By: Jessica R. Kendall, JD, Senior Technical Specialist, ICF

Jessica R. Kendall is a senior technical specialist at ICF, where she works on issues related to vulnerable children and families.

The views expressed in In Focus are exclusively those of the individual authors and do not necessarily reflect official positions of their employers or clients. References to materials or services in the public domain do not imply endorsement from those entities.

In 1998 the Centers for Disease Control (CDC) and Kaiser Permanente released the seminal Adverse Childhood Experiences (ACE) study. Surveying 17,000 adult HMO recipients, the study asked respondents about what anyone would consider to be adversity in childhood—death of a parent, abuse/neglect, exposure to domestic violence, and others.

The ACE study researchers found that ACEs are common. About two-thirds of respondents had experienced at least one ACE. About one-fifth had experienced three or more. And, as respondent’s ACE scores went up, so did the likelihood of experiencing serious physical and mental health problems—from heart disease to obesity, substance abuse, and depression.

The prevalence of trauma and adversity among children and families who touch social service and justice systems is even higher. And the cumulative effects of both acute and chronic adverse experiences take a toll.

Bessel van der Kolk, psychiatrist and researcher on trauma and post-traumatic stress disorder, has said that trauma is not just an event that took place in the past—it leaves an imprint on the mind, brain, and body. This imprint, he notes, has ongoing consequences for how we manage to survive in the present. He concludes that trauma can fundamentally reorganize the way we manage our perceptions—it can change not only how we think but also what we think about and our very capacity to think at all.

With a growing body of evidence that links child and adult experiences of trauma to negative health, school, work, and relationship outcomes, many child- and family-serving organizations have begun to implement programs, services, and policies that are trauma informed.

Distinct from trauma-specific interventions that may treat a trauma victim through therapy or cognitive behavioral strategies, trauma-informed approaches seek to understand the impacts of trauma, recognize its signs, respond through practice and policy, and avoid re-traumatization.

The Substance Abuse and Mental Health Services Administration (SAMHSA) notes six key principles for any organization implementing a trauma-informed approach:

  1. Safety: Staff and people served feel physically and psychologically safe within the organization—through both its physical setting and through interpersonal interactions.
  2. Trustworthiness and transparency: Organizational operations are conducted with transparency and with a goal of building and maintaining trust with clients and among staff.
  3. Peer support: Building trust and enhancing collaboration to promote recovery and healing among trauma survivors.
  4. Collaboration and mutuality: Leveling power differences between clients and staff and between staff at all levels.
  5. Empowerment, voice, and choice: Individual’s strengths and experiences are recognized and built upon. Clients are supported in choosing their own goals and to determine a plan of action needed to heal and move forward.
  6. Cultural, historical, and gender issues: The organization actively moves past cultural stereotypes and biases and offers access to culturally appropriate and gender-responsive services.


Many organizations in child welfare, justice, health, workforce, and education are adopting these principles, implementing new policies, and enhancing their service delivery models. In 2016 the U.S. Department of Health and Human Services released a helpful resource guide on trauma-informed services with resources specific for agencies serving child, youth, and adult populations. The U.S. Department of Justice has a useful guide for organizations working with human trafficking victims. Also, check out this resource from ICF on implementing trauma-informed approaches.

Treating clients with respect, ensuring their voices are heard, and assuring their safety—no matter your field—are universal best practices. These tenets help us move past managing cases to become guides to clients as they forge their own paths to recovery and resilience.