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Trauma Informed and Responsive Practice

College of Social Work Resilient Tennessee Community Partnership

Resilient Tennessee: Sustaining Resilient Organizations for Success (Resilient Tennessee) is a partnership between the University of Tennesse, Knoxville College of Social Work and All Children Excel Nashville (ACE Nashville) that is poised to influence Tennessee’s non-profit and public social service sectors. ACE Nashville is a collective impact initiative working to prevent and mitigate ACEs in Davidson County. Under this partnership and with support from a FY19 Tennessee Building Strong Brains grant, the College leveraged its existing online learning management infrastructure and expertise to enhance and sustain ACE Nashville’s “Templates for Resilient Organizations” under an expanded model now known as the Roadmap to Resilience.

Roadmap to Resilience (R2R) Model

Roadmap to Resilience

“The R2R is not a clearinghouse of static information, it is a dynamic platform designed for robust user engagement by providing a step by step “roadmap” for creating meaningful and sustained organizational change.”

Through the development of an online learning portal, the R2R increases the opportunity for wide scale adoption of trauma-informed policies and practices across Tennessee’s social services provider networks. The ultimate goal of Resilient Tennessee is to create a comprehensive statewide network of trauma-informed and resilient human service organizations. By creating a provider network that is grounded in trauma informed policies and practices, Tennessee will have a workforce that uses evidence-based science to maximize the physical and psychological safety of both clients and staff, facilitate recovery of the child and family, support individual, family and community resilience, and ultimately prevent and mitigate ACEs in communities throughout Tennessee.

The R2R is a comprehensive, step-by-step “roadmap” for organizations to build resilient cultures through the integration of trauma-responsive policies and practices and sustained organizational change. The R2R, unlike most best-practice implementations, focuses first on the staff of an organization because of the understanding that staff cannot give of themselves before first giving to themselves. With this approach to trauma-informed and responsive practices, the R2R looks at an organization’s programs, policies, environment, values, and culture.

The R2R translates into practice existing research and scholarship (e.g. Bloom; Fallot and Harris; Missouri Model, etc.) into the following best practices for trauma informed care (TIC):

  1. Trauma is preventable and treatable;
  2. Trauma is pervasive and impacts both short term cognitive, behavioral, emotional and social functioning and long term health and economic outcomes;
  3. Without intervention, violent trauma occurring within families and communities is often transmitted across generations;
  4. Traumatic experiences are potentiated by poverty, addiction, mental illness, disability and/or discrimination;
  5. Traumatized individuals and communities often survive through vigilance and suspicion, impacting their capacity to engage in supportive services;
  6. Trauma sensitive training, policies, procedures, supervisory and direct service practices decrease the risk of re-traumatization and increase opportunities for recovery and healing; and
  7. Trauma informed individuals and organizations build resilience and transform systems.

Additionally, the R2R is aligned with the “4 R’s” in SAMHSA’s TIP 57:

  1. Realizes the widespread impact of trauma and understands potential paths for recovery;
  2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
  3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
  4. Seeks to build a resilient organizational culture by actively resisting re-traumatization.

The R2R is comprised of a series of online learning modules based on SAMHSA’s 4 R’s of trauma-informed care and expanded to include the latest in high quality expert information and resources critical to successful adoption of a trauma-responsive approach. The strategically designed modules synthesize thousands of pages of material into a cohesive, user-friendly guide for trauma-responsive organizational change. Accessible online 24/7, the R2R includes resources such as recordings of live trainings and focus groups from trauma experts, assessment tools, templates of trauma-responsive policies and procedures (e.g. hiring/firing, onboarding, reflective supervision, diversity and inclusion, staff wellness, etc.), and a host of other trauma-related reference materials.

Please click here to download more information about the Roadmap to Resilience.

Click here to view the Building Strong Brains Tennessee Roadmap to Resilience webinar (January 2020).

For more information about how your organization can access the Roadmap to Resilience, please download this form and submit it to

What is Trauma Informed Care (TIC)?

Globally, over 70% of individuals report having endured at least one traumatic experience in their lifetime and over 30% report experiencing four or more events. Though the effects of traumatic experiences vary widely, traumatic stress is an umbrella term used to describe symptoms that occur as a result of traumatic experiences such as “violence, abuse, neglect, loss, and other emotionally harmful experiences” (SAMHSA, 2015; 2018). Individuals in the United States have, on average, experienced at least one lifetime traumatic event, with most having endured more than 3 among experiences (Benjet et al., 2017). Hence, traumatic experiences are pervasive, and individuals often have endured multiple events. Since the inception of Kaiser Permanente’s Adverse Childhood Experiences (ACE) seminal study, there has been an increased awareness of the connection between early life adversity and subsequent poor health outcomes later in adulthood (Leitch, 2017). This awareness has helped underscore the importance of assessing individuals for early life adversity and developing societal systems that effectively respond to and work to prevent such early life adverse experiences. This is especially true for individuals who experience cumulative stress response resulting from both childhood adversity and traumatic experiences as adults; the result is pernicious and pervasive trauma response symptomology.

Trauma informed care (TIC) has become the catch-all phrase for organizational operating paradigms that work to recognize and respond to the deleterious health outcomes among individuals who have been traumatized. Sandra Bloom presented the concept in her 1997 book, Creating Sanctuary, which offers a cogently written explication of trauma, trauma response, and a TIC operating system, though her Sanctuary Model remains proprietary. Since that time, efforts to increase the accessibility of TIC implementation have mounted. In 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) with the Department of Health & Human Services, USA, released the TIP 57 Treatment Improvement Protocol for Trauma-Informed Care in Behavioral Health Services. This protocol has served as a guide for widespread adoption of trauma-informed care principles but with varying adoption techniques, interventions, and measurement standards. In short, the phrase Trauma-informed care—or TIC—refers to a paradigm in which health or behavioral health entities realize, recognize, respond to, and work to resist further traumatizing individuals (SAMHSA, 2014) and does so through six principles—safety, trustworthiness/ transparency, peer support, collaboration and mutuality, empowerment/voice /choice, and attention to cultural/historical/and gender issues. (Brown, L. & Steckel, S. in preparation, 2019)