By Andrea Blanch, PhD, Carol Boyer, MA, Mary Blake, CRE
While the term “trauma-informed” is relatively new, the concept shares historical roots with ISTSS. As described in detail by Sandy Bloom, ISTSS grew out of a broad social movement examining and responding to the roots of violence. From the beginning, this movement represented multiple interests and issues, including the development of effective treatments for PTSD (particularly among veterans), concern for victims’ rights, and programs to address domestic violence and child abuse. Over the years, the focus has shifted back and forth between research, intervention and policy concerns.
Adopting a “trauma-informed” framework focuses attention on what can be done at the policy level. In the past few years, as this framework has gained traction, there has been an upsurge of interest and action among both State and Federal policy makers. Significantly, these efforts are almost always interagency and cross-sector in design. Equally noteworthy, they build on a public health approach, addressing both individual and structural concerns and integrating public education, health promotion, treatment and prevention. This trend reflects an understanding that trauma affects every aspect of life, across the lifespan, and that single-focus or single-agency solutions will not be adequate.
At the Federal level, an inter-agency group called the “Federal Partners Committee on Women and Trauma” has been meeting monthly since 2009. It was initially established by the Substance Abuse and Mental Health Services Administration (SAMHSA) as a workgroup within the Federal Partnership on Mental Health Transformation, under the President's Executive Order 13263 (2002) and the President’s New Freedom Initiative Commission on Mental Health. In 2011, it became an ongoing committee. The initial workgroup involved more than 25 representatives from six federal agencies and several departments within those agencies. Membership has grown to more than 100 representatives from 39 different divisions of 13 federal agencies (Agriculture, Defense, Education, Health and Human Services, Homeland Security, Housing and Urban Development, Interior, Justice, Labor, State, Veterans Affair, Peace Corps, and the Office of National Drug Control Policy). The committee is currently co-chaired by the U.S. Department of Labor and SAMHSA.
The group held their first federal “roundtable” in 2010. The roundtable was designed to create a common understanding across a wide span of government agencies about trauma and its effects on the nation. In the words of the roundtable report: “Violence against women—and the trauma that results—has a huge impact on the health, the economy and even the security of our nation.” A second roundtable, in 2011, examined how different sectors were implementing trauma-informed approaches. The second report, issued in 2013, outlines progress made by agencies participating on the Committee.
The concept of trauma-informed approaches as developed by SAMHSA provides a common framework that facilitates collaboration. Interagency efforts have resulted in joint training and curriculum development; re-examination and creation of new policies on workplace violence, bullying and health education; joint participation in international forums; changes in grant programs; joint research initiatives; the development of state coalitions; and technical guidance memoranda. A webinar series is ongoing, and the group is currently planning a third national event which will focus on systemic, cross-sector change.
Several states have launched similar efforts. In Florida, a statewide Interagency Trauma Informed Workgroup has met quarterly since 2009, with representation from across state government. Significant work has been done in juvenile justice and education, and a legislative committee is currently considering a bill that would require child protective services to be trauma-informed. In Missouri, an effort led by the Department of Mental Health has helped dozens of agencies and communities to become more responsive to trauma. The State has also developed a policy guidance document on trauma-informed organizational change, and has expanded partnerships with child welfare, education and health. Vermont passed the first bill in the nation calling for screening for adverse childhood experiences in health services and for integrating the science of trauma into medical education. All ten Vermont counties now have groups working on implementation. In Washington, the state legislature has established a public policy research institute that is examining, among other issues, the cost-effectiveness of prevention programs. Clearly, policymakers have started to realize that the cost of not responding to violence and trauma is too high to ignore.
The growth and success of these federal and state initiatives suggest that it is time to elevate the conversation about violence and trauma to a national policy discussion. We need a policy agenda that fully acknowledges—and responds to—the impact of toxic stress and trauma on the nation’s health, well-being and prosperity. Such an agenda would help to address multiple factors that are significantly eroding our human capital. It could also help to unify policy concerns about poverty and inequality, racism, violence against women and children, and behavioral health issues. ISTSS members and other trauma advocates across the country could be a major force for trauma-informed policy reform.
About the Authors
Andrea Blanch, PhD, is a consultant with SAMHSA’s National Center on Trauma-Informed Care (NCTIC), providing leadership on the development of trauma-informed public policy and program initiatives. She has published widely on trauma and systems change. She previously worked in senior administrative positions in state government in Vermont, Maine and New York.
Carol Boyer, MA, is chair of the Federal Partners Committee on Women and Trauma. A senior policy advisor at the U.S. Department of Labor’s Office of Disability Employment Policy, she works on topics related to the recruitment, hiring, retention and advancement of individuals with disabilities. She previously worked at the U.S. Departments of Justice and Education.
Mary Blake, CRE, is co-chair of the Federal Partners Committee on Women and Trauma. A Public Health Advisor in the Center for Mental Health Services at SAMHSA, she leads SAMHSA’s National Center on Trauma-Informed Care (NCTIC) program and provides leadership on implementation of trauma-informed approaches within SAMHSA and with other federal partners and stakeholders in the field.
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