Trauma-Informed Practice: The Six Principles in Care

Trauma-informed practice is an approach to health and care that recognises how trauma can affect the people you support, and shapes care so it doesn't re-traumatise them. The government's working definition sets out six principles: safety, trustworthiness, choice, collaboration, empowerment and cultural consideration. It isn't therapy. It's how your team explains, offers choices and responds, every shift.

"Trauma-informed care" and "trauma-informed practice" are generally used to mean the same thing.

The working definition

In November 2022 the Office for Health Improvement and Disparities (OHID) published a working definition of trauma-informed practice for practitioners in health and care. It reflects the original definition from the US Substance Abuse and Mental Health Services Administration (SAMHSA).

It describes trauma as resulting from an event, a series of events or a set of circumstances that a person experiences as harmful or life threatening, with effects that can last and limit their wellbeing.

The definition then asks practitioners to do three things:

• Realise that trauma can affect individuals, groups and communities.
• Recognise the signs and impact of trauma, and look beyond behaviour to ask "What does this person need?" rather than "What is wrong with this person?"
• Prevent re-traumatisation, meaning someone re-experiencing the thoughts, feelings or sensations of a past traumatic event.

Its purpose is to remove the barriers people affected by trauma face in getting health and care.

The six principles

1. Safety: the physical, psychological and emotional safety of people using the service and staff is prioritised.
2. Trustworthiness: the organisation and staff explain what they're doing and why, do what they say they will, and don't overpromise.
3. Choice: people are supported in shared decision-making, and choices are explained clearly.
4. Collaboration: the experience of staff and the people you support is valued, and people are actively involved in their care.
5. Empowerment: power is shared, feelings are validated, and people are supported to make decisions and act on them.
6. Cultural consideration: moving past stereotypes and biases based on things like gender, age, religion, disability, race or ethnicity.

Note that staff appear in the first principle. A team that doesn't feel safe struggles to make anyone else feel safe.

Trauma and PTSD aren't the same thing

Trauma is the experience. Post-traumatic stress disorder (PTSD) is a mental health condition some people develop afterwards. The NHS describes PTSD as caused by very stressful, frightening or distressing events, with symptoms such as flashbacks, intrusive thoughts and nightmares, which can start straight away or months or years later. Traumatic Stress Wales, an NHS Wales service, notes that most people don't go on to develop a mental health condition after a traumatic event, but a minority do.

Complex PTSD has largely the same symptoms but different causes, such as child abuse or ongoing domestic abuse. Diagnosis and treatment are for clinicians. Your team's job is to notice, support and avoid making things worse.

Adverse childhood experiences

Adverse childhood experiences (ACEs) are potentially traumatic events in childhood, such as abuse, or growing up with domestic violence, substance misuse or mental illness at home. In Public Health Wales's first ACE study, 47% of adults in Wales had experienced at least one ACE and 14% had experienced four or more.

ACEs are a reminder that trauma is common. They aren't a score to label anyone with: the point is understanding, not prediction.

What it looks like on shift

Most of it is ordinary good care, done consistently.

Safety

• Knock, wait, introduce yourself and explain what you're about to do before any personal care, every time.
• Ask what helps someone feel safe, such as a light left on or a door open, and write it in the care plan.
• Notice what might feel threatening: raised voices, sudden alarms, being approached from behind.

Trustworthiness

• If you say you'll be back in ten minutes, come back in ten minutes.
• Don't promise what you can't deliver. "I can't promise that, but I'll ask the manager today and tell you what they say" builds more trust than a yes that falls through.
• In children's homes, tell young people who's on shift and what happens next.

Choice

• Offer real choices: who supports with personal care, when, and in what order.
• In health settings, explain a procedure before it starts and agree a way for the person to say stop.

Collaboration

• Write care plans with the person, not about them. Ask what has helped before.
• Ask your team what they need too, and use peer support.

Empowerment

• Validate feelings: "That sounds frightening. It makes sense you're upset."
• Build on what the person can do, and support them to make decisions, including ones you wouldn't make.

Cultural consideration

• Respect requests for staff of a particular gender for personal care where you can.
• Take faith, language and culture into account, and check your own assumptions.

The flip side is spotting practices that can re-traumatise: touching without warning, restrictive practices, unexplained searches, and asking people to retell painful history to every new member of staff. For a young person whose behaviour escalates at bedtime, the trauma-informed question isn't "how do we stop this?" but "what might bedtime feel like for them?"

For children's teams, therapeutic parenting training goes deeper into attachment and developmental trauma. Positive behaviour support applies the same "what does this person need?" thinking to adults whose behaviour can challenge.

Looking after your team

Supporting people through trauma takes a toll. The Royal College of Nursing describes vicarious trauma as a process of change resulting from engaging with people who've suffered trauma, essentially the same as secondary traumatic stress. Signs include emotional numbness, intrusive images, poor sleep and struggling to keep boundaries.

The Scottish Government's 2021 trauma-informed practice toolkit warns that unsupported staff risk secondary traumatic stress, vicarious trauma and burnout. Support looks like:

• Supervision that covers how the work affects staff, not just tasks.
• A proper debrief after incidents, focused on learning rather than blame.
• A buddy or mentor for new starters.
• An easy route to a line manager or occupational health.

Common misunderstandings

• "It's therapy." It isn't. The working definition says its purpose is not to treat trauma-related difficulties, which is the role of trauma-specialist services and practitioners.
• "Staff need to know everyone's history." They don't. The approach assumes anyone may have experienced trauma, so your team works this way with everyone, without needing the details or asking people to disclose them.
• "It means no boundaries." Clear, consistent boundaries are part of safety and trust. See professional boundaries training.
• "One course and we're done." Training helps, but the definition also covers policies, practices and how staff are treated.

In England, CQC's Regulation 9 expects care to be personalised to each person. Trauma-informed practice is one practical way to do that.

How Kasorb can help

Our PTSD and trauma-informed care training is a one-day course, on-site or live online, for up to 12 staff. It covers what trauma is, PTSD, acute stress disorder and acute stress reaction, adverse childhood experiences, how trauma affects the brain, dissociation and defence strategies, how PTSD is managed, the six principles of a trauma-informed approach, and person-centred care planning. Learning is checked through discussion, scenarios and questions. It's awareness training: it doesn't train staff to diagnose or treat PTSD. Your trainer has used these skills for real, and certificates are emailed the next day.

FAQs

What is trauma-informed care?

Trauma-informed care is the same idea as trauma-informed practice: an approach to health and care that recognises how trauma affects people and avoids re-traumatising them. It's built on six principles: safety, trustworthiness, choice, collaboration, empowerment and cultural consideration. It shapes everyday care rather than treating trauma.

What are the six principles of trauma-informed practice?

The government's 2022 working definition lists safety, trustworthiness, choice, collaboration, empowerment and cultural consideration. Together they mean people feel safe, are told what's happening and why, have real choices, are involved in their care, are listened to, and are treated without stereotypes or bias.

Is trauma-informed practice the same as therapy?

No. The working definition is clear that its purpose is not to treat trauma-related difficulties, which is the role of trauma-specialist services. Trauma-informed practice is about how every member of staff works, so services are easier for people affected by trauma to use and don't add to the harm.

What is the difference between trauma and PTSD?

Trauma is the experience of an event or circumstances that feel harmful or life threatening. PTSD is a mental health condition some people develop afterwards, with symptoms such as flashbacks and nightmares. Most people who go through a traumatic event don't develop a mental health condition, and PTSD is diagnosed by clinicians.

Do staff need to know someone's trauma history?

No. Trauma-informed practice assumes anyone may have experienced trauma, so staff work this way with everyone. People shouldn't be pushed to disclose or retell painful experiences. Where someone shares their history, record it carefully so they don't have to repeat it, and share it only with those who need to know.