SAMHSA leads federal efforts to promote trauma-informed approaches to health care through campaigns, technical assistance, and other resources.
SAMHSA is one of the leading agencies addressing the impact of trauma on individuals, families, and communities. SAMHSA has made contributions in key areas through a series of significant initiatives over the past decade. These contributions include:
- The development and promotion of trauma-specific interventions
- The expansion of trauma-informed care
- The consideration of trauma and its behavioral health effects across health and social service delivery systems
SAMHSA promotes a trauma-informed approach to behavioral health care. This approach shifts away from the view of “What’s wrong with this person?” to a more holistic view of “What happened to this person?” This becomes the foundation on which to begin a healing and recovery process. While symptoms may prompt a person to seek the assistance of a doctor or counselor, employing the trauma-informed approach creates a place of safety and mutual respect where a person’s whole history can be considered. This enables trauma survivors and providers to work together to find the best avenues for healing and wellness. A program, organization, or system that is trauma-informed follows SAMHSA’s four “Rs”:
- Realizes the widespread impact of trauma and understands potential paths for recovery
- Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system
- Responds by fully integrating knowledge about trauma into policies, procedures, and practices
- Actively seeks to resist re-traumatization
Trauma-specific services refer to prevention, intervention, or treatment services that address traumatic stress as well as any co-occurring disorders (including mental health concerns and substance use) that developed during or after trauma. SAMHSA’s TIP 57: Trauma-Informed Care in Behavioral Health Services – 2014 provides detailed information.
SAMHSA’s six key principles of a trauma-informed approach and trauma-specific interventions are designed specifically to address the consequences of trauma in the individual and to facilitate healing. The key principles include:
- Safety—Throughout the organization, staff and clients should feel physically and psychologically safe.
- Trustworthiness and transparency—Organizational operations and decisions are conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members.
- Peer support and mutual self-help—Both are seen as integral to the organizational and service delivery approach and are understood as key vehicles for building trust, establishing safety, and empowerment.
- Collaboration and mutuality—There is true partnering between staff and clients and among organizational staff from direct care staff to administrators.
- Empowerment, voice, and choice—Throughout the organization, and among the clients served, individuals’ strengths are recognized, built on, and validated, and new skills developed as necessary.
- Cultural, historical, and gender issues—The organization actively moves past cultural stereotypes and biases, considers language and cultural considerations in providing support, offers gender-responsive services, leverages the healing value of traditional cultural and peer connections, and recognizes and addresses historical trauma.
In addition to trauma-informed care, promoting recovery and resilience for those who have experienced traumatic events involves developing and implementing supports that specifically consider the event and trauma experienced. It also means examining ways to reduce re-traumatization. Consistent with SAMHSA’s working definition of recovery, trauma-informed services and supports build on consumer and family choice, empowerment, and collaboration.
SAMHSA’s resilience and stress management collection provides a knowledge base for understanding the concept of resilience, as well as the concept of stress and stress management.
The SAMHSA National Center for Trauma-informed Care and Alternatives to Seclusion and Restraint (NCTIC) offers consultation and technical assistance to develop trauma-informed care approaches to eliminate the use of seclusion, restraints, and other coercive practices. It is also working to develop a knowledge base related to implementing trauma-informed approaches. SAMHSA’s report The Business Case for Preventing and Reducing Restraint and Seclusion Use – 2011 provides additional information on why such practices are harmful.
School and Community-Based Violence
Youth violence is a serious problem that can have lasting harmful effects on victims and their families, friends, and communities. Many prevention tools have been developed and implemented and found to be effective at preventing violence and related behaviors among youth.
SAMHSA collaborates with multiple federal agencies to prevent exposure to community violence, particularly for children and youth. The National Forum on Youth Violence Prevention brings together a diverse array of stakeholders at the federal, state, and local levels to prevent youth violence through comprehensive planning and the implementation of evidence-based strategies. SAMHSA also supports the My Brother’s Keeper initiative launched by President Obama to address persistent opportunity gaps faced by boys and young men of color and ensure that all young people can reach their full potential.
SAMHSA offers a number of grant programs and other resources designed to promote mental health and emotional development among school-aged youth and to prevent school violence and substance use in schools and on campuses. The Safe Schools/Healthy Students (SS/HS) program is designed to prevent violence and substance use among our nation’s youth, schools, and communities. SS/HS promotes states and communities working together to address mental health among students, enhance their academic achievement, prevent violence and substance use, and create safe and respectful school environments.
- Project AWARE (Advancing Wellness and Resilience Education), a component of the Now Is The Time Program, builds and expands the capacity of state educational agencies to increase awareness of mental health issues among school-aged youth. Project AWARE provides training for school personnel and other adults to detect and respond to mental health issues in children and young adults, and connects children, youth, and families who may have behavioral health issues with appropriate services.
Learn more about SAMHSA’s work on Now Is The Time.
The SAMHSA National Resource Center for Mental Health Promotion and Youth Violence Prevention provides states and local communities with resources to foster safe and healthy school and community environments and support well-being for children and youth. The National Resource Center supports states and communities funded under the SS/HS initiative and Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) programs to:
- Develop resources to build youth violence prevention programs
- Provide technical assistance to select, implement, and evaluate programs and services
- Build and enhance collaborations among education, public health, behavioral health, child welfare, juvenile justice, and law enforcement
- Using a public health approach to address youth violence
- Engaging youth and families
- Supporting trauma-informed approaches
- Providing culturally and linguistically competent services and programs
- Decreasing differences and reducing disparities among racial, ethnic, and sexual minority communities
- Improving delivery and financing of behavioral health services
- Introducing, supporting, and nurturing collaboration among and between systems at the local, state, and national levels
Bullying is unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Both children who are bullied and those who bully others may have serious, lasting problems. Trauma can be a consequence of bullying, which can lead to mental health issues, substance use, and suicide, particularly if there is a prior history of depression or delinquency.
To learn more, visit Stopbullying.gov and SAMHSA’s SS/HS Initiative for research and best practices in bullying prevention and interventions – 2012 (PDF | 1.9 MB). KnowBullying is a free mobile app provided by SAMHSA that gives parents tools to start the conversation with their children about bullying.
Child and Family Trauma
The mission of SAMHSA’s National Child Traumatic Stress Network (NCTSN) is to raise the standard of care and improve access to evidence-based services for traumatized children, their families, and communities throughout the United States. The NCTSN brings together the academic and research community’s specialized knowledge and experience in developing evidence-based treatments with the experience and expertise of frontline, community-based service providers and the voices of youth and families. The NCTSN reaches beyond traditional mental healthcare settings to schools, the juvenile justice system, child protective services, police and other first responders, foster care programs, medical settings, and other systems and organizations that serve children.
More than 25 interventions are being developed, tested and disseminated by the network to address the different types of traumatic events experienced by children and their families. Each month more than 3,500 children are treated within the network and more than 5,000 professionals trained.
Specific interventions have been developed for child sexual abuse, child physical abuse, and early childhood trauma. There are also interventions for use in juvenile justice and surgical/medical care settings, as well as for use by disaster responders who provide people with psychological first aid. Interventions and approaches for use with diverse populations, including people from racial and ethnic and lesbian, gay, bisexual, and transgender (LGBT) communities, have similarly been developed. To learn more, visit the NCTSN’s Culture and Trauma webpage.
Trauma negatively affects LGBT individuals in many ways. LGBT people of any age may suffer from the effects of prejudice, discrimination, heterosexism, homophobia, and internalized homophobia. Childhood abuse, adult abuse, and interpersonal violence, along with hate crimes, leave both physical and emotional scars. Even the fear of violence alone or anti-LGBT harassment can inflict trauma.
SAMHSA’s publication Building Bridges – 2013 provides additional information on this population group and the unique factors that promote or hinder recovery from substance abuse and mental health problems. The SAMHSA Office of Behavioral Health Equity’s LGBT webpage offers additional information and resources. Additionally, SAMHSA’s National Child Traumatic Stress Network has created several trainings and resources for behavioral health professionals when working to assist traumatized LGBT youth.
Trauma and the Criminal and Juvenile Justice System
While the effects of trauma and exposure to violence can be found in all service sectors, it is particularly prominent among people with mental and/or substance use disorders involved in the criminal and juvenile justice systems. SAMHSA is committed to improving the well-being and personal recovery of people with mental, substance use, or co-occurring disorders involved with the justice system through innovative diversion practices, strategic connections with community-based providers and correctional health professionals, effective re-entry programs, and policy development.
SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation focuses on expanding access to community-based services for adults diagnosed with co-occurring mental and substance use disorders at all points of contact with the justice system. It provides extensive training and technical assistance regarding trauma among justice-involved adults and in criminal justice settings.
Trauma and Disasters
The Disaster Technical Assistance Center (DTAC) supports SAMHSA’s efforts to prepare states, territories, tribes, and localities to deliver an effective behavioral health response to disasters. DTAC support includes technical assistance, training, consultation, disaster behavioral health resources, information exchange, and knowledge brokering.
The SAMHSA Disaster Behavioral Health Information Series (DBHIS) contains resource collections, toolkits, and a disaster app pertinent to disaster-related behavioral health issues. Installments in this series focus on specific populations, specific types of disasters, and other topics related to disaster-related behavioral health issues.
The mission of the Crisis Counseling Assistance and Training Program (CCP) is to assist individuals and communities in recovering from the effects of natural and human-caused disasters through the provision of community-based outreach and psycho-educational services.
Homelessness is traumatic. People experiencing homelessness are living with a multitude of losses. People experiencing homelessness have lost the protection of home and community, and are marginalized, isolated, and stigmatized within society at large. Additionally, people who are experiencing homelessness are highly vulnerable to violence and victimization. SAMHSA’s homelessness programs and resources include information about the linkages between trauma and homelessness.
Trauma and the Military
The stressful environment of military life and experiences of combat often lead to traumatic reactions. Approximately 18.5% of service members returning from Iraq or Afghanistan have post-traumatic stress disorder (PTSD)or depression. Coupled with substance use issues, suicidal issues, homelessness, and involvement with the criminal justice system, many service members and their families deal with the consequences of service-based trauma.
Additionally, military sexual trauma is an area under great scrutiny. Military sexual trauma is a term for sexual assault or repeated sexual harassment that occurs during military service. According to 2013 data from the Veterans Health Administration (VA), 24.3% of female veterans/VA users screened positively for military sexual trauma.
The SAMHSA Service Members, Veterans, and their Families Technical Assistance (SMVF TA) Center works with states and territories to strengthen their behavioral health systems for service members (including active duty, National Guard, and reservists), veterans, and their families. Learn more about SAMHSA’s efforts to address trauma and behavioral health issues experienced by military service members and their families at the Veterans and Military Families topic. Visit the VA’s PTSD webpage for additional information.