1002/jts.2490050305
- Herman, J. L. (2023). Truth and repair: How trauma survivors envision justice. Basic Books.
- Kezelman, C., & Stavropoulos, P. (2012). Practice guidelines for treatment of complex trauma and trauma informed care and service delivery. Adults Surviving Child Abuse.
- Kezelman, C., & Stavropoulos, P. (2019). Practice guidelines for clinical treatment of complex trauma. Blue Knot Foundation.
- Knight, C. (2015). Trauma-informed social work practice: Practice considerations and challenges. Clinical Social Work Journal, 43(1), 25–37. https://doi.org/10.1007/s10615-014-0481-6
- McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3(1), 131–149. https://doi.org/10.1002/jts.2490030110
- Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. W. W. Norton.
- Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). U.S. Department of Health and Human Services.
- Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319–333. https://doi.org/10.1192/bja.2018.29