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Trauma-Informed Approaches


It is the policy of the Oregon Health Authority (OHA) that all state and community providers, and those who oversee public mental health and addiction services: 

  • Be informed about the effects of psychological trauma,  
  • Assess for the presence of symptoms and problems related to that trauma, and 
  • Develop and offer services that facilitate recovery in accordance with Oregon Administrative Rules.

​Trauma can play a significant role in the lives of individuals with mental or substance use disorders. This is true whether the trauma was experienced in the past, present, or secondhand. Trauma is not always immediately obvious to others, or even to the person who experienced it.

As shown in this fi​gure​, when trauma occurs, it can prompt social, emotional and health difficulties across the lifespan. It has even been correlated with diseases and early death.

How trauma affects us across the lifespan

​Trauma affects people in all walks of life. Traumatic experiences include adverse childhood experiences and any others that make the individual respond with fear, horror and helplessness. They include:

  • Childhood abuse and neglect
  • War and other forms of violence
  • Physical, emotional or sexual abuse
  • Accidents and natural disasters
  • Grief and loss
  • Witnessing acts of violence
  • Cultural, intergenerational and historical trauma
  • Medical interventions

​OHA advocates that all health care partners apply these four R’s throughout their organizations:

  1. Realize how trauma affects the experiences and behaviors of the family, groups, organizations, communities and individuals.
  2. Recognize the signs of trauma. These signs may be specific to gender, age, or setting.
  3. Respond using language, behaviors and policies that respect children, adults, and staff members who have experienced traumatic events.
  4. Resist re-traumatization. Stressful environments or specific practices can trigger painful memories. This interferes with recovery and well-being. Organizations must review and change practices as needed to avoid re-traumatization.

Organizations must apply a trauma informed approach using six key principles:

  1. Safety: Everyone feels physically and psychologically safe. 
  2. Trustworthiness and transparency: The organization builds and maintains trust with staff and clients.
  3. Peer support: Is made available to help build a sense of safety, trust and empowerment.
  4. Collaboration and mutuality: Everyone in the organization takes part in creating a trauma informed environment.
  5. Empowerment, voice and choice: The approach reflects individual experiences/strengths.
  6. Cultural, historical, and gender issues: The organization is culturally responsive, respects traditional cultural connection and recognizes historical trauma.

​House Concurrent Resolution 33 (2017) recommends that all Oregon agencies work together to address trauma and provide trauma informed services. OHA is developing an agency-wide policy on trauma informed approaches to more effectively partner among OHA divisions and with other state agencies. 

OHA behavioral health contractors must use trauma informed approaches in their service delivery. Coordinated care organizations (CCOs) are working toward this goal which has been integrated into the CCO 2.0 contract expectations.

OHA funds Portland State University’s Trauma Informed Oregon (TIO), a valuable resource working to shape national policies and standards. TIO has trained thousands of providers and maintains a highly visited interactive website with training, educational, referral and other resources.


Youth Wellbeing Tools and Resources
Trauma Informed Oregon
Issues Brief: The Integration of Trauma-Informed Care in the Family Partner Program
National Child Traumatic Stress Network
SAMHSA's Guide to Trauma-Informed Care in Behavioral Health Services
Sidran Institute - Traumatic Stress Education and Advocacy


Trauma-Informed Services Policy
Cognitive Behavioral Therapy Proven to Benefit Children and Adolescents Following a Traumatic Event
Los Angeles Screening Checklist - Adolescent Version
Los Angeles Screening Checklist - Adult Version
Trauma - The Hidden Aspect of Addiction
Presentation - Trauma-Informed Care


Page Info

Kathleen Burns
Program and Policy Development​ Coordinator
Child and Family Behavioral Health Team Lead