The Key Elements of a Trauma-Informed Healthcare Practice

Why Trauma-Informed Practice?

Trauma-informed practice matters because trauma exposure is far more common than it is often recognised, and its impact is long-lasting. Many people accessing health and social care, including autistic people and people with a learning disability, have experienced a specific traumatic event, such as neglect, abuse, domestic violence, bullying, loss, medical trauma, or repeated invalidation. Without trauma-informed approaches, well-intentioned services can unintentionally cause harmful and life-threatening events.

Here’s a breakdown of why it’s fundamental:

1. Trauma shapes behaviour, not character – What may be labelled as “challenging” or “non-compliant” behaviour is often a survival response. Trauma-informed practice shifts the question from “What’s wrong with you?” to “What happened to you?”
2. Prevents re-traumatisation – Traditional systems can mirror past trauma through lack of choice and control, punitive responses, and poor communication. Trauma-informed approaches actively reduce these risks by prioritising safety, trust, collaboration, choice, and empowerment.
3. Improves outcomes across mental health and social care – When people feel safe and understood, emotional safety and regulation improve, distress and crisis episodes reduce, engagement with support increases and long-term well-being and health improvement are more achievable.
4. Supports autistic people and people with complex trauma – Autistic people often experience cumulative trauma, from sensory overwhelm, masking, social isolation, or misunderstood communication needs. Trauma-informed practice recognises this widespread impact and adapts support accordingly, rather than expecting individuals to adapt to systems that don’t meet their needs.
5. Creates ethical, person-centred services – Trauma-informed practice aligns with human rights principles, strength-based and Positive Behaviour Support approaches, and ethical decision-making in care. It ensures appropriate measures are in place to support people’s lives, not just manage risk.
6. Benefits care workers as well as the people they support – Care professionals are also affected by trauma, personal and vicarious. Trauma-informed organisations reduce burnout, improve care workers’ retention, and foster reflective, compassionate cultures.

The Foundation – Core Principles of TIC

Trauma-informed approaches are built on a clear foundation that recognises the widespread impact of trauma and responds in ways that promote healing, recovery, dignity, and trust. These core principles guide how services, teams, and people think, act, make decisions, and how support is designed, delivered, and experienced. While these principles are explored in detail in our blog post about trauma-informed care: definition and importance, their importance lies in how they collectively reorient services toward understanding trauma as a widespread and influential factor in people’s lives. As key principles of trauma-informed practice, safety, trust, peer support, collaboration, empowerment, and cultural awareness are not standalone ideas; they form a framework that ensures care responds to people with compassion rather than control.

Together, these principles shift practice away from managing behaviour and toward creating conditions for recovery. They influence everyday interactions, decision-making, environments, and organisational culture, ensuring that appropriate measures are in place to reduce distress and avoid re-traumatisation. When embedded consistently, they help mental health and social care services move beyond reactive responses and instead support long-term health improvement and stability.

Ultimately, these principles are what make trauma-informed approaches more than a theory. They anchor services in respect, dignity, and partnership, ensuring people are supported in ways that recognise their experiences, strengths, and right to be involved in decisions about their own lives. As the foundation of trauma-informed practice, they underpin meaningful change for both people receiving support and the systems designed to serve them.

Building a Trauma-Informed Organisation

To genuinely become trauma-informed, organisations must commit to whole-system change, not one-off training or isolated interventions. This transformation begins with clear leadership endorsement and strategic direction: senior leaders need to embed trauma-informed thinking into organisational vision, policies, procedures, governance, and quality assurance processes. Leadership commitment also means allocating resources, time, budget, training, supervision, and evaluation, so that trauma-informed practice isn’t just aspirational but embedded into everyday work across services and teams.

A core practical requirement is training and workforce development for all care workers, including clinical, non-clinical, operational, and managerial roles. This ensures everyone understands trauma-informed approaches and how to apply them in interactions, environments, policies and communications. Organisations are encouraged to co-produce training with people with lived experience and to support continuous reflective practice, supervision, and peer support to reduce burnout and support care teams’ well-being.

Finally, building a trauma-informed organisation relies on ongoing open communication and cultural change. It involves reshaping physical and psychological environments to promote safety and inclusivity, engaging care workers at all levels in decision-making, and creating feedback loops that allow people who use services and care workers to influence practice and policies. This is an evolving journey rather than a single initiative, requiring regular evaluation and adaptation to sustain trauma-informed ways of working across the organisation.

Read more about the stages of trauma-informed implementation.

Create a Safe Environment

Many people accessing support have experienced trauma following a traumatic event, and without careful consideration, services can unintentionally cause further harm or become emotionally harmful, even when intentions are good. Creating a safe environment is a cornerstone of trauma-informed practice and reflects the growing recognition across mental health services administration that safety must be understood broadly. Safety must be understood broadly, not only physical safety, but also emotional, psychological, sensory, and relational safety.

This starts with predictability and clarity: consistent routines, clear communication, transparent decision–making, and care workers who explain what is happening and why. When people know what to expect, uncertainty and threat responses are reduced. These trauma-informed approaches reduce uncertainty and threat responses, particularly for individuals who are supporting mental and emotional recovery after trauma. When people know what to expect, they are better able to regulate their emotions and begin overcoming challenges linked to fear, hypervigilance, or mistrust.

A safe environment is also shaped by how people are treated, not just where they are supported. Staff attitudes, tone of voice, body language, and responses to distress matter deeply in people’s ways to develop trusting relationships. Trauma-informed environments avoid shame, blame, and punishment, recognising that such responses can reinforce lasting adverse effects of trauma. Offering choice, seeking consent, and involving people in decisions, however small, restores a sense of control that trauma often takes away and creates conditions for trusting relationships to grow over time. Finally, safety must extend to care workers as well as the people being supported. When staff feel supported, valued, and emotionally safe, they are better able to co-regulate, respond calmly to distress, and maintain consistent, compassionate care.

Support Staff’s Well-being

Care workers’ well-being is best supported through strong leadership, emotional safety, reflective practice, fair working conditions, and a culture of respect. When staff are well supported, they are better able to provide calm, consistent, and compassionate care, benefiting everyone involved.

Most important ways organisations can support care workers’ well-being:

• Psychological safety and supportive leadership: Care workers need to feel safe speaking up, asking for help, and making mistakes without fear of blame. Leaders set the tone by being visible, consistent, and compassionate, modelling healthy boundaries and valuing staff well-being as much as performance.
• Regular reflective supervision and emotional support: Access to meaningful supervision allows people to process emotional labour, vicarious trauma, and complex situations. Reflective spaces reduce burnout, improve resilience, and help staff remain emotionally regulated.
• Trauma-informed training for all roles: Training should include understanding trauma, stress responses, co-regulation, and self-care strategies. This applies to clinical and non-clinical care teams alike, creating a shared language and realistic expectations across the organisation.
• Manageable workloads and clear role boundaries: Chronic understaffing, excessive caseloads, and unclear responsibilities are major drivers of stress. Organisations support well-being by ensuring reasonable workloads, protected breaks, predictable rotas, and clarity about roles and expectations.
• Open communication and staff involvement: When people are listened to and involved in decisions that affect their work, trust increases. Feedback mechanisms, co-production, and transparent communication help care workers feel valued and reduce feelings of powerlessness.
• Recognition, respect, and career development: Feeling appreciated matters. Genuine recognition, fair pay, opportunities for growth, and progression pathways contribute significantly to morale, retention, and long-term well-being.
• A culture that normalises self-care and support: Well-being improves when rest, boundaries, and asking for help are encouraged rather than seen as weakness. Trauma-informed organisations actively challenge “burnout culture” and prioritise sustainable care.

Hire a Trauma-Informed Care Team

A trauma-informed care team should be intentionally multidisciplinary, well-supported, and values-led, ensuring that people receive consistent, safe, and compassionate support across every interaction. Rather than focusing only on roles, care teams should balance professional expertise, relational skills, and lived-experience awareness.

Trauma-informed teams understand that distress and behaviours of concern are often adaptive responses, not intentional non-compliance. Hiring teams with this understanding ensures care is grounded in compassion rather than control. Without trauma-informed skills, everyday care practices, such as rushed communication, lack of choice, or restrictive responses, can unintentionally replicate past harm. Trauma-informed teams are trained to prioritise safety, consent, predictability, and emotional regulation, significantly reducing the likelihood of re-traumatisation and escalation.

Trauma-informed teams support:

• Greater emotional regulation
• Increased engagement and trust
• Fewer crisis incidents
• Improved physical, mental and spiritual well-being and stability

Use Trauma-Specific Treatments

Trauma-specific treatments are structured interventions with strong evidence showing they can reduce trauma symptoms and support recovery. Some commonly used models in the UK and internationally include:

• Trauma-Focused Cognitive Behavioural Therapy (TF-CBT): Helps people process traumatic experiences and reduce associated anxiety, flashbacks, or avoidance. It is commonly used with children, young people, and adults.
• Eye Movement Desensitisation and Reprocessing (EMDR): Supports the brain in processing traumatic memories, reducing emotional distress and intrusive thoughts.
• Narrative Exposure Therapy (NET): Particularly effective for people with multiple or complex trauma experiences, helping them construct a coherent life narrative.
• Dialectical Behaviour Therapy (DBT) and other trauma-informed CBT variants: Useful for people who experience emotional dysregulation and self-harm behaviours.
• Attachment-based and somatic therapies: Address trauma stored in the body or relational disruptions, especially important for people with early-life trauma.

Before implementing trauma-specific treatments, organisations should screen carefully to understand the person’s history and current needs. Effective trauma screening identifies the type, timing, and severity of trauma experiences, assesses current risk factors, mental health conditions, and coping strategies and guides treatment planning, ensuring interventions are safe, appropriate, and tailored.

Trauma-specific treatments should never occur in isolation. They are most effective when embedded within a trauma-informed environment that prioritises:

• Asking people receiving care what outcomes matter most to them, rather than imposing pre-determined targets.
• Involving families and caregivers. It enhances understanding, provides relational support, and improves the generalisation of coping strategies to daily life.
• Co-production of care plans. Ensuring plans reflect the person’s strengths, preferences, cultural identity, and communication needs.
• Education and support. Helping families understand trauma, its impact, and ways to support recovery while maintaining boundaries and safety.

Partnership with Community-Based Organisations

Partnerships with community-based organisations (CBOs) extend support beyond the immediate care setting, connect people to meaningful opportunities, and strengthen recovery pathways by addressing the social, emotional, and practical determinants of well-being. Such partnerships embody trauma-informed principles by promoting choice, collaboration, and empowerment.

Collaborating with CBOs helps organisations provide holistic support through social, recreational, educational, faith-based and vocational opportunities, connect people to local networks and safe community spaces, and support recovery by involving people in meaningful community activities that allow them to learn new skills. CBOs often have specialised expertise, cultural knowledge, or flexible approaches that complement formal care services.

Trauma-Informed Practice with Leaf Complex Care

Trauma-informed practice is about understanding, compassion, and partnership. It is not a single intervention but a philosophy that transforms how behaviour is viewed, how care is provided, and how organisations function. Thought-provoking questions emerge at every stage: Are we prioritising safety and dignity in every interaction?Are our systems truly responsive to the needs of people with complex trauma? Are we collaborating with young people to ensure their voices are heard and respected?

George, our Restrictive Practice Lead and Specialist Clinical Practitioner, illustrates how trauma-informed principles are applied in practice.

‘’With regard to autism, many of the most important aspects of the person’s experience as an autistic individual are invisible to others, which makes staff training essential. Understanding the individual’s perspective is fundamental, and whenever possible, the autistic person themselves should be involved in sharing their experiences. Key areas include sensory profiles, communication differences, and physiological responses. It is understood that Trauma significantly affects the body’s arousal system, and autistic people, who often have heightened sensory and emotional responses, may be more vulnerable to the impact of trauma on their physiology and behaviour. Working with the person to complete sensory assessments and sensory support plans can therefore be very important.’’ – shares George.

Read more what George has to share on this trauma-informed practices, here.

– Developing not just a care plan, but a life plan, written by the person living it. – Leaf Complex Care

Offices: Bristol, South East, the Midlands and Somerset