Play Your Cards Right- Become a trauma-informed care “ACE” Therapist!

Guest Blogger: Emily Zeman

We need to presume the clients we serve have a history of traumatic stress and exercise “universal precautions” by creating systems of care that are trauma-informed.” (Hodas, 2005).

Did you know:

47.9% of children report one or more adverse childhood experience (ACE), or a traumatic event, at some point in their lifetime, as well as over 60% of adults seeking health care services!

If we are to fully serve children or adult clients, using a trauma-informed care (TIC) approach should be our default. This is not (as commonly thought) a socioeconomic issue as it can and does affect people at every economic level/race/religion, etc.

First, what is trauma?

Trauma includes a sense of fear, helplessness, or horror after exposure to a psychologically distressing event where the person has inadequate internal or external resources to cope with an external threat. There are many adverse experiences that could lead to trauma such as:

  • abuse (physical, emotional, sexual)
  • neglect (physical, emotional)
  • parent substance abuse or mental illness
  • socioeconomic hardship
  • family member incarceration, divorce, the death of a loved one
  • witnessing domestic violence or a natural disaster.

To utilize our holistic skill set in delivering client-centered care, therapists want to consider a full client history, and upon finding out about traumatic event(s), engage in these following actions from a trauma-informed approach:

  • Realize the prevalence of trauma (develop screening measures, form community partnerships, and take a good client history!)
  • Recognize how trauma affects all individuals involved with the client, program, organization or system
  • Respond by putting this knowledge into everyday practice, including developing thorough outcome measurement management systems

Core Principles of a Trauma-Informed System of Care:

  • Safety – ensuring physical and emotional safety, by conducting yourself with non-threatening body presentation and calm voice
  • Trustworthiness – maintaining appropriate boundaries while building rapport, and making tasks clear
  • Choice – prioritizing client’s meaningful choices and control (people want choices and options; for people who have had control taken away, having small choices makes a big difference)
  • Collaboration– maximizing collaboration by encouraging clients to connect with their friends and family for support while providing evidence-based (EBP) interventions
  • Stay curious
  • Offer hope

Health professionals are considered mandated reporters. Always report suspected abuse and follow the protocols at your site.   

How do you assess trauma and/or modify your treatments as you become informed about a trauma? Please offer us your thoughts!


Centers for Disease Control and Prevention. (2017, April 4). Essentials for childhood framework: Steps to create safe, stable, nurturing relationships and environments for all children. Retrieved from: /essentials.html

  1. SAMHSA.for definitions of trauma and trauma-informed care; (n.d.) SAMHSAfor prevalence figures.

The National Child Traumatic Stress Network (n.d.) Types of traumatic stress. Retrieved from: