Trauma-informed practice in family mental health support services

Introduction

Since the early 2000s, practitioners working across a variety of service systems - including mental health, child welfare, criminal justice and health - have been increasingly aware of how common trauma experiences are in the broader community and the need to provide services that are trauma-informed (Becker-Blease, 2017; Quadara & Hunter, 2016).

Trauma-informed practice is an umbrella term for a range of practice behaviours intended to promote safety and trustworthiness, share power/control with clients, improve service effectiveness, enhance client-practitioner relationships and increase the person-centred focus of services (Department of Families, Fairness and Housing [DFFH], 2023). Trauma-informed practice requires services and those working within them to be aware of trauma and trauma responses, and to facilitate services that promote client dignity and safety.

While the intention of trauma-informed practice is to improve service experiences and outcomes for all people, one specific aim is to avoid re-traumatising people who have experienced trauma (Quadara & Hunter, 2016; Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Many aspects of service delivery can unintentionally cause harm: the physical environment, practices, policies, language and organisational culture (DFFH, 2023).

Implementing practices that are trauma-informed also reduces the likelihood of practitioners misattributing trauma-related responses and coping strategies (e.g. challenging or disruptive behaviours, difficulty regulating emotions, hypervigilance) as aggression or belligerence or seeing them as personality or cognitive disorders (Guevara et al., 2021; Quadara & Hunter, 2016).

It is common for community-based mental health practitioners to support children and families who have experienced trauma. Research suggests that 50%-75% of children have been exposed to at least one traumatic event by the age of 16 (Bendall et al., 2018). Experiences of trauma, particularly during childhood, can have a range of long-term physical and mental health effects (DFFH, 2023; Szcygiel, 2018).

Although community-based prevention and early intervention services do not provide trauma-specific treatment,¹ they are well-placed to identify support needs for families impacted by trauma and can play an important role in providing within-scope supports (e.g. psychoeducation) and/or referrals to specialist services (Guevara et al., 2021). By recognising and responding to potential trauma as early as possible, prevention and early intervention services may help reduce the mental health system demand for specialised, extensive and expensive interventions (Hanson & Lang, 2016).

Trauma-informed principles and assumptions

Trauma-informed principles and assumptions are used to guide working in a trauma-informed way or, at an organisational level, adopting a trauma-informed approach. There is no single universally accepted trauma-informed approach. However, one approach that has been influential on practice in Australia and internationally is the Substance Abuse and Mental Health Services Administration's (SAMHSA) Concept of Trauma and Guidelines for a Trauma-Informed Approach (SAMHSA, 2014).

The SAMHSA approach contains trauma-informed 'principles' that provide useful scaffolding for organisations implementing trauma-informed practice as core to service delivery. Six key principles (SAMHSA, 2014) of a trauma-informed approach are presented in Figure 1.²

Figure 1: Six principles of the SAMHSA trauma-informed approach

Source: MacDonald et al. (2024b)

Complementing the 6 principles are 4 trauma-informed assumptions (the '4 Rs') to guide services to work in a trauma-informed way (SAMHSA, 2014):

1. Realise the widespread impact of trauma and understand potential paths for recovery.
2. Recognise the signs and symptoms of trauma in families, staff and others involved with the service system.
3. Respond by fully integrating knowledge about trauma into policies, procedures and practices.
4. Seek to actively resist re-traumatisation.

What is trauma-informed practice?

As described in the previous section, trauma-informed approaches provide a set of overarching principles and assumptions from which you can develop strategies to work in a trauma-informed way. 'Trauma-informed practice'³ refers to the implementation of these trauma-informed approaches. Trauma-informed practice is an umbrella term used to describe a range of practice behaviours intended to promote safety, share control with clients, increase service effectiveness, enhance client-practitioner relationships and increase the person-centred focus of services (DFFH, 2023). It can include individual-level strategies (e.g. practice decisions and behaviours) as well as organisational policy and culture (e.g. professional development and supervision).

Trauma-informed practice does not mean practitioners should assume that all clients are trauma survivors or focus their service provision and interventions on addressing trauma (Knight, 2015). It does mean that practitioners are sensitive to the possibility that clients may have experienced trauma and understand the links between trauma and mental health (Knight, 2015; Sweeney & Taggart, 2018). It is not necessary to know the details of someone's trauma to work with them in a trauma-informed way (Bosk et al., 2020; Guevara et al., 2021; Knight, 2015).

For practitioners, key priorities of trauma-informed practice include:

• recognising signs and symptoms of trauma and trauma responses
• being sensitive to ways in which the client's current difficulties can be understood in the context of past trauma and how past experiences may impact the client's willingness and ability to engage with services
• strengthening practitioner-client relationships
• promoting a sense of safety for clients.

The next subsection highlights some of the benefits of trauma-informed practice. The 2 sections that follow it identify strategies for organisations and practitioners when considering how they can strengthen the trauma-informed work they are already doing.

Benefits of trauma-informed practice

It is generally accepted that trauma-informed practice can support the wellbeing of everyone involved in a service - those working in it and those accessing it - regardless of whether they have experienced trauma (DFFH, 2023).

The benefits for children and families of accessing trauma-informed support services include:⁴

• an enhanced sense of safety and associated improvements in engagement and help-seeking behaviours
• an enhanced sense of dignity and hopefulness
• a reduced risk of distress and re-traumatisation
• improved emotional regulation and expression, especially for children
• improved social skills, peer relationships and social connectedness.

Personal benefits experienced by practitioners who do their work in a trauma-informed way include:⁵

• an enhanced sense of personal safety, resiliency and wellbeing
• strengthened relationships with clients through increased understanding, respect and trust
• increased job satisfaction.

Trauma-informed practice aligns with the foundational values of many therapeutic professions including advocacy, empathy, empowerment, anti-oppressive practice and respect. Trauma-informed practice also incorporates factors common in effective therapeutic alliances, such as a focus on a relational bond, consent about the purpose of the intervention and agreement about what the client can expect while with the practitioner (MacDonald & Dobud, 2024; MacDonald et al., 2025).

The difference between these foundational practices and values and trauma-informed practice is that the latter views all elements of care through the lens of trauma and the goal of actively seeking to prevent re-traumatisation (Leotti & Wahab, 2024; Sweeney & Taggart, 2018).

Organisational-level responsibilities

This section is for organisational and program managers. It outlines the importance of their roles in embedding a trauma-informed approach in service delivery and supporting practitioners to effectively engage in trauma-informed practice. This section is not directly applicable to frontline practitioners but may still be of interest for understanding the organisational-level responsibilities to supporting practice.

It is important for organisations to consider their responsibilities in the delivery of trauma-informed practice. Practitioners need their organisations to lead the implementation of trauma-informed practice from the top down, with change driven by leadership teams, human resources departments, service managers and team supervisors (Guevara et al., 2021; Holmes et al., 2023; MHCC, 2018). For trauma-informed practice to be delivered at a practitioner level, organisations must work to align trauma-informed principles with their workplace policies, procedures and culture (SAMHSA, 2014).

Trauma-informed service delivery requires a long-term organisational commitment to embedding the principles of trauma-informed care in service and workplace culture. This requires an ongoing commitment to:

• open dialogue between funders, organisations, service providers, clients and communities
• adequate allocation of resources
• support for staff wellbeing
• research and evaluation that informs service enhancement
• workforce capacity building for all staff

(MHCC, 2018).

Organisations seeking to meaningfully implement or enhance their trauma-informed service delivery can start by auditing their existing governance, policies and workforce, and by using existing manuals for organisational change such as TICPOT from the Mental Health Coordinating Council (NSW).

Implementing trauma-informed practice

Organisations looking to implement trauma-informed practice can be guided by knowledge about organisational change (Fixsen et al., 2005). Implementation research is the scientific inquiry of organisational change and the integration of best practice (Moss & Mousavizadeh, 2017).

Adopting the core conditions of trauma-informed practice may require a period of adaptation for the experienced worker and mature agency (Proctor et al., 2015). There may be a period when learning new practices also involves unlearning old ones, which may lead to resistance as changes are rolled out. When this occurs, adopting the principles of trauma-informed practice should come before adapting specific day-to-day practices with children and families. This enables staff to gain more of an understanding of the evidence underpinning the organisational change towards trauma-informed practice. Organising a pilot team of 'trauma-informed champions' can help to smooth out this process and ensure the stages of implementation are followed, noting that it takes time for implementation to be embedded and sustained.

Fixsen and colleagues (2013) recommend a staged approach to implementation. Breaking implementation into stages helps to go beyond the traditional professional development activities undertaken by staff to sustain changes to practice at a policy level. The stages include:

• exploration (secure budget, communicate to all levels about new practice theory)
• installation (establish a transition group, conduct stakeholder analysis - i.e. seek ongoing and routine client feedback about service delivery, assess organisation readiness)
• initial implementation (train a pilot team, create a feedback loop across staff and management)
• full implementation (ongoing staff training, introduce new policies, consolidate research on effectiveness)
• sustainment (ongoing supervision and oversight, analyse data on effectiveness).

Making the most of feedback in the implementation process

Implementing trauma-informed practice at an organisational level involves a cultural shift that engages frontline staff working with clients in the process. Successful agency-wide implementation hinges on deliberate planning and ongoing critical reflection, including incorporating what frontline staff learn from clients. In particular, aligning implementation with the experience of delivering and receiving care is crucial. If the implementation of trauma-informed practice is not grounded in the experiences of frontline staff and clients, tension and resistance to the organisational change may slow or reduce the likelihood of it being successfully implemented.

Feedback loops help organisations to foster a responsive, trustworthy, safe and engaging trauma-informed agency. Staff at the managerial level can help frontline staff build feedback loops with clients to ensure that systems are in place to collect information about 'what works' and about what services can be improved or better tailored.

Following the implementation stages outlined above can help to reduce the likelihood of agency change fatigue stemming from staff implementing new changes too quickly without adequate planning and preparation. New service policies and procedures - such as ongoing confirmation of informed consent, privileging client choice and increasing safety and trustworthiness - require adopting practices that may be new to workers and management. To protect staff during times of agency-level change, those in supervisory and managerial positions should create a culture of feedback so that staff implementing trauma-informed practices can do so at a slow pace, ensuring all staff understand the background and evidence informing the organisational changes (Moss & Mousavizadeh, 2017). Supervisors should be open to staff feedback about the implementation process.

The organisation should also collect client data (e.g. about 'no shows', dropouts, ratings of the therapeutic alliance and outcome) to explore if the shift to trauma-informed principles and practices are improving their experiences and increasing engagement in care. This allows the organisation to make data-driven decisions for improving service delivery and effectiveness.

Privileging service user feedback begins from the initial meeting when seeking informed consent. In trauma-informed practice, informed consent goes beyond consenting to the service in general. To preserve the client's sense of safety, clients must be able to decline a specific activity or session and leave prematurely if they wish. Informed consent and discussions about the client's rights must continue throughout service provision to promote agency, active engagement and trustworthiness. To better tailor and adapt service delivery to each client, seeking user feedback in real time during service delivery is important.

Strategies for strengthening trauma-informed practice

This section provides practical guidance on trauma-informed practice. It brings together research on trauma-informed practice with best practice literature and guidance, including guidance produced by the Victorian State Government Framework (DFFH, 2023) and the NSW Mental Health Coordinating Council (MHCC, 2018).

Although there is a wide range of existing resources broadly exploring what trauma-informed practice is and why it is important, this resource aims to present practical tips for how to implement and embed trauma-informed practice in everyday service delivery.

Practitioners will likely already be using many of the strategies listed below in their day-to-day work, without necessarily labelling their practice as 'trauma-informed'. This is because trauma-informed strategies intersect with other best-practice approaches such as strengths-based and person-centred care. This resource seeks to enhance the good work that practitioners already do by clarifying existing practice, suggesting new strategies and providing a foundation for starting conversations with your team about how to create safe and effective service delivery for all.

This section presents a collection of practice tips, interweaving SAMSHA'S principles for trauma-informed practice across 3 stages of support:

1. Initial contact
2. Screening and assessment
3. During sessions between practitioners, young people and their families

Initial contact

Relational safety

The creation of safe relationships is particularly important when working with families who have experienced trauma (Bosk et al., 2020; Knight, 2019).

The following strategies can be used by those greeting new families over the phone and in-person to establish relational safety before they attend their first session:⁶

• Use non-stigmatising, strengths-based language. There are many trauma-informed language guides available online that can help with this. These include this short example and this full guide from the NSW Mental Health Coordinating Council.
• Use vocal tone and body language to project warmth and friendliness.
• Do not ask clients to disclose any sensitive information that is not specifically needed prior to screening and assessment.
• Ask clients how they want to be identified including pronouns.

Physical safety

A focus on creating a safe physical setting for clients can promote a sense of belonging and dignity in the service setting (Ajeen et al., 2023). Many factors to do with creating safety in the physical environment will be the responsibility of organisations and management but, where possible, practitioners can inform and adjust service settings to meet the unique needs of the families they work with (Ajeen et al., 2023; Becker-Blease, 2017; MHCC, 2018).

Things to consider when creating a more trauma-informed physical environment include:⁷

• Is the furniture comfortable?
• Is the space private? This is particularly important when families are completing forms and waiting to be seen.
• Is there space for a family's personal belongings?

Other considerations:⁸

• Allow clients to choose where and how they position themselves. For example, avoid positioning people with their back facing the door.
• Choose lighting that is soft and warm, whether artificial or natural, rather than harsh fluorescents.
• Think about your use of colour - soft, muted colours create a calming environment, while brighter tones can be uplifting.
• Use posters to encourage clients to give feedback. This can include feedback about any concerns they have with the service and what could be done better (refer to these examples from YoungMinds UK).
• Reduce noise - quiet environments can promote a sense of safety for some clients.
• Make facilities accessible. Facilities should be easy to navigate and well-signposted.
• Maintain spaces so that physical spaces are clean, tidy and in good condition.
• Have play areas for children - consider cultural safety⁹ and inclusivity.

Transparency

Trauma-informed service delivery also involves clearly, simply and continually informing clients and their families about your organisation's policies about:¹⁰

• eligibility criteria
• disclosure and reporting requirements
  • This is particularly important when discussing suicidal thoughts or behaviours - respond with empathy and avoid shutting down conversations.
• use and maintenance of case notes
  • Explain why case notes are being taken and offer the client the opportunity to review notes.
• fees
• confidentiality and sharing/accessing information with/from other services.

Screening and assessment

Practitioners can adopt trauma-informed practice during the early stages of screening and assessment by creating a predictable, structured and safe environment for families (Macedo et al., 2022; Mirick et al., 2022).

Strategies include:¹¹

• Explain what will happen during the session, the purpose of the session and who will be involved.
• Ask permission before moving on to next steps, making decisions or asking about sensitive topics.
• Ensure screening and assessment includes the identification and recognition of strengths rather than just the assessment of 'problems'.
• Only ask families to disclose information that is relevant to service supports, especially when considering sensitive or traumatic experiences.

During sessions between practitioners, young people and their families

Relational safety and collaboration

Building meaningful and collaborative relationships is essential to trauma-informed practice (Guevara et al., 2021). Trauma-informed therapeutic relationships combine the practitioner's professional knowledge with the family's expertise about their own life narrative, coping responses and strengths (Levenson, 2017).

Strategies for enhancing relational safety and collaboration with families include:¹²

• Recognise and emphasise that families, including children and young people, are the experts in their own life experience, safety and wellbeing.
• Practise active listening skills:
  • Listen with curiosity, compassion and non-judgement.
  • Validate challenging or traumatic family experiences through simple messaging such as: 'I believe you', 'I'm glad you told me that', or 'I'm sorry that happened to you'.
• Consider your use of language and tone:¹³
  • Use a clear, calm voice and open body language.
  • Avoid negatively charged language or labels when speaking about people or their behaviours (e.g. think about what happened to someone instead of what is wrong with them).
  • Reframe challenging behaviour as adaptive strategies used to cope with traumatic experience that reflect resilience.
• Identify, acknowledge and build on client's strengths and abilities:
  • Focus on what is working well for clients and what they need to thrive.
  • Consider how notes, reports and referrals can elicit hope for healing.
• Model respectful interpersonal boundaries to help establish safe and appropriate relationships.
• Build connections with local peer support, community or specialist programs to enhance referrals and information sharing with families.

Empowerment, voice and choice

Trauma-informed approaches value and respect family's choices and autonomy (MHCC, 2018). They recognise the effect of power in therapeutic relationships and strive to ensure that power is shared (MHCC, 2018), allowing families as much control and choice as possible (Knight, 2019). These aspects of trauma-informed practice are particularly important when supporting culturally and linguistically diverse families and those from refugee and migrant backgrounds (Danielson & Saxena, 2019; Kulkarni, 2018; Mirick et al., 2023; Némorin et al., 2019; Speck et al., 2023).

Strategies for maximising client empowerment, voice and choice include:¹⁴

• Pay attention to, name and mitigate the inherent power imbalance in practitioner-family relationships:
  • Consider how these power dynamics make clients feel in practice settings and how this affects their engagement.
  • Consider how these power dynamics may mirror victim-perpetrator relationships - practitioners hold a lot of decision-making power.
• Support client engagement:
  • Create opportunities and support clients to self-reflect and identify their strengths.
  • Provide options for self-expression and storytelling (e.g. through evidence-based play or art strategies).
  • Continually emphasise to families that they have a choice over what they disclose and at what pace. Remind clients they don't have to answer any questions they do not wish to and accept when clients do not want to disclose certain information (we have created resources on responding to disclosures by children and young people, as well as those by adult mental health clients).
  • Explain all available support options.
  • Ask permission to discuss sensitive topics.
• Actively provide clients with the opportunity to ask questions or express concerns throughout your work together.
  • Follow up with families about their experience with services and supports offered and consider their responses in future decision making.

Culture and history

Practitioners should account for cultural factors such as ethnicity, religious affiliation and norms, which have a profound influence on families' experiences, understanding and responses to trauma (Danielson & Saxena, 2019; MHCC, 2018). Clients with culturally diverse, migrant or refugee backgrounds may also have distinct experiences of trauma, such as racism, discrimination and displacement, that result in unique service needs (Danielson & Saxena, 2019; Lee et al., 2023).

Trauma-informed services also need to recognise and understand the impacts of recent and historical loss, ongoing racism and discrimination, and the intergenerational impact of trauma on Aboriginal and Torres Strait Islander peoples as well as the strengths embedded within Aboriginal and Torres Strait Islander communities (MHCC, 2018).

Practitioners wanting to strengthen their trauma-informed practice through a cultural and historical lens¹⁶ can:¹⁷

• Consider the political, social and economic conditions that shape health and wellbeing:
  • Rather than trying to 'fix' clients' behaviour, consider their behaviours in the context of the person's broader environment.
  • Consider how unequal access to resources and services can impact people's mental health, behaviour and ability to recover from trauma.
  • Consider how white privilege,¹⁸ implicit or unconscious bias, systematic and systemic racism, intergenerational injustice and racial trauma may impact the families you work with.
  • Be aware that highly publicised local and international news events may cause or intensify distress for families. For example, families may be distressed by news reports of high-profile incidents of racism or conflict in their birth country.
• Convey appreciation for difference and diversity by being inclusive, respectful and curious about what matters to families:
  • Seek to understand the cultural identity, world views, histories and norms of the families and communities you work with.
  • Ask families how their culture interprets, understands and responds to experiences of trauma, and consider how these understandings may be different to your own.
  • Employ interventions and strategies that are respectful of and specific to cultural backgrounds.
  • Identify protective cultural and social factors to incorporate into support plans.
• Reflect on how your own culture, power, privilege, beliefs, stereotypes and biases may influence your practice and client relationships:
  • Acknowledge and address areas of reduced understanding, particularly in relation to issues that affect the communities you work with.
  • Be aware of the potential or tendencies toward pathologising experiences of discrimination, racism and oppression.
• Acknowledge that culturally safe and appropriate support for Aboriginal and Torres Strait Islander peoples requires genuine collaboration in service design and delivery.

Nature of the evidence

In developing this resource, we searched for literature from 2014 to 2024 that included the terms 'trauma-informed approach', 'trauma-informed practice' or 'trauma-informed care'.

The intention of this resource is to provide information and advice for practitioners working with children and families in community-based early intervention mental health services. We found a substantial body of literature about trauma-informed approaches and practice across a broad range of human services. Most of the literature focused on studies about trauma-informed practice in specific settings (e.g. youth justice, out-of-home care, homelessness services, suicide prevention). Although these relate to specialist services, the research evidence provided useful insights for community-based and early intervention services more broadly. This is because trauma-informed practice assumes that anyone accessing services may have experienced trauma without needing to know a person's trauma history. Research specifically about trauma-informed practice in early intervention settings is limited.

The trauma-informed practice literature does a good job of describing practitioner attitudes, barriers and perceived benefits to working in trauma-informed ways but is less useful for understanding client experiences and outcomes.

Most studies do not provide definitions of trauma-informed approaches or trauma-informed practice. Terms such as 'trauma-informed approaches', 'trauma-informed practice' and 'trauma-informed care' are often used interchangeably. Although almost all studies draw on the SAMHSA principles and assumptions for trauma-informed practice (SAMHSA, 2014), the literature does not provide any commonly used frameworks or guidelines from which organisations could practically implement trauma-informed practice strategies. This means that trauma-informed practice looks different from one organisation to another (even when considering organisations providing similar services) and studies did not always outline what concrete or practical strategies they were using.

In this resource we have collated trauma-informed strategies from the diverse range of studies identified in the literature search and complemented this empirical literature with insights from government and non-government organisational frameworks and recommendations. Specifically, we found the Victorian Government Department of Families, Fairness and Housing framework (DFFH, 2023) and the NSW Mental Health Coordinating Council Framework toolkit provided useful practical insights and guidelines. A targeted search did not identify similar trauma-informed frameworks developed for broad use across human services published by other state or territory governments.

To date, there is a lack of published evaluation of trauma-informed practice, meaning our understanding of how trauma-informed practice directly relates to client outcomes is limited, as is our understanding of what aspects of trauma-informed practice are most beneficial. Although it is widely accepted that trauma-informed practice is beneficial to clients, further evidence is required to confidently report that trauma-informed practice is meeting the intended purpose of minimising harm and risk of re-traumatisation for clients. The fact that trauma-informed practice closely aligns with the foundational values of many therapeutic professions - coupled with the considerable variability in research studies of trauma-informed practice¹⁹ - makes it difficult to identify which specific benefits come from adopting trauma-informed practice (Guevara et al., 2021).

Further reading and resources

Trauma-informed practice

• Framework for trauma-informed practice
  This framework, by the Victorian State Government Department of Families, Fairness and Housing, supports service providers in delivering trauma-informed practice. It promotes a shared understanding of what being trauma-informed means to children, individuals, families, professionals and volunteers.
• Translating trauma-informed principles into social work practice
  This research study explores ways to incorporate trauma-informed care principles into real-world service delivery.
• A paradigm shift: Relationships in trauma-informed mental health services
  This research study, authored by trauma survivors and service providers, describes trauma-informed approaches to mental health care, why they are needed and how to overcome implementation barriers.
• SAMHSA's concept of trauma and guidance for a trauma-informed approach
  This manual explains the SAMHSA framework, referred to throughout this practice guide, for becoming a trauma-informed organisation, system or service sector. The manual provides a definition of trauma and a trauma-informed approach and offers 6 key principles and 10 implementation domains.
• Principles of trauma-informed approaches to child sexual abuse
  This AIFS report provides clarity on the concept of trauma-informed care. Drawing on the international evidence, it reviews the emergence of trauma-informed care in Australia and overseas, how it is being implemented in practice, trauma-informed systems and service settings, trauma-integrated interventions, and the utility, strengths and limitations of this approach.
• Building trauma-informed organisations
  This Phoenix Australia video describes what trauma-informed care is and how organisations can apply trauma-informed principles.
• Trauma sensitive language with children
  This short resource from the Australian Childhood Foundation is a trauma-informed language guide for working with children and young people. It provides useful examples of negatively charged language, underlying determinants of childhood behaviour, and desirable terminology.
• Together: A collection of activities for exploring and strengthening relationships
  This document from the Australian Childhood Foundation contains practice-based ideas for building relationships with children and young people who have experienced trauma. The 20 activities cover a range of treatment settings, including one-on-one sessions with children and family sessions.
• Visit the Australian Childhood Foundation's Professional Community for more trauma-informed activities relating to increasing predictability and safety for children.

Research and evaluation

• Principles for doing trauma-informed research and program evaluation
  This AIFS resource is designed to provide practitioners with an understanding of what trauma-informed research is, including an appreciation of the value of considering trauma throughout the research process. It includes knowledge of high-level principles of trauma-informed research to apply within projects.
• How to do trauma-informed research and evaluation
  This AIFS resource extends on the principles resource listed above. It provides evidence-informed, practical insights for doing trauma-informed research and program and service evaluation.

Understanding trauma and supporting clients

• Helplines, telephone and online counselling services for children, young people and adults
  This AIFS resource sheet is designed to provide practitioners and service providers with the contact details and links to helplines, telephone and online counselling services for children, young people and adults. It includes services related to topics such as family and domestic violence, gambling, mental health and wellbeing, alcohol and drug use, legal services and parenting. It also includes services specifically for Aboriginal and/or Torres Strait Islander people, people from culturally and linguistically diverse backgrounds and people living or working in rural areas. Services are grouped according to the location in which they operate.
• Phoenix Australia
  Phoenix Australia is the Australian National Centre of Excellence in Posttraumatic Mental Health. This website contains research and resources designed to help you understand, prevent and recover from the impacts of trauma, and to support trauma-impacted loved ones or communities. Some useful resources from this website include:
  • About posttraumatic stress disorder
  • Treatment for posttraumatic stress disorder
  • Helping children after a traumatic event
  • Child help strategies
  • Dealing with trauma: A guide for young people who have experienced trauma
• The effect of trauma on the brain development of children
  This AIFS practice guide provides an overview of what we know from research about cognitive development in children who have experienced trauma and provides principles to support effective practice responses to those children's trauma.
• How to recognise complex trauma in infants and children and promote wellbeing
  This webinar from AIFS and Emerging Minds explores:
  • the evidence about what complex trauma is, how it might present in children and how it can impact their development
  • how to recognise and respond to the effects of complex trauma in practice with infants and children, and their parents and caregivers
  • how to have preventative and early intervention conversations with parents and caregivers of infants and children who have experienced complex trauma.
• Calming the body before calming the mind: Sensory strategies for children affected by trauma
  This AIFS short article describes how practitioners can use strategies that help calm children's bodies in order to help calm their minds and emotions - specifically, the Regulate-Relate-Reason approach used in Berry Street's Take Two program.
• Supporting children who have disclosed trauma
  This webinar from AIFS and Emerging Minds explores:
  • how self-blame operates and how perpetrators may manipulate children to blame themselves
  • how to help children challenge feelings of complicity in their trauma experiences by focusing directly on the power difference between children and adults
  • children's stories of protests or choices they made throughout their experiences that kept them or their loved ones safe, to acknowledge that no child is a passive recipient of trauma.
• Managing uncertainty in professional practice
  This practice guide provides an overview of what uncertainty and uncertainty tolerance are and their significance to professional practice. It also outlines the individual, practice and organisational factors that can contribute to uncertainty and describes evidence-based strategies for how practitioners can manage practice uncertainties. This resource is useful because cases involving trauma often lead to a sense of uncertainty for practitioners.
• Helping children and young people cope with crisis: Information for parents and caregivers
  This booklet from the Australian Red Cross was developed for parents and carers wanting to support their child following a traumatic event. It includes a breakdown of common trauma responses across age ranges and a list of positive coping activities that families can explore.
• Blue Knot Professional Community
  The Blue Knot Foundation hosts a Professional Community for professionals working with people with experiences of complex trauma. Their website contains fact sheets on a variety of trauma-related topics including emotions, arousal, identity, belonging and healing. They also provide paid professional training and organisational development consultation services.
• The Trauma and Grief Network (TGN)
  TGN develops free resources for parents and caregivers who are supporting children and people experiencing trauma, loss or grief. Their resources cover people impacted by disasters, First Nations peoples, and those living in rural and remote areas.
• Emerging Minds
  Emerging Minds has many free resources for practitioners working with children and young people, families and communities following disasters. They include strategies and practice guidance for supporting infant and child mental health, as well as a Community Trauma Toolkit.
• Sesame Workshop
  The Sesame Workshop provides a suite of evidence-based multimedia resources for children (1-6 years), parents and carers about discussing tough topics, including trauma and supporting the social and emotional needs of children. This includes videos for children, worksheets, online storybooks and games that can be completed as a family, featuring characters from the Sesame Street show.
• Trauma informed care: A guiding tool to discussing sexual health with young people
  This resource from NSW Ministry of Health examines how practitioners can have discussions about sexual health with young people through a trauma-informed lens. It includes guidance on sexual health education and considerations when engaging in trauma-informed discussions with diverse groups of young people.

Co-design

• Supporting children and families: How does co-design invite us to think differently?
  This Emerging Minds paper provides insights for practitioners about engaging in co-design. In the paper, a series of reflective questions are responded to by a lived experience consultant, a practitioner and a researcher.
• This two-part podcast series by Emerging Minds provides practical insights for implementing co-design in your work with children and families:
  • Podcast | Co-design: Disrupting business as usual part 1
  • Podcast | Co-design: Disrupting business as usual part 2

Supporting First Nations families

• Decolonising mental health when working with Aboriginal and Torres Strait Islander families
  This Emerging Minds webinar co-produced with the Mental Health Professionals' Network (MHPN) discusses the importance of decolonising mental health for Aboriginal and/or Torres Strait Islander children and families, and strategies that support the cultural needs of First Nations children and families at an individual, family and community level.
• Racial stress and trauma
  This short resource from The Healing Foundation and the National Aboriginal Community Controlled Health Organisation (NACCHO) introduces the concept of racial stress (aka racial trauma), looks at coping strategies and provides a list of support services for First Nations clients.

Organisational-level responsibilities

• Trauma Informed Organisational Change Manual
  This manual by the Institute on Trauma and Trauma-informed Care (University at Buffalo) helps organisations and systems plan for, implement and sustain trauma-informed care. It steps through aspects of organisational change and provides resources and examples for action planning.
• Trauma-informed Care and Practice Organisational Toolkit (TICPOT)
  This toolkit, by the Mental Health Coordinating Council, is a free public resource, to be used by any organisation wishing to improve its organisational and service delivery culture and practices.
• Young Minds UK
  Posters, like these examples from Young Minds UK, reinforce policies around treatment choice, complaints and disclosure to create a physically safe environment for those who may have experienced trauma.
  • Something not right? Giving feedback and making complaints about your service
  • Whatever your age, it's your information, so it's your choice
  • Taking control. Having a say in your care and treatment

References

Ajeen, R., Ajeen, D., Wisdom, J. P., Greene, J. A., Lepage, T., Sjoelin, C. et al. (2023). The impact of trauma-informed design on psychological well-being in homeless shelters. Psychological Services, 20(3), 680-689. doi.org/10.1037/ser0000724

Australian Institute of Health and Welfare (AIHW). (2018). Family, domestic and sexual violence in Australia, 2018. Canberra: AIHW. www.aihw.gov.au/reports/domestic-violence/family-domestic-sexual-violence-in-australia-2018

Ballard, J., Turner, L., Cuca, Y. P., Lobo, B., & Dawson-Rose, C. S. (2022). Trauma-informed home visiting models in public health nursing: An evidence-based approach. American Journal of Public Health, 112(S3), S298-S305. 
doi.org/10.2105/AJPH.2022.306737

Barrett, G. M. (2023). The new immigration crisis: Creating trauma-informed yoga programs for asylum seekers, refugees, and new immigrants. Yoga Therapy Today. static1.squarespace.com/static/5ec830b6bcf1e41590235fed/t/64f8e3f98f09dc6e049e7f95/
1694032910121/YTT+Summer+2023_Barrett.pdf

Becker-Blease, K. A. (2017). As the world becomes trauma-informed, work to do. Journal of Trauma & Dissociation, 18(2), 131-138. doi.org/10.1080/15299732.2017.1253401

Bendall, S., Phelps, A., Browne, V., Metcalf, O., Cooper, J., Rose, B. et al. (2018). Trauma and young people: Moving towards trauma-informed services and systems. Melbourne: Orygen, The National Centre of Excellence in Youth Mental Health.

Berger, R., & Quiros, L. (2016). Best practices for training trauma-informed practitioners: Supervisors' voice. Traumatology, 22(2), 145-154. doi.org/10.1037/trm0000076

Bosk, E. A., Williams-Butler, A., Ruisard, D., & MacKenzie, M. J. (2020). Frontline staff characteristics and capacity for trauma-informed care: Implications for the child welfare workforce. Child Abuse & Neglect, 110(Pt 3). 
doi.org/10.1016/j.chiabu.2020.104536

Choi, K. R., Records, K., Low, L. K., Alhusen, J. L., Kenner, C., Bloch, J. R. et al. (2020). Promotion of maternal-infant mental health and trauma-informed care during the COVID-19 Pandemic. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(5), 409-415. doi.org/10.1016/j.jogn.2020.07.004

Danielson, R., & Saxena, D. (2019). Connecting adverse childhood experiences and community health to promote health equity. Social and Personality Psychology Compass, 13(7). doi.org/10.1111/spc3.12486

Department of Families, Fairness and Housing (DFFH). (2023). Framework for trauma-informed practice: Supporting children, young people and their families. Melbourne: DFFH. www.dffh.vic.gov.au/publications/framework-trauma-informed-practice

Fernandez, V., Gausereide-Corral, M., Valiente, C., & Sanchez-Iglesias, I. (2023). Effectiveness of trauma-informed care interventions at the organizational level: A systematic review. Psychological Services, 20(4), 849-862. 
doi.org/10.1037/ser0000737

Fixsen, D. L., Blase, K. A., Naoom, S. F., & Duda, M. (2013). Implementation drivers: Assessing best practices. National Implementation Science Network, Frank Porter Graham Child Development Institute, University of North Carolina Chapel Hill. 

Fixsen, D., Naoom, S. F., Blase, K. A., Friendman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Louis de la Parte Florida Mental Health Institute.

Guevara, A. M. M., Johnson, S. L., Elam, K., Rivas, T., Berendzen, H., & Gal-Szabo, D. E. (2021). What does it mean to be trauma-informed? A multi-system perspective from practitioners serving the community. Journal of Child and Family Studies, 30(11), 2860-2876. doi.org/10.1007/s10826-021-02094-z

Hanson, R. F., & Lang, J. (2016). A critical look at trauma-informed care among agencies and systems serving maltreated youth and their families. Child Maltreatment, 21(2), 95-100. doi.org/10.1177/1077559516635274

Holmes, M. R., King, J. A., Miller, E. K., King-White, D. L., Korsch-Williams, A. E., Johnson, E. M. et al. (2023). Innovations in trauma-informed care: Building the nation's first system of trauma-informed recreation centers. Behavioral Sciences (Basel, Switzerland), 13(5). doi.org/10.3390/bs13050394

Hunter-Dehn, A. (2021). A trauma-informed transition model for new entrants with dysregulated behaviours. New Zealand Journal of Educational Studies, 56(2), 301-314. doi.org/10.1007/s40841-021-00219-y

Knight, C. (2015). Trauma-informed social work practice: Practice considerations and challenges. Clinical Social Work Journal, 43(1), 25-37. doi.org/10.1007/s10615-014-0481-6

Knight, C. (2019). Trauma informed practice and care: Implications for field instruction. Clinical Social Work Journal, 47(1), 79-89. doi.org/10.1007/s10615-018-0661-x

Kulkarni, S. (2018). Intersectional trauma-informed Intimate Partner Violence (IPV) services: Narrowing the gap between IPV service delivery and survivor needs. Journal of Family Violence, 34(1), 55-64. doi.org/10.1007/s10896-018-0001-5

Lee, A. T., Chin, P., Nambiar, A., & Hill Haskins, N. (2023). Addressing intergenerational trauma in Black families: Trauma-informed socioculturally attuned family therapy. Journal of Marital and Family Therapy, 49(2), 447-462. doi.org/10.1111/jmft.12632

Lee, E., Kourgiantakis, T., Lyons, O., & Prescott-Cornejo, A. (2021). A trauma-informed approach in Canadian mental health policies: A systematic mapping review. Health Policy, 125(7), 899-914. https://doi.org/10.1016/j.healthpol.2021.04.008

Leotti, S. M., & Wahab, S. (2024). Mapping the landscape of trauma-informed care in social work: A critical scoping review. Trauma Violence Abuse. doi.org/10.1177/15248380241286810

Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62(2), 105-113. doi.org/10.1093/sw/swx001

Lotty, M., Dunn-Galvin, A., & Bantry-White, E. (2020). Effectiveness of a trauma-informed care psychoeducational program for foster carers: Evaluation of the Fostering Connections Program. Child Abuse & Neglect, 102. 
doi.org/10.1016/j.chiabu.2020.104390

MacDonald, J. B., Butler, K., Willoughby, M., Gartoulla, P., & Dobud, W. (2024a). How to do trauma-informed research and evaluation: Practice guide. Melbourne: Australian Institute of Family Studies. aifs.gov.au/resources/practice-guides/how-do-trauma-informed-research-and-evaluation

MacDonald, J. B., Butler, K., Willoughby, M., Gartoulla, P., & Dobud, W. (2024b). Principles for doing trauma-informed research and program evaluation: Practice guide. Melbourne: Australian Institute of Family Studies. aifs.gov.au/resources/policy-and-practice-papers/building-resilience-children-and-young-people

MacDonald J. B., & Dobud, W. (2024) Counselling effectiveness and the therapeutic alliance. Melbourne: Australian Institute of Family Studies. aifs.gov.au/resources/short-articles/counselling-effectiveness-and-therapeutic-alliance

MacDonald, J. B., Dobud, W., & Muir, S. (2025). Building resilience in children and young people: Practice guide. Melbourne: Australian Institute of Family Studies. aifs.gov.au/resources/policy-and-practice-papers/building-resilience-children-and-young-people

Macedo, D. M., Reilly, J. A., Pettit, S., Negoita, C., Ruth, L., Cox, E. et al. (2022). Trauma-informed mental health practice during COVID-19: Reflections from a Community of Practice initiative. International Journal of Mental Health Nursing, 31(4), 1021-1029. doi.org/10.1111/inm.13013

Mental Health Coordinating Council (MHCC). (2018). Trauma-informed care and practice organisational toolkit (TICPOT): An organisational change process resource, Stage 1 - Planning and audit. MHCC.

Mirick, R. G., Bridger, J., & McCauley, J. (2022). Trauma-informed clinical practice with clients with suicidal thoughts and behaviors. Smith College Studies in Social Work, 92(3), 169-184. https://doi.org/10.1080/00377317.2022.2104778

Mirick, R. G., Bridger, J., & McCauley, J. (2023). Trauma-informed school-based postvention services: Support to students following a suicide death. Clinical Social Work Journal, 52(1), 3-11. doi.org/10.1007/s10615-023-00887-x

Mirick, R. G., McCauley, J., & Bridger, J. (2023). Integrating trauma-informed principles into suicide prevention, intervention, and postvention. Practice Innovations, 8(4), 305-316. doi.org/10.1037/pri0000212

Moss, R. K., & Mousavizadeh, V. (2017). Implementing feedback-informed treatment: Challenges and solutions. In D. S. Prescott, C. L. Maeschalck, & S. D. Miller (Eds.), Feedback-informed treatment in clinical practice: Reaching for excellence (pp. 101-121). American Psychological Association. doi.org/10.1037/0000039-006

National Office for Child Safety. (2021). Keeping our kids safe: Cultural safety and the national principles for child safe organisations. Commonwealth of Australia. www.childsafety.gov.au/resources/keeping-our-kids-safe-cultural-safety-and-national-principles-child-safe-organisations-guide-0.

Némorin, S., Momartin, S., & Junaid, M. (2019). Community partnership with Rohingya refugees in Sydney, Australia: A systemic approach towards healing and recovery. Intervention, 17(2), 225-230. https://doi.org/10.4103/intv.Intv_31_19

Niimura, J., Nakanishi, M., Okumura, Y., Kawano, M., & Nishida, A. (2019). Effectiveness of 1-day trauma-informed care training programme on attitudes in psychiatric hospitals: A pre-post study. International Journal of Mental Health Nursing, 28(4), 980-988. doi.org/10.1111/inm.12603

Oral, R., Coohey, C., Zarei, K., Conrad, A., Nielsen, A., Wibbenmeyer, L. et al. (2020). Nationwide efforts for trauma-informed care implementation and workforce development in healthcare and related fields: A systematic review. Turkish Journal of Pediatrics, 62(6), 906-920. doi.org/10.24953/turkjped.2020.06.002

Proctor, E., Luke, D., Calhoun, A., McMillen, C., Brownson, R., McCrary, S. et al. (2015). Sustainability of evidence-based healthcare: Research agenda, methodological advances, and infrastructure support. Implementation Science, 10, 1-13. 
doi.org/10/1186/s13012-015-0274-5

Quadara, A., & Hunter, C. (2016). Principles of trauma-informed approaches to child sexual abuse: A discussion paper. Sydney: Royal Commission into Institutional Responses to Child Sexual Abuse.

Richard, D., Rousseau, D., Umapathy, K., Pandya, H., Rousis, G., & Peeples, P. (2024). Exploring the impact of a trauma-informed yoga and mindfulness curriculum for multiple populations: A pilot study. Explore (New York, New York), 20(1), 54-61. 
doi.org/10.1016/j.explore.2023.05.007

Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach (Vol HHS Publication No (SMA) 14-4884). Rockville, MD: SAMHSA

Speck, P. M., Robinson, L. S., Johnson, K., & Mays, L. (2023). Care for women with past trauma using trauma-informed care. Advances in Family Practice Nursing, 5(1), 119-135. doi.org/10.1016/j.yfpn.2022.11.002

Sweeney, A., & Taggart, D. (2018). (Mis)understanding trauma-informed approaches in mental health. Journal of Mental Health, 27(5), 383-387. doi.org/10.1080/09638237.2018.1520973

Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319-333. doi.org/10.1192/bja.2018.29

Sweeney, A., White, S., Kelly, K., Faulkner, A., Papoulias, S., & Gillard, S. (2022). Survivor-led guidelines for conducting trauma-informed psychological therapy assessments: Development and modified Delphi study. Health Expectations, 25(6), 2818-2827. doi.org/10.1111/hex.13585

Szczygiel, P. (2018). On the value and meaning of trauma-informed practice: Honoring safety, complexity, and relationship. Smith College Studies in Social Work, 88(2), 115-134. doi.org/10.1080/00377317.2018.1438006

Tibbitts, D. C., Aicher, S. A., Sugg, J., Handloser, K., Eisman, L., Booth, L. D. et al. (2021). Program evaluation of trauma-informed yoga for vulnerable populations. Evaluation and Program Planning, 88. doi.org/10.1016/j.evalprogplan.2021.101946

van der Hoeven, M. L., Widdershoven, G. A. M., van Duin, E. M., Hein, I. M., & Lindauer, R. J. L. (2022). A resilience enhancing trauma-informed program for children and mothers in domestic violence shelters: A qualitative study. Child & Family Social Work, 28(2), 515-526. doi.org/10.1111/cfs.12981

Wilson-Ching, M., & Berger, E. (2023). Relationship building strategies within trauma informed frameworks in educational settings: A systematic literature review. Current Psychology, 43(4), 3464-3485. doi.org/10.1007/s12144-023-04590-5

Yinger, O. S. (2022). I am safe and I am strong: Understanding adverse childhood experiences and building resilience through trauma-informed music therapy. In Beer, L. E., & Birnbaum, J. C. (Eds.), Trauma-Informed Music Therapy (pp. 47-55). 
doi.org/10.4324/9781003200833-8