Table 1.

Trauma-Informed Programming in Different Healthcare Domains

Healthcare domain	Examples of trauma-informed programming	Examples of trauma-informed programming for a patient with justice involvement
Care environment	Create welcoming, easy to navigate spaces that minimize visual, auditory, or other potentially re-traumatizing triggers	Assess for and minimize things that can be triggering in the clinic environment, ex. uniformed security guards. Include reentry service organization pamphlets or posters to signal welcome and belonging
Dialog and interactions between patients, staff, and providers	Focus on positive, accepting language that facilitates patient safety, disclosure, and engagement, and create a supportive work environment for the entire care team	Recognize unfamiliarity with community healthcare systems and explain the reasoning behind common screening questions and what to expect during examinations and procedures. Always obtain consent before examination. Support patients to make choices and regain a sense of control over their bodies and healthcare
Patient and provider workflows	Reduce barriers to care access (e.g., insurance coverage, physical access to the clinic), and facilitate efficient and effective patient throughput, provider workflows, and meaningful patient-provider interactions	Medicaid is suspended or revoked while incarcerated and can take time to reinstate upon release; see patients whose Medicaid may not yet be reinstated as services can be billed retroactively
Standard operating procedures	Incorporate trauma-informed principles into all aspects of clinic operations, including human resources, budgeting and financial management, and infrastructure, including incorporating trauma survivors and those with lived experience (e.g., CJS involvement) as a part of the care team	Hire peers with experience of the criminal justice system as health educators or community health workers. Budget a small amount of funds to support recently released patients with immediate needs (a meal, clothing, bus passes, etc.), potentially increasing trust and engagement. Make walk-in appointments available to allow patients to see a clinician on their terms
Trauma screening and disclosure	While data are limited, some TIC advocates have called for upfront and universal trauma screening, including screening adults for ACEs, which can provide a better understanding of a patient’s trauma history, allow for targeted interventions, and encourage normalization and disclosure as an act of healing.33 Weigh the pros and cons of trauma screening before deciding if it is right for your clinic	Should you decide to screen for trauma or CJS involvement, ensure that staff are trained in proper screening techniques and appropriate support is available for patients, including behavioral health and social service referral options. In the absence of screening, all staff can be trained in patient-centered communication strategies and how to appropriately respond if a patient discloses CJS involvement
Self-regulation and social resilience	Build concrete behavioral modification tools for staff, providers, and clients to manage everyday states of emotional-hyperarousal, facilitate better communication, and strengthen relationships22, 34	When creating tools and guidance, study perspectives of healthcare inside correctional facilities and understand how these experiences can contribute to a patient’s emotional state and engagement in care when back in the community