Report of the Federal Partners 

Committee on Women and Trauma

A Federal Intergovernmental Partnership 

on Mental Health Transformation

A Working Document

JUNE, 2011

WOMEN

AND

TRAUMA
1

Note:

The views reflected in this report only reflect those of the 

authors or speakers, and not of their agencies or institutions 

of employment

 
2

Table of Contents

Preface ..............................................................................................................................................4

Background: The Need for a “Women and Trauma Committee”............................................................. 4

“Women and Trauma Committee” Operational Development................................................................ 5

Executive Summary............................................................................................................................7

Introduction and Call to Action...........................................................................................................9

Contextualizing Trauma in the Lives of Women and Girls ..................................................................10

Violence against Women and Girls......................................................................................................... 10

Violence as a Public Health Epidemic: The ACE Study ............................................................................ 11

From Trauma to Trauma-Informed Care ................................................................................................ 13

The Importance of Listening to First Hand Experience .......................................................................14

Trauma as a Cross-Cutting Issue .......................................................................................................17

U.S. Department of Defense (DOD) ........................................................................................................ 17

U.S. Department of Education (ED) ........................................................................................................ 18

ED Office for Civil Rights (OCR) ............................................................................................................... 19

ED Office of Safe and Drug-Free Schools (OSDFS) .................................................................................. 20

ED Office of Special Education and Rehabilitative Services (OSERS)...................................................... 21

U.S. Department of Health and Human Services (DHHS) ....................................................................... 21

Administration for Children and Families (ACF)...................................................................................... 21

Family Violence Prevention and Services ............................................................................................... 21

DHHS Agency for Healthcare Research and Quality (AHRQ) .................................................................. 24

DHHS Centers for Disease Control and Prevention (CDC) ...................................................................... 25

DHHS Substance Abuse and Mental Health Services Administration (SAMHSA) ................................... 26

Center for Mental Health Services (CMHS)............................................................................................. 26

DHHS SAMHSA ........................................................................................................................................ 27

Center for Substance Abuse Treatment (CSAT)...................................................................................... 27

DHHS Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau, Office 

of Women’s Health ................................................................................................................................. 28

DHHS National Institutes of Health (NIH), Office of the Director, Division of Program Coordination, 

Planning and Strategic Initiatives, Office of Research on Women’s Health ........................................... 29

DHHS Administration for Children and Families, Office of Refugee Resettlement (ORR)...................... 30

DHHS Office on Women’s Health (OWH)................................................................................................ 31

U.S. Department of Justice (DOJ)............................................................................................................ 32

National Institute of Corrections (NIC) ................................................................................................... 32
3

DOJ Office of Juvenile Justice and Delinquency Prevention (OJJDP)...................................................... 33

DOJ Office for Victims of Crime (OVC) .................................................................................................... 34

DOJ Office on Violence against Women ................................................................................................. 36

U.S. Department of Labor....................................................................................................................... 37

DOL Office of Disability Employment Policy (ODEP)............................................................................... 38

DOL Women’s Bureau............................................................................................................................. 40

U.S. Department of Veterans Affairs (DVA)............................................................................................ 42

Getting Into Action ..........................................................................................................................43

New Partners and Next Steps...........................................................................................................44

Appendix A......................................................................................................................................51

Appendix B ......................................................................................................................................52

Appendix C ......................................................................................................................................57

Appendix D......................................................................................................................................72
4

Preface

Background: The Need for a “Women and Trauma Committee”

In the early 1990s, the Substance Abuse and Mental Health Services Administration (SAMHSA)

began a series of initiatives to raise awareness regarding the increasing numbers of women 

seeking services from public mental health and substance abuse programs who had

experienced personal histories of violence and trauma, frequently beginning in childhood. 

Initially, attention focused on the pervasiveness of the problem, with experiences of violence 

leading to traumatic stress in more than 80-90% of women seeking services. Troubling 

manifestations of traumatic stress included physical health consequences and precipitous 

spiritual questioning as well as commonly labeled psychiatric and substance use disorders. For 

women survivors, addressing the full range of impacts of trauma often required involvement of 

the entire spectrum of public health services in ongoing trauma resolution and recovery efforts, 

typically involving the need for supported “safe” housing, supported education and 

employment assistance, family welfare supports, and possible contact with criminal justice 

and/or victim assistance programs. Due to the spiraling number of people impacted and the 

wide range of consequences, trauma is now believed to be a “public health crisis.”

Existing providers lacked the capacity to effectively assist women with histories of abuse and 

trauma. A number of troubling service delivery breakdowns were identified, including 

widespread lack of screening or assessment for trauma; lack of training in clinical and 

community-based trauma treatment; and misdiagnosis, under-diagnosis or failure to diagnose 

trauma as the issue underlying a wide range of problems. Compounding problems further, 

providers typically offered only the standard regimen of services-as-usual for these women, 

which often led to a revolving door of treatment and discharge. Even when correctly diagnosed, 

trauma was typically viewed as one episode or event in the lives of these women, rather than 

an ongoing series of violent events woven throughout the life cycle. Little or no attention was 

paid to the inter-generational cycle of trauma that kept recurring within trauma-impacted 

families. 

To address the lack of capacity to effectively serve women who had experienced trauma,

SAMHSA sponsored a five-year “Women and Violence” Study (1998-2003) to develop and 

evaluate new trauma service paradigms. This research study demonstrated that trauma 

requires a central focus in treatment and needs to be integrated into the provision of related 

public health and social services. This approach, called “trauma-integrated counseling,” has 

demonstrated efficacy and practicality. New gender-specific group psychosocial empowerment 

and education counseling models introduced in the “Women and Violence” study are now 

evidence-based interventions that have been widely applied with significant impact on the 

recovery of women trauma survivors.

In 2004 SAMHSA’s National Center for Trauma-Informed Care (NCTIC) was funded to provide 

technical assistance to public health programs interested in adopting a “trauma-informed” 
5

organizational and services delivery paradigm that focuses on trauma as the key issue to be 

addressed in facilitating recovery. Currently, more than 45 State Mental Health Authorities are 

in the process of implementing trauma-informed systems and services, and trauma-informed 

care is spreading rapidly to all segments of the public health system. The Women and Trauma

Committee will be instrumental in leading and supporting these new movements.

Susan Salasin

Chair, Women and Trauma Federal Partners Committee, and

Director, Trauma and Trauma-Informed Care Program

Center for Mental Health Services

Substance Abuse and Mental Health Administration

U.S. Department of Health and Human Services

“Women and Trauma Committee” Operational Development

The Women and Trauma Federal Partners Committee was launched on April 1, 2009. The 

Committee first developed as a work group within the Federal Partnership on Mental Health 

Transformation. This partnership was established by one of the nation’s health authorities, the 

Substance Abuse and Mental Health Administration (SAMHSA). SAMHSA was tasked to 

implement a Presidential Order calling for aggressive actions to develop policy and practice in 

many priority areas, including suicide prevention, employment, women, youth in transition 

from school to work, to name just a few. SAMHSA’s Center for Mental Health Services was the 

agency that initiated and coordinated this task.

The Women and Trauma Federal Partners Committee consists of representatives from more 

than 20 federal agencies and sub-agencies from the Departments of Defense, Education, Health 

and Human Services, Housing and Urban Development, Justice, Labor, Veterans Affairs, and 

others. The Committee meets regularly, and continues to seek additional Federal Partner 

agencies that can provide support, collaboration, and resources on trauma-informed care.

On April 29, 2010, the Committee held a Roundtable on Women and Trauma. The goal of the 

Roundtable was to initiate a dialogue on the behavioral impacts of trauma affecting women and 

girls, identify gaps in addressing these impacts, and develop recommendations for an agenda 

for comprehensive systems change, integration, and collaboration. Approximately 80 

participants from federal, state, and nonprofit organizations attended, including two White 

House staffers—Jennifer Kaplan, Deputy Director of the White House Council on Women and 

Girls, and Lynn Rosenthal, White House Advisor on Violence against Women. The 

recommendations from stakeholders at the Roundtable are included in an appendix to this 

report.

On October 22, 2010, the Committee held a strategic planning retreat to advance the 

Roundtable’s agenda by moving from a focus on providing a common knowledge base among 

the Federal Partners and collaborators regarding the prevalence of trauma in the lives of 

women and girls and its behavioral impacts to the development and implementation of an 
6

action agenda to address these issues. The objectives of the planning retreat were to: (1) 

provide a comprehensive overview of how information from the Roundtable has been used to 

stimulate a variety of activities among participants; (2) develop specific recommendations for 

integrating trauma-informed care into prevention, intervention, and treatment activities within 

each partner agency through education and information dissemination; (3) discuss and begin 

formulating a strategy to strengthen support for trauma informed care among Federal Partner 

agencies, and to interest new agencies in participating; and (4) determine whether the

Committee can jointly support specific projects and initiatives across agencies, including the 

development of policy recommendations. 

From the discussions at the retreat, the Committee developed a set of priorities that are being

integrated into an action agenda to address the impact of trauma on the lives of women and 

girls at the federal agency and Administration levels. The ultimate goal of the Committee’s work

is to galvanize the Federal Partners into action in their spheres of influence to address this 

crucial issue that affects the lives of so many. 

Most significant in the Federal Partners’ work is that, thus far, more than sixteen traumainformed actions or initiatives have resulted directly from the Federal Partners Committee and 

Roundtable efforts. 

Carol Boyer

Co-chair, Women and Trauma Federal Partners Committee, and

Policy Advisor

Office of Disability Employment Policy

U.S. Department of Labor
7

Executive Summary

Unaddressed trauma experienced by women, including trauma caused by violence, affects all of 

us. Advances in the science and practice of behavioral health have helped us to understand 

that violence against women - and the trauma that results - have a huge impact on the health, 

economy and even the security of our nation. Trauma occurs whenever an external threat 

overwhelms a person’s coping resources. While concern about trauma is not new, research 

over the past ten years has provided a stunning picture of the depth and breadth of its 

consequences. Recognizing that immediate action is necessary and urgent, a group of Federal 

agencies have been working together for more than a year to highlight the scope of the 

problem and to develop collective strategies for action. The Federal Partners Committee on 

Women and Trauma is an outgrowth of the SAMHSA-sponsored “Federal Intergovernmental 

Partnership on Mental Health Transformation Working Group on Women and Trauma.” This 

report provides background on women and trauma, describes a Roundtable held on April 29, 

2010, and presents an outline of what the Committee plans for the coming year.

This report is a call to action, not a comprehensive review. The agencies involved represent 

only a subset of all agencies whose constituents may be affected by violence and trauma, and 

many important related issues, such as HIV/AIDS, prevention, housing, and cultural issues, are 

only touched on in this document. However, the report takes an important first step by 

describing the level of violence against women and girls in our society and exploring its 

consequences. Children growing up in the United States today face a surprising level of social 

violence, including child abuse, witnessing domestic violence, crime, and bullying. 

Epidemiological research on “adverse childhood experiences” demonstrates convincingly that 

violence against children is a significant public health issue, and documents strong relationships 

between adverse childhood experiences and adult health and behavioral health problems, 

social and economic costs, and early mortality. Women face high rates of domestic violence and 

sexual assault. Violence is gendered: While men are most likely to experience violence from 

strangers, women and girls are most likely to be hurt by people they know intimately. For 

women in the military, the greatest risk of harm is from fellow soldiers; for an adolescent girl, it 

is from the person she tells that she loves. The Federal Partners Committee has come together 

with the collective mission of developing strategies to address the consequences of trauma on 

women.

The report illustrates the importance of listening to and incorporating the voices of people who 

have been directly impacted by trauma, and describes “trauma-informed care,” a new 

approach to addressing trauma that can be implemented in any setting. Trauma-informed care 

provides a way for different agencies and groups to come together around a common concern. 

In a trauma-informed framework, prevention programs, human services, government agencies, 

and civic groups work together to create healthier, safer, more healing and more productive 

communities. As individuals, groups, and organizations become aware of trauma and its 

consequences, new forms of collaboration emerge and people work together to prevent 
8

violence and trauma and to respond effectively when it does occur. Trauma-informed care is 

an inclusive approach, where everyone has a role to play. 

The report also provides an introduction to the key issues facing each participating agency, with 

statistics documenting the impact of violence against women and girls on their mission and 

information on how each department is responding. Agencies that participated in the first year 

of the Federal Partners Committee are the Department of Defense; the Department of 

Education: Office for Civil Rights; the Department of Health and Human Services: 

Administration for Children and Families, Agency for Healthcare Research and Quality, Centers 

for Disease Control and Prevention, Substance Abuse and Mental Health Services 

Administration, Health Resources and Services Administration, National Institutes of Health, 

Office of Refugee Resettlement, and Office on Women’s Health; the Department of Justice: 

National Institute of Corrections, Office of Juvenile Justice and Delinquency Prevention, Office 

for Victims of Crime, and Office on Violence against Women; the Department of Labor: Office of 

Disability Employment Policy and the Women’s Bureau; and the Department of Veterans 

Affairs. Representatives from several additional federal agencies or offices within agencies 

have also become active participants, including the Department of Housing and Urban 

Development, the Rehabilitation Services Administration within the Department of Education, 

the White House Office on Drug Control Policy, and the Peace Corps.

The Roundtable held in April 2010 brought together more than 80 individuals representing 

federal and state agencies, advocacy organizations, academic and research institutions, and 

individuals with direct experience of trauma. A collective momentum emerged from the 

meeting, and agencies have followed up with concrete actions designed to implement traumainformed principles and practices. Examples include the development of informational 

materials and curricula; webinars; prevention toolkits; workforce training programs; universitybased training; and conference presentations and workshops. One webinar series on “The 

Impact of Trauma on Women and Girls across the Lifespan,” sponsored by DHHS/SAMHSA, was 

immediately oversubscribed. Other actions reflect new policies, changes in grant programs, 

and new research directions. Examples include participation in international and global forums; 

re-examination of policies on workplace violence, bullying and health education; agency 

resource mapping; development of new state coalitions; and the development of technical 

guidance memoranda. 

The Women and Trauma Committee continues to meet monthly as a multi-agency workgroup, 

exchanging information about relevant activities, sharing resources, and planning interagency 

initiatives. Sub-committees have been formed to focus on: 1) trauma-informed care for frontline community providers; 2) trauma screening and assessment; 3) integration of the first 

person experience; 4) cross-cultural and diversity issues in trauma; 5) trauma-informed care in 

the workplace; and 6) military women and trauma-informed care. A second roundtable being 

planned for December, 2011, will highlight the work of the sub-committees and will focus on 

effective strategies for prevention and intervention, moving from identifying the problem to 

discussing effective approaches to implementing trauma informed approaches across the 

service spectrum. 
9

Introduction and Call to Action

Unaddressed trauma and violence against women affect

all of us. Advances in the science and practice of 

behavioral health have helped us to understand that

violence against women - and the trauma that results -

have a huge impact on the health, the economy and even 

the security of our nation. Recognizing that immediate 

action is necessary and urgent, six Federal agencies have 

been working together for more than a year to highlight 

the scope of the problem and to develop collective 

strategies for action. This report results from the work of 

the “Federal Partners Mental Health Transformation 

Committee on Women and Trauma” and from a 

Roundtable held on April 29, 2010 with Federal, State, 

tribal, private and community stakeholders working with 

women and girls affected by trauma across multiple 

services sectors and settings. While the focus of this 

report is on women, these issues cannot be discussed 

without also considering the impact of trauma on men.

While concern about trauma and violence against women 

is not new, research over the past ten years has provided a 

stunning picture of the depth and breadth of its

consequences. A confluence of biological and 

epidemiological research, case studies, first person 

reports, and growing advocacy from survivor groups has 

made it clear that the time for action is now. “Traumainformed care” - a new approach to violence and trauma 

based on universal precautions and organizational 

sensitivity - provides tools for change. Trauma-informed 

care directly responds to the failures of the current public 

system to foster safety and transparency in healing and 

recovery, and it can be implemented in any setting.

Violence against women occurs to women of all ages and 

in all settings, and it affects all of our social institutions. 

Public education, prevention, early identification and 

intervention, and effective trauma treatment are all 

necessary to break the cycle of violence. A coordinated, 

multi-level interagency effort is essential. The agencies 

participating in the Federal Partners Committee recognize 

that addressing trauma and violence against women can 

Definition of Trauma

Trauma occurs when an external threat 

overwhelms a person’s coping 

resources. According to the diagnostic 

manual used by mental health providers 

(DSM IV-TR) trauma involves “direct 

personal experience of an event that 

involved actual or threatened death or 

serious injury or other threat to one’s 

physical integrity; or a threat to the 

physical integrity of another person; or 

learning about unexpected or violent 

death, serious harm or threat of death 

or injury experienced by a family 

member or other close associate.” 

To meet the DSM definition, trauma 

must also involve “intense fear, 

helplessness, or horror,” or in children 

“disorganized or agitated behavior.” 

Trauma can result from a wide variety 

of events, including experiencing or 

witnessing violent crime, accidents, 

abandonment (especially for small 

children), physical or sexual abuse or 

neglect, cultural dislocation, terrorism, 

wars, historical violence, institutional 

trauma, and natural disasters. This 

monograph focuses primarily on 

trauma resulting from violence.

Being aware of the pervasive impact of 

trauma is the first step towards 

becoming “trauma informed” -

integrating knowledge about trauma 

and recovery into all aspects of 

organizational culture, including 

physical environment, policies and 

procedures and staff attitudes and 

behaviors. People speak about traumainformed care, practices, services and 

systems because it is imperative that 

this awareness be integrated into 

organizational culture and settings as 

well as informing individual practice . 
10

assist them in meeting their missions.

Addressing violence and trauma against women will help:

Department of Defense to provide the military 

forces needed to deter war and to protect the 

security of our country.

Department of Education to ensure access to equal 

educational opportunities for every individual and 

to promote improvements in the quality of 

education.

Department of Health and Human Services to 

protect the health of all Americans and to provide 

essential human services, especially for those who 

are least able to help themselves.

Department of Justice to enforce the law, ensure 

public safety, and ensure fair and impartial 

administration of justice for all Americans.

Department of Labor to foster and promote the welfare of the job seekers, wage 

earners, and retirees of the United States.

Department of Veterans’ Affairs to provide veterans the world-class benefits and 

services they have earned.

This document is a call to action, not a comprehensive review. Each section provides an

introduction to the key issues facing each department. The agencies involved in the Federal 

Partners Committee represent only a subset of all agencies affected by violence and trauma, 

and many important issues - such as HIV/AIDS, prevention, housing, and cultural issues – are 

only touched upon in this document. The work of the Federal Partners Committee is 

developmental and incremental, and expanding the effort to include new partners is a top 

priority.

Contextualizing Trauma in the Lives of Women and Girls

Violence against Women and Girls1

Children growing up in the United States today face a surprising level of social violence. An 

estimated 3 to 10 million children witness domestic violence every year.i More than a third of 

adolescents between the ages of 14 and 17 have seen a parent assaulted.ii Television 

programming designed for children has an average of 20-25 violent acts per hour: The typical 

child will see 8,000 murders by the time they complete elementary school and 40,000 acts of 

violence by the time they turn 18.iii Children are also the victims of violence. Every 35 seconds 

 

1 Drawn in part from Covington, S. (2010) Gender Matters: Creating a Trauma-Informed Culture. Presentation at 

the Federal Partners Roundtable on Women and Trauma, April 29, Washington, DC.

At the White House, we have learned that 

the response (to violence against women) 

cannot sit with our domestic violence 

service providers alone. Each federal 

program that serves families has got to 

play a part. We need to better understand 

the intersections that you are talking 

about at the federal roundtable. And we 

know that trauma-based care is a very 

critical part.

Lynn Rosenthal, White House Advisor 

on Violence against Women
11

a child is abused or neglected in the United States, and every six hours a child dies from abuse 

or neglect.

iv

 One in five girls and one in ten boys are sexually abused before adulthood.v More 

than 60% of all children between the ages of 10 and 17 report being exposed to violence in the 

past year; 50% report being assaulted, and 32% report being bullied.vi

While both boys and girls are affected by violence, adolescent girls between the ages of 16-19 

are four times more likely than boys to be a victim of rape, attempted rape, or sexual assault.vii 

More than one thousand women are murdered every year by their partnerviii, and one of six 

women will be sexually assaulted in her lifetime.ix Violence is also gendered: While men are 

most likely to experience violence from strangers, women and girls are most likely to be hurt by 

people they know intimately. For women in the military, the greatest risk of harm is from 

fellow soldiers; for an adolescent girl, it is from a person whom she loves. 

Given the extent of violence in our country, it is imperative to institute what the medical field 

refers to as “universal precautions” – making trauma-sensitive services available to everyone. 

It is also important to 1) identify factors that increase the likelihood of becoming a victim, 

including relationships with peers, intimate partners, and family members, 2) explore the 

settings in which social relationships occur (e.g., schools, workplaces, neighborhoods) to 

identify factors that increase risk, and 3) consider social factors that affect the occurrence of 

violence. The most effective interventions are gender-responsive – they reflect an 

understanding of the realities of the lives of women and girls, respond to their strengths and 

challenges, and use knowledge about female socialization and development to guide all aspects 

of program and system design. 

Violence as a Public Health Epidemic: The ACE Study2 

The Adverse Childhood Experiences (ACE) Studyxis an analysis of the relationship between 

traumatic stress in childhood and the leading causes of morbidity, mortality and disability in the 

U.S. A collaborative effort between Kaiser Permanente’s Department of Preventive Medicine in 

San Diego and the Centers for Disease Control (CDC), the study includes more than 17,000 

middle-class Americans with health insurance. Eighty percent of the participants were white 

(including Hispanic), 10 percent black, and 10 percent Asian; half were men and half women; 

and 74 percent had attended college. The average age at entry into the study was 57. In the 

first wave of the study, subjects were asked whether or not they had experienced any of eight 

ACE categories during their first 18 years of life (emotional, physical or sexual abuse; domestic 

violence; substance abuse, mental illness or incarceration of a household member; and parental 

separation). Two categories of neglect were added in the second wave. The individual’s ACE 

score was calculated by a count of the number of categories reported. Multiple occurrences

within a category were not recorded, making this a conservative measure.

 

2

Drawn in part from Jennings, A. (2010) The Tragic Consequences of Unaddressed Childhood Trauma. Presentation 

at the Federal Partners Roundtable on Women and Trauma, April 29, Washington, DC. For further information on 

the ACE study, see Felitti, V.J., Anda, R.F. et al (1998) The relationship of adult health status to childhood abuse and 

household dysfunction. American Journal of Preventive Medicine, 14, 245-258.
12

Retrospectively reported ACE scores were then matched 

with the individual’s current state of health and wellbeing and with various measures of health care 

utilization, cost, and death. Only one-third of the 

population had an ACE score of zero. One in four had an 

ACE score of two or more; one in six had an ACE score of 

four or more; one in nine had a score of five or more. 

Women were 50 percent more likely than men to report 

an ACE score of five or more. ACEs did not occur 

randomly: If any one category was present, there was an 

eighty-seven percent likelihood that at least one 

additional category would be present. ACE categories 

were approximately equal in their impact.

ACE scores are highly correlated with serious emotional 

problems, health risk behaviors, social problems, adult 

disease and disability, mortality, high health care and 

other costs, and worker performance problems. ACE 

scores are significantly correlated with depression,

attempted suicide, hallucinations, the use of 

antipsychotic medications, the abuse of substances, 

multiple sex partners, and increased likelihood of

becoming a victim of sexual assault or domestic violence. 

Several measures of worker performance are also related 

to ACE scores, including absenteeism, serious financial 

problems, and serious job problems. High ACE scores are 

significantly related to liver disease, chronic pulmonary 

obstructive disease, heart disease, autoimmune disease, 

and lung cancer. Sixty percent of people with an ACE 

score of 0 live to age 65, but more than 97 percent of 

those with an ACE score of 4 or more die before 65. 

Women are significantly more likely than men to have a 

high ACE score, and therefore have a higher risk for all of 

the above conditions, even without additional risk factors. Women are twice as likely as men to 

experience depression; fifty-four percent of depression in women can be attributed to 

childhood abuse. 

Adverse experiences in childhood affect the health and behavior of adults through two primary 

mechanisms. First, they increase conventional risk factors such as smoking, excessive drinking, 

overeating and engaging in risky sex – behaviors that are often used to cope with the pain of 

the trauma. Second, childhood trauma affects the developing brain and body and causes 

Anna’s Story

Anna was not even three years old 

when the sexual abuse began. It 

was at the hands of a trusted 

caregiver, and it continued for 4 

years. Her family was unaware 

that it was happening, and Anna 

did not have the language to tell 

them. She was seen by a number 

of health and human service 

providers, but no one recognized 

the signs. No one asked or looked 

into what might have happened to 

her. Instead, they focused on what 

was wrong: Was she learning 

disabled? Did she have a mental 

illness? When she “broke” at age 

19, she was misdiagnosed as

schizophrenic. For 17 years she 

was in the mental health system, in 

and out of hospitals, homeless 

shelters, and clinics. For 17 years, 

no treatment helped, and some 

made her worse. When she was 23, 

she learned from other patients 

that she was not the only one to 

have been sexually abused as a 

child. She diagnosed herself with 

PTSD. No one listened, understood, 

or helped her. At that time, no one 

had trauma training. Anna took 

her life at the age of 32 in the back 

ward of a state hospital. The 

lifetime cost of her care was almost 

five million dollars. Her story, 

unfortunately, is not unique.

 Ann Jennings, PhD
13

deregulation of the stress response. Biomedical, behavioral and neuroscience research is now 

confirming these effects. 

The costs of untreated trauma are astounding. The cost of chronic illness goes far beyond the 

actual medical expenses ($277 billion in 2003). According to a 2007 study, the annual financial 

cost of chronic illness on lost work productivity is $1.1 trillion.xi Research on the full cost of 

violence and abuse to the health and social service systems has not yet been done; however, a 

study using 2008 health care and population data shows that the predicted incremental cost to 

the health care system alone ranges between $333 billion and $750 billion annually, or nearly 

17 percent to 37.5 percent of the total health care dollar.xii

From Trauma to Trauma-Informed Care3

The implications of the data on violence and the ACE study are clear. Most, if not all,

government agencies are already serving people with 

trauma histories, whether they know it or not. For those 

working with particularly vulnerable populations, such as 

women and children, veterans, people with disabilities, 

refugees and immigrants, and people who are homeless 

or in institutions, the numbers are even higher. Staff

members themselves may be trauma survivors. In fact, 

some of the thorniest problems in health and human 

services today may be the result of undiagnosed trauma among staff and clients. Often, if the 

problem is named correctly, solutions emerge. 

In the past decade, a new understanding of the impact of trauma stemming from violence has 

begun to fundamentally alter the way services are delivered. The initial work on trauma in the 

1970’s focused largely on posttraumatic stress disorder (PTSD) in veterans returning from 

Vietnam. In the 70’s and 80’s, the domestic violence field was instrumental in bringing 

attention to violence against women, and the groundbreaking Violence against Women Act

(VAWA) was passed in 1994. In 1998, the Substance Abuse and Mental Health Services 

Administration (SAMHSA) launched a five-year study on “women, co-occurring disorders and 

violence” which highlighted how trauma can become the “central organizing principle” in a 

person’s life, affecting the ability to form relationships, keep a job, or live in stable housing. This 

study made it clear that many people previously labeled as “mentally ill,” “substance abusers” 

or “criminals” were coping with the results of severe trauma histories. The study raised 

awareness about how people can be “re-traumatized” by helping professionals who fail to 

recognize their clients’ trauma histories and unintentionally recreate the dynamics of the 

original abuse. The study also highlighted the strength and resilience of trauma survivors. 

 

3

Drawn in part from Blanch, A. (2010) From Trauma to Trauma-Informed Care. Presentation at the Federal 

Partners Roundtable on Women and Trauma, April 29, Washington, DC.

Trauma-informed services 

don’t ask “What’s wrong?” 

They ask “What happened?”
14

Today, human service providers are increasingly making the distinction between “traumaspecific” services, which are behavioral health interventions designed to treat the specific 

symptoms of trauma, and “trauma-informed” practices, which can be implemented anywhere -

in educational settings, in job programs and in the workplace, in housing, in law enforcement, 

in religious settings, in advocacy programs, and of course, in health and behavioral health 

settings. In a trauma-informed program, everyone – clinical staff, support staff, and clients – is 

educated about trauma and its consequences. People are alert for ways to make their 

environments more healing and less re-traumatizing for both clients and staff. They 

understand that when you have been traumatized, regaining control over the environment is 

the number one priority, so they emphasize safety, choice, trustworthiness, collaboration, and 

empowerment.

xiii Trauma-informed services support resilience, self-care and self-healing. And 

because violence and healing both occur in a context, trauma-informed programs respect and 

include culturally specific healing modalities. Trauma-informed care is also an effective 

platform for building interagency partnerships.

The Importance of Listening to Firsthand Experience

One of the most fundamental values of a trauma-informed system is listening to and 

incorporating the voices of people who have been directly impacted by trauma. For many, the 

experience of trauma has been wrapped in secrecy and silence, often for years. Finding and 

using one’s voice – particularly in a way that helps to make change – can be a profound healing 

experience. In the SAMHSA Women, Co-Occurring Disorders and Violence Study (WCDVS), 

peers moved from “being silent witnesses to the processes and procedures of a complex 

national study, to being ‘allowed’ to speak, to being actively engaged in providing information 

to make the research truly relevant to the lives of the women and children it was intended to 

affect.” xiv This process had a deep and lasting impact on the study as well as on the women 

involved. 

Testimony from women trauma survivors is also one 

of the most powerful ways to educate the public 

and to bring the issues to the attention of 

policymakers. It conveys the reality of violence and 

trauma in a way that can’t be denied, and it 

provides a role model of strength, resilience and 

healing. Peers can make critical contributions at all 

stages of the change process, from educating the 

public and policymakers to establishing a 

participatory, collaborative culture in the service 

setting. xv Peer involvement rests on the belief that 

healing and recovery are possible for everyone, that peer to peer relationships are a tool for 

healing, and that each of us has something to learn from the other. It requires time to build 

trust and to engage in difficult conversations, and it rests on a commitment to identifying and 

supporting natural leaders. The Federal Partners Committee recognizes the importance of peer 

It is not enough for women to be 

empowered in their treatment and 

services. They need to be empowered in 

their lives. Women and girls impacted by 

trauma must lead us in designing, 

implementing and evaluating systems, 

programs and supports that allow them to 

heal and build meaningful lives in their 

communities. At SAMHSA, we are 

developing new materials and products to 

help the field move in this direction.

Mary Blake, Leader of SAMHSA’s 

Peer Trauma Development Project
15

involvement, and holds it as the highest value in developing trauma-informed services. The 

following stories of trauma and survival were shared at the roundtable. 

Jacki’s Story

It’s wonderful to be able to talk about having lived so long and about being strong, because I wasn’t always strong. I’m 

going to put 75 years into 14 minutes today, and I can do it – I do it sometimes before I go to sleep. 

I was two years old, that’s what the newspaper said, and the newspaper was old and brown like me. There was a man 

who took the two year old baby. Everyone was a person of color – all brown – all Negroes in those days.- People of 

color have gone through many names. And the paper said this man took the baby and knocked on people’s doors, 

saying that the baby is wet and sick and hungry, let us in. And they would let him in, and he would abuse them in ways 

we won’t discuss. He would wreck their lives forever, because in the community where I grew up, a man could never let 

something happen to his wife and still be a man. So the husbands demanded that no matter what had happened, they 

could never, ever tell anyone. The newspapers called me the “Baby Bandit.”

I ended up in a mental hospital at nine years old with all these white people, even the people who cooked and cleaned 

were white. I had never lived around white people before, and my family was not allowed to visit. I was really 

traumatized. But no one dealt with what had happened. When I came out of the hospital, it was me and my alter ego 

that I called ”my sister,” and we tore up the world wherever we went. By 19, I had 5 kids. Every time I had a kid, my 

family would take charge.

I took the children and ran away to New York, and the welfare rights people picked me up. They said, “Come on, you 

can go to school, you can go to work. I got everything together, and eventually I got some of those kids back. Then 

along came trouble all over again. I had this fine husband. We had a big house. Then one night, I’m walking down the 

street and I met a man with a gun and an attitude. And when he left me I was not a person anymore. He raped 8 other 

women in the community. One woman died. And in the courtroom, I heard women screaming. I couldn’t talk. Do you 

know what happened to me because I couldn’t testify? I broke inside. I felt like I betrayed all these people who needed 

me to say that he was the one. So I left my home, my husband, my children, my world, and I lived homeless in the 

streets. They called me “mad.” I was in and out of jail, never prison; in and out of day treatment. 

Eventually I ended up in Washington, DC, walking down the streets. It was 90 degrees, but I had a coat and four jackets

on. I wonder how people knew I was crazy. There was this little store, and I would go in and take whatever I wanted, 

because I had an attitude. I figured the world owed me a meal. There were these women that also ate there, and I 

wouldn’t tell them my name, but sometimes they would keep the police from taking me away. I decided one day that I 

would kick the window in. I would break the glass with my foot. Don’t ask me why. They said I was crazy, and they 

were probably right. I went into the store, and what that man said to me was just unbelievable. He said, “Eat, Momma, 

eat.” It changed my life. The tears came out and I could feel something moving in my chest, something that had been 

frozen for a long time. And I let those girls take me to the local rape crisis center and to a hospital. 

I never went back to say thanks to those women. I didn’t know what to say to them. But they – and some of you in this 

room – have been a blessing not just to me, but to my 17 grandchildren, my 20 great grandchildren that I took out of 

foster care. I want to you know that my dreams have come true.

Jacki McKinney, Federal Partners Roundtable on Women and Trauma, April 29, 2010
16

Tonier’s Story 

At age 9, I believed I would amount to nothing. My mother was an alcoholic. I had 8 brothers and sisters. My mother 

“entertained” all the time, and when she stopped singing and laughing, I knew I would hear the footsteps coming to 

my door. There were a lot of sexual assaults, a lot of abuse. Sometimes I couldn’t go to school, but no one asked me 

why. I also started drinking at age 9. When I started to drink, my mother would slap me down, but when the men 

came, it didn’t feel as painful, so I drank. 

Eventually someone noticed and they sent out a social worker. She removed us from the family immediately, and put 

us in foster care. I was given back to my mother, but she needed a place to live, and she had an alcoholic friend of 

hers who she thought was pretty cute. So I married him, and she moved in. I was pregnant, and every day he beat 

me. Then I started using crack cocaine, and I didn’t have to feel. I thought I never had to feel anything every again. 

But unfortunately, the cocaine introduced me to the criminal justice system. I stand before you with 86 arrests and 

66 convictions. They told me I was going to spend the rest of my life in and out of prison or on the streets. They kept 

calling me crazy and I didn’t know why. 

I was a “repeat offender,” and every time I was arrested it got worse. One time I told them I was pregnant – I was 5 

months pregnant at the time – and they told me no, I had a urinary tract infection. I was called manipulative, 

attention seeking. I spent time in 20-day programs – just long enough to get some rest and figure out when to get 

high again. I was raped so many times I can’t count them, but they assigned me a male counselor. At one point I was 

alone with this man, sharing the things that had happened to me, and how despite it all I had graduated the 

program, and he raped me. And he told me, “No sense telling anyone about it. You’re just a convict, a prostitute. He 

has since been held accountable for his actions, but given my history, maybe a male counselor wasn’t the best thing 

for me.

One of the worst things was being put into seclusion or restraint. I don’t care if the room is padded or not, it triggers 

my issues with my mother. My survival mode kicks in. One time I pushed a tray out my face, and someone got hit 

with the tray. So they call a code, and then I’m down on the ground being restrained. Restraining a rape victim? 

Doing more harm, causing more trauma.

I lived under a bridge for 19 years. But then I ended up in the Maryland Correctional Institution for Women, and I 

got into this program. The first thing they told me was that what had happened to me wasn’t my fault. And you 

know what? After years of everyone telling me that I deserved everything I got, I believed them, and my thought 

process changed. One of the best things I did was to take a course on how to be a mother. I had lost 4 kids to the 

system, I knew how to do that, but I didn’t know how to take care of a kid. I had been told that when they cry, 

they’re attention-seeking. When you come from abuse, sometimes it takes real work not to be abusive. And I didn’t 

want that for my daughter. 

Today I’m a home owner. My daughter goes to a private school. Treating my trauma, you kept me out of your 

system, and I’m grateful. You also helped me to break that intergenerational curse I had in my family. My daughter 

will never know what I felt. She doesn’t know what it’s like to live in the projects, to be hungry. All she knows is that 

her mom loves her, feeds her. What if, at age 9, someone had recognized my trauma? Is it possible that I could have 

become the woman I am today without the substance abuse, the homelessness, the mental health diagnoses? And I 

have one last question. When I was in prison – 83 times in and out – when you looked across your desk and saw me, 

would you have seen the woman I am today? Would you have been able to see a woman who would be speaking to 

all of you at a federal roundtable meeting? Do you truly believe in the people you serve? Treat the trauma. I 

promise you, you’re going to get different results.

Tonier Cain, Federal Partners Roundtable on Women and Trauma, April 29, 2010
17

Trauma as a Cross-Cutting Issue

U.S. Department of Defense (DOD) 

Women make up an increasing percentage of our Armed Services, and play a critical role in the 

defense of our country. A focus on gender-based research and practice within DOD is therefore 

essential. However, 85 percent of the military are men, and violence and trauma clearly affect 

them, as well. Key issues for DOD include implementing a universal precautions and traumainformed approach in the military healthcare system, addressing trauma experienced by 

women serving in combat, and military sexual trauma (MST).

Women in the US military have steadily increased over the past two decades, and 

currently make up 15 percent of the Armed Services.xvi

Since 9/11/2001, 53 percent of female Service members have been deployed. Of that 

group, 44 percent deployed two or more times, 85 percent deployed to a combat zone, 

and 42 percent report being involved in combat operations.

xvii

By the end of 2009, 125 women had died in deployment in Iraq and Afghanistan, 68 of 

them by hostile action.xviii

Women veterans are 9 times more likely to have PTSD if they have a history of military 

sexual trauma, 7 times more likely if they have a history of childhood sexual assault, and 

5 times more likely with a history of civilian sexual assault.xix

Given the data on violence in society, as well as the specific nature of the military, 

implementing a “universal precautions” approach to trauma would be prudent. Assessing for 

trauma histories as part of a comprehensive medical exam could improve both effectiveness 

and efficiency of military healthcare, avoid re-traumatization, and guide efforts to prevent MST 

and PTSD based on identified risk factors. The military healthcare system already has excellent 

healthcare benefits (for members in uniform, families, and retirees) designed to respond to 

both gender and age. Preliminary discussions are underway about the potential of adding a 

universal trauma screening and assessment to this system. 

While U.S. policy bans female service members from serving in direct ground combat, women 

may be attached temporarily to all-male combat units to perform specific functions. As a 

result, women may engage in the same direct combat actions as men, although they may not 

have received the same training and may be less likely to be officially or publicly recognized as 

combatants, potentially impeding the process of healing. Alternatively, women combatants 

may be stigmatized as “victims” rather than celebrated as warriors. Ensuring that traumainformed and trauma-specific services are available and easily accessed by women combat vets 

is a high priority.

Women may also be exposed to sexual assault or harassment, which has the potential to 

compound combat stress or trauma that occurred prior to enlistment. Some women may be 

reluctant to seek help for trauma, fearing possible ramifications for career advancement. The 
18

Sexual Assault Prevention and Response Office in the Office of the Secretary of Defense has a 

number of initiatives designed to prevent sexual assault and to encourage women to get help 

for trauma-related problems. They have partnered with the civilian community in Sexual 

Assault Awareness Month, have implemented a comprehensive sexual assault education and 

prevention strategy, and conduct officer training beginning in college or at one of the three 

Military Service Academies. 

The Family Advocacy Program (FAP), managed by the Office of the Secretary of Defense and 

implemented by the military Services, provides resources for families experiencing child abuse 

and domestic abuse, including prevention services, early identification and intervention, 

support for victims, and treatment for offenders. FAP is responsible for ensuring victim safety 

and access to support and advocacy services as well as ensuring that offenders receive 

appropriate intervention and treatment services. FAP programs and services are available to 

service members, their spouses/intimate partners, and children.

Additional Resources:

Department of Defense Advisory Committee on Women in the Services (DACOWITS). Annual 

Report 2009.

http://dacowits.defense.gov/annual_reports/DACOWITS%2009%20Final%20Report.pdf

Department of Defense FY 2009 Annual Report on Sexual Assault in the Military 

http://www.sapr.mil/media/pdf/reports/fy09_annual_report.pdf

Department of Defense Report to the White House Council on Women and Girls, Sept 1, 2009 

http://www.defense.gov/pubs/pdfs/DoD_WHC_on_Women_and_Girls_Report_personal_info_

redacted_C82A.pdf

Department of Defense Family Advocacy Program: 

http://www.militaryhomefront.dod.mil/portal/page/mhf/MHF/MHF_HOME_1?section_id=20.8

0.500.188.0.0.0.0.0

U.S. Department of Education (ED)

The Successful, Safe and Healthy Students program is included in the Administration’s 

Elementary and Secondary Education Act (ESEA) reauthorization proposal. The new program, 

which builds off of the Safe and Supportive Schools program, would increase the capacity of 

States, high-need districts, and their partners to provide the resources and supports necessary 

to ensure that students are safe, healthy, and successful. Further, the program would also 

provide increased flexibility for States and districts to design and implement strategies that best 

reflect the needs of their students and communities, which may include activities that ensure 

schools offer girls a safe and supportive environment. Programs and activities supported by 

this program would include those that reduce or prevent drug use, alcohol use, bullying, 

harassment, or violence and promote and support the physical and mental well-being of 

children.
19

ED - Office for Civil Rights (OCR)

Sexual harassment of and sexual violence against girls and 

women is a real and serious problem in education at all 

levels. It can affect any student, regardless of race or age. 

Sexual harassment can threaten a student's physical or 

emotional well-being, influence how well a student does in 

school, and make it difficult for a student to achieve his or 

her career goals. A school has a responsibility to respond 

promptly and effectively to sexual harassment. Lack of 

education on and ineffective methods of combating sexual 

harassment and violence may create unsafe learning 

environments for women and girls, in particular.

A Department of Justice study estimated that 20 to 

25 percent of college women are victims of rape or 

attempted rape during their time in college and 

15.5 percent of women are subjected to sexual 

violence during an academic year.xx

In 2008, there were nearly 3,300 forcible sex 

offenses reported by college campuses.

xxi

In the 2007-2008 school year, there were 800 

reported incidents of rape and attempted rape and 

more than 3,800 reported incidents of other sexual 

batteries at public high schools.xxii

A 2001 study that surveyed 2,064 students between 

8th grade and 11th grade reports that 83 percent of 

girls have experienced sexual harassment, and 38 

percent of students have been sexually harassed by 

a teacher or other school employee.xxiii

OCR enforces Title IX of the Education Amendments of 

1972, which prohibits discrimination on the basis of sex, including sexual harassment, in all 

public and private educational institutions receiving federal funds. The law protects both male 

and female students from sexual harassment by school employees, other students, or nonemployee third parties. The Department of Education and OCR are committed to ensuring that 

all students feel safe at school so that they have the opportunity to fully benefit from the 

school’s education programs and activities. OCR helps schools combat sexual harassment and 

sexual violence in a variety of ways:

OCR investigates and resolves complaints alleging that schools receiving federal funds 

have failed to protect students from sexual harassment and sexual violence. Resolution 

agreements often require schools to adopt effective anti-harassment policies and 

procedures, train staff and students, and address the incidents in question. Between FY 

Violence against Girls in Schools

Most people think of Title IX as the law 

that prohibits discrimination against 

girls in athletics, but it is much more. 

Title IX protects individuals from sexual 

harassment, a form of sex 

discrimination, and sexual assault, 

which is a form of sexual harassment. It 

is all covered. The harassment and 

discrimination policies and procedures 

that schools are required to have, must 

cover not only discrimination and 

harassment by school employees of a 

student, but also student-on-student 

harassment and third-party harassment, 

such as harassment by a visiting athlete 

or a volunteer in the program. The law 

requires that harassment and 

discrimination policies and procedures 

address all these issues. Also, the effects 

of trauma on an individual may result in 

that individual having a disability. 

Schools have a responsibility under the 

disability laws to support students with 

disabilities, both to protect them from 

discrimination and to provide them 

accommodations if necessary.

Kristi Bleyer, Office for Civil Rights
20

2007 and FY 2010, OCR has received approximately 170 complaints annually alleging 

sexual harassment. Approximately 60% of these complaints came from elementary and 

secondary schools.

OCR initiates compliance reviews focused on specific issues. Such reviews increase the 

impact of OCR’s resources, complement the complaint resolution process, and can 

benefit larger numbers of students. Over the past 5 years, OCR has initiated 12 sexual 

harassment compliance reviews, including 3 in FY 2009. In FY 2010, OCR initiated a 

sexual harassment/sexual violence review of a school district, and a sexual violence 

review of a postsecondary institution. 

OCR issues policy guidance to inform schools of their obligation to provide an 

environment free from sexual harassment.xxiv In October 2010, OCR issued guidance to 

help school districts, colleges, and universities that receive federal funding combat 

harassment and bullying in schools. The letter explains educators’ legal obligations to 

protect students from student-on-student harassment, including sexual and genderbased harassment.xxv

 In April 2011, OCR issued guidance to help school districts, 

colleges and universities that receive federal funding address sexual violence in schools. 

The letter explains that the requirements of Title IX pertaining to sexual harassment also 

cover sexual violence and lays out the specific Title IX requirements applicable to sexual 

violence.xxvi

OCR field offices offer schools technical assistance to encourage them to improve their 

anti-harassment policies and procedures and to assist students and their parents to 

work with schools to enhance the schools’ anti-harassment capability.

In addition, OCR recently modified its requirements for the Civil Rights Data Collection, which 

collects data on key education and civil rights issues from nearly 7,000 school districts. For the 

first time, a reporting school district is now required to submit information regarding 

harassment, including whether it has a sexual harassment and bullying policy, school-level data 

on reported allegations of harassment or bullying based on sex, and school-level data on 

students disciplined for harassment or bullying based on sex. ED – Office of Postsecondary 

Education (OPE)

OPE administers the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime 

Statistics Act, which requires all colleges and universities that participate in federal financial 

assistance programs to (1) collect statistics of crimes that occur on or around campus; (2) issue 

timely warnings to the campus community about crimes that may threaten the safety of 

students or employees; (3) prepare and disseminate an annual report that contains the crime 

statistics above and the institution’s campus security policies; and (4) maintain a daily log of 

crimes that occurred on or around campus. 

ED – Office of Safe and Drug-Free Schools (OSDFS)

The mission of OSDFS is to create safe schools, respond to crises, address alcohol and drug 

abuse and violence, and promote the health and well being of students, as well as the 

development of good character and citizenship. OSDFS administers grants, coordinates
21

programs, and recommends policy for improving conditions for learning. OSDFS participates in 

interagency committees specifically focused on gender-based volence prevention. The office 

regularly posts information about bullying and gender-based violence on its listserv and in 

weekly newsletters and hosted a gender-based violence summit in April 2011. Two examples of 

OSDFS grant program that may address gender-based violence as part of their program 

activities are the Safe Schools/Healthy Students (SS/HS) initiative and the Safe and Supportive 

Schools (S3) initiative.

The ED Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention, 

administered by OSDFS, assists institutions of higher education in developing, implanting, and 

evaluating alcohol, other drug, and violence prevention policies and programs that will foster 

students’ academic and social development and promote campus and community safety. A 

number of resources are available related to gender-based violence.

ED – Office of Special Education and Rehabilitative Services (OSERS)

The National Institute on Disability and Rehabilitation Research (NIDRR), within OSERS, 

currently sponsors two research grants that are evaluating interventions aimed at preventing 

violence against women with disabilities. Both violence prevention programs that are being 

studied are conducted in collaboration with the Centers for Independent Living, which are 

administered by the Rehabilitation Services Administration (RSA) within OSERS. The violence 

prevention programs aim to increase knowledge, safety-promoting behaviors, and self-efficacy 

of women with disabilities. These research grants are being conducted by Portland State 

University and the University of Montana.

Additional Resources:

Higher Education Center http://higheredcenter.ed.gov

Office for Civil Rights http://www2.ed.gov/about/offices/list/ocr/index.html

Office of Safe and Drug Free Schools http://www2.ed.gov/about/offices/list/osdfs/index.html

Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act

http://www2.ed.gov/admins/lead/safety/campus.html

Studies sponsored by NIDRR

http://www.naric.com/research/record.cfm?search=1&type=all&criteria=violence&phrase=no

&rec-1774

http://www.naric.com/research/record.cfm?search=1&type=all&criteria=violence&phrase=no

&rec=2254

U.S. Department of Health and Human Services (DHHS)

Administration for Children and Families (ACF)

Family Violence Prevention and Services 

The Family Violence Prevention and Services Act (FVPSA) provides the primary federal funding 

stream dedicated to the support of emergency shelter and related assistance for victims of 

domestic violence and their dependents. The FVPSA deals with issues of trauma and violence 
22

against women every day, with every person the

program serves. In addition to supporting a national 

network of domestic violence services, The 

Administration for Children and Families (ACF) funds 

state domestic violence coalitions, national resource 

centers, training centers, culturally specific institutes, a 

national hotline and an institute on trauma and mental 

health. 

Each year, domestic violence programs funded through 

FVPSA serve more than 1.2 million survivors of 

domestic violence and their children. Domestic 

violence has been associated with a wide range of 

mental health consequences, including depression, post 

traumatic stress disorder, and a range of behaviors 

related to trauma reactions. For many survivors, these 

issues may resolve with increased safety and support, 

but others may benefit from additional resources and 

treatment. Survivors of domestic violence, and their 

children who experience that trauma directly or 

vicariously, are better served in trauma-informed 

settings where staff take the trauma into account, 

avoid triggering reactions, adjust their behavior to 

accommodate trauma reactions, and allow survivors to 

manage their trauma through a range of coping 

strategies. 

More than 1500 domestic violence programs

across the country respond to more than 1.4 

million crisis calls annually.xxvii

More than 300,000 adults and children were 

provided housing in 2005.xxviii

Across studies of battered women, rates of 

mental health problems are very high: 54-84 

percent for PTSD; 63-75 percent for depression; 

and 38-75 percent for anxiety disorders.xxix

More than half of all women seen in a range of mental health settings are currently or 

have in the past experienced abuse by an intimate partner.xxx

Three of five discretionary ACF grants targeting the hardest to serve populations focus 

on abuse survivors with mental health and/or substance abuse problems. 

In a 2008 study of more than 3,400 domestic violence survivors in eight states, 86 

percent of participants requested help with obtaining counseling.xxxi 

Domestic Violence: Where Mental 

Health and Social Justice Meet

Our center was established in 2005 by 

DHHS to serve as a national resource

on domestic violence and mental 

health. To get a picture of the 

problem, on any given day in 2009 

about 9,000 women were turned away 

because there weren’t enough services. 

Integrating (mental health and 

domestic violence) services has taken a 

very long time because historically, 

mental health has been used against 

women – by the abusers, by the courts, 

and by the child welfare system. It 

works because an abuser is more 

credible than a woman who has had a 

history of mental health treatment. 

We’re working on changing the culture 

of DV programs to become traumainformed, and the mental health 

system, to be aware of DV. One small 

change can make a difference: instead 

of only asking if you are a danger to 

yourself or others, asking if you are in 

danger from another person.

So how do we bring in a social justice 

lens? We need to think not only about 

the traumatic effect of abuse, but also 

about the social realities of ongoing 

abuse, violence and danger, as well as 

the social structures that support 

abuse of power.

Carole Warshaw, MD
23

In the same study, 98 percent requested help with safety issues and learning about 

options, 97 percent with understanding domestic violence and paying attention to their 

own needs, 95 percent with making connections with others, 93 percent with obtaining 

emotional support, and 92 percent with dealing with upsetting feelings or stress.

Many domestic violence survivors seek counseling services as an important part of their 

recovery from trauma. Very limited research exists on evidence-based treatments for 

addressing mental health issues in the context of ongoing domestic violence. In addition, there 

are few controlled studies on the treatment of complex trauma for domestic violence survivors. 

Current best practice approaches involve combining core principles of domestic violence 

advocacy work with evidence-informed trauma treatment. Research is needed to assess the 

types of interventions that will be most helpful to survivors of domestic violence.xxxii

Currently there is a strong movement across the country for family violence programs to 

become trauma-informed. Because it is based on “what happened to you not what’s wrong 

with you,” the approach is helpful in empowerment-oriented domestic violence programs. 

Several states have received grants to strengthen the partnership between domestic violence 

and behavioral health providers and to expand training in trauma-informed care. Traumainformed care is also being extended to programs for children exposed to domestic violence, 

teaching mothers to identify and address the impact of trauma on their children and teaching 

children the skills they need to talk it through. 

As part of the network of domestic violence National and Special issue Resource Centers 

funded through FVPSA, the National Center on Domestic Violence, Trauma and Mental 

Health is committed to developing comprehensive, accessible, and culturally-relevant 

responses to the range of trauma- and mental health-related issues faced by domestic 

violence survivors and their children, promoting advocacy that is survivor-defined and 

rooted in the principles of justice, and eradicating the social and psychological conditions 

that contribute to interpersonal abuse and violence across the lifespan. The Center offers 

information about current practice, model approaches and policies, and successful 

collaborations as well as individualized training, capacity-building assistance, and 

consultation. They are leading a six-state initiative to help domestic violence coalitions and 

programs to implement trauma-informed program practices and services. For more 

information they can be reached at 312-726-7020 or www.dvmhpi.org.

Additional Resources:

http://www.acf.hhs.gov/programs/fysb/content/programs/fv.htm

National Online Resource Center on Violence against Women http://www.vawnet.org/

National Center on Domestic Violence, Trauma and Mental Health at the Domestic Violence 

and Mental Health Policy Initiative http://www.dvmhpi.org/Aboutdvmh.htm
24

DHHS – Agency for Healthcare Research and Quality (AHRQ)

The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, 

safety, efficiency, and effectiveness of health care for all Americans through services research, 

knowledge synthesis, and development of tools for improving services and practice. Women’s 

health is one of AHRQ’s priority areas. Since violence and trauma affect all areas of women’s 

health, healthcare providers need to be informed about and skilled in addressing these issues. 

Research on the efficacy of trauma-informed care as well as tools to assist in training and 

implementation would contribute to this goal.

ACE study researchers believe that women’s significantly higher rates of childhood 

abuse may explain their proneness to ill-defined health problems like fibromyalgia, 

chronic fatigue syndrome, obesity, irritable bowel syndrome, and chronic non-malignant 

pain syndromes. 

xxxiii

Including a trauma assessment as part of a comprehensive medical evaluation led to a 

35 percent reduction in doctor office visits during the subsequent year, an 11 percent

reduction in emergency visits and a 3 percent reduction in hospitalizations.

xxxiv

Only 23 percent of physicians, nurses, physician assistants, and medical assistants 

believe they have strategies that could assist victims of domestic abuse.

xxxv

A study using 2008 health care and population data shows that the predicted 

incremental cost of violence and abuse to the health care system ranges between $333 

billion and $750 billion annually, or 17 to 37.5 percent of the total health care dollar.xxxvi

In the late 1990’s AHRQ issued an RFA on violence against women, resulting in a number of 

tools currently available on their website, including an assessment instrument to evaluate 

domestic violence programs in hospital settings, a manual of evidence-based practices for 

medical examination and treatment of victims of sexual assault, and a review of programs and 

tools that improve care for victims of domestic violence. AHRQ works in partnership with other 

HHS agencies to develop and disseminate knowledge about trauma and trauma-informed care 

in primary care settings. 

Additional Resources:

http://www.ahrq.gov/research/womenix.htm

Academy on Violence and Abuse http://www.avahealth.org/
25

Dolezi, T., McCollum, D., and Callahan, M. (2009) Hidden Costs in Health Care: The Economic 

Impact of Violence and Abuse. Eden Prairie, MN: Academy on Violence and Abuse.

DHHS – Centers for Disease Control and Prevention (CDC)

Within the CDC mission to promote public health and safety, the National Center for Chronic 

Disease Prevention and Health Promotion has a strong focus on chronic disease and 

reproductive health, both profoundly affected by violence against women. The Adverse 

Childhood Experiences (ACE) study, a partnership between CDC and Kaiser Permanente, has 

been a major force in bringing the issue of trauma and abuse to public attention.xxxvii Next steps 

include examining the gender implications of the ACE study, researching the link between 

women’s cardiovascular health risks and ACEs, conducting gender-based data analyses, and 

considering the impact of violence on the developmental trajectory of women. Compared to 

men:

Women experience significantly higher rates of abuse in all ACE categories except 

physical abuse and physical neglect.

xxxviii

Women report being victimized by family members significantly more often.

xxxix

Women experience significantly higher levels of depression across all ACE scores.

xl

Starting in 2009, CDC included an optional module on ACEs in their Behavioral Risk Factor 

Surveillance System (BRFSS) survey, an extensive national telephone survey conducted through 

state health departments. The first report on findings was released in December 2010.xli These 

findings indicate that ACEs (see list on page 3) were common in a representative sample of 

adults. Almost two-thirds (59 percent) reported at least one ACE. CDC partnered with the 

World Health Organization (WHO) and other agencies to develop an ACE instrument designed 

to be adaptable to persons with a range of economic and cultural differences and to address 

forms of violence not included in the original ACE questionnaire (e.g., war, disaster, extreme 

poverty).

Additional Resources:

Addressing Trauma in the Child Welfare System

Child Welfare has an outdated image that does not serve the greater good and the needs of vulnerable children and 

young women. 67% of abused children are less than 1 year old; 80% are less than 3 years old. Adopted and 

fostered children can be forced into prostitution, beaten or forced to sell on the street. Child welfare can help to 

change the picture. There are opportunities that abound, and we must come together. Stop blaming us. When 

there's a two-month old that's been raped and then brutally murdered, we didn't do that. And the most horrifying 

thing for a worker in our agency is to take a baby out of a mother's arms. Go and find out what is going on in child 

welfare. Find out what the workers go through. You want to talk trauma? It’s trauma to the 10th power for child 

welfare workers. Child fatalities? At Christmas time, the rate goes up. Summer is coming, the rate goes up. We 

will fail girls and also young boys and men if we allow differences in perspective to keep us apart and keep us from 

protecting children. In modern society, we create things that can be tossed away. We have treated our girls and 

young women the same way. We think of them as disposable. And that's a tragedy. Let's go with the conservation 

approach. Let's save our girls. Let's save our planet.

Sharon Cadiz, PhD
26

The ACE study 

http://www.cdc.gov/nccdphp/ace/index.htm

Lifecourse Effects of Trauma in the Life of Women and 

Girls: Findings from the ACE Study

https://services.choruscall.com/links/womenshealth.html 

WHO (2006) Preventing Child Maltreatment: A Guide to 

Taking Action and Generating Evidence

DHHS – Substance Abuse and Mental Health Services 

Administration (SAMHSA)

Center for Mental Health Services (CMHS)

More than half of the people served by mental health 

systems across the country are female, and the vast 

majority have histories of trauma and abuse. Trauma 

affects how women and girls engage in services, what 

outcomes are achieved, and the mental health of future 

generations. 

85 – 95 percent of women in the public mental 

health system have histories of physical or sexual 

abuse, most as children.xlii

Symptoms considered indicative of psychosis and 

schizophrenia, particularly hallucinations, are 

strongly related to childhood abuse and neglect. 

Large-scale general population studies indicate the 

relationship is causal, with more severe abuse 

leading to higher symptomatology.xliii

Prospective studies demonstrate an association

between child sexual abuse and subsequent

increases in rates of both childhood and adult 

mental disorders.xliv

One out of four adolescent girls exhibits depressive 

symptoms, a rate that is 50 percent higher than 

boys. One of ten girls exhibits severe depressive 

symptoms. Abused girls have twice the number of 

symptoms of poor mental health as those who 

have not been abused.xlv

The majority of patients treated for PTSD in 

randomized trials improve, making these 

approaches some of the most effective mental 

health treatments devised to date.xlvi

Cultural Concerns and Historical 

Trauma

To understand trauma means being acutely 

sensitive to the conditions under which 

people grew up, to how they live today, to 

the journeys they have taken along the way, 

and to the meaning they make of their 

experiences. Culture can affect what 

behaviors are seen as legitimate, how 

distress is expressed, and how healing 

occurs. Cultural conditions may also affect 

patterns of behavior for generations. For 

example, during much of this country’s 

history, a black person put his or her life at 

risk by antagonizing a white person. Tight 

control over children’s behavior – still 

common in some African American 

communities - was a matter of survival.

Women who are not part of the dominant 

culture face “multiple oppressions,” and 

newcomers (refugees and immigrants) face 

the added trauma of cultural dislocation. 

While some of us may see extreme violence 

as an aberration, for some it is a part of life.

Many groups also carry the wounds of 

“historical trauma,” defined by Maria 

Yellow Horse Brave Heart as “cumulative 

emotional and psychological wounding over 

the lifespan and across generations, 

emanating from massive group trauma.” 

Historical trauma can come from many 

sources. Jews experienced the holocaust, 

Japanese-Americans were interned in 

camps during WWII, Hawaiians and 

Mexicans were colonized by the US. The 

impact of historical trauma can be 

especially profound in situations where 

entire cultures were lost or destroyed, as 

with enslaved Africans and American 

Indians/Alaskan Natives (AI/AN). 

Historical trauma highlights the need for 

group as well as individual healing. 

Overlooking cultural concerns can lead to 

re-traumization, and inattention to the 

historical root causes of social epidemics 

such as violence against AI/AN women and 

HIV/AIDS among African Americans 

effectively repeats the social trauma 

perpetrated against these groups. 
27

Trauma-integrated care - a combination of trauma-specific treatments and trauma-informed 

environments - has been shown to be effective in providing mental health services and 

supports for women with complex mental health and trauma histories. Mental health services 

that are not trauma-informed may inadvertently do serious psychological damage through 

practices such as seclusion and restraint, housing without adequate privacy provisions, crisis 

intervention techniques that replicate traumatic dynamics, and forcing parents to lose parental 

rights in order to access services. The Center for Mental Health Services (CMHS) has promoted 

trauma-informed services through national centers on adult and children’s trauma and is 

currently working to integrate principles of trauma-informed care throughout their portfolio, 

including a trauma-informed systems guide, development of trauma-informed peer leadership 

and training materials, a trauma focus within Mental Health Transformation grants, and an 

effort to include trauma in the integration of health and mental health. One new project 

launched as a result of the roundtable involves training almost 200,000 clinical service 

providers serving more than 6 million adults and children through the National Council of 

Community Behavioral Health. 

Additional Resources:

Najavits, L. M. (2007) Psychosocial treatments for posttraumatic stress disorder. In P.E. Nathan 

and J.M. Gorman, (Eds.) A Guide to Treatments that Work (3rd Edition, pp 513-529) NY: Oxford.

National Center on Trauma-Informed Care http://mentalhealth.samhsa.gov/nctic/

National Child Traumatic Stress Network http://www.nctsnet.org/nccts/nav.do?pid=hom_main

The Anna Institute http://annafoundation.org/ To join listserv, email afj@gwi.net

Action Steps for Improving Women’s Mental Health 

http://download.ncadi.samhsa.gov/ken/pdf/OWH09-PROFESSIONAL/ActionSteps.pdf

DHHS – SAMHSA

Center for Substance Abuse Treatment (CSAT)

The Center for Substance Abuse Treatment (CSAT) has known since the early 1990’s that many 

women in substance abuse treatment have trauma histories – histories that include but extend 

far beyond domestic violence. As a partner in the Women, Co-Occurring Disorders and Violence 

Study, CSAT learned that in order to be effective, substance abuse and mental health services

must work hand-in-hand to address the trauma underlying the symptoms, and in order to 

interrupt the intergenerational cycle of violence, services must focus on the entire family. 

CSAT’s current work emphasizes working with all family members and kinship arrangements -

including fathers, children, extended family members, foster care families, and others – to 

stabilize situations and do family healing work.

Substance abuse can lead to worsened medical and mental health conditions, infectious 

diseases (e.g., HIV/AIDs), unintentional injuries, low birth weight, premature deliveries, 

developmental disabilities, domestic violence and child abuse and neglect.xlvii

A high percentage of people who are addicted to substances have experienced trauma 

as children or adults.xlviii More than half of all women seeking substance abuse 

treatment report one or more lifetime traumas.xlix
28

Helping clients gain control over trauma-related symptoms greatly improves their 

chances of recovery. l

Women are more likely than men to meet criteria for PTSD once exposed to trauma.li

Alcohol and drug use can be, for some women, an effort to manage PTSD symptoms. lii

Perpetrators of violent assault are often under the influence of substances. Helping the 

client protect against future trauma is an important part of treatment.liii

Given these statistics, it is of critical importance that substance abuse programs become 

trauma-informed. A universal precautions approach is essential, staff must be able to work 

with the person “where he or she is”, and environments must clearly demonstrate safety and 

protection for both mothers and their children. Women can easily be re-traumatized if staff 

don’t focus on relationships or are insensitive to women’s trauma histories. For example, when 

women are separated from their children during an initial assessment, they may become 

extremely fearful for the safety of the child – especially if they see the child being led away by a 

male staff person. 

 

CSAT is currently working to ensure that all their grantees in the Women, Children and Family 

Treatment Program are trauma-informed, including the Residential Treatment for Pregnant and 

Post-Partum Women (PPT) grantees. PPT is a gender and culturally specific program that 

targets traditionally underserved populations, especially racial and ethnic minority women and 

their minor children. A “learning collaborative” approach is being used, emphasizing 

participatory learning, training and technical assistance, site visits, and action planning. The 

goal is for all grantees to adopt and implement at least one best practice model for traumainformed care within the next 12 months.

Additional resources:

National Center on Substance Abuse and Child Welfare http://www.ncsacw.samhsa.gov/

Najavits, L.M. (In press) An implementation guide to Seeking Safety. In: D. Springer, A. Rubin 

(Eds.), Substance Abuse Treatment for Youths and Adults from Clinician's Guide to EvidenceBased Practice Series. Hoboken, NJ: John Wiley.

Najavits, L.M., Gallop, R., and Weiss, R. (2006) Seeking Safety Therapy for Adolescent Girls with 

PTSD and Substance Use Disorder: A Randomized Controlled Trial. The Journal of Behavioral 

Health Services and Research, 33(4):453-463.

Center for Substance Abuse Treatment (2009) Substance abuse treatment: Addressing the 

specific needs of women. Treatment Improvement Protocol (TIP) Series 51. HHS Publication 

(SMA) 09-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration.

DHHS - Health Resources and Services Administration (HRSA), Maternal and Child Health 

Bureau, Office of Women’s Health

The Health Resources and Services Administration (HRSA) is the primary federal agency for 

improving access to healthcare services for people who are uninsured, isolated or medically 

vulnerable. The HSRA Office of Women’s Health focuses on reducing sex and gender-basedliv

disparities in health care and ensuring that women from all walks of life receive quality health 
29

care. Since 1991, HRSA has been working to address the consequences of the epidemic of 

intimate partner and family violence through policy development, training, technical assistance, 

service delivery, education, and research. Efforts include domestic violence service linkages 

through primary healthcare sites, grants to improve identification and treatment of victims of 

domestic violence during pregnancy, and training of healthcare professionals. HRSA’s Women’s 

Health Databook, currently in its 9th edition, presents current and historical data on some of the 

most pressing challenges facing women, their families, and their communities; profiles 

women’s health from a variety of data sources; highlights emerging issues and trends in 

women’s health; and highlights racial/ethnic, sex/gender, age and socioeconomic disparities. 

The health indicators section of the Databook includes information on intimate partner 

violence. The Bright Futures for Women’s Health and Wellness (BFWHW) emotional wellness 

guides, available in English and Spanish online, focus on achieving better physical, emotional, 

social and spiritual health by encouraging healthy relationships and behaviors. The guides are 

based on the latest research on emotional wellness, and include tips and information on coping 

skills, self-appreciation, finding balance and purpose, and connecting with others. 

Several new initiatives address violence prevention and trauma, including a project in 

collaboration with the National Institute of Justice (NIJ) and other DHHS agencies focusing on 

teen dating violence. A continued focus on trauma-informed women’s health services is 

planned, starting with the HRSA Women’s Health Coordinating Committee as a structure for 

initiating widespread education and action.

Additional Resources:

Women’s Health USA 2010 Databook http://www.hrsa.gov/womenshealth/

Trauma and Disaster Preparedness http://gainscenter.samhsa.gov/atc/

DHHS, HRSA. One Department: Overview of Activities on Violence Against Women 2008-2009

http://www.womenshealth.gov/pub/owh/violence-against-women.cfm

Stop Bullying Now http://www.stopbullyingnow.gov/

DHHS – National Institutes of Health (NIH), Office of the Director, Division of Program 

Coordination, Planning and Strategic Initiatives, Office of Research on Women’s Health

Violence against women is a major research priority across the National Institutes of Health 

(NIH). In FY 09, more than $41 million was spent on 135 research projects on violence against 

women in 10 different research institutes, centers and offices. The majority of studies were 

conducted by the National Institutes on Mental Health, Alcohol Abuse and Alcoholism, Drug 

Abuse, and Child Health and Human Development, and projects on violence against women 

were also supported through the Institutes on Nursing Research; Heart, Lung and Blood; and 

General Medical Sciences. Research spans a wide variety of topics, from PTSD and 

consequences of violence in different populations and age groups, to risk and protective factors 

and research on services and interventions. Knowing the factors that put women at risk for 

violence is key to prevention. For example, violence against women is often associated with 

alcohol, and women are at higher risk for violence when they are pregnant or post-partum. 
30

The Director of Research Programs serves as the coordinator of violence against women 

programs across NIH. The Office works collaboratively with other federal agencies and with 

academia to ensure that research data are available and accessible to policymakers, 

practitioners, and educators. While much progress is being made, further research is needed 

on the impact of trauma-informed care on health and social outcomes for women. 

Additional Resources:

NIH Research Portfolio Online Reporting Tools (RePORT) Categorical Spending. 

http://report.nih.gov/rcdc/categories/

DHHS – Administration for Children and Families, Office of Refugee Resettlement (ORR)

Refugees leave their home countries involuntarily and, by definition, cannot return home 

because of a “well-founded fear of persecution.” The trauma experienced by refugee women is 

likely to have been prolonged and repeated, consciously caused, and exacerbated by forced 

exile. Sources of trauma for refugees may include war, rape or atrocities, or “disappearance” of 

friends and family. Trauma for women refugees may also result from previous experiences 

within the country of origin – domestic violence, rape, honor killings, torture and combat. 

Women and girl refugees are extremely vulnerable to gender-based violence during migration 

and in refugee camps, and upon resettlement, women and girls continue to be vulnerable to 

gender-based violence, discrimination and exploitation.

More than 2.5 million refugees have been resettled in the US since 1975. Approximately 

75 percent of all refugees are women and children.lv

Women refugees have higher levels of PTSD severity and more mental health symptoms 

than men.lvi

Women and children comprise 80 percent of international war casualties and 

increasingly serve as combatants.

lvii

Women and girls are at high risk for torture due to their small size and in order to 

retaliate or intimidate family members.lviii

Women and girls are particularly vulnerable to gender-based violence during migration 

and in refugee settings.lix

Women refugees without employment are at higher risk for sexual exploitation and 

abuse; those who work may face increased risk for violence at home.lx

While the Office of Refugee Resettlement (ORR) is primarily responsible for helping refugees to 

gain independence, a partnership with SAMHSA provides a focus on the development of 

trauma-informed services. Such services are essential to ensure safety for refugee women, to 

avoid re-traumatization, and to recognize trauma-based symptoms that might be misdiagnosed 

as mental illnesses. In 1995 ORR established the Refugee Women’s Network, a national 

nonprofit dedicated to empowering refugee and immigrant women through leadership training, 

education and advocacy. ORR also supports women trauma survivors through their Torture 

Treatment, Assistance for Victims of Human Trafficking, and Ethnic Self-Help programs. 
31

Additional Resources:

Refugee Women’s Network http://www.riwn.org/

Women’s Refugee Commission (2009). Peril or Protection: The Link between Livelihoods and 

Gender-based Violence in Displacement Settings http://womensrefugeecommission.org/

Blanch, A. (2008) Transcending Violence: Emerging Models for Trauma Healing in Refugee 

Communities. CMHS/SAMHSA. 

http://www.theannainstitute.org/RefugeeTraumaPaperJuly212008.pdf

DHHS - Office on Women’s Health (OWH)4

The Office on Women’s Health (OWH) strives to ensure that "all women and girls are healthier 

and have a better sense of well being” by developing innovative gender-based programs, 

educating health professionals, and disseminating health information. Violence and trauma 

affect the health of women and men across the lifespan and across generations. In partnership 

with other agencies, OWH focuses on breaking the intergenerational cycle of violence through 

prevention, early intervention and trauma-informed treatment. 

Trauma survivors report more symptoms, have higher rates of both physical and mental 

health problems,lxi use more healthcare services, and have higher health care costs.lxii

Trauma survivors use significantly more costly healthcare services and fewer preventive 

interventions such as mammograms, cervical cancer screenings, and regular dental 

care,lxiii in part due to re-traumatization (secondary victimization).

lxiv

Secondary victimization increases mental health symptoms.

lxv

Current healthcare training requires only 2 hours on trauma for medicine and dentistry 

and 6 hours for nursing, and focuses primarily on mandated reporting.lxvi

Health and social service providers interact on a routine basis with women and children who 

are survivors of domestic violence, sexual assault, childhood sexual abuse, combat, street 

violence, and natural disasters. Without adequate training in trauma, health care providers can 

unintentionally re-traumatize patients through procedures such as dental and pelvic exams (for 

sexual abuse survivors), ER visits (where medical staff may dismiss or ignore the woman’s 

experience), or even surgery (where a person loses control over the situation.) Healthcare 

providers working in school systems or other child-serving agencies who are not traumainformed can easily misinterpret trauma symptoms as behavioral problems. 

Medical education is one key strategy in developing trauma-informed care. Widespread 

dissemination of basic knowledge about trauma is another. In order to provide effective 

healthcare, all health and social service provides, regardless of specialization, must be trained 

 

4

Drawn in part from Raja, S. (2010) Interdisciplinary Approaches to Trauma-Informed Care: Survivors and the 

Healthcare System. Presentation at Federal Partners Roundtable on Women and Trauma, April 29, Washington, 

DC
32

to be trauma-informed. Health care professionals can become trauma-informed by making 

simple changes such as allowing the patient to take a break if the exam becomes stressful and 

knowing what types of questions not to ask. Current plans to create a more trauma-informed 

healthcare system include expanding trauma training to include both a broader array of 

providers and topics beyond mandated reporting and addressing issues of secondary 

victimization. 

OWH regional offices have the capacity to reach a wide variety of providers through an 

extensive grassroots network and partnerships with community groups and organizations. 

Regional offices can also respond to local events like disasters, which often have a 

disproportionate impact on underserved populations with less access to services. For example, 

in OWH Region II the impact of 9/11 on women in NYC was profound, particularly on food 

service workers who were on the site (largely Hispanic women). OWH regional offices are 

currently providing training in trauma-informed care to faith-based and community groups, 

particularly front-line workers, bringing different perspectives from the field together for crossfertilization of ideas and developing a pool of local experts and people with the lived experience 

of trauma and violence. This initiative includes a series of webinars that will reach a wide 

variety of people and organizations, including health care settings, fertility clinics, WIC 

programs, rape crisis centers, schools, housing and work programs, and criminal justice 

settings. An intensive 2-3 day trauma skills training institute will also be offered. 

Additional Resources:

http://www.womenshealth.gov/owh/

To register for webinars: owh.reg.V.webinars@hhs.gov

U.S. Department of Justice (DOJ)

National Institute of Corrections (NIC)

Trauma is a prominent feature of the experience of justice involved women and can be a 

contributing factor to entering the system. Women are often introduced to drugs and crime by 

a partner and frequently use substances to mask the pain of abuse. While woman are 

incarcerated, trauma may affect their institutional conduct and as a result, may negatively 

impact their eligibility for treatment and educational programs, increase the likelihood of 

disciplinary action, and extend release dates. Trauma also affects women’s re-entry into the 

community and can contribute to their risk of re-offending. 

Women now make up 17 percent of all offenders.lxvii

Female inmates in federal and state prisons and in jails have much higher rates of 

mental health problems than male inmates. The percentage of women with the most 

severe mental illnesses in jails is twice that of men.lxviii

Women under correctional supervision are more likely to experience physical and sexual 

abuse than either male offenders or women in the general population.lxix

Behavioral disruptions in prisons are most likely to involve disturbed inmates with 

histories of trauma, mental illness and substance abuse.lxx
33

It is critical that correctional staff in prisons and jails and probation and parole officers in the 

community be trauma-informed. Correctional procedures such as cell searches, escorts, and 

cell removal can easily retrigger earlier trauma, leading the woman to protest or fight back and 

often ending up with a disciplinary report. Correctional staff not trained in trauma-informed

practices can unwittingly re-traumatize the women through typical system responses and 

further entrench her in the correctional system. Often a woman’s response to a trigger could 

be more effectively addressed by staff who have been trained in application of traumainformed practices. Emerging evidence-based research in correctional practices has identified 

areas of risk and need that contribute to recidivisim and can improve treatment targets for 

both men and women. Gender-responsive research on women offenders further targets areas 

of concern, including mental health history, depression, relationship dysfunction, and child 

abuse. Add to the list for women under probation and/or parole supervision, housing safety, 

anger, victimization as an adult, and stress in the parenting role. These areas should be taken 

into consideration when managing women in institutional or community corrections settings,

and can contribute to improved individual and system outcomes with justice involved women.

The National Institute of Corrections (NIC) has integrated training on trauma-informed practices

into training programs specific to women offenders as well as other emerging products,

women’s risk and need assessment, a women offender case management model, and a genderinformed practices assessment – all for use with prisons, jails, and community corrections 

settings

Additional Resources:

Tonier Cain, Healing Neem (DVD) http://www.healingneen.com/about.html

Bloom, B., Owen, B., and Covington, S. (2005) Gender-responsive strategies for women 

offenders. http://nicic.gov/pubs/2005/020418.pdf

National directory of programs for female offenders www.nicic.gov/wodp

For information on Women’s Risk Needs Assessment Project www.uc.edu/womenoffenders 

www.nicic.gov/womenoffenders

DOJ - Office of Juvenile Justice and Delinquency Prevention (OJJDP)5

Girls are the fastest growing population in the juvenile justice system, and a very high 

percentage of them have experienced violence and trauma. Since traditional practices may 

backfire with girls who have trauma histories, it is critical for the juvenile justice system to 

become trauma-informed and to involve families whenever possible. 

More than 93,000 children are currently locked up in juvenile correction facilities 

around the country.

lxxi

Among a sample of incarcerated youth, girls were 50 percent more likely to be suffering 

from PTSD than boys.lxxii

 

5 Drawn in part from Gonsoulin,S. (2010) Federal Roundtable on Women and Trauma: Juvenile Justice. 

Presentation at the Federal Partners Roundtable on Women and Trauma, April 29, Washington, DC.
34

Girls are more like to be victims of sexual abuse, are more likely to be victimized by 

family members, and more likely to run away from home to escape violence.lxxiii

Risk factors for delinquency in girls include sexual abuse, maltreatment, early onset of 

puberty, and intense mother-daughter conflict.lxxiv

Girls who have been sexually assaulted are five times more likely to commit a 

delinquent act; almost 30 percent of physically assaulted girls commit a delinquent act 

compared to 3.2 percent of others. lxxv

The detention environment can exacerbate negative feelings and loss of control among girls 

with trauma histories, resulting in suicide attempts or self-inflicted violence. Traditional 

methods of preserving order and asserting authority (especially “tough” physically 

confrontational methods and the use of isolation or restraints) may result in re-traumatization. 

In addition, symptoms of post-traumatic stress may be misdiagnosed – for example, as 

oppositional defiance disorder. In contrast, ensuring that girls have access to gender-specific 

health and personal care items (such as female clothing) or getting treatment closer to home 

has a positive impact. The National Juvenile Justice Network identified 13 recommendations 

for improving the juvenile justice response to girls, including mandating trauma screening and 

assessment, training all staff in trauma-informed care, and instituting gender-specific policies 

and programs. OJJDP has also created four issue teams to address specific problems with atrisk youth, tribal youth, community re-entry and transition to adulthood, and racial/ethnic 

disparities. 

Additional Resources:

Adams, E.J. (2010) Healing invisible wounds: Why investing in trauma-informed care for children 

makes sense. Washington, DC: Justice Policy Institute

DOJ – Office for Victims of Crime (OVC)

To be a victim of crime is to be invaded at the deepest level. As a victim, one’s sense of 

personal safety and autonomy is shattered. A crime inflicted on one person affects dozens, 

even hundreds more. From emergency responders to victim service providers, from court 

personnel to the victim’s friends and family, from the media to the public, even a single incident 

ripples throughout the community and changes the environment. 

As part of the U.S. Department of Justice’s Office of Justice Programs, the Office for Victims of 

Crime (OVC) supports a network of victim service providers who supply a full range of services 

to victims of every type of crime. OVC is charged by Congress with administering the Crime 

Victims Fund (the Fund), a major source for funding victim services throughout the Nation. 

Established by the Victims of Crime Act of 1984 (VOCA), the Fund supports thousands of 

programs annually that represent millions of dollars invested in victim compensation and 

assistance in every U.S. state and territory, as well as training and demonstration projects 

designed to enhance the skills of victim service providers. VOCA victim assistance funding –

awarded through sub-grants to state agencies and local service providers – is the most farreaching and visible demonstration of OVC’s commitment to providing crisis intervention, 
35

shelter, counseling, social service support, and criminal justice advocacy to those in urgent need 

of assistance. VOCA compensation grants supplement a state’s efforts to provide financial 

assistance and reimbursement to victims, most frequently for medical and dental care in the 

aftermath of a violent assault. Discretionary grants administered by OVC play an important role 

of funding a broad array of programs to meet emerging needs, fill gaps in existing services, 

demonstrate promising practices and help strengthen the skills and abilities of service 

providers. For example, through projects supported through discretionary funding, we have 

made progress toward understanding the service needs of victims of human trafficking, identify 

theft, and domestic violence victims living abroad. Throughout all of our programs and 

initiatives, while services are most often offered to both males and females, the issue of 

violence against women, and the need for comprehensive, gender-specific, and traumainformed services to women across their lifespan is central to the support and resources that 

are provided through OVC.

In 2009, 20 million crimes were committed in the Unites States. Of these, 4.3 million were 

violent and 15.6 million were property crimes. Only about half (49 percent) of violent crimes 

and 40 percent of property crimes were reported to the police. lxxvi

Of female rape or sexual assault victims in 2009, 21 percent were assaulted by a stranger, 

39 percent of offenders were friends or acquaintances of their victims, and 41 percent were 

intimate partners.lxxvii

Of female murder victims in 2009, 35 percent were killed by an intimate partner.lxxviii

The National Survey on Children Exposed to Violence measured the past-year and lifetime 

exposure to violence for children. Using a sample of 4,549 children and adolescents aged 17 

and younger, researchers found that during a 1-year period, 60.6 percent of children and 

youth from birth to 17 years of age experienced at least one direct or indirect (as a witness) 

victimization. Overall, 9.8 percent of the sample had been sexually victimized in their 

lifetimes. Adolescents aged 14 to 17 were by far the most likely to be sexually victimized; 

nearly 1 in 6 (16.3 percent) was sexually victimized in the past year; and more than 1 in 4 

(27.3 percent) had been sexually victimized during their lifetimes.lxxix

In 2004, more than 65 percent of elder maltreatment victims who reported to adult 

protective services were women.lxxx

Rape survivors who had the assistance of an advocate were significantly more likely to have 

police reports taken and were less likely to be treated negatively by police officers. These 

victims also reported less distress after their contact with the legal system.lxxxi

OVC recognizes that while most victim service providers have a general understanding of the 

traumatic impact that crime has on victims, some programs still don’t always integrate policies 

and procedures that support the kinds of “trauma-informed” services that victims and survivors 

want and need. In addition, while the Crime Victims Fund has supported the creation of a 

strong web of services for many victims, some victims remain inadequately served or unserved. Too often, multiple systems within a community do not work collaboratively to ensure 

that victims from marginalized communities, who may have experienced multiple forms of 

victimizations, are being seen in a holistic and coordinated fashion. Training and technical 
36

assistance to victim service providers and allied professionals is paramount to ensure that 

trauma-informed, victim-centered services are made available to all victims. OVC is committed 

to working with its federal partners to infuse its training and technical assistance resources, 

such as the National Victim Assistance Academy, State Victim Assistance Academies, online 

training opportunities, Web forums, training workshops and grantee meetings with current and 

relevant information to improve responses to women and girls impacted by violence. 

Additional resources: 

Office for Victims of Crime: www.ovc.gov.

OVC Training and Technical Assistance Center: www.ovcttac.gov. 

2009 Report to the Nation: http://www.ovc.gov/welcovc/reporttonation2009/welcome.html. 

National Criminal Justice Reference Service (NCJRS) - for updates on publications, grant funding, 

training opportunities, etc. www.ncjrs.gov. 

Defending Childhood Initiative http://www.justice.gov/ag/defendingchildhood

DOJ – Office on Violence against Women

The Office on Violence against Women (OVW) provides national leadership in developing the 

nation's capacity to reduce violence against women through the implementation of the 

Violence against Women Act (VAWA). Created in 1995, OVW administers financial and technical 

assistance to communities across the country that are developing programs, policies, and 

practices aimed at ending domestic violence, dating violence, sexual assault, and stalking. 

Currently, OVW administers two formula grants program and 17 discretionary grant programs, 

which were established under VAWA and subsequent legislation. Since its inception, OVW has 

awarded nearly $4 billion in grants and cooperative agreements, and has launched a 

multifaceted approach to implementing VAWA. By forging state, local, and tribal partnerships 

among police, prosecutors, victim advocates, health care providers, faith leaders, and others, 

OVW grant programs help provide victims with the protection and services they need to pursue 

safe and healthy lives, while simultaneously enabling communities to hold offenders 

accountable for their violence. 

The 2009 Stalking Victimization Report found that, during a 12 month period, an 

estimated 3.4 million persons age 18 or older were victims of stalking. Nearly 75 percent 

of victims knew their offender in some capacity.lxxxii

According to the 2007 National Crime Victimization Survey, approximately 554,000 

violent crimes were committed by an intimate partner against female victims and 

248,300 rape/sexual assaults occurred in 2007.lxxxiii

In 2009, 10 percent of high school students reported being physically hurt by a 

boyfriend or girlfriend in the past 12 months. Girls are more likely to report physical 

injury.lxxxiv

According to a 2004 study by the Bureau of Justice Statistics, American Indians are twice 

as likely as all other races to experience sexual assault crimes. According to the 2000 

National Violence against Women Survey, one in three Indian women reported having

been raped during her lifetime.

lxxxv
37

Additional resources:

http://www.ovw.usdoj.gov/

U.S. Department of Labor

In the workplace, violence and trauma can significantly affect workers’ productivity and job 

performance, their use of sick leave and health insurance, turnover rates, accident rates, use of 

supervision, human resources, EEOC and legal resources, and the cost of recruiting and training 

new employees. The medical care, mental health services, and lost productivity (e.g., time 

away from work), cost of intimate partner violence (IPV) was an estimated $5.8 billion in 1995. 

Updated to 2003 dollars, that’s more than $8.3 billion. lxxxvi According to National Violence 

against Women Survey estimates, U.S. women lost nearly 8.0 million days of paid work each 

year because of violence perpetrated against them by current or former husbands, cohabitants, 

dates, and boyfriends. This is the equivalent of 32,114 full-time jobs each year. lxxxvii

Adverse childhood events correlate strongly with several measure of adult work performance, 

including absenteeism, serious job problems and financial problems.lxxxviii The authors of a study 

on childhood abuse, household dysfunction, and indicators of impaired adult worker 

performance suggest that adverse childhood experiences merit serious attention from the 

business community, labor leaders, the everyday practitioners of medicine, and government 

agencies because child abuse and household dysfunction are common and have long-term 

effects that are highly disruptive to workers’ health and well-being. They suggest that their 

data indicate the need to adopt the World Health Organization definition of health, 

necessitating a paradigm shift in which the disease-oriented biomedical approach is replaced by 

a biopsychosocial approach in which child abuse and household dysfunction are understood in 

terms of their long-term effects on worker health and well-being.lxxxix

According to the 2003 CDC publication Costs of Intimate Partner Violence against Women in the 

United States:

More qualitative and quantitative data are needed to better determine the full 

magnitude of IPV and associated human and economic costs. There is also a need for 

primary prevention – preventing IPV from occurring in the first place – rather than 

focusing only on treating victims and rehabilitating perpetrators after abuse has 

occurred. xc

CDC, in its Injury Research Agenda, has identified several key areas of research for IPV 

prevention. These areas include learning how to change social norms that accept 

intimate partner violence; developing programs for perpetrators and potential 

perpetrators; increasing our understanding of how violent behaviors toward intimate 

partners develop; improving collection of data about IPV and its health effects; 

developing and evaluating training programs for health professionals; and disseminating 

strategies that work to prevent IPV.xci

Significant resources for research are needed to better understand the causes and risk 

factors for IPV and to develop and disseminate effective primary prevention strategies. 
38

Until we reduce the incidence of IPV in the United States, we will not reduce the 

economic and social burden of this problem.xcii

Violence prevention, including sexual violence and intimate partner violence, is one of the 

injury research priority topics of the CDC Injury Research Agenda. More detail on this topic can 

be found in the agenda at www.cdc.gov/injury/Research Agenda/CDC Injury Research Agendaa.pdf. 

It is critical that work settings become trauma-informed in order to prevent workplace violence, 

intervene effectively if it occurs, and identify and respond appropriately to trauma-related 

incidents. If supervisors are not aware of the impact of violence and trauma, they may not 

recognize when women with prior trauma histories are being retriggered by something in the 

work environment, which could result in unnecessary negative consequences for all involved.

Just as awareness of trauma in the workplace must be increased as a preventive measure, so 

too must the value of work be recognized for its potentially critical role in recovery from trauma 

and behavioral health disabilities. Pitney Bowes, Inc., for example, was recognized by the 

National Business Group on Health for developing a highly innovative personalized program to 

facilitate the timely, efficient return to work for employees on leave due to mental health 

issues. The program is based on the following three tenets: (1) Work has inherent therapeutic 

value; (2) An individual must suffer a significant amount of distress to reach the point where he 

or she cannot function adequately at work; and (3) Absence from work longer than necessary is 

not beneficial and may be potentially harmful. 

One of the key features of Pitney-Bowes’ program is a team approach, which includes the 

employee, disability clinical care managers, employee assistance program (EAP), Pitney Bowes 

disability nurse, and a psychiatrist. A detailed, initial assessment allows the team to jointly plan

a course of treatment that will result in an efficient, timely return to work. Returning to work is 

viewed as part of recovery and return-to-work goals are integrated into the treatment process. 

Constant communication is maintained between the behavioral health disability clinical care 

manager and the Pitney Bowes disability nurse. Similarly, employee contact with the workplace 

occurs regularly throughout the recovery process. As a result of the company’s efforts, the 

program has led to a 40 percent reduction in the duration of short-term disability claims. 

Furthermore, because employees return to work sooner, productivity is restored, morale is 

boosted, and cost-savings are recognized. 

Additional resources:

http://www.workplacementalhealth.org/Pages/EmployerInnovations

DOL - Office of Disability Employment Policy (ODEP)

The emotional, physical and sexual abuse of women with disabilities is a problem of crisis 

proportions.xciii Tolerating abuse from caregivers who inflict pain, threaten to not help with 
39

essential tasks, or withhold medications, wheelchairs, and other 

orthotic devices until money, sex or other favors are given; 

abandonment; voyeurism and inappropriate body touching 

during hygiene tasks; and stealing or extortion “may be the only 

way for some women to survive.”xciv Women with disabilities 

are more likely than their peers to be abused or threatened 

with violence by their partners, by caregivers, or by others, and 

as a result may be affected in their ability to carry out their job 

functions. In addition, trauma can also cause both short- and 

long-term physical, cognitive, and emotional disabilities. 

Workplace policies and practices need to reflect this reality. In 

addition, government and private employers need to ensure 

that violence prevention strategies for people with disabilities, 

especially women, are widely adopted.

37.3 percent of women with disabilities have 

experienced violent abuse in their lifetime, compared 

with 20.6 percent of women without disabilities. 28.5 

percent have been threatened with violence, compared 

with 15.4 percent of those without disabilities.xcv

A high percentage of women with disabilities report 

abuse by personal assistants. This abuse prevents them 

from being employed (29 percent), taking care of their 

health (64 percent), and living independently (61 

percent).xcvi

Women with disabilities are significantly more likely than 

men with disabilities to be unemployed, to live in 

poverty, and to have part-time rather than full-time 

jobs.xcvii

Women with disabilities who have experienced violence and 

trauma may need specific counseling and support, 

environmental modifications, or job accommodations. Options 

for abused women with disabilities may be much more 

problematic than women without disabilities for the following 

reasons. Many shelters are physically inaccessible or unable to 

meet the women’s needs for personal assistance for daily living 

activities; accessible transportation to the shelter may be nonexistent or only available during certain times of the day or night; shelter staff may be 

inexperienced in communicating with a woman who is deaf or hard of hearing or with speech 

limitations; the woman may depend on the abuser for assistance with personal needs and have 

no family or friends to stay with; or she may be physically incapable of executing and 

implementing an escape plan.xcviii The Office of Disability Employment Policy (ODEP) is planning 

a comprehensive study of national and international research, literature, and programs that 

EAPs: A Response to Trauma in 

the Workplace

The same kinds of physical and 

emotional traumas that happen in 

the world at large happen in the 

workplace. Employee Assistance 

Programs (EAPs) are designed to 

assist work organizations in 

addressing productivity issues and 

“employee clients” in identifying 

and resolving personal concerns 

that may affect job performance. 

All federal agencies and private 

sector companies with federal 

contracts are mandated by law to 

have EAP programs. The Employee 

Assistance Professionals 

Association Standards and 

Guidelines place the EAP in 

position to interact with relevant 

departments in the work 

organization to develop trauma 

specific policies. Such goals could 

include:

1) Develop policies that identify 

and prohibit traumatizing 

behaviors 

2) Train human resource staff, 

union reps, managers and 

supervisors to be trauma-informed

3) Educate all employees about 

trauma

4) Screen employees presenting 

with health complaints for trauma

5) Ensure that all EAP staff have 

training in trauma

Nancy Pentz, LICSW, CAC, CEAP
40

affect women with disabilities with special attention to 

trauma and trauma-informed care. Key findings will be 

disseminated widely through briefings and web-based 

publications, and will provide policy and research 

recommendations for further consideration by ODEP and 

key national and international stakeholders. 

ODEP and DOL's Women’s Bureau (WB) signed a 

Memorandum of Agreement in August 2010 to collaborate 

on a Workplace Flexibility (WF) initiative. In January 2011, 

ODEP and the WB held a Workplace Flexibility Forum: 

Advancing Workplace Flexibility Policy and Practices, 

attended by the Secretary of Labor, the Assistant Secretary 

of ODEP, the Director of the WB, the Deputy Director and 

Deputy Chief of Staff of the Office of Personnel 

Management, other key federal staff, and several subject 

matter experts from the general WF field and the disability 

community. Deliverables from this ODEP-WB WF initiative 

will be a roadmap of recommendations and a WF 

electronic toolkit. These deliverables will not only provide 

general WF recommendations, resources, effective 

practices, and success stories for employers, employees, 

policymakers, and researchers, but they will also address 

the specific WF needs of women and women with 

disabilities who are in the workforce and/or desiring to 

enter the workforce. WF (telework, flexi-place, flexischedules, job sharing, flexibility around the job tasks, etc.) 

can be an effective employer workplace policy or practice as a reasonable accommodation to 

assist women exposed to trauma for any ensuing mental health conditions, such as posttraumatic stress disorder (PTSD) and any other types of mental health issues brought on by 

PTSD, and to provide WF policies and practices for women who require safe work environments 

related to domestic violence or intimate partner violence.

DOL - Women’s Bureau

Violence against women can have a profound impact on women in the workforce. Women 

workers may have histories of trauma and abuse, and in addition, they may be subjected to 

workplace bullying, domestic violence within the work setting or which impacts them as 

workers, sexual harassment, and harassment based on sex. Women in traditionally male jobs 

such as the construction trades may experience both sexual harassment and other forms of 

gender-based harassment. 

A 2007 survey found that 37 percent of workers had been bullied in the workplace. 60 

percent of bullies are men; 57 percent of targets are women. 45 percent of targets 

report stress-related health problems.xcix 

Workplace Bullying

13% of all adult Americans are 

currently being bullied and 57% of 

them are women. 24% have been 

bullied in the past, and 12% have

witnessed bullying. That's a total of 

71 million people. You would think 

that something that is evident at this 

proportion would be discussed all the 

time, and would be a source of public 

policy change. Men and women are 

bullied differently. The majority of 

the perpetrators are still male. The 

press loves the “devil wears Prada 

phenomenon” - they love to tell 

about a woman targeting a man -

but 7 out of 10 cases target women. 

The big thing I find is that people -

just as they discount a victim of 

violence, saying you should have 

known better, you should have just 

gotten out of there and all the rest -

they discount stress and workplace 

bullying.

Gary Namie, PhD
41

A 2003 study found that targeted individuals suffered debilitating anxiety, panic attacks, 

clinical depression, and post-traumatic stress.c

In FY 2009, EEOC received 12,696 charges of sexual harassment, 84 percent filed by 

women.

ci

While the effects of sexual harassment differ from person to person, it has been linked 

to anxiety, nausea, headache, high blood pressure, sleeplessness, and ulcers in some 

persons.

cii

12 percent of women report that their current or past intimate partner harassed them 

at work.ciii 

Of women experiencing domestic violence, almost 24 percent report that it caused 

them to be late for work or miss work; 15 percent report difficulty in keeping a job, and 

20 percent report that it affected their career advancement.civ

The Women’s Bureau was created by law in 1920 to formulate standards and policies to 

promote the welfare of wage-earning women, improve their working conditions, increase their 

efficiency, and advance their opportunities for profitable employments. Its vision is to 

empower all working women to achieve economic security. The Women’s Bureau has four 

priorities: equal pay, workplace flexibility, higher paying jobs, and homeless women veterans. 

Women who have experienced violence and the consequent trauma it can cause need

employment that provides economic security and workplace flexibility. The need is especially 

great for homeless women veterans because the majority of women in homeless veterans 

programs have serious trauma histories.cv The Women’s Bureau contracted with The National 

Center on Family Homelessness Institute in California to develop an organizational guide for 

providing trauma-informed care to women veterans, which will provide examples of traumainformed practices, encourage service providers to examine their programs with an 

organizational self -assessment, and offer concrete steps for adopting new practices.

On October 23, 2010, the Women’s Bureau sponsored a mini-retreat and stand-down in Kansas 

City, Missouri, for active duty women and women who served in the military. At the standdown, the U.S. Department of Veterans Affairs had a specialist on hand to provide information 

on military sexual trauma and PTSD.

On January 24, 2011, ODEP and the Women’s Bureau collaborated on a workplace flexibility 

initiative for employees with complex needs, including women (and men) who have 

experienced trauma. Common flexible work options include: flextime; compressed work 

weeks; part-time work; job sharing; telecommuting; personal days; paid-time-off banks; leaves 

of absence; emergency flexibility; reporting late; vacation buying, borrowing, sharing; day-at-atime vacation; floating holidays; shift flexibility; and no-meeting days/hours. Creating a flexible 

workplace can improve the recruitment, retention, productivity, performance, morale, and 

commitment of employees, decrease turnover and absenteeism, extend employer business 

hours, ensure coverage during peak hours without overstaffing, assist in retaining older 

workers’ skills and experience, and offer options in lieu of layoffs. It is also a primary strategy 

for making work environments and employment practices trauma-informed, offering a way for 

all employees, including people experiencing the consequences of trauma, to receive supports. 
42

Additional Resources:

http://www.dol.gov/wb/

http://www.dol.gov/odep/

http://homeless.samhsa.gov/ResourceFiles/cenfdthy.pdf

Center for Research on Women with Disabilities (CROWD) www.bcm.edu//crowd

Nosek, M.A. (2009) Violence against Women with Disabilities: Fact Sheet #1 – Findings from 

Studies 1992-2002. http://www.bcm.edu/crowd/?pmid=1409

Nosek, M.A. (2009) Violence against Women with Disabilities: Fact Sheet #2 – Issues and 

Recommendations. http://www.bcm.edu/crowd/?pmid=1410

Powers, L.E. and Oschwald, M. (2002) Violence and Abuse against People with Disabilities: 

Experiences, Barriers, and Prevention Strategies. Portland OR: Center on Self-Determination, 

Oregon Health and Sciences University.

http://www.temple.edu/instituteondisabilities/programs/justice/docs/bibliographyScans/Powe

rs_Oschwald.pdf

The Workplaces Respond to Domestic and Sexual Violence: A National Resource Center 

www.workplacesrespond.org

Curriculum on Abuse Prevention and Empowerment. http://www.wid.org/programs/health-access-andlong-term-services/curriculum-on-abuse-prevention-and-empowerment-cape

U.S. Department of Veterans Affairs (DVA)6

Female Veterans are at risk for a number of trauma-related problems, including military sexual 

trauma (MST). MST is defined in US Code as “psychological trauma which resulted from a 

physical assault of a sexual nature, battery of a sexual nature, or sexual harassment that 

occurred while a Veteran was serving on active duty.cvi Approximately one out of every five 

female VA patients screens positive for MST.cvii

All VA facilities screen Veterans for a history of MST and provide free treatment for all MSTrelated mental and physical health conditions. Additionally every VA facility has a designated 

MST coordinator who serves as a point person for all MST-related issues. In order to treat 

women Veterans effectively, the VA offers education and training on evidence-based therapies 

that have been proven to be effective in treating mental health conditions related to MST.

Female Veterans returning from Iraq and Afghanistan are seeking healthcare services from the 

VA at a higher rate than their male Veteran counterparts (49.7 percent of women compared to 

47.1 percent of men.) cviii Of women seeking health care services from the VA, 46.7 percent 

have a mental health diagnosis. The most frequently reported mental health disorders are 

adjustment reactions, which include PTSD and depression.cix

 

6 Drawn in part from McCutcheon, S. (2010) Women Veterans and Trauma. Presentation at the Federal Partners 

Roundtable on Women and Trauma, April 29, Washington, DC.
43

The VA provides both physical and mental health care for all eligible Veterans. Trauma-specific, 

evidence-based treatments available at the VA include cognitive processing therapy and

prolonged exposure for PTSD, and acceptance and commitment therapy for anxiety and 

depression. Specialized residential programs are also available for those Veterans requiring a 

more intense level of service. 

Additional Resources:

http://www.va.gov/

Department of Veterans Affairs National Center for PTSD http://www.ptsd.va.gov/index.asp

Getting Into Action

At the Federal Partners “Roundtable on Women and Trauma” held on April 29, 2010, more than 

80 participants came together to discuss the issues and make recommendations for action. 

Participants represented a broad range of federal and state agencies, advocacy organizations, 

academic and research institutions, and individuals 

with direct experience with trauma (see participant list 

in Appendix C). In the morning, plenary panel sessions 

provided basic information about the impact of trauma 

and violence against women across federal agencies. 

In the afternoon, a facilitated small group process led 

to a comprehensive list of recommendations for action 

in four broad areas: 1) a national action plan; 2) 

federal policy; 3) practice; and 4) incorporating the 

perspective of women and girls who have directly 

experienced trauma (recommendations are included in

Appendix D).

Evaluation data showed that participants were

informed, inspired, and moved to action. One hundred 

percent of respondents agreed (74 – 89 percent agreed

strongly) that the meeting had satisfied their 

expectations, improved their awareness and 

knowledge base, illustrated the importance of multisystems approaches, and created a platform for partnership. Ninety-four percent were already

considering new approaches to their work as a result of the meeting. 

Change began immediately. A collective momentum emerged from the meeting, and many 

agencies and individuals moved forward to implement suggested changes. Within a month, a

national behavioral health organization had launched a training program on trauma and 

trauma-informed care for more than 200,000 clinical service providers, at least one state had 

plans to replicate the roundtable, and several federal agencies were working to add 

requirements for trauma-informed practice into all of their RFPs. 

Vice President Biden authorized the 

Violence against Women Act to improve 

the criminal justice response to domestic 

violence and sexual assault. We have 

accomplished a great deal through VAWA, 

and now is the time to look at what more 

needs to be done. In the early days, 

advocates expressed concern that a 

trauma-based approach would take the 

focus off of systems reform. Today we 

know that trauma informed care and 

systems advocacy are complementary 

approaches. We can and must do both.

Lynn Rosenthal, White House Advisor on 

Violence against Women
44

On October 22nd, 2010, the Federal Partners Committee convened a follow-up strategic 

planning retreat to: 1) review actions taken as a result of the roundtable; 2) prioritize specific 

recommendations for integrating trauma-informed care into prevention, intervention and 

treatment activities within each partner agency; 3) formulate a strategy for further raising 

awareness about trauma-informed care; and 4) select specific projects/initiatives that the 

Committee could jointly support.

Every agency had followed up with concrete actions designed to implement trauma-informed 

principles and practices. While some actions had begun prior to the Roundtable and reflected a 

longstanding commitment to the issue, others were a direct result of the Roundtable and 

subsequent interagency discussions. The majority of initiatives were in the area of training and 

technical assistance. Examples included the development of informational materials and 

curricula; webinars; prevention toolkits; workforce training programs; university-based training; 

and conference presentations and workshops. One webinar series on “The Impact of Trauma 

on Women and Girls across the Lifespan,” sponsored by DHHS/SAMHSA, was immediately 

oversubscribed. Other actions reflected new policies, changes in grant programs, and new 

research directions. Examples included participation in international and global forums; reexamination of policies on workplace violence, bullying and health education; agency resource 

mapping; development of new state coalitions; and the development of technical guidance 

memos. 

New Partners and Next Steps

Since the Roundtable, representatives from several additional federal agencies and offices have 

joined the effort, including the Department of Housing and Urban Development, the 

Department of Education’s Rehabilitation Services Administration, the White House Office on 

Drug Control Policy, and the Peace Corps. These agencies have already become key players, 

bringing new issues and insights to the table.

The Department of Housing and Urban Development (HUD) brings to the Committee a focus on 

reducing the risk of homelessness and general housing instability. Victims of domestic violence 

are often isolated from support networks and financial resources by their abusers. As a result, 

they may lack steady income, employment, credit history, or landlord references, making 

affordable housing options difficult to find. They have both short- and long-term housing needs 

that must be met so that victims do not need to choose between life with their abusers and life 

on the streets. Homeless shelters, especially domestic violence shelters, play a key role in 

providing a safe place to stay when leaving their abuser. The McKinney-Vento Act defines any 

individual or family fleeing or attempting to flee domestic violence, sexual assault, stalking, or 

other life-threatening conditions that have no other residence and lack the resources to obtain 

other permanent housing as homeless. In the long term, domestic violence victims need 

options that let them transition into safe, stable and affordable housing, along with social 

services that can help them start a new life without their abuser.
45

Victims of domestic violence are eligible to receive assistance through a variety of HUD

programs, including: 1) The Emergency Shelter Grants Program; 2) The Homelessness 

Prevention and Rapid Re-housing Program; 3) The Supportive Housing Program; 4) Community 

Development Block Grant Program; 5) HOME Program; and 6) Public and Indian Housing 

Programs, including Public Housing and the Section 8 Housing Choice Voucher programs.

HUD will continue to work with HHS, VA, DOL and all agencies represented on the Federal 

Partners Committee to confront the needs of women experiencing violence and trauma, to 

make preventing and ending homelessness a top priority among the Committee agencies, to 

highlight the importance of affordable housing, and to work with Public Housing Authorities 

(PHAs) to ensure that the Violence Against Women Act (VAWA) of 2005 is being implemented 

effectively. In 2010, HUD issued the Final Rule implementing VAWA, which ensures that victims 

of domestic violence, dating violence, or stalking are not evicted, terminated from assistance, 

or denied assistance in HUD’s Public Housing and Section 8 programs as a result of the abuse 

committed against them, in addition to other protections. HUD will issue further guidance to 

PHAs to assist them in implementing the VAWA Final Rule. Not only will this guidance instruct 

PHAs on how to effectively implement VAWA, it will provide recommendations on efforts to 

better inform and protect victims beyond the requirements of VAWA. Further, HUD is actively 

developing a VAWA Fact Sheet to inform victims of their rights under VAWA. HUD will also 

recommend new changes to VAWA that will help us to better serve and protect women 

experiencing violence.

HUD recently issued guidance making it clear that residents who are denied or evicted from 

housing as a result of domestic violence may have basis to file a discrimination complaint with 

HUD under the federal Fair Housing Act. HUD's guidance states that while the Violence 

Against Women Act (VAWA) provides some protections to victims of abuse who experience 

housing discrimination, the Fair Housing Act provides authority for HUD to investigate whether 

the denial or eviction violates the Act based on gender or another federally-protected basis.

This guidance is available through: http://www.hud.gov/offices/fheo/library/11-domesticviolence-memo-with-attachment.pdf In addition, HUD's domestic violence forms, HUD form 

91066, "Certification of Domestic Violence, Dating Violence or Stalking" and HUD form 91067, 

"Lease Addendum - Violence Against Women and Justice Department Reauthorization Act of 

2005," are available in 14 different languages on HUD's Limited English Proficiency Web site.

http://portal.hud.gov/hudportal/HUD?src=/program_offices/fair_housing_equal_opp/promoti

ngfh

The Office of National Drug Control Policy (ONDCP) has also become actively involved in the 

Federal Partners Committee. For many women, substance abuse is connected with traumatic 

experiences. Victims of trauma often self-medicate with alcohol or other drugs, rather than 

seeking proper medical attention.cx Furthermore, women who experience trauma are more 

likely to experience mental health problems, which are also predictors of substance abuse.

To ensure that women who have experienced trauma have access to adequate services, ONDCP 

is focused on expanding access to gender-responsive treatment and recovery services. ONCDP 
46

recognizes that many women who have been victims of trauma, particularly sexual violence, 

can feel inhibited from sharing their experiences in group therapy sessions with men, or may be 

re-traumatized in such intimate settings. By supporting an increase in the availability of 

services for women, ONCDP intends to support recovery from substance abuse disorders.

Given the significant correlation between lifetime history of drug and alcohol-facilitated rape, 

posttraumatic stress disorder, and nonmedical use of prescription drugscxi, medical 

professionals working with these populations should be aware of the importance of screening 

for drug abuse to avoid further health and safety issues. Treatment providers should also be 

aware of this connection and seek to address the underlying traumatic experiences that have 

led their patients to abuse substances. ONCDP currently conducts outreach efforts to providers 

on a number of substance abuse issues and will use this avenue to encourage the use of 

trauma-informed practices that promote healing.

The Peace Corps is currently developing a “Sexual Assault Prevention and Response” program 

to address the problem of rape and sexual assault on volunteers. This program, which is being 

developed by the Office of Safety and Security in partnership with DOJ, DOD and others, will 

include both training and risk reduction and response strategies, and will incorporate principles 

of trauma-informed care. With 7500 volunteers in 77 countries, the Peace Corps works in 

cultural settings where gender roles and expectations vary widely, and collaborates with local 

law enforcement and legal structures to prosecute crimes. Their international focus will bring 

an important perspective to the workgroup.

Over the course of the next year, the Federal Partners Committee will continue to meet 

monthly as a multi-agency workgroup, exchanging information about relevant activities, sharing 

resources, and planning interagency initiatives. Three overall priorities have been identified for 

2011:

1) Broad dissemination of information about the impact of trauma across federal and state 

agencies and stakeholder groups, and involvement of new partners in the effort. While 

the Federal Partners Committee has been an exceptional multi-agency effort, some 

areas of vital importance have not yet been fully explored. Bringing additional partners 

to the table will expand the scope and impact of the effort. 

2) Development and dissemination of topical informational materials on high priority 

issues, particularly materials that will be useful across agencies, address the concerns of 

community-based, frontline organizations, and help to integrate knowledge about 

trauma into the bureaucracy

3) Health care reform. The consequences of violence and trauma for the health of both 

individuals and populations are clear. An exploration of opportunities to apply this 

knowledge to health care delivery and preventive services is now needed.

Sub-committees have also been formed to examine specific issues in depth and to continue the 

process of cross-agency sharing and education. Sub-committees include: 1) trauma-informed 

care for front-line community providers; 2) screening and assessment; 3) integration of the first 

person experience; 4) cross-cultural and diversity issues; 5) the workplace and trauma-informed 
47

care; and 6) military women and trauma-informed care. A second roundtable being planned for 

December 2011 will highlight the work of the sub-committees and will focus on effective 

strategies for prevention and intervention, moving from identifying the problem to discussing 

effective approaches to implementing trauma-informed approaches across the service 

spectrum. 

 

i

Family Violence Prevention Fund (2009) Children and Domestic Violence, 2008. Available at 

http://www.endabuse.org

ii Child Trends Databank (2010) The Child Indicator. Violence in the Lives of Children and Youth. Publication 

2010-04, 10 (1).

iii Herr (2007) Internet Resource to Accompany the Sourcebook of Teaching Science. California State University, 

Northridge. Available at http://www.csun.edu/science/health/docs/tv&health.html#tv_stats

iv Children’s Defense Fund (2009) Available at http://www.childrensdefense.org

v National Center for Missing and Exploited Children . Statistics. Available at http://www.missingkids.com

vi Child Trends Databank (2010) The Child Indicator. Violence in the Lives of Children and Youth. Publication 

2010-04, 10(1).

vii Rape, Abuse, and Incest National Network (2007) Available at http://www.rainn.org

viii Family Violence Prevention Fund (2009) The Facts on Domestic, Dating and Sexual Violence. Available at 

http://www.endabuse.org

ix Rape, Abuse and Incest National Network (2007) Available at http://www.rainn.org

x

Felitti, V.J. & Anda, R.F. (2010) The Relationship of Adverse Childhood Experiences to Adult Medical Disease, 

Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare. In R. Lanius and E. Vermetten, Eds., The 

Hidden Epidemic: The impact of Early Life Trauma on Health and Disease. Cambridge University Press. 

xi DeVol, R, & Bedroussian, A. (2007) Unhealthy America: The Economic Burden of Chronic Disease. Report from 

the Milken Institute. (http://www.chronicdiseaseimpact.com)

xii Dolezl, T., McCollum, D., & Callahan, M. (2009) Hidden Costs in Health Care: The Economic Impact of 

Violence and Abuse. Eden Prairie, MN: Academy on Violence and Abuse.

xiii Fallot, R.D. & Harris, M. (2008) Trauma-Informed Services. In Reyes, G., Elhai, J.D., & Ford, J.D. (Eds.) The 

Encyclopedia of Psychological Trauma (pp. 660-662). Hoboken, NJ: John Wiley.

xiv Mockus, S., Mars, L.C., et al (2005) Developing Consumer/Survivor/Recovering Voice and its Impact on 

Services and Research: Our Experience with the SAMHSA Women, Co-Occurring Disorders and Violence Study. 

Journal of Community Psychology, 33(4), 515-525, p. 517.

xv Andersen, R. & Hiatt, J. (2009) Participatory Process – Questions to Help Guide the Process. Unpublished 

manuscript. 

xvi Department of Defense Advisory Committee on Women in the Services (DACOWITS). Annual Report 2009. 

http://dacowits.defense.gov/annual_reports/DACOWITS%2009%20Final%20Report.pdf

xvii Ibid.

xviii Ibid.

xix Suris, A., Lind, L., Kahner, M., Borman, P.D., & Petty, F. (2009) Sexual Assault in Women Veterans: An 

Examination of PTSD Risk, Health Care Utlilization, and Cost of Care. Psychosomatic Medicine, 66, 749-756.

xx Krebs, KC.P, et al. (2007) The Campus Sexual Assault Study Final Report 2-1, NIJ, US DOJ, October 2007, 

available at http://www.ncjrs.gov/pdffiles1/nij/grants/221153.pdf

xxi US Department of Education, Office of Postsecondary Education, Summary Crime Statistics (data compiled from 

reports submitted in compliance with the Clery Act). Available at 

http://www.ed.gov/admins/lead/safety/criminal2006-08.pdf

xxii Robers, S. et al (2010) Indicators of School Crime and Safety, 104, US Department of Education, US Department 

of Justice, Nov. Available at http://nces.ed..gov/pubs2011/2011002.pdf

xxiii American Association of University Women Educational Foundation (2001) Hostile Hallways: Bullying, 

Teasing, and Sexual Harassment in School, 4 (5). Available at 

http://www.aauw.rg/learn/research/upload/hostilehallways.pdf

xxiv Revised Sexual Harassment Guidance: Harassment of Students by School Emplyees, Other Students, or Third 

Parties. January 19, 2001. www.ed.gov/about/offices/list.ocr/docs/shguide.html. 
48

 

xxv Dear Colleague Letter: Harassment and Bullying (2010), available at 

http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201010.html.

xxvi Dear Colleague Letter: Sexual Violence (2011), available at 

http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201104.html

xxvii http://www.acf.hhs.gov/programs/fysb/content/programs/fv.htm

xxviii Ibid.

xxix http://www.dvmhpi.org/Aboutdvmh.htm

xxx Ibid.

xxxi Lyon, E., Lane,S., & Menard, A. ( 2008) Meeting Survivors’ Needs: A Multi-State Study of Domestic Violence 

Shelter Experience, Final Report. U.S. DOJ Report, Document # 225025.

xxxii Warshaw, C. & Brashler, P. (2009) In C. Mitchell & D. Anglin (Eds) Intimate Partner Vilence: A Health Based 

Perspective. NY: Oxford University Press., p. 147.

xxxiii Felitti, V.J. & Anda, R.F. (2010) The Relationship of Adverse Childhood Experiences to Adult Medical 

Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare. In R. Lanius & E. Vermetten, 

Eds., The Hidden Epidemic: The impact of Early Life Trauma on Health and Disease. Cambridge University Press. 

xxxiv Ibid.

xxxv Koss-Bartelmes, B.L. & Rutherford, M.K. (2004) Women and Domestic Violence: Programs and Tools That 

Improve Care for Victims. Rockville, MD: Agency for Healthcare Research and Quality, AHRQ Pub. No. 04-0055.

xxxvi Dolezl, T., McCollum, D., & Callahan, M. (2009) Hidden Costs in Health Care: The Economic Impact of 

Violence and Abuse. Eden Prairie, MN: Academy on Violence and Abuse.

xxxvii Felitti, V.j., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, 

J.S. (1998) American Journal of Preventive Medicine, 14, 245-258.

xxxviii Prevalence of Individual Adverse Childhood Experiences. Available at 

http://www.cdc.gov/nccdphp/ace/index.htm

xxxix Edwards, V., Holden, G.W., Felitti, V.J., & Anda, R.F. (2003) Relationship between Multiple Forms of 

Childhood Maltreatment and Adult Mental Health in Community Respondents: Results from the Adverse Childhood 

Experiences Study. American Journal of Psychiatry, 160 (8), 1453-1460.

xl Chapmana, D.P., Whitfield, C.L., Felitti, V.J., Dubea, S.R., Edwards, V.J., & Anda, R,F. (2004) Research Report: 

Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood. Journal of Affective Disorders, 

82, 217-225.

xli Center for Disease Control and Prevention. Adverse Childhood Experiences Reported by Adults – Five States, 

2009. MMWR 2010, 59, 1609-1613.

xlii Gillece, J. What is Trauma and Why Must We Address It? Available at 

http://www.nasmhpd.org/ota/NCTIC/what%20is%20traua%20Joan.pdf

xliii Read, J., van Os, J., Morrison, A.P., & Ross, C.A. (2005) Childhood Trauma, Psychosis and Schizophrenia: A 

Literature Review with Theoretical and Clinical Implications. Acta.Psychia.Scand., 112: 330-350.

xliv Spataro, J., Mullen, P.E., Burgess, P.M., Wells, S.A., & Moss, S.A. (2004) Impact of child sexual abuse on 

mental health. Prospective study in males and females. British Journal of Psychiatry, 184, 416-421.

xlv Schoen, C., Davis, K., Collins, K.S.,et al (1997) The Commonwealth Fund Survey of the Health of Adolescent 

Girls. The Commonweath Fund. Available at http://www.commonwealthfund.org/Content/Publications/FundReports/1997/Nov/The-Commonwealth-Fund-Survey-of-the-Health-of-Adolescent-Girls.aspx#citation

xlvi Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005) A multidimensional meta-analysis of 

psychotherapy for PTSD. American Journal of Psychiatry, 162(2), 214-227.

xlvii Clark, H.W. (2008) Recovery Oriented Systems of Care: SAMHSA/CSAT’s Public Health Approach to 

Substance Use Problems and Disorders. http://www.ireta.org/ireta_main/philly/CLARK-CSATPublicHealthApproach.ppt

xlviii Ompad, D.C., Ikeda, R.M., Shah, N., Fuller, C.M., Bailey, S., Morse, E., Kerndt, P., Maslow, C., Wu, Y., 

Vlahov, D., Garfein, R.,& Strathdee, S.A. (2005)The Collaborative Injection Drug Users Study II. Childhood 

Sexual Abuse and Age at Initiation of Injection Drug Use. American Journal of Public Health 95(4):703-709.

xlix Farley, M. Golding, J.M., Young, G., Mulligan, M., & Minkoff, J.R. (2004) Trauma history and relapse 

probability among patients seeking substance abuse treatment. Journal of Substance Abuse Treatment 27,161-167.

20 Ibid; Najavits, L.M., Harned, M.S., Gallop, R.J., Butler, S.F., Barber, J.P., Thase, M.E., & Crits-Christoph, P. 

(2007) Six-month Treatment Outcomes of Cocaine-dependent Patients with and without PTSD in a Multisite 

National Trial. Journal of Studies on Alcohol and Drugs 68(3):353-361.
49

 

li Tolin, D.F., & Foa, E.B. (2006) Sex differences in trauma and posttraumatic stress disorder: A quantitative review 

of 25 years of research. Psychological Bulletin 132(6):959-992.

lii Khantzian, E.J.(1997) The self-medication hypothesis of substance use disorders: A reconsideration and recent 

applications. Harvard Review of Psychiatry 4(5):231-244.

liii Bureau of Justice Statistics, 1992; Najavits, L.M. (2002) Clinicians’views on treating posttraumatic stress 

disorder and substance use disorder. Journal of Substance Abuse Treatment 22(2):79-85.

liv According to the FY 2010 NIH Research Priorities for Women’s Health, the term sex refers to being male or 

female according to reproductive organs and functions assigned by chromosomal complement. Gender refers to 

socially defined and derived expectations and roles rooted in biology and shaped by environment and experience.

lv Blanch, A. (2008) Transcending Violence: Emerging Models for Trauma Healing in Refugee Communities.

CMHS/SAMHSA. http://www.theannainstitute.org/RefugeeTraumaPaperJuly212008.pdf

lvi Ai, A.L. & Peterson, C. (2005) Symptoms, Religious Coping, and Attitudes of Refugees from the Kosovar War. 

In T.A. Corales, Ed., Focus on Posttraumatic Stress Disorder Research. Hauppauge, NY: Nova Science Publishers.

lvii Sanchez-Hucles, J., & Gamble, K. (2006) Trauma in the lives of girls and women. In J. Worell & C.D. 

Goodheart, Eds., Handbook of Girls’ and Women’s Psychological Health. Oxford: Oxford University Press, 103-

112.

lviii Pope, K. (2001) Torture. In J. Worell, Ed., Encyclopedia of Women and Gender: Sex Similarities and 

Differences and the Impact of Society on Gender. San Diego, CA: Academic Press, p. 1141-1150.

lix Vasquez, M., Han, A., & De Las Fuentes, C. (2006) Adaptations of immigrant girls and women. In J. Worell & 

C.D. Goodheart, Eds., Handbook of Girls’ and Women’s Psychological Health. Oxford: Oxford University Press, p 

439-446.

lx Women’s Refugee Commission (2009). Peril or Protection: The Link between Livelihoods and Gender-based 

Violence in Displacement Settings http://womensrefugeecommission.org/

lxi Sledjeski, E.M., Speisman, B.A., & Dierker, L.C. (2008) Does the number of lifetime traumas explain the 

relationship between PTSD and chronic medical conditions?Answers from the National Comorbidity Survey –

Replication (NCS-R). Journal of Behavioral Medicine, 31(4), 341-349

lxii Rivara, F.P., Anderson, M.L., Fishman, P., Bonomi, A.E., Reid, R.J., Carrell, D., et al (2007) Healthcare 

Utilization and Costs for Women with a History of Intimate Partner Violence. American Journal of Preventive 

Medicine, 32(2), 89-96.

lxiii Stalker, C.A., Russel, B., Carruthers, D., Teram, E., & Schachter, C.L. (2005) Providing Dental Care to 

Survivors of Childhood Sexual Abuse: Treatment Considerations for the Practitioner. Journal of the American 

Dental Association, 136, 1277-1281.

lxiv Campbell, R. (2005) What Really Happened? A Validation Study of Rape Survivors’ Help-Seeking Experiences 

with Legal and Medical Systems. Violence and Victims, 20(1), 55-68.

lxv Campbell, R. & Raja, S. (2005) The Sexual Assault and Secondary Victimization of Female Veterans: HelpSeeking Experiences with Military and Civilian Social Systems. Psychology of Women Quarterly, 29(1), 97-106.

lxvi Personal communication, S. Raja.

lxvii Bloom, B., Owen, B., & Covington, S. (2003) Gender-responsive Strategies. Research, Practice and Guiding 

Principles for Women Offenders. National Institute of Corrections, www.nicic.org

lxviiilxviiilxviiilxviii Steadman, H., Osher, F., Robbins, P.C., Case, B., & Samuels, S. Prevalence of Serious Mental Illness 

Among Jail Inmates. http://consensusproject.org/downloads/psysjail.mhstudy.pdf

lxix Bureau of Justice Statistics, 1999.

lxx VanVoorhis, P., Salisbury, E., Wright, E., & Bauman,A. (2008) Achieving Accurate Pictures of Risk and 

Identifying Gender Responsive Needs: Two New Assessments for Women Offenders. Washington, DC: USDOJ,

NIC.

lxxi Adams, E.J. (2010) Healing invisible wounds: Why investing in trauma-informed care for children makes sense. 

Washington, DC: Justice Policy Institute

lxxii Steiner, H., Garcia, I.G., and Mathews, Z. (1997) Posttraumatic Stress Disorder in Incarcerated Juvenile 

Delinquents. Journal of the American Academy of Child and Adolescent Psychiatry, 36(3), 357-365.

lxxiii Hennessey, M., Ford, J.D., Mahoney, K., Ko, S.J., and Siegfried, C.B. (2004) Trauma among Girls in the 

Juvenile Justice System. NCTSN Juvenile JusticeWorking Group. Available at: www.NCTSNet.org

lxxiv Gonsoulin,S. (2010) Federal Roundtable on Women and Trauma: Juvenile Justice

lxxv National Child Traumatic Stress Network (2005)

lxxvi Bureau of Justice Statistics (2009) Criminal Victimization. Washington, DC: US Department of Justice, 

Retrieved Nov.3, 2010, from http://bjs.ojp.usdoj.gov/content/pub/pdf/cv09.pdf
50

 

lxxvii Ibid.

lxxviii Federal Bureau of Investigation (2009) Crime in the United States: Murder. Washington, DC: US Department 

of Justice.

lxxix Finkelhor, D., Turner, H.A., Ormrod, R.K., & Hamby, S.L. (2009) Violence, crime and exposure ina national 

sample of children and youth. Pediatrics, 124, (5).

lxxx Teaster, P.B. et al (2006) The 2004 Survey of State Adult Protective Services. National Center on Elder Abuse, 

Washington, DC: 5.

lxxxi Campbell, R. (2006) Rape Survivors’ Experiences with the Legal and Medical Systems: Do Rape Victim 

Advocates Make a Difference? Violence Against Women, 12 (30).

lxxxii Baum. K., Catalano, S., Rand, M.,and Rose, K. (2009) BJS Report: Stalking Victimization in the US. NIJ.

lxxxiii Available at http://bjs.ojp.usdoj.gov/index.cfm?ty=pbdetail&iid=1743

lxxxiv http://www.childtrendsdatabank.org/?q=node/313

lxxxv http://www.ovw.usdoj.gov/ovw-fs.htm#fs-indian-country

lxxxvi Understanding Intimate Partner Violence, fact sheet, Centers for Disease Control and Prevention, National 

Center for Injury Prevention and Control, 2009.

lxxxvii Costs of Intimate Partner Violence Against Women in the United States, Department of Health and Human 

Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, March 

2003, p. 19.

lxxxviii Anda RF, Felitti VJ, Edwards VJ, Whitfield CL, Dube SR, Williamson DF. Childhood Abuse, Household 

Dysfunction, and Indicators of Impaired Adult Work Performance, The Permanente Journal/Winter 2004/Volume 8 

No. 1, pages 30-38.

lxxxix Ibid..

xc Op Cit., Costs of Intimate Partner Violence Against Women in the United States.

xci Ibid.

xcii Ibid.

xciii Nosek, M.A. (2010) Abused Women with Disabilities. Paraplegia News, June, 42-50.

xciv Ibid, p. 43.

xcv http://www.cdc.gov/ncbddd/disabilityandhealth/women.html

xcvi Powers, L. E., Curry, M. A., Oschwald, M., Maley, S., Eckels, K., & Saxton, M. (2002). Barriers and 

Strategies in Addressing Abuse within Personal Assistance Relationships: A Survey of Disabled Women's 

Experiences. Journal of Rehabilitation, 68 (1), 4-13. 

xcvii Leadership Forum for Women with Disabilities: Final Report (1998) Rehabilitation Institute: NY, NY.

xcviii Nosek, M.A. (2009) Violence against Women with Disabilities: Fact Sheet #2 – Issues and Recommendations. 

http://www.bcm.edu/crowd/?pmid=1410

xcix Carried out by Zogby International for the Workplace Bullying Institute.

c The Workplace Bullying Institute.

ci http://www.eeoc.gov/eeoc/statistics/enforcement/sexual_harassment.cfm

cii Effects of Sexual Harassment on the Victim. http://www.sexualharassmentsupport.org/effects.html

ciii National telephone poll commissioned by The Body Shop in 1997.

civ Ibid.

cv Hopper, E.K., Bassuk,E.L., & Oliver, J. (2010) Shelter from the storm: Trauma-informed care in homelessness 

services settings, Open Health Services and Policy Journal, 3, 80-100.

cvi Title 38 U.S. Code 1720 D

cvii http://www.ptsd.va.gov/public/pages/military-sexual-trauma-general.asp

cviii McCutcheon, S. (2010) Women Veterans and Trauma. Presentation at the Federal Partners Roundtable on 

Women and Trauma, April 29, Washington, DC

cix Ibid.

cx McCauley, J.A., Amstadter, A., Danielson, C., Ruggiero, K., Kilpatrick, D., and Resnick, H. (2009) Mental Health 

and Rape History in Relation to Non-Medical Use of Prescription Drugs in a National Sample of Women, Addictive 

Behaviors, 34: 641-648. 

cxi Ibid.
51

 

Appendix A: Participating Agencies

U.S. Department of Agriculture

State Research, Education & Extension Services www.csrees.usda.gov/

U.S. Department of Defense

Defense Centers of Excellence www.dcoe.health.mil

Office of the Secretary of Defense www.defense.gov/osd/

Health Affairs

Sexual Assault Prevention and Response office www.sapr.mil

U.S. Department of Education www.ed.gov

Office for Civil Rights www2.ed.gov/about/offices/list/ocr/index.html

Office of Safe and Drug-Free Schools www2.ed.gov/about/offices/list/osdfs/index.html

Rehabilitation Services Administration www2.ed.gov/about/offices/list/osers/rsa/index.html

U.S. Department of Health & Human Services

Administration on Aging www.aoa.gov

Administration for Children & Families www.acf.hhs.gov/

Agency for Healthcare Research & Quality www.ahrq.gov/

Centers for Disease Control & Prevention www.cdc.gov/

Federal Occupational Health Services www.foh.dhhs.gov/

Health Resources & Services Administration www.hrsa.gov/

Office of Public Health & Science www.hhs.gov/agencies/ophs.html

Office of the Surgeon General www.surgeongeneral.gov/ 

Office on Women's Health www.womenshealth.gov/owh/

Substance Abuse & Mental Health Services Administration www.samhsa.gov/

U.S. Department of Housing & Urban Development

Community Planning and Development

http://portal.hud.gov/portal/page/portal/HUD/program_offices/comm_planning

U.S. Department of Justice

Bureau of Prisons, National Institute for Corrections http://nicic.gov/

Office of Juvenile Justice Prevention & Delinquency http://www.ojjdp.gov/

Office for Victims of Crime www.ovc.gov

Office of Violence Against Women www.ovw.usdoj.gov/

U.S. Department of Labor

Office of Disability Employment Policy www.dol.gov/odep

Women's Bureau www.dol.gov/wb

Worklife, Leave and Benefits Policy & Programs http://labornet.dol.gov/me/worklife/index.htm

Peace Corps www.peacecorps.gov/

U.S. Department of State

Bureau of International Narcotics & Law Enforcement www.state.gov/p/inl/

Veterans Affairs

Office of Mental Health Services www.mentalhealth.va.gov/

White House Office of National Drug Control Policy http://www.whitehousedrugpolicy.gov/
52

 

Appendix B: Committee Membership

Susan Allen DOL, HRC allen.susan@dol.gov

Frances E. Ashe-Goins HHS, OWH frances.ashe-goins@hhs.gov

Mary Atlas-Terry DOJ, OVC Mary.atlas-terry@usdoj.gov

Sandra Battle ED, OCR sandra.battle@ed.gov

Sandra Bennett-Pagan HHS, OWH sandra.bennett-pagan@hhs.gov

Eve Birge ED, OSDFS eve.birge@ed.gov

Mary Blake HHS, SAMHSA mary.blake@samhsa.hhs.gov

Carol Boyer DOL, ODEP boyer.carol@dol.gov

Alice Brathwaite DOJ, OVW alice.brathwaite@smojmd.usdoj.gov

Neal Brown HHS, SAMHSA neal.brown@samhsa.hhs.gov

Maureen Buell DOJ, NIC mbuell@bop.gov

Christopher Button DOL, ODEP button.christopher@dol.gov

Mary (Tib') E. Campise DOD, OSD mary.campise@osd.mil

Cynthia A. Caporizzo WH, ONDCP ccaporizzo@ondcp.eop.gov

Colanda Cato DOD, OSD Colando.Cato@tma.osd.mil 

Christopher Carroll HHS, SAMHSA Christopher.carroll@samhsa.hhs.gov

Greg B. Case HHS, AOA greg.case@aoa.hhs.gov

Tarsha M. Cavanaugh HHS, HRSA tcavanaugh@hrsa.gov

Kim Clum HHS, OASPE kimberly.clum@hhs.gov

Millicent Crawford DOJ, OVC millicent.crawford@usdoj.gov

Caroline E. Crocoll USDA ccrocoll@csrees.usda.gov

Shawndell Dawson HHS, ACF shawndell.dawson@acf.hhs.gov

Meredith DeFraites WH, ONDCP Mdefraites@ondcp.eop.gov
53

 

Valerie Edwards HHS, CDC valerie.edwards@cdc.hhs.gov 

Kana Enomoto HHS, SAMHSA kana.enomoto@samhsa.hhs.gov

Wanda Finch HHS, SAMHSA wanda.finch@samhsa.hhs.gov

Pamela Fischer HHS, SAMHSA Pamela.Fischer@samhsa.hhs.gov

Karen Furia DOL, WB furia.karen@dol.gov

Nicole Gaskin-Laniyan HHS, SAMHSA nicole.gaskin-laniyan@samhsa.hhs.gov

Michelle Gleason HHS, SAMHSA michelle.gleason@samhsa.hhs.gov

Don Green HUD, OCPD don.green@hud.gov

Kellie Greene PC kgreene@peacecorps.gov

Jacqueline Hackett WH, ONDCP jhackett@ondcp.eop.gov

Michelle Hoersch HHS, OWH michelle.hoersch@hhs.gov

Ed Hobson PC, OSS ehobson@peacecorps.gov

Suzanne Holroyd DOD suzanne.holroyd@wso.whs.mil

Robert Ireland DOD, OSD robert.ireland@ha.osd.mil

Laura Ivkovich DOJ, OVC laura.ivkovich@usdoj.gov

Edna W. James HHS, ACF edna.james@acf.hhs.gov

Darlene Johnson DOJ, OVW darlene.s.johnson@smojmd.usdoj.gov

Mark Johnston HUD, OCPD Mark.johnston@hud.gov

Nicole S. Johnson DOL, HU Johnson.nicole@dol.gov

Marylouise Kelley HHS, ACF Marylouise.Kelley@ACF.hhs.gov

Anna L. Kindermann HHS, HRSA akindermann@hrsa.gov

Laura Kunkel HUD, OCPD Laura.A.Kunkel@hud.gov

Claudia Kuric PC, OSS ckuric@peacecorps.gov

Timothy Lawler PC, VS tlawler@peacecorps.gov

Amy Loder DOJ, OVW Amy.Loder@usdoj.gov

Sabrina Matoff-Stepp HHS, CDC sabrina.matoff-stepp@hrsa.hhs.gov
54

 

Kathie S. McCracken DOD, OSD kathie.mccracken@ha.osd.mil

Susan McCutcheon VA, OMHS susan.mccutcheon@va.gov

Erika McDuffe DOJ, NIC emcduffe@bop.gov

Leah McGee HHS, SAMHSA leah.mcgee@samhsa.hhs.gov

Emily Miles ED, OSDFS emily.miles@ed.gov

Matthew Mishkind DOD, ARMY matt.mishkind@us.army.mil

Winnie Mitchell HHS, SAMHSA winnie.mitchell@samhsa.hhs.gov

Charlotte A. Mullican HHS, AHRQ charlotte.mullican@ahrq.hhs.gov

Susan Parker DOL, ODEP parker.susan@dol.gov

Catherine Pierce DOJ, OVW Catherine.pierce@usdoj.gov

A. Kathryn Power HHS, SAMHSA kathryn.power@samhsa.hhs.gov

Ruby Qazilbash DOJ, OJP Ruby.qazilbash@usdoj.gov

Allison Randall HHS, ACF allison.randall@acf.hhs.gov

Fran Randolph HHS, SAMHSA fran.randolph@samhsa.hhs.gov

Stephanie Rapp DOJ, OJJDP Stephanie.rapp@usdoj.gov

Morrisa B. Rice HHS, HRSA mrice@hrsa.gov

Susan Salasin HHS, SAMHSA susan.salasin@samhsa.hhs.gov

Patrick R. Schmidt WH, ONDCP pschmidt@ondcp.eop.gov

Marnie Shiels DOJ, OVW Marnie.shiels@usdoj.gov

Cassandra Shoffler ED, RSA cassandra.shoffler@ed.gov

Deborah Stone HHS, SAMHSA deborah.stone@samhsa.hhs.gov

Lisa Teems HHS, PSC lteems@psc.gov 

Adrienne Thal DOL, ODEP thal.adrienne@dol.gov

Melvina Thornton DOD, OSD melvina.thornton@osd.mil

Maria Town DOL, ODEP town.maria.m@dol.gov

Janet Voight-Miro DOL, ODEP voight-miro.janet@dol.gov
55

 

Jane Walstedt DOL, WB walstedt.jane@dol.gov

Melodye Watson HHS, ACF melodye.watson@acf.hhs.gov

Rachel Weinstein ED, OCR Rachel.weinstein@ed.gov

Linda White-Young HHS, SAMHSA Linda.White-Young@samhsa.hhs.gov

Kaye Whitley DOD kaye.whitley@wso.whs.mil

Shena Williams HHS, ACF Shena.williams@acf.hhs.gov

Alice Yao ED, OCR alice.yao@ed.gov

Fran Zandi DOJ, NIC fzandi@bop.gov

Glossary of Acronyms:

ACF Administration for Children and Families (HHS)

AHRQ Agency for Healthcare Research and Quality (HHS)

AOA Administration on Aging (HHS)

ARMY Army (DOD)

CDC Centers for Disease Control (HHS)

DOD Department of Defense

DOJ Department of Justice

DOL Department of Labor

ED Department of Education

HHS Department of Health and Human Services

HRC Human Resources Center (DOL)

HRSA Health Resources and Services Administration (HHS)

HU Health Unit (DOL)

HUD Department of Housing and Urban Development

NIC National Institute of Corrections (DOJ)

OASPE Office of the Assistant Secretary for Planning and Evaluation (HHS)
56

 

OCPD Office of Community Planning and Development (HUD)

OCR Office of Civil Rights (ED)

ODEP Office of Disability Employment Policy (DOL)

OJJDP Office of Juvenile Justice and Delinquency Prevention (DOJ)

OJP Office of Justice Programs (DOJ)

OMHS Office of Mental Health Services (VA)

ONDCP Office of National Drug Control Policy (WH)

OSD Office of the Assistant Secretary of Defense (DOD)

OSDFS Office of Safe and Drug Free Schools (ED)

OSS Office of Safety and Security (PC)

OVC Office of Victims of Crime (DOJ)

OVW Office on Violence against Women (DOJ)

OWH Office of Women’s Health (HHS)

PC Peace Corps

PSC Program Support Center (HHS)

RSA Rehabilitation Services Administration (ED)

SAMHSA Substance Abuse and Mental Health Services Administration (HHS)

USDA United States Department of Agriculture

VS Volunteer Support (PC)

WB Women’s Bureau (DOL)

WH White House

VA Department of Veterans Affairs
57

 

Appendix C: Federal Roundtable Participant Information

Angela Agnew

Peer Advocate

DC Jail Advocacy Project

University Legal Services

aagnew@uls-dc.org

Rene Andersen (small group facilitator)

Trauma and Professional Development Consultant

rene@andersenhealing.com

Frances Ashe-Goins, RN MPH 

Acting Director

Office on Women’s Health

Department of Health and Human Services

Frances.AsheGoins@hhs.gov

Mary Atlas-Terry

Victim Justice Program Specialist

Office for Victims of Crime

Department of Justice

mary.atlas-terry@usdoj.gov

Barbara J. Bazron (meeting facilitator)

Deputy Director

DC Department of Mental Health

Barbara.bazron@dc.gov

Lisa Begg, Dr. P.H., R.N.

Director of Research Programs

Office of Research on Women's Health

Office of the NIH Director

National Institutes of Health/DHHS

beggl@od.nih.gov

Mary Blake

Public Health Advisor

SAMHSA/CMHS

Department of Health and Human Services

mary.blake@samhsa.hhs.gov
58

 

Andrea (Andy) Blanch (speaker)

Director

Center for Religious Tolerance

akblanch@aol.com

Kristi Bleyer (speaker)

Senior Attorney

DC Enforcement Office

Office for Civil Rights

Department of Education

kristi.bleyer@ed.gov

Carol Boyer (speaker)

Policy Advisor

Office of Disability Employment Policy

Department of Labor

Co-Chair, Federal Partners Women and Trauma Committee

boyer.carol@dol.gov

Suzanne Brown-McBride

Deputy Director

Justice Center

Council of State Governments

smcbride@csg.org

Maureen Buell

Correctional Program Specialist

National Institute of Corrections

Department of Justice

maureen.buell@bop.gov

Chris Button

Supervisory Policy Advisor

Office of Disability Employment Policy

Department of Labor

button.christopher@dol.gov

Sharon Cadiz (speaker)

Director of Clinical Consultation Program

Office of Child and Family Health

sharon.cadiz@dfa.state.ny.us
59

 

Tonier Cain (speaker)

Project Coordinator

National Center for Trauma -Informed Care

tonier.cain@nasmhpd.org

Jeanne Campbell

Executive Vice President

National Council for Community Behavioral Healthcare

jeanniec@nccbh.org

Mary (Tib) E. Campise

Program Analyst

Family Advocacy Program

Military Community and Family Policy

ODUSD(P&R)

Department of Defense

mary.campise@osd.mil

Cathy Cave

Peer Outreach Coordinator

National Center for Trauma-Informed Care

ccave@ahpnet.com

Janet Chiancone

Research Coordinator

Office of Juvenile Justice and Delinquency Prevention

Department of Justice

janet.chiancone@usdoj.gov

Theodore J. Corbin, M.D.

Assistant Professor, Department of Emergency Medicine

Director, Violence Intervention Program (Healing Hurt People: An Innovative Program of the 

Center for Nonviolence & Social Justice)

Drexel University College of Medicine

Theodore.Corbin@DrexelMed.edu

Stephanie Covington (speaker)

Co-Director

Center for Gender and Justice and the Institute for Relational Development

sscird@aol.com
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Maria del Carmen Santos

Health Education Program

Graduate School of Public Health

University of Puerto Rico

maria.santos7@upr.edu

Deborah Delman

Executive Director

The Transformation Center

deborahd@transformation-center.org

Rebecca Dreke

Senior Program Associate

Stalking Resource Center

National Center for Victims of Crime

rdreke@ncvc.org

Mary Ann Dutton

Professor and Associate Director

Center for Trauma and the Community

Department of Psychiatry

Georgetown University Medical Center

mad27@georgetown.edu

Kana Enomoto (speaker)

Principal Advisor to the Administrator of SAMHSA

Department of Health and Human Services

Kana.enomoto@samhsa.hhs.gov

Sandra Estepa (small group facilitator)

Regional Women’s Health Coordinator

Office on Women’s Health – Region II

Department of Health and Human Services

sandra.estepa@hhs.gov

Kathy Ferguson

Maryland Coalition Against Sexual Assault

Kathy@mcasa.org

Beth Filson 

Consultant

National Center for Trauma-Informed Care

bethfilson@gmail.com
61

 

Wanda Finch

Public Health Advisor

CDR, US Public Health Service

SAMHSA/CMHS

Department of Health and Human Services

wanda.finch@samhsa.hhs.gov

Pamela Fischer

Social Science Analyst

SAMHSA/CMHS

Department of Health and Human Services

pamela.fischer@samhsa.hhs.gov

Robert (Bob) Geffner

Co-chair, National Partnership to End Interpersonal Violence

President, Institute on Violence, Abuse, & Trauma

Clinical Research Professor, Alliant International University

bgeffner@pacbell.net

Joan Gillece (speaker)

Project Director, National Center on Trauma-Informed Care

Project Director, National Coordinating Center for the Seclusion and Restraint Initiative at the 

National Association of State Mental Health Program Directors

joan.gillece@nasmhpd.org

Simon Gonsoulin (speaker)

Project Director

National Evaluation and Technical Assistance Center for the Education of Children and Youth 

Who Are Neglected, Delinquent, or At Risk

American Institutes of Research

sgonsoulin@air.org

Michelle Hoersch (small group facilitator)

Office on Women’s Health – Region V

Department of Health and Human Services

michelle.hoersch@hhs.gov
62

 

Larke Nahme Huang

Senior Advisor, Office of the Administrator

Lead for SAMHSA’s Strategic Objective on Trauma and Justice

SAMHSA

Department of Health and Human Services

Larke.huang@samhsa.hhs.gov

Elizabeth Hudson

Trauma Services Coordinator

Consultant to the Bureau of Prevention

Treatment and Recovery

Division of Mental health Services

elizabeth.hudson@dhs.wisconsin.gov

Neil Irvin

Vice President of Programs

Men Can Stop Rape

nirvin@mencanstoprape.org

Edna W. James

Family Violence Prevention and Services Program

Family & Youth Services Bureau

Administration for Children and Families

Department of Health and Human Services

edna.james@acf.hhs.gov

Ann Jennings (speaker)

Executive Director

The Anna Institute, Inc.

afj@gwi.net

Jennifer Kaplan (speaker)

Deputy Director of the White House Council on Women and Girls

Rachel Kaul

Senior Public Health Analyst

Office of the Assistant Secretary for Preparedness and Response

Department of Health and Human Services

rachel.kaul@hhs.gov
63

 

Marylouise Kelley

Director

Family Violence Prevention & Services Program

Administration on Children and Families

Department of Health and Human Services

marylouise.kelley@acf.hhs.gov

Eileen King

Regional Director

Justice for Children – DC

kingeil656@aol.com

Stacey Lesko

Program Management Officer

SAMHSA/CMHS

Department of Health and Human Services

stacey.lesko@samhsa.hhs.gov

Melissa Lucchesi

Outreach Education Coordinator

Security on Campus, Inc.

mlucchesi@securityoncampus.org

Helga Luest

Founder/President & CEO

Witness Justice

hluest@witnessjustice.org

Amanda Manbeck

Executive Director and Program Manager

White Bison, Inc.

amanda@whitebison.org

Luz Marquez-Benbow

Associate Director

The National Organization of Sisters of Color Ending Sexual Assault (SCESA)

marquez@sisterslead.org

Ledia I. Martínez

Regional Women's Health Liaison

Office on Women's Health

Department of Health and Human Services

Ledia.Martinez@hhs.gov
64

 

Sabrina Matoff-Stepp

Director

Office of Women’s Health

Health Resources Services Administration

smatoff-stepp@hrsa.gov

Ruta Mazelis

Consultant/Trainer

rutamaz@eohio.net

Kathie McCracken

Director

Women’s Health Patient Advocacy and Medical Ethics

Department of Defense

kathie.mccracken@ha.osd.mil

Susan McCutcheon (speaker)

Director

Family Services, Women's Mental Health and Military Sexual Trauma

Office of Mental Health Services

Department of Veterans Affairs

susan.mccutcheon@va.gov

Jacki McKinney (speaker)

Co-Founder

Trauma Knowledge Utilization Project

(215) 844-2540

Marian Mehegan

Regional Women’s Health Coordinator

Office on Women’s Health – Region I

Department of Health and Human Services

marian.mehegan@hhs.gov

Anne Menard

Director

National Resource Center on Domestic Violence

amenard@pcadv.org
65

 

Niki Miller

PREA Project Manager

New Hampshire Department of Corrections

niki.miller@comcast.net

Phyllis Modley

Senior Manager

Center for Effective Public Policy

phyllismodley@verizon.net

Charlotte Mullican

Senior Advisor for Mental Health Research

Center for Primary Care, Prevention, and Clinical Partnerships

Agency for Healthcare Research and Quality

Department of Health and Human Services

charlotte.mullican@ahrq.hhs.gov

Lisa Najavits, PhD (speaker)

Professor of Psychiatry, Boston University School of Medicine

Lecturer, Harvard Medical School

Lnajavits@hms.harvard.edu

Gary Namie, PhD (speaker)

Director

The Workforce Bullying Institute

namie@workplacebullying.org

Chanson D. Noether

Division Director for Criminal Justice

Policy Research Associates

cnoether@prainc.com

Emmeline Ochiai

Public Health Advisor

Office of Disease Prevention and Health Promotion

Office of Public Health and Science

Office of the Secretary

Department of Health and Human Services

emmeline.ochiai@hhs.gov
66

 

Lolita O’Donnell

Acting Director

Clearinghouse, Outreach and Advocacy Directorate

Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)

lolita.odonnell@tma.osd.mil

Kathleen O’Leary

Acting Chief

Women's Program

Office of Research on Disparities and Global Mental Health

National Institute of Mental Health

olearyk@mail.nih.gov

Dylan Orr, J.D.

Special Assistant

Office of Disability Employment Policy

Department of Labor

orr.dylan@dol.gov

Susan Parker (speaker)

Director

Division of Policy Development

Office of Disability Employment Policy

Department of Labor

parker.susan@dol.gov

Terri Pease (small group facilitator)

Adult Trauma Specialist

Domestic Violence & Mental Health Policy Initiative/National Center on Domestic Violence, 

Trauma & mental Health/

Director of Research, Spin USA, Inc.

tpease@dvmhpi.org

Nancy Pentz (speaker)

Dickinson, Pentz, McCall, Honnold Associates/

Washington DC Chapter of the Employee Assistance Professionals Association

nkpentz@verizon.net

Catherine Pierce 

Deputy Director 

Office on Violence Against Women 

Department of Justice

Catherine.Pierce@usdoj.gov
67

 

Pamela Pine

Founder and CEO

Stop the Silence 

(301) 464-4791

Nicole Player

Director of Marketing

Men Can Stop Rape

nplayer@mencanstoprape.org

A. Kathryn Power (speaker)

Director, Center for Mental Health Services SAMHSA

Department of Health and Human Services

Kathryn.power@samhsa.hhs.gov

Melissa Rael

Captain – US Public Health Service

Senior Program Management Officer

SAMHSA/CSAT/DSCA/PPGB

Department of Health and Human Services

melissa.rael@samhsa.hhs.gov

Sheela Raja (speaker)

Assistant Professor of Dentistry and Medicine

University of Illinois at Chicago

Sraja1@uic.edu

Stephanie (Steffie) Rapp

Juvenile Justice Specialist

Office of Juvenile Justice and Delinquency Prevention

Department of Justice

stephanie.rapp@usdoj.gov

Morrisa Rice

LCDR, US Public Health Service

Health Resources and Services Administration

mrice@hrsa.gov
68

 

Maria Taranjo Rodman

Associate Director 

Western Massachusetts Training Consortium

mrodman@wmtcinfo.org

Rebecca Rose

Policy Advisor for Substance Abuse and Mental Health

Bureau of Justice Assistance

Department of Justice

rebecca.rose@usdoj.gov

Sarah Lynn Rosenthal (speaker)

White House Advisor on Violence Against Women

Susan Salasin (speaker)

Director

Trauma and Justice Program

SAMHSA/CMHS

Department of Health and Human Services

Co-Chair federal Partners Women and Trauma Committee

susan.salasin@samhsa.hhs.gov

Alisa Santucci

Director

Commission on Youth at Risk

American Bar Association

santucca@staff.abanet.org

Diana Schneider

Director, Office of Research and Evaluation

Office of Population Affairs

Department of Health and Human Services

diana.schneider@hhs.gov

Andrea Spencer-Linzie

Executive Director

New Jersey Coalition Against Sexual Assault

Board Member

National alliance to End Sexual Violence

aspencer-linzie@njcasa.org
69

 

Lauren Spiro

Director of Public Policy

National Coalition of Mental Health Consumer/Survivor Organizations

laurenspiro1@gmail.com

Shelby Strong

School Counseling Intern

American School Counselor Association

intern@schoolcounselor.org

Adrienne Thal

Policy Advisor

Office of Disability Employment Policy

Department of Labor

thal.adrienne@dol.gov

Jenifer Urff (small group facilitator)

Senior Policy Associate

Advocates for Human Potential

jurff@ahpnet.com

Ronald E. Voorhees, M.D., M.P.H.

Chief, Office of Epidemiology and Biostatistics

Allegheny County (PA) Health Department

rev12@pitt.edu

Janet Voight-Miro

Social Science Research Analyst

Office of Disability Employment Policy

Department of Labor

voight-miro.janet@dol.gov

Jane Walstedt

Social Science Advisor

Women’s Bureau

Department of Labor

walstedt.jane@dol.gov
70

 

Carole Warshaw, MD (speaker)

Executive Director 

Domestic Violence & Mental Health Policy Initiative

Director, National Center on Domestic Violence, Trauma & Mental Health

clwarshaw@aol.com

Rachel Weinstein

Staff Attorney

Program Legal Group

Office for Civil Rights

Department of Education

rachel.weinstein@ed.gov

Linda White Young

Public Health Advisor

SAMHSA

Department of Health and Human Services

linda.white-young@samhsa.hhs.gov

Jennifer Williams

Executive Director

Out of the Crossfire

Jennifer.Williams2@uc.edu

Rhonda Williford

Senior Counsel to Board Member

National Labor Relations Board

rhonda.williford@nlrb.gov

Jay Womack

Deputy Director

Anti-Trafficking in Persons Division 

Office of Refugee Resettlement

Department of Health and Human Services

jay.womack@acf.hhs.gov

Courtney Yadoo

Assistant 

White House Advisor on Violence Against Women
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Alice Yao

Staff Attorney

Program Legal Group

Office for Civil Rights

Department of Education

alice.yao@ed.gov

Fran Zandi

Correctional Program Specialist

National Institute of Corrections

Department of Justice

fzandi@bop.gov
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Appendix D: Recommendations from the Federal Roundtable

During the Roundtable, participants took part in multiple breakout sessions during which they 

were asked to discuss the following questions:

1) From your perspective, what are the policy and practice implications of the information 

shared during the panel presentation?

2) How can we increase awareness and public education, increase outreach and 

engagement with trauma-affected women and girls, and enhance implementation of 

trauma-informed care and related supports and services?

3) How can Federal partners and community stakeholders ensure that the voices of 

women and girls are incorporated into all aspects of the action agenda?

The responses to these questions, as captured in the transcript of the proceedings, are outlined 

below. The responses reflect recommendation from the stakeholders participating in the 

Roundtable as possibilities for next steps to be explored. Their inclusion in this Report does not 

reflect any judgment as to their feasibility, nor do they reflect the endorsement of the Federal 

Partners Committee or the official views of the federal agencies or other entities that 

participated in the Roundtable. 

A National Action Plan

Political leadership

Presidential level effort – like President’s New Freedom Commission but on trauma

Massive public outreach, similar to An Inconvenient Truth

Involve federal, state and local partners, advocates, and all branches of government

Unified message across all agencies using shared values and language

Work to make the issue of women and trauma a national priority

Role of Federal Partners Workgroup

Use recommendations from the Roundtable to develop priorities and a plan for action

Reconvene group, form sub-committees, and host roundtables at national and local 

levels

Identify and create strategies to counter resistances and sources of misinformation 

Encourage and reward activity at local level (e.g., local legislators, educators)

Develop website and annual report of progress

Cross-walk the Adverse Childhood Experiences study with all agencies

Strategies and approaches

Use the Adverse Childhood Experiences study and its implications for both prevention 

and trauma-informed care to inform a national action plan. Include short-, medium-, 

and long-term goals and strategies

Include a major public education effort, which frames violence as a public health crisis:
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o Widespread dissemination of ACE study findings;

o Continuum of violence;

o Focus on safety and wellness of children; and

o Celebration of resilient adults who have broken the cycle of violence.

Use the media, the arts, celebrities, messaging in TV soaps, and novellas to promote 

awareness about the issue of women and trauma

Branding of the message, through public relations aids like t-shirts, events, and contests

Examine which effective programs are currently being funded and which are not

Develop a public health campaign similar to campaigns for seat belt use and to stop 

smoking – including social media, technology, financial incentives and disincentives, and 

legal reform

Connect with other networks, including disability rights, the National Child Traumatic 

Stress Network, and Employee Assistance Programs

Local community involvement

Use grassroots simultaneously with national approaches

Have target audiences (such as cultural groups, and youth) participate in designing and 

disseminating the message in a meaningful way

Provide training for local faith communities to engage them as part of the effort to 

increase awareness about the issue of women and trauma; include a range of faith 

traditions (e.g., Native American spirituality)

Use Mothers Against Drunk Driving model of involving the entire community in 

promoting awareness about the issue of women and trauma

Sponsor dialogues in promoting awareness about the issue of women and trauma in 

communities across the country involving peers and local leaders

Federal Policy 

Legislation and policy 

Identify barriers to trauma-informed care related to federal housing, re-entry and family 

reunification (e.g, women barred from federal housing due to felony conviction)

Review the Department of Health and Human Services’ Action Agenda to Improve the 

Health of Women and Girls developed by the Office on Women’s Health 

Review the Department of Health and Human Services’ Healthy People: 2020

Review policies and legislation regarding access to services for undocumented 

immigrants and refugee communities

Review policies on reasonable accommodations for disabled veterans returning to 

school

Develop trauma-informed accountability measures for federal agencies

Encourage federal grant-making and contracting bodies to identify priority areas critical 

to trauma-informed care, require community collaboration and consumer participation, 
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and incorporate language and principles of trauma-informed care in federal grantmaking and contracting

Review federal policies and guidance to ensure the rights of victims of domestic 

violence and child abuse when the perpetrator is a family member

Support VAWA’s amendment to include trauma-informed services

Create a “czar” position on the rights of women and children

Issue an annual report on violence against women and girls in the United States

Change Medicaid rules to better support trauma-informed care

Review policies that protect people in the workplace

Review educational policies such as “zero tolerance” for consistency with traumainformed care; identify support for school districts and communities that helps children 

handle violence better

Program interventions and approaches

Invest in prevention programs; focus on communities not just high-risk individuals

Fund services for couples/marital therapy for returning vets 

Fund gender-specific services

Fund multi-site, multi-issue collaborative approaches

Fund peer and family support and peer specialist services

Fund pilot projects on a state level for prevention of violence against women coupled 

with trauma-informed care

Ensure focus on the LGBT community, with a focus on women and girls

Prioritize screening and diversion of juvenile offenders and cross-agency support

Encourage support for programs that educate and heal perpetrators of trauma

Training and human resource development

Encourage trauma-informed care across all professional training programs and in 

accreditation, licensure and credentialing standards (e.g., education, mental health, 

DOC, healthcare, etc)

Examine ways to help federal agency leaders and staff to incorporate the Adverse 

Childhood Experiences study and trauma-informed care in mandated training and

performance plans

Encourage support for gender-specific trauma training for mental health providers

Develop a trauma-informed disaster response curriculum that includes peer 

involvement, gender issues, and how to avoid re-traumatization 

Develop a clearinghouse to gather and disseminate research, best practices, practice 

models, speakers, etc. Develop technical assistance partnerships.

Develop a curriculum for all medical personnel related to trauma-informed care and 

cultural sensitivity as a condition for medical licensure

Identify ways to educate all levels of the court system and judicial personnel about 

trauma and trauma-informed care
75

 

Identify ways to use mandated federal training on diversity and discrimination as 

doorways into trauma-informed care

Use webinars and in-service training

Research

Invest in services research to test and evaluate promising practices in trauma-informed 

care, including peer support and peer mentoring, culture-specific approaches, and 

trauma-informed care in rural and isolated areas

Enlist the Centers for Disease Control in doing research to establish an evidence base for 

trauma-informed care

Develop a transparent research agenda informed by trauma survivors and practitioners

Agree on common outcome measures

Identify quasi-experimental and qualitative research respecting complexities of traumainformed care

Ensure research agenda reflects the diversity of our communities. Test and evaluate 

models that begin in the community

Conduct a cost/benefit analysis of prevention, addressing trauma and holistic healing in 

comparison to current disease-based treatment models; also conduct a cost/benefit 

analysis of prevention and early intervention in comparison to long-term incarceration 

and institutionalization. Include cost to workplace in analysis.

Encourage research and scholarship on why we are such a violent society, how it relates 

to our history, and social mechanisms that perpetuate violence

Encourage research and scholarship on historical and intergenerational trauma

Involvement and collaboration of federal partners

Identify mechanisms for sharing funding between agencies more flexibly

Encourage collaboration across agencies regarding re-entry from jails and prisons

Identify ways to ensure that faith communities and representatives of other communitylevel groups are part of the discussion

Use this Federal Partners Committee to begin development of cross-agency curricula, 

policies, protocols, and service models

Develop guiding principles for trauma-informed care across all federal agencies

Identify ways to strengthen the involvement of the Department of Justice in promoting 

awareness about the issue of women and trauma

Invite and encourage involvement from the following federal partners:

o US-Mexico Border Health Commission (Department of Health and Human 

Services, Office of the Secretary, Office of Global Affairs);

o Office of Adolescent Health (Department of Health and Human Services , Office 

of the Secretary, Office of Public Health and Science);

o Office of Refugee Resettlement;

o US Immigration and Customs Enforcement (Detention and Remand Operations); 

and
76

 

o US Custom and Border Protection (Department of Homeland Security), US 

Border Patrol.

Practice

Organizational change strategies

Identify effective approaches to organizational development in implementing traumainformed care

Collect examples of workplaces that have successfully incorporated trauma-informed 

care

Make the business case for great investment in trauma-informed care, how it will save 

money and improve effectiveness, and what it will take to make it work

Move from focus on changing client behavior to developing healing environments

Practice guidelines and standards

Develop and implement guidelines for trauma-informed practice in different professions 

and different settings

Promote operational principles of “do no harm” and “ask what happened rather than 

what’s wrong” for different settings

Collect examples of professionals who do their work from a trauma-informed 

perspective (eg, a police officer who tells someone why they are patting them down, 

dentists changing their practice, etc)

Institute universal precautions across all settings

Replace punitive approaches to risky behaviors with trauma-based approaches

Focus on trauma assessment – who, how, when, and where? 

Incorporate relational principles into practice guidelines

Take existing guidelines for trauma-informed care and standardize, or adapt for 

different settings

New partnerships, programs and collaborations

Shift focus to prevention and early intervention across all agencies

Reach out to recreational centers, sport organizations, faith communities, holistic health 

workers, and other community settings where trauma-informed care is needed

Encourage agencies to work together at the community level to replicate the roundtable 

and begin discussion about trauma-informed care

Focus on social interventions as well as individual treatment 

Work to ensure access for underserved populations

Staff training and human resource development

Work to ensure that all front line staff are trained in trauma and are engaged in traumainformed practice

Encourage reflective practice and supervision on trauma-informed care

Acknowledge staff trauma and support staff healing
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Incorporating the Perspective of Women and Girls

Increasing voice 

Identify trauma survivors in all services and settings who can share their experiences 

(beyond Center for Mental Health Services and Substance Abuse and Mental Health 

Services Administration)

Educate other systems about the resilience of survivors and the importance of including 

their voice

Encourage all federal agencies to engage in a listening process bringing survivors and 

providers to the same table

Explore the process of how people change from the perspective of people going through 

trauma; address issues of vicarious trauma and burnout for peers

Creating functional roles for people with lived experience

Create organizational roles for peers to review policies, curricula, training programs, and 

to shape awareness messages

Provide a safe way for providers to acknowledge their own status as survivors of trauma 

and violence

Use peers in all stages of product development rather than only having them test or 

review something already developed

Involving new and different survivors and peer groups

Recognize that every experience is different and therefore many voices must be heard

Identify organized groups of women and girls with lived experience of trauma and bring 

them into the discussion

Bring in leaders from refugee, immigrant, LGBT communities and communities of color 

and other groups who may not be well represented in mainstream or organized groups

Beyond stories to structural change

Ensure that personal stories lead to program and policy changes

Pay people for telling their stories and for sharing their experiential wisdom

Set goal of “tipping point” for peer involvement to become norm; avoid tokenism

Hold agencies and organizations accountable for ensuring peer involvement 

Explore how concepts of trauma-informed care are defined differently by different 

groups (eg, “safety” looks different to staff and patients in a state hospital)

Explore how power plays out in organizations, and how truly democratic structures and 

relationships provide safety 

Eliminate the negative consequences of asking for help

Maintain emphasis on gendered violence while also expanding focus to men and boys
78