Trauma Informed Care Implementation Tool

square bulletTIC Implementation Tool Introduction and Origin

The Trauma Informed Care (TIC) Implementation Tool was created by the Human Services Implementation Lab and Trauma Informed Oregon to assist organizations, systems, and agencies in implementing trauma informed care and tracking their progress. In 2022, the Human Services Implementation Lab and Trauma Informed Oregon tested the tool with six diverse organizations, receiving feedback that helped to improve the tool. The TIC Implementation Tool was developed in response to a growing demand from organizations seeking to evaluate their alignment with trauma informed care and monitor their progress. Organizations can use the tool to conduct independent assessments or receive support and a full audit from the HS Implementation Lab.

How the TIC Implementation Tool was Developed

The tool itself is based on TIO’s 10 years of consultation, the Standards of Practice, training in the field, SAMHSA’s Six Key Principles of Trauma-Informed Care, and on SAMHSA's Ten Impelementation Domains.

SAMHSA’s Six Key Principles of Trauma-Informed Care

  1. Safety
  2. Trustworthiness and Transparency
  3. Peer Support
  4. Collaboration and Mutuality
  5. Empowerment, Voice and Choice
  6. Cultural, Historical, and Gender Issues

SAMHSA's Ten Implementation Domains

  1. Governance and Leadership
  2. Policy
  3. Physical Environment
  4. Engagement and Involvement
  5. Cross Sector Collaboration
  6. Screening, Assessment, Treatment Services
  7. Training and Workforce Development
  8. Progress Monitoring and Quality Assurance
  9. Financing
  10. Evaluation

Five Essential Elements of Trauma Informed Care

TIO’s Standards for Trauma Informed Care are grouped under five key elements:

  1. Organizational Commitment
  2. Training and Education
  3. Policy, Procedure, Practice Review
  4. Feedback and Quality Assurance
  5. Culture and Climate

Each standard can be rated on a scale for 1 to 5, where 1 equals “Organization is unaware of the need for this standard” and 5 equals “Standard is sustainably in place and monitoring for continuous quality improvement occurs regularly”.

Systematically assessing TIC implementation accomplishes two things. First, it documents the extent that the organization is trauma-informed and clearly identifies systemic strengths, weaknesses and gaps. Second, it helps the organization decide on overall goals, and identify and prioritize specific practice changes to make.

TIC Implementation Tool Files

TIC Implementation Tool

A PDF of the TIC Implementation Tool can be useful if you’re using the tool in a group setting to assess your program, clinic, agency or system. Sample reports can also be seen and downloaded from the HS Implementation Lab's website.

TIC Essential Elements

Read Mandy Davis, PhD’s blog to learn more about the TIC Essential Elements. A fifth element, Organizational Commitment, has since been added to this tool to reflect feedback from piloting this tool with organizations throughout Oregon.


If you are interested in support with formulating a plan after your TIC Implementation report, contact us. For assessment support, you can go directly to HS Implementation Lab’s website.

square bulletHow to Use the TIC Implementation Tool

There are multiple ways to approach this tool. For consultation and assessment support, contact the HS Implementation Lab for full scope of options and price quotes.

square bullet Resources by Essential Element

You will see various resources below each TIC Essential Element. These resources are a compilation of TIO material and external material that offer insights and tips to consider when planning around the TIC Essential Elements. Please note that external material has not been vetted by TIO and is included to encourage exploration of other perspectives and knowledge outside of TIO. The navigation links below will jump to a specific section of resources.

Element #1: Organizational Commitment

Organizational commitment is demonstrated through dedicated support for a trauma-informed infrastructure that includes specific funding and employee time for implementing trauma-informed care. Organizations acknowledge that an understanding of the impact of trauma is central to effective service delivery and make operational decisions accordingly. Organizational commitment is evident within all four domains outlined in SAMHSA’s TIC Guidance: (1) Governance and Leadership, (2) Policy, (3) Financing, and (4) Engagement and Involvement. Leadership collaborates with other organizations to create a trauma-informed community that follows the principles of trauma-informed care across sectors.

Behaviors and Actions of TIC Leaders

This TIO TIP sheet includes a summary of data on what trauma informed care looks like in leadership, among staff, and in an organization. Characteristics of a trauma informed leader are mapped out. Source: Trauma Informed Oregon

Hosting a Meeting Using TI Principles

This bulleted list outlines things to do to prepare for and run a meeting that is trauma informed. Source: Trauma Informed Oregon

Hosting a Virtual Meeting Using TIC Principles

This TIP sheet offers strategies for hosting virtual meetings that promote safety, power, and value using SAMHSA’s six principles of trauma informed care. Source: Trauma Informed Oregon

Dealing with Resistance to Trauma Informed Care

Within communities attempting Trauma Informed Care, some people resist the science and spending of tax dollars to help people who have been damaged by Adverse Childhood Experiences (ACEs). In this video, Laura Porter from Ace Interface talks about how to respond. Source: Laura Porter, ACE Interface

Practice Guidelines for the Delivery of TI and GLBTQ Culturally-Competent Care

This practice guide highlights key practice issues related to serving youth impacted by trauma who may also be dealing with issues of sexual orientation and gender identity. Source: The American Institute for Research, in partnership with WestEd and Justice Resource Institute.

Providing TIC to Autistic Adults

These resources, many of which are focused on trauma informed care for the Autistic community, are designed to encourage conversation about TIC for all disability communities to mitigate negative life experiences. Source: Trauma Informed Oregon

Racial Justice and TIC

This document explores the intersections of racial justice and trauma informed care. Its authors identify 6 primary themes in regard to the intersection of TIC and racial justice and what is needed to center anti-racism in TIC efforts moving forward. Source: Trauma Informed Oregon

TIC Workgroup Meeting Guidelines

This list of questions helps set guidelines for Workgroup meetings to keep the process on track when gathering information, identifying opportunities, setting priorities for change, and proposing solutions. Source: Trauma Informed Oregon

What One Thing Can You Do Feedback Questionnaire

This workshop activity helps participants consider concrete action steps to implement trauma informed care in their organizations. Source: Trauma Informed Oregon

Element #2: Culture and Climate

Culture and climate is the cohesive narrative, the glue, that holds a trauma-informed community together. It is the embodiment of all that is seen, heard, done, and experienced in spaces and settings. Trauma-informed practices and settings demonstrate an understanding of the impact of trauma and toxic stress on the body (both individual and organizational) and the power of relationship and belonging. This understanding appears in the language used, protocols that are followed, and behaviors that are witnessed.

Welcoming Families with a TI Approach

These posts are part of our family engagement series on trauma-informed family engagement practices. Source: QSLA

Agency Components for Trauma Informed Care

This checklist can help assess the physical environment and selected intake and service procedures in an agency setting. Source: Region 3 Behavioral Health Services, Kearney, Nebraska

Trauma Informed Environments – Assessment Tools

This tool is set up in a check-list format, and provides a wide range of things to consider about an organization’s physical space being trauma informed vs non-trauma informed. Source: PACES Connection

Physical and Emotional Environment Resource List

Feeling unsafe may cause extreme anxiety in a person who has experienced trauma, potentially leading to re-traumatization and engagement challenges. These resources support creating a safe physical, social, and emotional environment for patients. Source: Trauma-Informed Care: Implementation Resource Center

SAMHSA Key Ingredients for Successful Trauma Informed Implementation

This brief draws on interviews with national experts on trauma-informed care to create a framework for organizational and clinical changes that can be practically implemented across the health care sector to address trauma. It also highlights factors to consider for the physical and socio-emotional environment. Source: SAMHSA

Suicide, Trauma, and Trauma Informed Care – TIO Happenings September/October 2017

This blog highlights TIO’s goals and suicide prevention resources. Source: Trauma Informed Oregon

The Role of Trauma in Suicidal Behavior

This blog discusses the impact of childhood, multigenerational, and historical trauma on suicidal risk. Source: Trauma Informed Oregon

Empowering Youth to Have Trauma Informed Experiences in Emergency Rooms

This blog discusses youth experiences in the emergency room and OTAC’s tip sheet that offers ideas for emergency room providers on how to engage with youth in a TI way. Source: Trauma Informed Oregon

Practice Guidelines for the Delivery of TI and GLBTQ Culturally-Competent Care

This practice guide highlights key practice issues related to serving youth impacted by trauma who may also be dealing with issues of sexual orientation and gender identity. Source: The American Institute for Research, in partnership with WestEd and Justice Resource Institute

TIC Introduction to Workforce Wellness

This document developed by TIO provides foundational information about workforce wellness. It provides background and definitions to assist partners that are beginning to address workforce wellness in their programs and organizations. Source: Trauma Informed Oregon

Addressing Secondary Stress: Strong in the Broken Places

This PowerPoint presentation, with accompanying video, addresses secondary stress and the impact and solutions to vicarious traumatization in the workforce. Source: Wayne Scott, MA, LCSW

Wellness Relapse Prevention Plan

This workshop exercise helps training participants to identify warning signs of excess stress or secondary trauma in their work and to create a plan to address it effectively. Source: Trauma Informed Oregon

Workforce Wellness

Building on Foundations content, this TIO workshop unpacks the notion of parallel process in a trauma informed system, setting the foundation for both individual and organizational responsibility for workforce wellness. Source: Trauma Informed Oregon

Moving Workforce Wellness into Organizational Culture

Staff blog that discusses how organizations can support work-life balance and self-care by integrating wellness activities into the working hours of their teams. Source: Trauma Informed Oregon

Rethinking How to Support Teachers’ Emotional Wellbeing in a Time of COVID-19

Staff blog that summarizes what research recommends to address burnout among teachers. Source: Trauma Informed Oregon

The Importance of Imagination – Active Optimism and Resilience

Staff blog about how fostering imagination can help climate change activists and others overcome burnout related to the intensity of their work. Source: Trauma Informed Oregon

Person-Centered Planning

This document provides foundational information about Person Centered Planning (PCP) and its relationship to trauma informed care. It is intended for those who are wanting an overview or are considering using Person-Centered Planning in their programs and organizationsSource: Trauma Informed Oregon

Element #3: Training and Education

The professional development plan for staff is demonstrated by staff competency and skills, as well as how the principles and values of trauma-informed care are applied in the training methodology. The plan’s goal is staff embodiment of the content shared. Training is paired with educational opportunities that promote competence (knowledge) and confidence (skill) to apply to trauma informed approaches (TIA). This learning is done at a reasonable pace, is role specific, and performed throughout the job cycle (Ask “who needs to know what by when?”).

There are multiple TIC trainers in Oregon.

Considerations When Hiring a Trainer

This document can assist with finding the best trauma informed care trainer for your specific needs. It includes both reflective questions and interview questions. Source: Trauma Informed Oregon

Foundations of TIC

This 4 hour TIO training provides foundational knowledge appropriate for individuals across sectors and job titles. The training explores how trauma affects service access, the difference between trauma specific services and trauma informed care, and reframing behaviors with a trauma informed lens. Source: Trauma Informed Oregon

TIO Introduction to TIC Training Modules

These free online training modules have been created to increase access to foundational training so that the key guiding principles of trauma informed care are accessible to everyone. These four modules are self-guided and self-administered. Source: Trauma Informed Oregon

Applying Trauma Informed Care in Home Visits

This full-day TIO training covers the definition of trauma and trauma informed care (TIC), the neurobiology of trauma, principles of TIC, and workforce stress. Originally created for home visiting and early childhood professionals; some content has been tailored for these fields. Source: Trauma Informed Oregon

Tools From Our Training Events

Our Trauma-Informed workshop series provides a general and basic foundation of TIC principles and conceptual approaches, a brief self-evaluation of professional competencies and needs, as well as a deeper understanding of the impact of trauma across several domains. Source: Case Western Reserve University

TReSIA: Self-Assessment

This worksheet helps assess where your organization is at relative to key TI characteristics, including staff skills. Staff skills are defined as “Employee awareness of and commitment to trauma-responsive efforts, employee knowledge and skills, and similar issues.” Source: Washington State’s Health Care Authority

DMHA Guidelines for Conducting an Organizational Self-Assessment of Staff Competencies to Provide TI Services

This checklist helps determine which staff are competent in TIC values and skills. Recommends that all staff should be assessed for their readiness to provide TIC. Source: New Jersey Department of Human Services

Trauma Lens Exercise

This table provides examples of how to reframe challenging behaviors through a TI lens. The examples in the table are some of the most frequently reported in TIO trainings and include challenging behaviors from service recipients and staff, as well as challenging environmental features. Source: Trauma Informed Oregon

Hiring a TI Workforce Fact Sheet

This fact sheet is a product of Advancing Trauma-Informed Care, a national initiative focused on better understanding how trauma-informed approaches can be practically implemented across the health care sector. Source: Center for Health Care Strategies

Trauma Informed Care Interview Questions

This tool provides sample interview questions to help organizations assess how a potential employee may fit into an organization that’s pursuing trauma-informed approaches. Source: Trauma Informed Care Implementation Resource Center

Human Resources Practices to Support TIC

This list compiles strategies to promote trauma informed care through human resource policies and practices, including hiring, onboarding, supervision and performance reviews. Source: Trauma Informed Oregon

Child Welfare Training Kit

This curriculum is designed to teach basic knowledge, skills, and values about working with children who are in the child welfare system and who have experienced traumatic events. Source: National Child Traumatic Stress Network, 2013

General Parenting Resources

These books by experts in the field may be helpful to parents and other caregivers dealing with children and youth affected by trauma. There are additional books for adult survivors of trauma who are parenting. Source: Trauma Informed Oregon

Parallel Process and Application of TIC Principles

This 3 hr TIO training builds on the Foundations content and is appropriate for individuals across sectors and job titles. This training covers skills to engage populations who have experienced trauma, making programs and policies more trauma informed, the principles of trauma informed practice, and workforce wellness. Source: Trauma Informed Oregon

Supporting Each Other and Ourselves: TI Peer Support

This training is designed for people who provide peer recovery and support services and peer wellness services. The focus of this training is to help service recipients better understand how their body responds to trauma and chronic stress, as well as strategies to help them through those times. Source: Trauma Informed Oregon

Trauma and Trauma Informed Responses

This brief discusses trauma informed responses in the courtroom. Source: National Center for State Courts

Element #4: Policy, Procedure, and Practice Review

Policies and procedures offer a mechanism to sustain TIC, allowing helpful practices to flourish and evolving over time in response to feedback and growing knowledge about the field. Policies and procedures are reviewed through a TI lens with a process that defines how misalignment with TI values is handled. The process will continuously examine “who is at the table” and whose voice and experience is centered. Changes are made in areas within an organization’s locus of control. The limitation of regulatory bodies is recognized and system change is sought.

Trauma Lens Exercise

This table provides examples of reframing challenging behaviors through a trauma lens. The examples in the table are some of the most frequently reported in Trauma Informed Oregon (TIO) trainings and include challenging behaviors from service recipients and staff, as well as challenging environmental features. Source: Trauma Informed Oregon

Guide to Reviewing Existing Policies

This guide helps organizations review a specific policy about service exclusion through a trauma informed lens. Some of the questions in the guide may be helpful as you are developing or reviewing policies. Source: Trauma Informed Oregon

Oregon Health Authority Trauma Policy

This resource is a 2015 Trauma Informed Services Policy for the Oregon Health Authority (OHA), Addictions and Mental Health (AMH). Source: Oregon Health Authority

Example: Trauma Informed Services Policy (Clackamas County Behavioral Health Division)

This agency-wide trauma informed services policy was developed by the Clackamas County Behavioral Health Division (CCBHD). Source: Clackamas County Behavioral Health Division (CCBHD)

Qualities of Supervision

This table was developed during a supervisor’s retreat held by TIO. Participants were asked to brainstorm on the differences between quality supervision and trauma informed supervision. Source: Trauma Informed Oregon

TIC Care Supervision: Questions and Ideas Table

This table includes ideas and questions to help supervisors implement trauma informed care in their supervision practices. Source: Trauma Informed Oregon

Human Resources Practices to Support TIC

This list of strategies from TIO promotes trauma informed care through human resource policies and practices, including hiring, onboarding, supervision and performance reviews. Source: Trauma Informed Oregon

Considerations for Responding to Crisis

This crisis response resource is for agencies providing housing and shelter services to youth. Feel free to use this document in the development of your own agency trauma informed crisis response plan. Source: Trauma Informed Oregon

Helping Teens with Traumatic Grief: Tips for Caregivers

This tip sheet offers ways to recognize and help your teen who may have difficulty coping after a sudden or violent death. Each teen grieves in a unique way so it’s important to understand your teen’s point of view. Source: National Child Traumatic Stress Network (NCTSN)

Homeless Youth Continuum Tragedy Response Plan

The Homeless Youth Continuum created this Tragedy Response Plan as a way to support organizations in the continuum when a tragedy has occurred. This plan can be adapted to fit your organization or specific community. Source: Homeless Youth Continuum, Trauma Informed Oregon

Talking About Trauma and Suicide in Public Meetings

This resource assists in preparing, facilitating and responding in a meeting when sharing personal experiences that may cause distress and trauma, to reflect a trauma informed approach. Source: Trauma Informed Oregon, Oregon Health Authority (OHA)

The Anatomy of a TI Script

This TIP sheet provides tools for making communication trauma informed. The resource maps out the key components that make a script (or set of words) trauma informed, and will help you stay regulated when delivering difficult news or getting hard questions. Source: Trauma Informed Oregon

Responding to Trauma and Tragedy Resource List

This resource list includes: Crisis and Traumatic Events for schools, families and students, adults responding to racism and violence, schools on students and suicide, and how to talk about traumatic events and tragedies. Source: Department of Education

Trauma Specific Services: A Resource for Implementation and Use

This document is intended to serve as a resource to anyone seeking or referring trauma specific services (TSS) and those seeking to implement effective TSS programs, services or activities for individuals or groups. Source: Trauma Informed Oregon

Looking for Trauma Specific Services?

This document is intended to serve as a resource to those seeking trauma specific services (TSS) and those who may be making referrals for TSS. Source: Trauma Informed Oregon

Element #5: Feedback and Quality Assurance

Feedback and quality assurance techniques are used to impact practice. Trauma-informed organizations demonstrate inclusive and effective feedback practices that solicit how staff and service recipients feel and experience the organization. The feedback process is routine, multimodal, and centers those most impacted by the work. The feedback received and plans for practice change are shared. These processes demonstrate knowledge about the impacts of trauma in the organization’s methods, language, how the feedback that is sought, and how the information is used.

Example: Clackamas County Behavioral Health Clinics Adult Consumer Services Survey

This consumer feedback survey includes elements of trauma informed care, developed by Clackamas County Behavioral Health Clinics to help improve services and monitor progress in implementing trauma informed care. Source: Clackamas County Behavioral Health Division (CCBHD)

Respect at Work: Is Your Grievance Process Trauma Informed?

This article discusses how trauma affects the grievance process and characteristics of a trauma informed grievance process using the six principles of trauma informed care. Source: Culture Plus Consulting

Workforce Questions Related to Trauma Informed Care

This list of questionscaptures the experience of the workforce related to the development of a trauma informed organization. Source: Trauma Informed Oregon

Creating Cultures of TIC: A Self-Assessment and Planning Protocol

This assessment tool provides guidelines for agencies or programs interested in facilitating trauma-informed modifications in their service systems. For use by administrators, providers, and survivor-consumers. Source: Community Connections; Washington, D.C. Roger D. Fallot, Ph.D. and Maxine Harris, Ph.D.

TI System Change Instrument: Organizational Change Self-Evaluation – The Current System

This organizational assessment was created for child welfare agencies to track system change at a service provider level, at an agency level, and at the county system level. Source: Southwest Michigan Children’s Trauma Assessment Center

TI System Change Instrument Scoring Guide and Psychometrics: Organizational TI Change

This tool provides psychometric information and the scoring protocol for child welfare agencies using the Trauma Informed System Change Instrument: Organizational change Self-Evaluation. Source: Southwest Michigan Children’s Trauma Assessment Center

Trauma Informed Organizational Assessments

This spreadsheet list different tools to utilize for organizational assessments. Source: Greater Richmond Trauma-Informed Community Network

Trauma-Informed Care Outcome Study

This study within a residential addiction treatment agency aims to operationalize the processes an agency can take to become trauma informed, and assess the impact of a multiyear TIC implementation project. Source: Travis W. Hales, Susan A. Green, Suzanne Bissonette, Alyssa Warden, Josal Diebold, Samantha P. Koury, and Thomas H. Nochajski

The Humans Services Implementation Lab (I-Lab)

The Humans Services Implementation Lab (I-Lab) at PSU’s Regional Research Institute serves the organizations who design promising and evidence-based practices (EBPs) as well as the organizations who use them. Source: Human Services Implementation Lab

TIO Trauma-Informed Care (TIC) Implementation Assessment Tool: Self-Assessment Considerations

This tip sheet offers factors, reflections, and considerations for organizations determining whether or not they should conduct a self-assessment using the TIC Implementation Tool. An example is included in this tip sheet. Source: Trauma Informed Oregon