Creating a trauma-informed clinic takes time and commitment from all levels of leadership within an organization. It is important to start with a team of people committed to ensuring that there is a shift in the entire system serving the students.

Completing an assessment on how the clinic is currently operating in terms of trauma-informed and healing-centered practices can be instrumental in determining what is working well and creating an improvement plan.

The National Council for Behavioral Health’s Organizational Self Assessment is one example of a possible assessment tool and a description of more healing organizations.

Practices for Trauma-Informed Clinics

Principle

Shift perspective from

“What is wrong with you”

“What has happened to you”

“What is right with you?”

Practices

All staff are trained on stress, trauma, and resilience from front desk staff to top levels of leadership
Provide universal psychoeducation on stress, trauma, resilience, and self-regulation to all staff, patients, and students
Flexibility in staff work schedules in order to support staff caring for their work/life balance
Morning huddles with team to increase connection and mindfulness
Include relational supervision for staff directly involved with patients, i.e. for medical assistants providing screening

Principle

The organization values the healing value of traditional cultural connections, recognizes and addresses historical trauma and resilience, and creates policies that are responsive to the cultural needs of clients served.

Practices

All staff reflect on biases and the ways racial, cultural, and social identity inform thinking and actions
Hire professionals that reflect the patient population and are committed to cultural humility and continued self-reflection
Understand how sociocultural factors and structural adversities such as racism impact a person’s experience and stress response
Ensure signs and forms are inclusive of gender identity

Principle

Client physical and emotional safety are prioritized and the client description of feeling safe determines the practices.

Practices

Ensure patient understands their choice in all decisions and paperwork
Use positive and welcoming signs
Clearly lay out directions and expectations, i.e. “check in here,” and how the appointment will go and who will be seen
Confidential and private space for filling out forms and discussing material
Adolescent confidentiality rules displayed in exam rooms
Safe space signage clearly displayed

Principle

Makes decisions with transparency and with the goal of building trust with the staff, patients, families, and communities served.

Practices

Organizational culture that supports providers and attends to stress and burnout
Train all staff on how to recognize and build upon patient strengths and provide welcoming space
Use a non-judgmental approach and establish routines and predictability when coming to the clinics
Show you are available and schedule follow-up appointments
Clear descriptions for what the patient will experience to minimize anxiety
Informed consent policies given up front

Principle	Healing happens in relationships and that means it is important to share power in decision making between provider and patient and all staff.
Practices	Solicit and incorporate family and patient voices into practices and policies Implement inter-professional collaboration Offer choices throughout the visit, such as informing them that answering questions on screeners is optional Include patients in planning and evaluating services

Principle	Understanding that all people, staff and patients, may have experiences of trauma as well as the innate ability to heal and grow. Staff are facilitators of recovery and patients are supported in self-advocacy in their own healing.
Practices	Facilitate group interactions for sharing healing, resilience, and lived experiences Include peer supports as a part of the team of health professionals Include patient voice in treatment planning and draw upon strengths in treatment plan Ensure all staff are trained in the impacts of toxic stress and burnout and supported organizationally to care for themselves

SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach

This toolkit gives guidance on the principles and the ten implementation domains to create a trauma-informed clinic.

National Council for Behavioral Health Fostering Resilience Change Package

This toolkit has resources and guidance for implementing trauma-informed practices in clinics.

ACEs Aware Trauma-Informed Care Overview

This toolkit explains trauma-informed care and implementation inclusive of screening for ACEs.

The Sanctuary Model

This describes an evidence-based, trauma-informed organizational system.

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Assessments

Practices for Trauma-Informed Clinics

Understanding Stress and Trauma

Principle

Practices

Cultural Humility and Equity

Principle

Practices

Safety and Stability

Principle

Practices

Compassion and Dependability

Principle

Practices

Collaboration and Empowerment

Principle

Practices

Resilience and Recovery

Principle

Practices

Resources

SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach

National Council for Behavioral Health Fostering Resilience Change Package

ACEs Aware Trauma-Informed Care Overview

The Sanctuary Model