Table 6.

Directed content analysis of the defining characteristics of trauma-informed care

Defining Characteristics a	Representative Example of Content Coded
Trauma-informed framework (n = 6) b	“SAMHSA outlines a “four R” perspective for the elements that are required to create this shift in organizational culture: (1) realizing the prevalence of trauma, (2) recognizing how trauma affects all individuals involved with the organization (clients, families and team members), (3) responding by putting this knowledge into practice, and (4) actively resisting retraumatization.” [133]
Understanding the effects of trauma (n = 3) c	“Taking into account the impact of trauma on the lives, development, and drug use of people. This does not necessarily require disclosure of trauma.” [59]
Avoiding re-traumatization (n = 1) d	“We should make great efforts to do nothing that could be retraumatizing, such as exercising authority and/or control, asking intrusive questions, being unpredictable, or using shaming language/ techniques.” [79]

^aA total of 9 references defined trauma-informed care. Coded categories were not mutually exclusive such that a reference might have defined the principle of patient-centered care at more than one category. Bracketed numbers represent the number of unique references coded at each category

^bReferences coded at this category [41, 42, 58, 133–135]

^cReferences coded at this category [44, 59, 79]

^dReferences coded at this category [79]