Implementing Trauma-Informed Care in SUD Treatment and Recovery Settings

Mid-America ATTC and TMC partnership on TIC in SUD treatment and recovery settings

Given the complex neurological, physiological, and behavioral consequences of both SUD and trauma, Mid-America ATTC, in partnership with Truman Medical Center’s Center for Trauma-Informed Innovation, is committed to providing SUD treatment providers with the knowledge and support they need to become trauma-informed organizations. 

Truman Medical Centers is a not-for-profit, academic health system with a comprehensive behavioral health division that is a respected leader in the field of trauma informed care. TMC-Behavioral Health worked closely with other key groups to create the Missouri Model, a developmental paradigm for organizations seeking to become fully trauma-informed.

Defining trauma-informed care

As stated by the Missouri Model for Trauma-Informed Care:

“The implementation of a trauma-informed approach is an ongoing organizational change process. A ‘trauma-informed approach’ is not a program model that can be implemented and then simply monitored by a fidelity checklist. Rather, it is a profound paradigm shift in knowledge, perspective, attitudes and skills that continues to deepen and unfold over time."

SAMHSA designated trauma-informed care as a best practice. Organizations that fully implement trauma-informed care will design policies, physical environments, and services that avoid re-traumatizing clients while promoting practices that reinforce resilience.

Implementing trauma-informed care is a multi-year process that often benefits from external facilitation and consultation. The goals of this multi-level transformation within an SUD treatment context are to create a culture that:

  • Realizes the prevalence of trauma.
  • Recognizes how trauma affects individuals
  • Responds by putting this knowledge into practice
  • Resists re-traumatization

While every SUD treatment organization operates within a unique context and can leverage a distinct array of strengths, the transition to trauma-informed care often entails equipping staff with in-depth knowledge of trauma and its relationship to mental health and SUD; an array of skills to employ in interactions with clients and coworkers to safely process trauma; and ongoing supervisory support for mitigating vicarious trauma and staff well-being. TIC implementation will also facilitate increased client choice and inclusion in treatment planning and improved client experience in engaging with and receiving services from SUD treatment providers. Moving beyond staff training on trauma to actually implementing trauma-informed care leads to the elimination of coercive practices and language, changes in hiring and supervisory practices, and the creation of safe, accessible physical environments for staff and clients. For a summary of the stages of organizational implementation, please see the MO Model Developmental Model Framework.

Mid-America ATTC-TMC BH CTII Collaboration for Trauma-Informed Care Consulting

Mid-America ATTC is collaborating with Truman Medical Center’s Center for Trauma Informed Innovation team to develop and pilot a manual for TTCs facilitating TIC implementation in SUD treatment and recovery services settings. The manual will provide guidance for TIC consulting teams on issues such as:

  • Evidence for TIC implementation, including improved client experience and employee well-being and retention
  • Key considerations for TTCs as they determine staffing capacity and strategies to provide TIC consultation
  • Examples of different levels of TA activities to promote implementation
  • Core components of trauma-informed care and corresponding consultant and organization activities during each stage of implementation
  • Defining and navigating the role of a consultant in facilitating long-term organizational change
  • Validated organizational assessment tools, meeting facilitation techniques, and approaches for developing strategies for change with leadership
  • Strategies for building and supporting organizational capacity to lead, sustain, and evaluate TIC implementation
  • Special considerations for TIC implementation with peer recovery coaches, CLAS standards, child welfare, and other community partners

For more information, please contact Mid-America ATTC Senior Project Manager, Kate Mallula, at