Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy

Abstract

Trauma-informed care is a service provision model used across a range of practice settings. Drawing on an extensive body of research on trauma (broadly defined as experiences that produce enduring emotional pain and distress) and health outcomes, we have argued that the principles of trauma-informed care can be extended to social policy. Citing a variety of health-related policy examples, we have described how policy can better reflect 6 core principles of trauma-informed care: safety, trustworthiness and transparency, collaboration, empowerment, choice, and intersectionality. This framework conveys a politicized understanding of trauma, reflecting the reality that trauma and its effects are not equally distributed, and offers a pathway for public health professionals to disrupt trauma-driven health disparities through policy action.

Mapping “Trauma-Informed” Legislative Proposals in U.S. Congress

“…The boundaries of bill sections were delineated by the headings “Sec.” before and after the mentions trauma-informed practice. In this article, bills that included trauma-informed language are referred to as “trauma-informed bills” and bill sections that included trauma-informed language referred to as “trauma-informed sections.” Preliminary coding categories and sub-categories were established a priori based on an earlier policy mapping study of federal legislative proposals to address post-traumatic stress disorder (PTSD) (Purtle, 2014) and scholarship about trauma-informed policy (Ardino, 2014; Bloom, 2016; Bowen & Murshid, 2016; Fairbank & Gerrity, 2007; Gerrity, 2007; ISTSS, 2010; Shern et al, 2016; Shonkoff & Fisher, 2013). …”

“…In response to the far-reaching effects of trauma, the construct of trauma-informed practice emerged in the 1990s to better meet the needs of trauma survivors (Baker, Brown, Wilcox, Overstreet, & Arora, 2016; Bloom, 2013; Bowen & Murshid, 2016; Harris & Fallot, 2001; Ko et al, 2008; Treatment, 2014).…”

“…Within this context of growing interest in trauma-informed practice, mental health researchers and practitioners have called for the translation of trauma-informed practice into public policy (Ardino, 2014; Bloom, 2016; Bowen & Murshid, 2016; Fairbank & Gerrity, 2007; Gerrity, 2007; ISTSS, 2010; NCTSN; Shern, Blanch, & Steverman, 2016; Shonkoff & Fisher, 2013). As Bowen and Murshid (2016) describe, “Now, therefore, is an opportune time for public health and allied fields to expand on the shift toward trauma-informed care already underway in the service system and promote a parallel transformation in social policy.” (p. 228) Despite enthusiasm about the notion of trauma-informed policy—and its potential to maximize the public health impact of traumatic stress research (Sorenson, 2002; Thoits, 2010)—no empirical studies have investigated if and how the construct of trauma-informed practice has been integrated into public policy proposals.…”

“…As Bowen and Murshid (2016) describe, “Now, therefore, is an opportune time for public health and allied fields to expand on the shift toward trauma-informed care already underway in the service system and promote a parallel transformation in social policy.” (p. 228) Despite enthusiasm about the notion of trauma-informed policy—and its potential to maximize the public health impact of traumatic stress research (Sorenson, 2002; Thoits, 2010)—no empirical studies have investigated if and how the construct of trauma-informed practice has been integrated into public policy proposals. Consequently, little is known about the current status of trauma-informed public policy and limited guidance exists to guide trauma-informed policy advocacy efforts.…”

Response to commentary, “Trauma and the structuring of complex care: Back to the settlements?” by Elizabeth Bowen

“…Structural competency — similar to what Bowen and Murshid (2016), have called “trauma-informed social policy,” or social policy that reflects principles of trauma-informed care — infers engagement not only at the level of patient care provision but activism within communities and neighborhoods, and advocating change at the level of social and health policy. Like Bowen, we believe that even the best trauma-informed care is a downstream intervention that cannot address the fundamental causes of trauma and poor health.…”