Table 2.

TIC dimensions, associated activities, & recommendations

OTR dimension	TIC activity	Recommendations
Trauma Responsive Services	Psychological trauma screening	1) integrate universal screening, brief intervention, referral to treatment (SBIRT) for trauma into routine care, with non-clinical staff conducting SBIRT and reducing the number of repeated non-systematized questions on sensitive topics; 2) incorporate mental health and trauma assessments for all positive screens; 3) utilize electronic patient-reported outcomes; 4) integrate resilience assessments; and 5) conduct Plan-Do-Study-Act cycles to improve mental health screening practices in an on-going way.
	Formal trauma assessments	1) trauma screening tools should be followed with gold standard assessment tools following positive screens; 2) multi-level resilience assessments should be integrated; and 3) PTSD assessments should include two-step process to confirm diagnoses.
	Clinical trauma interventions	1) adapt evidence-based approach to setting via implementation science methods; 2) implement intervention(s) to improve patient mental health, access to services, and HIV outcomes, and 3) train more providers to administer different stages of trauma interventions, including paraprofessionals and community health workers; 4) decrease reliance on Licensed Clinical Social Workers for case management, freeing them up to work at the top of license to provide clinical trauma therapy.
Practices of Inclusivity, Safety, and Wellness	Initiatives to promote professional quality of life (Pro-Qol) and culture or trauma resilience	1) implement multi-level interventions to alter institutional climate and culture; 2) utilize instruments as repeated measures (e.g., pre/post/post, etc.) to measure changes in to measure Professional Quality of Life, climate, and culture; and 3) conduct pre-implementation stage research to explore perceived barriers and facilitators to personnel-level TIC interventions; 4) engage advisory board to co-produce TIC implementation efforts.
Training and Sustaining a Trauma Responsive Workforce	TIC training for personnel	1) implement interventions as repeated measures (e.g., pre/post/post, etc) to measure changes in attitudes, practices, etc. to change personnel TIC knowledge, attitudes, and practices; 2) utilize instruments to measure attitudes; and 3) conduct further pre-implementation stage research to explore perceived barriers and facilitators to TIC implementation.
Cultural Responsiveness	Initiatives to promote cultural responsiveness	1) implement interventions to promote humanistic communication among providers and address racism as a form of trauma; and 2) conduct further pre-implementation stage research to explore perceived barriers and facilitators to addressing cultural responsiveness as part of TIC.