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Trauma-informed care is a service provision model used across a range of practice settings. Drawing on an extensive body of research on trauma (broadly defined as experiences that produce enduring emotional pain and distress) and health outcomes, we have argued that the principles of trauma-informed care can be extended to social policy. Citing a variety of health-related policy examples, we have described how policy can better reflect 6 core principles of trauma-informed care: safety, trustworthiness and transparency, collaboration, empowerment, choice, and intersectionality. This framework conveys a politicized understanding of trauma, reflecting the reality that trauma and its effects are not equally distributed, and offers a pathway for public health professionals to disrupt trauma-driven health disparities through policy action. (Am J Public Health. 2016;106:223-229. doi:10.2105/AJPH.2015. 302970)
In recent years, trauma-informed care has diffused as a model of service provision across a variety of health and social service settings.1-4 Trauma is broadly defined as experiences that produce intense emotional pain, fear, or distress, often resulting in long-term physiological and psychosocial consequences.3,5 For example, the landmark Adverse Childhood Experiences Study linked childhood experiences that are traumatic for many individuals, such as abuse and domestic violence, with adult health outcomes, including premature mortality, mental and physical health problems, and substance abuse.6-8 A trauma-informed care approach recognizes the intersection of trauma with many health and social problems for which people seek services and treatment, aiming to sensitively address trauma along with an individual's issues.
Trauma-informed care is conceptualized as an organizational change process centered on principles intended to promote healing and reduce the risk of retraumatization for vulnerable individuals.9 The literature indicates a growing interest in trauma-informed care among service providers, researchers, and government agencies, with this interest concentrating primarily on direct service settings.10-13 Policy in the trauma-informed care literature is typically discussed only at the institutional level, for example in terms of ensuring that an agency's policies and procedures adequately promote clients' confidentiality and safety.1,14
Because a social determinants of health perspective drives public health toward an emphasis on promoting "health in all policies," 15 we argue that the principles of trauma-informed care constitute a meaningful framework for analyzing social policy and guiding advocacy efforts. Such a framework builds on previous policy analysis models, such as Rapp, Petus,...