Table 1.

Strategies for trauma informed care (TIC).

Core Principles of Trauma-Informed Care & Related Actions
RealizeUnderstand broad impact of trauma	Understand short and long-term impact of ACEs and toxic stress on development and health	Shift perspective from “what is wrong with you?” to “what happened to you?”
	ACEs have physiological, biological, psychological, social, and spiritual effects on children
RecognizeSigns & symptoms of trauma in families	Use open ended questions	Assess for physiological, biological, psychological, social, and spiritual effects: suicidality, depression, anxiety, substance abuse, self-injurious behavior, developmental delay, sleep disorders, disordered eating and relational health.
	Screen for trauma for every child, every visit	Tool: Pediatric ACEs screening and related life-events screener
RespondCoordination of response to trauma particularly with family, community, and health care systems	Anticipatory guidance: Resilience promotion, ACEs education, consistency in parenting skills
Resist Re-traumatizationUniversal trauma precautions for both caregivers and care receivers	Approach all children & families with trauma universal precautions mindset	TIC and resiliency training for all personnel interacting with children and families.
	Promote a culture of TIC in organizations and communities

ACEs = Adverse Childhood Experiences; TIC = Trauma informed care.