By Whitney Marris, Trauma Therapist and CTIPP's Director of Practice & System Transformation

2022 marked a successful advocacy year for the Campaign for Trauma-Informed Policy and Practice’s (CTIPP) network. Federal and state leaders proposed and supported legislation to prevent and address trauma and create more long-term health, equity, and resilience in more significant numbers than in past years. There is no doubt that the continued commitment and efforts of advocates around the country have continued to move the needle and grow further momentum toward trauma-informed change.

The promising uptick in integrating trauma-informed, resilience-building, healing-centered, and allied concepts into policy and legislation was bolstered by society's growing awareness of trauma – encouraging a greater focus on addressing and preventing it altogether.

In January of this year, the Institute on Trauma and Trauma-Informed Care (ITTIC), which operates out of the Buffalo School of Social Work, created a report tracking 2022 public policy initiatives aligned with the goals, values, and principles of a trauma-informed approach.

Want to learn more? Join our March 15th CTIPP CAN call to discuss this report's findings and to build momentum for future advocacy and policymaking!

The report does not necessarily capture every state and federal measure across the United States that merely mention terms like “trauma-informed care” or “Adverse Childhood Experiences” (ACEs).

Instead, the report seeks to identify a more meaningful integration of key values, principles, and concepts that will support individuals, families, communities, and systems to become more trauma-informed.

To accomplish this, the report was created through careful analysis and consideration for what legislative measures saw action in 2022, which robustly integrated vital concepts, values, and principles of a trauma-informed approach, with 350 notable policy proposals ultimately being highlighted and summarized in ITTIC’s report.

Specifically, ITTIC’s team looked to the following frameworks to determine which measures were substantially aligned with a trauma-informed approach to include in the report:

Now, guided by CTIPP's mission, vision, and values, we have analyzed ITTIC’s report to uplift key findings, trends, and insights and to spotlight opportunities for continued advocacy in 2023 and beyond.

OVERALL TRENDS

The report from ITTIC offers valuable insights into the areas in which legislators concentrated their efforts and how trauma-informed solutions were framed in legislative proposals.

From accessing model language to use in your state to getting insight on what legislators are paying attention to, to illuminating areas to put more significant pressure on legislators to take meaningful action, advocates for a universal precaution and sweeping systemic trauma-informed change might find both the core information in ITTIC’s report as well as what we have chosen to lift based on our helpful analysis to guide their work.

It is important to note that even when policy suggestions are not signed into law, these conversations indicate that awareness and interest in exploring trauma-informed solutions are growing among legislators. Advocates nationwide can take notice of trends and themes to draw inspiration and determine the direction for work to advance change in your communities.

COVID-19 recovery remains a motivator. As the impacts of the COVID-19 pandemic continue to ripple through society, it is clear that states recognize the need to integrate trauma-informed approaches and practices into policy proposals to promote equitable, accessible healing and to build resiliency for future trauma exposure and potential impacts.

Inclusion of NEAR (Neuroscience, Epigenetics, ACEs, and Resilience) science concepts. More than half (53%) of the trauma-informed bills analyzed included direct references to the evidence we have connecting trauma, adversity, and chronic stress to a variety of potential impacts across the lifespan as well as the promise that trauma-informed approaches hold in leveraging protective factors, strengths, capacities, and the wisdom of lived experience to create resilient, healthy pathways forward for generations to come.

Common barriers to trauma-informed policies and practices. While it is tough to pinpoint precisely what might prevent specific measures from being signed into law in all cases, we can look to governors’ veto memos (I.E., the notes that governors include to justify their use of a veto to prevent bills passed by the state legislature from being made law) to provide some insight into what state leaders are considering when presented with the opportunity to advance trauma-informed policies and practices.

Most of these statements speak to the significant fiscal impact the trauma-informed bills proposed would have. This is promising as it illuminates that critical decision-makers are not deterred by trauma-informed concepts themselves but instead are not aware of the ways that investing upfront in implementing trauma-informed solutions to address costly and challenging issues ultimately contributes to long-term cost savings through providing pathways to address and prevent the trauma at the root of such issues. Undoubtedly, it is still important for those implementing trauma-informed policies and practices to continue to collect data on and emphasize to leaders and policymakers the long-term cost savings of implementing trauma-informed policies and practices.

Beyond budgeting and funding reasons, it is clear that leaders are being thoughtful about protecting the misapplication of NEAR concepts. For example, Hawaii’s governor vetoed a bill over privacy concerns. In this case, the proposed legislation would have expanded investigative power and the responsibilities of the government in determining foster placements, and the governor saw the potential for unintended consequences and opportunities for data misuse that ultimately could harm children and families.

Bipartisanship. The highlighted legislation in ITTIC’s report demonstrated a mix of bipartisan and party-led efforts, and this context can provide valuable guidance for advocates. Building on the types of policy proposals with broad and existing bipartisan support can illuminate a more accessible, impactful avenue to pursue than focusing solely on proposals or concepts endorsed more explicitly by one party. Indeed, highlighting the universality of trauma and how trauma-informed policies and practices will benefit all of us by addressing issues of common concern holds promise to bridge partisan divides.

Collaboration and coordination to support systemic solutions. There was a notable uptick in support for coordinated, collaborative approaches to addressing trauma. Over 40% of the trauma-informed measures analyzed supported a cross-sector, cross-systems approach to mitigating trauma and fostering individual and collective resiliency. Notably, this was one of the most commonly-represented themes in bipartisan legislative proposals.

These actions range from the creation of central databases to promote more intentional connections with accessible, quality supports to the creation of multidisciplinary teams, committees, and working groups to guide change implementation to improved workforce capacity to minimize the possibility of re-traumatization in providing wraparound services and beyond. Such efforts are critical for aligning policies and resources in states to implement supports, services, and interventions known to prevent, mitigate, and heal trauma and adversity.

Attentive to ABDEIJ concepts. Over a quarter (28%) of the trauma-informed bills analyzed in ITTIC’s report integrated concepts aligned with the trauma-informed principle concerning gender, historical, and cultural issues, grounded in ideas that promote accessibility, belonging, diversity, equity, inclusion, and justice.

Much of the trauma-informed legislation explicitly referred to the unequal distribution of trauma and its repercussions in broader society, including an acknowledgment that these disparities and inequities are reflected in the shortcomings of our systems and institutions. Similarly, the nature and impacts of historical, racial, cultural, intergenerational, and other types of collective trauma were explored in policy proposals. Many bills considered in 2022 explicitly state that trauma-informed solutions are a promising way to address such issues' sociopolitical and economic roots.

LEGISLATIVE POLICY DIMENSIONS

We analyzed ITTIC’s report to determine what percentage of trauma-informed bills aligned with our comprehensive vision dimensions, which are rooted in science and have been integrated across the lifespan, industry sectors, and rural, suburban, and urban communities.

Improve quality and accessibility of community-based services (64% of trauma-informed bills analyzed aligned with this policy dimension)

• Summary of sample legislation: California Assembly Bill 1117: would have established the “Healthy Start: Toxic Stress and Trauma Resiliency for Children Program,” which would award qualified entities with grants to plan and operate programs providing support services to students and their families in the community. (Learn more)

Expand trauma-informed, healing-centered workforce (54%)

• Summary of sample legislation: Vermont Senate Bill 195 & House Bill 560 would have expanded the trauma-informed, healing-centered workforce in alignment with the peer support principle of a trauma-informed approach by creating statewide standards and funding for peer support specialists throughout the state. (Learn more)

Build partnerships and community resilience (42%)

• Summary of sample legislation: Massachusetts House Bill 3953 contained language promoting individual and collective resilience and community-level healing to mitigate ACEs – Adverse Childhood Experiences and Adverse Community Environments. (Learn more)

Address injustice and inequity in the legal system (36%)

• Summary of sample legislation: Washington House Bill 1756 & Senate Bill 5639 concerned solitary confinement, including aligning the state’s use of such practices with the United Nations Nelson Mandela Rules. (Learn more)

Integrate historical, cultural, racial, and other forms of collective and/or intergenerational trauma (32%)

• Summary of sample legislation: Hawaii House Bill 2315 captured the overrepresentation of the Native Hawaiian community, Pacific Islander communities, and communities of color in the state legal system, among other disproportionate impacts, that trauma and adversity have on such populations, and frames this as a reflection of intergenerational trauma, cultural dislocation, exposure to ACEs, and risk factors associated with poverty as perpetuated by the status quo. (Learn more)

Progress mental and behavioral health (30%)

• Summary of sample legislation: Colorado House Bill 1281 established the Behavioral Healthcare Continuum Gap Grant Program within the Behavioral Health Administration of the state (created through legislation in 2021). (Learn more)

Support healthy, resilient, and thriving families (30%)

• Summary of sample legislation: Louisiana House Bill 921 created and outlined implementation guidelines for pilot programs that integrate education on ACEs into outreach to parents, legal guardians, and other relevant caregivers of children who engage with early childhood centers. (Learn more)

Prevent and address trauma while building resilience in the K-12 education sector (22%)

• Summary of sample legislation: Kentucky Senate Bill 102 added greater accountability and resources to build a more resilience-focused, trauma-informed environment in schools statewide. Through this measure, schools are tasked with providing an annual census of trauma-informed school-based providers who support student wellbeing with the intent to utilize positive school relationships, environments, and supports to address the high rates of ACEs and trauma endorsed by residents across the Commonwealth. (Learn more)

Make local, state, and federal governments trauma-informed (19%)

• Summary of sample legislation: New York Assembly Bill 3074 & Senate Bill 1067 would have amended New York’s Constitution by integrating a new section declaring the prevention and mitigation of ACEs as a matter of public concern and further requires that the state and its subdivisions address ACEs in key policy decision-making arenas that would advance the integration of a trauma-informed approach in government and the public sector. (Learn more)

Grow the evidence base for trauma-informed, trauma-responsive, and trauma-specific practices and programs (17%)

• Summary of sample legislation: Federal H.R. 3467 & S. 4332 would have authorized the Centers for Disease Control and Prevention (CDC) to utilize relevant public health surveillance systems and surveys to conduct longitudinal research and collect data (concerning privacy/confidentiality and in cooperation with the states) connecting ACEs with various public health outcomes with an emphasis on addressing the equity concerns in the original ACE study by including a more diverse, nationally-representative sample. (Learn more)

Develop a public health approach to trauma (12%)

• Summary of sample legislation: California Assembly Bill 1929 expanded Medi-Cal coverage to include violence prevention services and programming for survivors of community violence and other individuals at high risk of exposure to community violence. (Learn more)

Increase positive experiences in early childhood (7%)

• Summary of sample legislation: Colorado House Bill 1295 established a new entity – The Department of Early Childhood (“the Department”) – and tasks it with consolidating the currently disparate early childhood programming initiatives, which are spread across multiple agencies throughout the state with different eligibility requirements and funding streams, to reduce the burdens families and providers face in navigating the system and create more integrated, trauma-informed services and support so families may thrive. (Learn more)

Cultivate aging, bereavement, and end-of-life care (>1%)

• Summary of sample legislation: Illinois House Bill 5698 would have created the Strategic Action Planning Commission for Aging Equity, an entity tasked with researching and developing a comprehensive, cross-sector, long-term strategic action plan to support equity in aging through 2023-2035. (Learn more)

Champion veterans, military members, and their families (>1%)

• Summary of sample legislation: Federal House Bill 6961 supported and affirmed veterans who experienced sexual trauma while serving in the military. Given the high prevalence of such experiences among veterans, the changes this measure makes could tremendously impact supporting individuals as they navigate the Board of Veterans’ Appeals (“the Board”) claims appeal process – a process that increases the likelihood of re-traumatization among survivors. (Learn more)

Advance environmental and climate justice (>1%)

• Summary of sample legislation: Federal H.R. 9201 & S. 5251 would have addressed the individual and collective trauma caused by natural disasters through a trauma-informed, community-centered lens. (Learn more)

Opportunities & Lessons Learned from 2022

Considerable support for trauma-informed approaches. Given that only a small percentage of all proposed legislation becomes law, it is encouraging that 92 of the 313 trauma-informed bills (28%!) analyzed became law!

To build on this momentum, it is helpful for advocates to prioritize working with lawmakers who are already supportive of the trauma-informed movement. Through relationship-building, we can tap into these legislators’ networks to spread the word about the promise of adopting trauma-informed solutions to address problems their constituents care about.

ITTIC’s report also includes links to the full text of selected legislative proposals so that advocates can view sponsors and authors, as well as any other notable procedural aspects that might be useful to inform further action (e.g., testimony from hearings, memos sharing context and intent for submitting bills for consideration, etc.).

Remember – as a constituent, you have tremendous power to help policymakers understand the science and advance proven methods to prevent, mitigate, and address trauma.

Majority of legislation targeted children/younger people. Of the trauma-informed measures analyzed that were made law, around two-thirds (68%) specifically targeted younger people. While these are valuable advancements, a truly trauma-informed approach will more comprehensively address the importance of involving whole families, systems, and communities in preventing and addressing developmental adversity throughout a person's life.

The messaging that trauma-informed approaches primarily address ACEs alone is not unique to the policy space. Advocates have a unique opportunity to raise awareness among policymakers and the public about the protective factors that can be mobilized at the individual, family, community, and systems levels to address the trauma that has occurred at any point across the lifespan as well as to foster wellbeing and resilience for generations to come.

Emerging emphasis on preventive, public health approaches. There is growing policy interest in upstream strategies that look more holistically at interrupting cycles of intergenerational trauma and preventing future harm. This analysis also offers plenty of opportunities to inform legislators on how trauma-informed solutions are worth the initial investment to support constituents in realizing their full potential as engaged members of their community.

Expanding the evidence base. Trauma is a relatively young legislative topic, and it has only been present in public policy proposals since around 2009. As the evidence base demonstrating the efficacy of trauma-informed interventions continues to grow, so do legislative proposals seeking to enshrine the principles and values of a trauma-informed approach in law.

Notably, 17% of the trauma-informed proposals analyzed in the report seek to use data, promote intentional evaluation, advance empirical research, and otherwise build on the evidence base to determine the best and promising practices to address the interrelated issues that the experiences of trauma and adversity have been connected to.

CONCLUSION

Policymakers are increasingly prioritizing the need to address trauma and promote holistic well-being. This is supported by the growing body of evidence on the nature and impacts of trauma across various domains throughout one's lifetime and the efforts of advocates bringing awareness to the ongoing learnings that strengthen the case for creating trauma-informed transformation.

ITTIC’s report demonstrates strong momentum behind translating trauma-informed practices into public policy, which presents a promising opportunity for advocates to continue to promote the adoption of resilience-building and healing-centered practices.

By institutionalizing trauma-informed approaches through legislation, individuals, families, organizations, communities, and systems can receive the necessary support and resources to address the impacts of trauma and improve their overall well-being. These efforts contribute powerfully to building more resilient and supportive communities.

Therefore, it is essential to continue building awareness of trauma and advocating for trauma-informed policies and practices to create a society where all can be healthy, enjoy holistic well-being, and thrive.

Remember: Legislation is one of several pathways to paving a more trauma-informed future! To learn about other actions leaders and policymakers are spearheading across the states, check out the National Governors Association report on state actions to mitigate ACEs.