Implementing a Trauma-Informed Approach 

for Youth across Service Sectors

This brief is based on a webinar, Implementing a Trauma-Informed Approach for Youth Across Service Sectors, held Tuesday, May 21, 2013, 

2:00 p.m. to 3:30 p.m. EDT. The webinar was sponsored by the Interagency Working Group on Youth Programs (IWGYP), a collaboration of 

18 Federal departments and agencies that support programs and services focusing on youth and promote the goal of positive, healthy outcomes 

for youth. The webinar was planned jointly by the IWGYP and the Substance Abuse and Mental Health Services Administration (SAMHSA). The

webinar slides are housed on the IWGYP website, FindYouthInfo.gov, under the Mental Health Youth Topic. The webinar featured three content 

experts nationally known in their field: Eugene Griffin, J.D., Ph.D., Northwestern University, Feinberg School of Medicine; Julian Ford, Ph.D., 

University of Connecticut, School of Medicine; and Charles Wilson, MSSW, Chadwick Center for Children and Families Rady Children’s Hospital - 

San Diego, California; all of whom have been supported by SAMHSA trauma-focused grants. Additionally, the webinar included two youth 

presenters, NC and LS, who spoke about their own lived experience and the importance of trauma-informed care. Both youth are referred to 

only by initials to protect their privacy. NC is a peer specialist and LS is a law student.

Introduction

Trauma affects youth in all communities, and responses to those experiences by child-serving systems are critical. It is 

important for providers serving youth to understand how best to respond and support healing. 

Service providers and policymakers in the youth-serving field are continually learning more from researchi

about 

trauma, traumatic experiences, and the various responses to traumatic events. It is important for youth serving systems 

to develop a greater understanding of the association between trauma and mental health and substance use disorders, 

and how it can derail the healthy development of youth. The field

recognizes the importance of addressing trauma and using a traumainformed approach in prevention, treatment, and recovery efforts. 

This brief discusses the concept and prevalence of trauma; techniques 

for coping with, and recovering from trauma at an individual and 

systems level; the core principles for building a framework for 

understanding trauma; and implementation of elements essential for a 

trauma-informed system as presented by the featured experts. 

Recognizing the effects of trauma and understanding 

how to address trauma are fundamental to the 

Trauma and Justice Strategic Initiative at the 

Substance Abuse and Mental Health Services 

Administration (SAMHSA), a division of the U.S. 

Department of Health and Human Services (HHS). 

The focus of SAMHSA’s Trauma and Justice 

Strategic Initiative is on integrating a trauma-informed 

approach throughout health, behavioral health, and 

related systems to reduce the harmful effects of 

trauma and violence on individuals, families, and 

communities and using innovative strategies to 

reduce the involvement of individuals with trauma 

and behavioral health issues in the criminal and 

juvenile justice systems.

As part of this Initiative, with the help of experts, 

SAMHSA will be releasing a concept paper outlining 

a framework for trauma and guidance for developing 

and implementing a trauma-informed approach.

What Do We Mean by Trauma?

After an introduction by Dr. Larke Huang from the Substance Abuse and 

Mental Health Services Administration (SAMHSA), Dr. Eugene Griffin 

provided a framework for understanding trauma.

Trauma is a complex experience that affects youth and the systems that 

serve them in a variety of ways. The experience of trauma can be 

described through some common elements: event, experience, and 

effects, also known as “Three E’s.”ii These elements address the 

uniqueness of an individual’s response to an event and how an event 

affects one’s future behavior and well-being.
An Event is objective and measurable. Traumatic events include abuse (physical, emotional, sexual); domestic or 

community violence; an accident or natural disaster; and war or terrorism. 

1. An Experience is subjective and difficult to measure because it relates to how someone reacts to an event. It is often 

thought to be life threatening or physically or emotionally overwhelming, and intensity can vary among people and 

over time. The way one person experiences an event might differ from the way another person does; culture, 

gender, and age all influence one’s experience of the event. Additionally, people experience events in different 

ways. Resilience, risk and protective factors, and supports may contribute to this experience. 

2. Effects are the reactions a person has to an event and the ways an experience changes or alters that person’s 

ongoing and future behavior. Classic symptoms include experiencing hyperarousal, such as overreacting or being 

hypervigilant; re-experiencing an event as nightmares or flashbacks; and avoiding a situation by having a fight, flight, 

or freeze reaction. The effects of a traumatic event can have a long-term impact on neurobiological development

and contribute to negative physical, hormonal, and chemical changes due to stress responses. 

Building on this “Three E’s” concept of trauma, SAMHSA frames its

concept of trauma as: an event, series of events, or set of 

circumstances that is experienced by an individual as physically or 

emotionally harmful or life threatening and that has lasting adverse 

effects on the individual’s functioning and mental, physical, social, 

emotional, or spiritual well-being.iii Researchersiv report that traumatic 

stress occurs when an extreme experience overwhelms and alters an individual’s stress-related physiological systems 

and compromises the functioning of stress-response systems (e.g., neuroimmune, neuroendocrine, autonomic, and 

central nervous system networks). 

“What I found worked best is when I was 

surrounded by people who really got it, who 

really understood trauma.” — LS

Prevalence of Trauma

Many youth are exposed to traumatic events, including those in the 

juvenile justice and child welfare systems, as well as those who 

experience homelessness. Building on the three E’s concept, we know 

that the experience of trauma is complex and particular to each 

individual’s life circumstances, which can make quantifying the extent 

difficult. Some people experience multiple traumas; for example, a 

youth who has been separated from his or her family and then 

experiences assault or abuse in a foster home. As many as half of all 

children that have been involved with the mental health, child welfare, 

and juvenile justice systems have experienced multiple traumas.

v

 LS 

and NC, two young people formerly involved with the foster care system, comment in the box above on their 

experiences with multiple traumas. 

“When I was seven years old...my brothers 

and I were placed in foster care...We were 

immediately separated, and so I felt like that

was probably the first traumatic event that I 

experienced.” — LS 

“While I was at my foster home, I had gotten 

into altercations with my foster brother and 

before he hit me, I felt scared...” — NC

2 

Coping with and Reactions to Trauma

Dr. Julian Ford provided an overview of strategies for youth, families, and communities to recover from trauma.

Recovery from the adverse effects of trauma begins with the recognition that the experience of survival threat caused 

by traumatic events has caused some major changes in the way a person now copes with stress. These ways of coping 

are necessary and effective in emergencies such as traumatic events, but they interfere with ordinary day-to-day life. 

Youth who have experienced trauma may develop coping strategies to help them survive.
Chronic Survival Coping

Trauma affects a youth’s relationships, sense of survival, and sense of trust and security with people. The reaction to 

terrible shock, stressors, challenges, and loss is chronic survival coping. An individual trying to cope or recover from 

serious challenges and stressors will learn techniques to survive, such as staying on edge; being vigilant, watchful, or

even distrustful (hypervigilance); or using indifference to mask hopelessness.

Posttraumatic Survival Coping

Physically, posttraumatic survival coping reflects a change in the body, 

not just a mental and psychological change. It changes how a person’s 

brain works. The brain helps a person learn, explore, try activities, and 

experience different ways of living. However, a person cannot 

experience life freely when trying to survive trauma. Instead, that 

person must put everything else aside and concentrate only on basic 

survival needs. Some common survival modes or hypervigilance 

practices are scanning the environment and being on guard for danger; attempting to block out or not think about 

upsetting things; being ready to fight or flee; experiencing elevated heart rate and adrenalin rush; and being unable to 

regulate aggression or use anger management techniques. 

Hypervigilance can make it difficult to set and accomplish goals even for the most persistent and high achieving person; 

all goals are trumped by the larger objective of staying safe. This type of coping can lead to difficulties trusting, including 

parents, caregivers, friends, teachers, and other adults. 

“I wish that the people who I was working with 

in my school were more trauma informed and 

that they were focused - instead of on the 

disruptive behavior - on what was causing the 

disruptive behavior.” — LS 

3 

Neurobiological Brain Research

Neuroscience indicates that a person’s response to stress and use of coping techniques have three components. Dr. Ford 

provided a metaphor for understanding these complex brain processes:

• The “alarm” in the brain tells a person to wake up and pay attention. It also tells the body when there is a crisis and 

to be ready to react and survive.

• The “librarian” and “search engine” file and retrieve memories. When the alarm goes off, the memory filing center 

pulls information from all parts of the brain to figure out what is going on.

• The “computer hard drive” is the thinking center where all the information is put together and decisions are made.

If the three above components are working well, the thinking center is activated and a person can handle the stressful 

situation, not worry about survival, and come up with good ideas and plans for handling the situation, thus the alarm is 

turned off. However, if the alarm is so strong because of extreme stress (e.g., a threat to survival), it can crash the 

memory filing center and the hard drive in the brain. At that point, survival coping tactics take over. These activities take 

place in the part of the brain that helps a person survive and be safe. Operating in survival mode is not the ideal way to 

live because it leads to difficulty relaxing, trusting, focusing, and handling things appropriately. 

Recovery from Trauma

A trauma-informed approach is a framework for providing services that should be integrated into everything that a 

program and system does. Dr. Ford noted that the goal of recovery from trauma is to tap into an existing strength to 

reset the brain’s alarm to not be in persistent survival mode. Resetting the alarm requires strategies to resume thinking

clearly. Evidence-based trauma-informed and trauma-specific therapy programs provide youth and their caregivers with 

strategies to focus their minds and deal with not feeling safe. Learning the strategies for regulating emotions and 

controlling anxiety is vital to everyday functioning in society. A trauma-informed approach includes youth and caretakers 
in future planning. Trauma takes away control of a person’s body or life.

Reintroducing some control can tap into resiliency, and planning for the 

future provides hope.

vi

Strategies for recovery from trauma include recognizing one’s own and 

others’ alarm reactions, sweeping one’s mind clear before judging and 

acting, focusing on what is most important and positive, and being aware 

of stress and personal control levels. These strategies activate the thinking 

center and reset the alarm. 

The webinar presenters acknowledged that there are many paths to 

recovery and recommended common therapeutic approaches 

implemented by mental health professionals that can assist individuals 

who have experienced trauma. It is important to understand that traumainformed care principles can be implemented by people who are not mental health professionals and work in various 

systems that provide services for individuals who have experienced trauma. 

Many Paths to Recovery: 

Evidence-Based Models

• Cognitive-behavioral therapies

• Emotion regulation therapies

• Relational-interpersonal therapies

• Psychotherapies for dissociation

• Parent-child and family system therapies

• Social/helping network therapies

• Peer-to-peer support programs

Trauma at the Systems Level

Mr. Charles Wilson provided a discussion of the child welfare system, and its role in addressing youth and families who 

have experienced trauma. The experience of trauma is complex and personal, and youth and families who have 

experienced trauma receive services within a variety of community systems. Providers and systems have the ability to 

help or potentially re-traumatize. A trauma-informed system aligns interactions among youth-serving agencies, such as 

the child protection systems, lawyers, juvenile judges, law enforcement, schools, and mental health providers so that 

they better understand how youth, families, and adults respond to trauma. 

A trauma-informed system is not just about raising awareness, but changing behavior, actions, and responses. The 

approach requires doing things differently so as not to re-traumatize or introduce additional trauma. Systems need to 

support the natural resiliency of children and youth and assist them in identifying their unique strengths. 

In a trauma-informed system, caregivers play a central role in recovery, 

help promote youth’s natural resiliency, and give youth tools for 

managing stress. A strengths-based approach considers and includes 

the assistance given to caregivers within the system. This approach 

considers how the system helps caregivers deal with both current and 

past traumatic stress. The trauma-informed system assists caregivers 

understand the significant trauma histories of the children and youth 

that are in their care. Child welfare workers, mental health therapists, 

foster parents, juvenile judges, and all those working with children who 

have experienced significant traumatic events are influenced and 

touched by the trauma and can experience secondary or vicarious 

traumatic reactions. Therefore, the trauma-informed system responds to the varying impacts of traumatic stress on 

children, caregivers, and all those who are in contact with the system. Practitioners take this thinking and awareness 

about trauma and use it in everyday practice. 

“The aftercare team also took a lot of time to 

do safety planning and future planning with 

me, and that is important because a lot of 

young people who experience trauma, they 

express feelings of hopelessness and they are 

in a constant state of anxiety, and so their 

ability to project into the future and plan for 

the future can be seriously impaired.” — LS

4 
Core Principles of a Trauma-Informed Approach

Given the presence of trauma in the lives of many youth and the need for systems and providers to support healing, a 

trauma-informed approach to providing services is critical. According to SAMHSA’s concept of traumavii, a program, an 

organization, or a system that is trauma informed is based on four key assumptions: 

• Realizes the widespread impact of trauma and understands potential paths for recovery. 

• Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system. 

• Responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings. 

• Resists re-traumatization of clients as well as staff.

The Chadwick Trauma-Informed Systems Project (CTISP)

viii National 

Advisory Committee says that in a trauma-informed child welfare 

system, all parties recognize and respond to the varying impact of 

traumatic stress on children, caregivers, and those who have contact 

with the system. Programs and organizations within the system infuse 

this knowledge, awareness, and skill into their organizational cultures, 

policies, and practices. They act in collaboration, using the best 

available science, to facilitate and support resiliency and recovery. 

SAMHSA’s six principlesix support a framework for understanding trauma and developing a trauma-informed approach: 

“I was 13 years old in my first foster home, 

and I must admit I did not want to be there at 

first because I was at home with people who I 

was unfamiliar with...” — NC

5 

• Safety: Throughout the organization, the staff and the people they serve feel physically and psychologically safe; the 

physical setting is safe and interpersonal interactions promote a sense of safety.

• Trustworthiness and transparency:Organizational operations and decisions are conducted with transparency and with the 

goal of building and maintaining trust among clients, family members, staff, and others involved with the organization. 

• Collaboration and mutuality: There is true partnering and leveling of power differences between staff and clients 

and among organizational staff, from direct care staff to administrators; they recognize that healing happens in 

relationships and in the meaningful sharing of power and decision making. 

• Empowerment: Throughout the organization and among the clients served, individuals’ strengths are recognized, 

built on, and validated and new skills are developed as needed. 

• Voice and choice: The organization aims to strengthen the experience of choice for clients, family members, and 

staff and recognizes that every person’s experience is unique and requires an individualized approach. 

• Culture, historical and gender issues: The organization incorporates policies, protocols, and processes that are 

responsive to the racial, ethnic and cultural needs of individuals served; are gender-responsive; and incorporate a 

focus on historical trauma. 

These principles underlie the values, beliefs, and attitudes of individuals and organizations offering a trauma-informed 

approach. Using this approach, organizations foster a belief in resilience and in the ability of individuals, organizations, 

and communities to heal and promote recovery from trauma. Trauma-informed organizations build on strengths and 

assets of clients, staff, and communities instead of responding only to their perceived deficits. They recognize that 

everyone has a role to play. They address cultural, historical, and gender issues; actively move past cultural stereotypes 

and biases; offer gender-responsive services; promote the value of cultural connections; and recognize and address 

historical trauma. In the words of Dr. Ford, “A person does not have to be a therapist to be therapeutic.” 
Implementation

In his presentation, Mr. Charles Wilson shared the following central elements of providing trauma-informed care within 

programs, policies, services, and systems as outlined by the child welfare committee of the National Child Traumatic 

Stress Network. Sources with additional information are provided in the resources section of this brief.

Element 1: Maximize Physical and Psychological Safety for Children and Families

• Safety is a priority. Children and families who have experienced trauma may still feel unsafe even when they are no 

longer in danger. In addition to ensuring physical safety, it is important to help children and families feel 

psychologically safe. 

• Sometimes even a noise or smell can trigger the feeling of being unsafe and elicit a reaction that a caretaker might 

not expect or understand. Being aware of and understanding these triggers and changing something seemingly small 

or insignificant in a daily routine can change behavior from negative to positive.

Element 2: Identify the Trauma-Related Needs of Children

• One of the first steps in helping trauma-exposed children and 

families is to understand how they have been impacted by trauma. 

• Trauma-related needs can be identified through trauma screening 

and assessment. 

• It is important to consider the type(s) of trauma children have 

experienced when making service referrals and developing service 

plans. All children need individualized services that are based on 

their unique circumstances, strengths, and challenges.

“I had reported a child abuse and neglect 

incident with social services and they did not 

come and take us out of our home. It was a 

form of betrayal of trust because you are 

expecting someone to help you and when that 

help does not come, then your relationship 

with the institutions that you need to rely on in 

order to get out of a bad situation, the 

relationship is broken.” — LS

Element 3: Enhance Child Well-Being and Resilience

• Many children are naturally resilient. 

• Systems must recognize and build on children’s existing strengths. 

• Both individual caseworkers and overall agency policies should support the continuity of children’s relationships. 

• Staff and agencies should also ensure that children who have been traumatized have access to evidence-based 

treatments and services. 

Element 4: Enhance Family Well-Being and Resilience

• Families are a critical part of both protecting children from harm 

and enhancing their natural resilience. 

• Providing trauma-informed education and services to parents and 

other caregivers enhances protective capacities. 

• Agencies should recognize and assist caregivers to understand the 

significant trauma histories of the children and youth that are in 

their care.

• Agencies should assist caregivers to understand their own trauma 

histories. 

“We need to do some self-esteem building and 

work with young people to acknowledge their 

strengths. I think when you have experienced 

trauma, you have a lot of thoughts, beliefs, or 

feelings of being unworthy or ashamed and 

you feel a lot of guilt and sometimes that leads 

to hopelessness. You are not going to work 

hard to achieve goals if you do not believe you 

can achieve them, if you do not believe you 

are worthy of achieving them...” — LS

6 
Element 5: Enhance the Well-Being and Resilience of Those Working 

in the System

• Staff play important roles in supporting children, but working with 

people who have experienced abuse, neglect, violence, and other 

trauma can cause staff to develop secondary traumatic stress 

reactions. 

• Agencies should collect information about trauma and secondary 

trauma experienced by staff, implement strategies and practices 

that build resilience and help staff manage stress, and address the impact of secondary traumatic stress on both 

individuals and on the system as a whole. 

“The aftercare team was most useful because 

they worked across the systems...I did not have 

to do the work that a lot of young people are 

burdened with, which is finding a way to get our 

systems to work with one another.” — LS

7 

Element 6: Partner with Youth and Families

• Youth and families should have choices and an active voice in decision making on individual, agency, and systemic 

levels. 

• Youth and family members who have been in the system have a unique perspective and can provide valuable 

feedback. 

• Partnerships with youth and families should occur at all levels. 

Element 7: Partner with Agencies and Systems That Interact with Children and Families

• Agencies need to establish strong partnerships with other child- and family-serving systems. 

• Service providers should develop common protocols and frameworks. 

• Cross-system collaboration enables all helping professionals to see the child as a whole person, thus preventing 

potentially competing priorities and messages. 

• Collaboration between systems promotes cohesive care and better outcomes. 

Conclusion

This brief provides an overview of the webinar content as presented by experts in the field regarding the concepts and 

prevalence of trauma, principles for understanding trauma, and practices for addressing trauma and working with youth 

who have experienced trauma.

LS and NC, two young people formerly involved with the foster care system, provided much insight on their experiences 

with multiple traumas. Their shared comments provide important information and practice-based evidence and 

strategies that child and youth serving systems could incorporate into their work with children and youth who have 

experienced trauma. Some of the practical applications they described as beneficial to them include: 

• Staff working in schools need to be aware of, educated and informed on the effects of trauma for children and 

youth, and trained in the causes of disruptive behaviors and ways to address these behaviors that do not 

re-traumatize children and youth;

• Aftercare teams need to provide consistent and ongoing planning with youth to address the after effects of trauma, 

(e.g., anxiety, sadness, depressions, feelings of hopelessness, anger, shame, guilt) and to build upon their strengths 

to instill good self-esteem and a belief that they are worthy of and can achieve goals in their life; 
• Aftercare teams need to provide ongoing assistance for children and youth to learn skills for daily life, safety 

planning to address potential re-traumatization, and development of goals for the “here and now” and in their 

future;

• Aftercare teams need to provide quick response for children and youth who have been traumatized when reports or 

incidents of child abuse and/or neglect occur. Teams need to remember that these children and youth have been 

placed in unfamiliar surroundings and they do not feel safe or trust the people or environment immediately. They 

must rely on the aftercare teams to provide a trusting relationship with staff that will provide safety, protection and 

security in their lives; 

• Aftercare teams need to work across systems to advocate for children and youth who have experienced trauma, and 

to assist them with the work needed for their daily care and consistent planning for life transitions. 

Many strategies for coping with trauma have been noted in this brief, as well as the experiences of LS and NC which can 

inform child and youth serving systems on the successful practices and strategies that could improve the experience of 

children and youth who are coping with and healing from trauma. The resources noted below offer a starting point for 

deeper understanding of trauma and trauma-informed approaches.

Resources

Helping Children and Adolescents Cope with Violence and Disasters: What Community Members Can Do, National 

Institute of Mental Health, 2013 website information 

http://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasterscommunity-members/index.shtml

National Child Traumatic Stress Network, Learning Center for Child and Adolescent Trauma, Resources and Training 

http://learn.nctsn.org/index.php

National Council for Behavioral Health; Trauma Informed Care 

http://www.thenationalcouncil.org/topics/trauma-informed-care/

National Council for Behavioral Health; How to Manage Trauma 

http://www.thenationalcouncil.org/wp-content/uploads/2013/05/Trauma-infographic.pdf 

Cady, D., & Lulow, E. (2012.) Trauma-Informed Method of Engagement [Flyer]. Washington, DC: National Technical 

Assistance Center for Children's Mental Health.

8 
References

i

 http://www.samhsa.gov/traumajustice/traumadefinition/ 

Felitti, V., Anda, R., Nordenberg, D., et al. (1998). Relationship of child abuse and household dysfunction to many of the leading 

causes of death in adults: The Adverse Childhood Experiences (ACE) Study; 

Green, J. G., McLaughlin, K. A., Kessler, R. C., et al. (2010). Childhood adversities and adult psychopathology in the National 

Comorbidity Survey Replication (NCS-R) III: Associations with functional impairment related to DSM-IV disorders; 

McLaughlin, K. A., Green, J. G., Kessler R. C., et al. (2010). Childhood adversity and adult psychiatric disorder in the U.S. National 

Comorbidity Survey; 

Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2009). Collaborative treatment of traumatized children and teens: The Trauma Systems 

Therapy Approach; 

Mollica, R. F. (2006). Healing invisible wounds: Paths to hope and recovery in a violent world.

ii Griffin, G. & Sallen, S. (2013) Considering Child Trauma Issues in Juvenile Court Sentencing. Children’s Legal Rights Journal, 34, 1 - 

22.

iii

 SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.

iv

 Ungar, M., & Perry, B. (2012). Violence, trauma, and resilience In cruel but not unusual: Violence in Canadian families (2nd ed.). 

Wilfried Laurier University Press. http://johnjay.jjay.cuny.edu/wordpress/wp-content/uploads/2012/12/Ungar.pdf 

v

 Ford, J. D. (n.d). Where there’s heat ... Violence, poly-victimization and developmental trauma in children’s lives. University of 

Connecticut School of Medicine. Retrieved from 

http://www.governor.ct.gov/malloy/lib/malloy/SHAC_Doc_2013.04.26_Ford_presentation.pdf; 

Center for Advanced Studies in Child Welfare. (2013). Trauma-informed child welfare practice. Retrieved from 

http://cascw.umn.edu/wp-content/uploads/2013/12/CW360-Ambit_Winter2013.pdf.

vi

 Ford, J.D., Courtois, C.A. (Eds.) (2013). Treating complex traumatic stress disorders in children and adolescents: Scientific 

foundations and therapeutic models. New York: Guilford Press.

vii SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.

viii Chadwick Trauma-Informed Systems Project. (2013). Creating trauma-informed child welfare systems: A guide for administrators 

(2nd ed.). San Diego, CA: Chadwick Center for Children and Families. Retrieved from 

http://www.chadwickcenter.org/CTISP/images/CTISPTICWAdminGuide2ndEd2013.pdf

ix

 SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.

9