NCTIC offers consultation and technical assistance to stimulate and support interest in developing approaches to eliminate the use of seclusion, restraints, and other coercive practices and to further develop the knowledge base related to the implementation of trauma-informed approaches, consistent with SAMHSA’s conceptual framework for trauma and trauma-informed practice, in publicly funded systems and programs.
NCTIC is funded by the SAMHSA Center for Mental Health Services (CMHS) through a contract with the National Association of State Mental Health Program Directors and its partner, Advocates for Human Potential, Inc.
Purpose and Mission of NCTIC
NCTIC offers consultation and technical assistance, education and outreach, and resources to support a broad range of service systems, including systems providing mental health and substance abuse services, housing and homelessness services, HIV services, peer and family organizations, child welfare, criminal justice, and education.
History of NCTIC
Created in 2005, NCTIC is a long-term commitment by SAMHSA to improve public behavioral health services to consumers and trauma survivors. It supports several of SAMHSA’s strategic initiatives, including Trauma and Justice and Recovery Support.
NCTIC was inspired by several groundbreaking SAMHSA initiatives to better understand and address the needs of people with trauma histories who receive mental health services:
- Dare to Vision Conference. In 1994, SAMHSA convened a conference focusing on the high rate of women with physical and sexual abuse histories in the public mental health system. Dare to Vision provided a forum for survivors and consumers to discuss their trauma histories, to stress the importance of and value in addressing trauma in treatment services, and to highlight the re-victimization experienced in residential or in-patient settings through such practices as seclusion and restraint.
- Women, Co-Occurring Disorders, and Violence Study (WCDVS). In 1998, SAMHSA launched a five-year study to explore the interrelation among violence, trauma, and co-occurring mental health and substance use disorders among women. The study was co-sponsored by the three SAMHSA Centers: CMHS, the Center for Substance Abuse Prevention, and the Center for Substance Abuse Treatment. WCDVS provided recommendations for "trauma-integrated services counseling" for these women. WCDVS also sparked the development of guiding principles for positive change, including the principle that providers should be mindful of the ways in which their own practices and policies might put women in danger, physically and emotionally, or bring about re-traumatization.
- Dare to Act Conference. In 2004, CMHS built on the growing momentum for trauma-informed care by hosting Dare to Act, a second national conference devoted to understanding and addressing the needs of trauma survivors. At this conference, practitioners, researchers, and policymakers discussed WCDVS and related research findings regarding trauma-specific services, strategies for implementing trauma-informed care, and personal stories of survival, healing, recovery, and triumph.
- Dare to Transform Conference. In 2008, SAMHSA hosted a third national conference, Dare to Transform. At this conference, people working to implement trauma-informed care shared best practices and explored innovative strategies for organizational change.
NCTIC's Current Framework
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. NCTIC facilitates the adoption of trauma-informed environments in the delivery of a broad range of services including mental health, substance use, housing, vocational or employment support, domestic violence and victim assistance, and peer support. In all of these environments, NCTIC seeks to change the paradigm from one that asks, "What's wrong with you?" to one that asks, "What has happened to you?"
Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors so as to be more supportive and avoid re-traumatizaton. SAMHSA has framed its concept for trauma around three “E’s”: event(s), experience of the event, and effect. According to SAMHSA’s conceptual framework, “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.”
Most individuals seeking public behavioral health and other public services, such as homeless and domestic violence services, have histories of physical and sexual abuse and other types of trauma-inducing experiences. These experiences often lead to mental health and co-occurring disorders such as chronic health conditions, substance abuse, eating disorders, and HIV/AIDS, as well as contact with the criminal justice system.
When a human services program takes the step to become trauma-informed, its entire organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services. NCTIC now focuses on further developing the implementation science for trauma-informed organizational and practice change so that human services are better poised to recognize the experience of trauma in those served and those in the workforce, and to move systemically and measurably toward being more responsive to those experiences and minimizing the potential for re-traumatization, including the use of seclusion, restraints, and other coercive practices.