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The Role of Policies and Some of the Considerations Around Them in Trauma-Informed Care

From Mandy Davis, LCSW, PhD, Director, Trauma Informed Oregon

The following is adapted from a chapter co-authored with Dr. Karen Treisman and me for a forthcoming book: Davis, M., & Treisman, K. (in press, 2026). Navigating the journey to trauma-informed organizational change: 40 real-world questions, dilemmas and strategies. Jessica Kingsley Publishers. The information has been abbreviated and adapted to meet TIO-specific audiences and does not represent the entire chapter’s work.

The Role of Policies in Trauma-Informed Care

“You can’t policy away your problems,” and “you can’t policy in a trauma-informed approach.” So, what then is the role of policy when implementing trauma-informed care and practices? We believe policies are essential components of a comprehensive trauma-informed approach. We also acknowledge that policies, like most components, are not successful on their own. Education, skills, feedback loops, accountability, practices, and commitments must accompany policies. Policies play an important role in organizations. In a trauma-informed organization, we want policies to embed and implement the values and principles of trauma-informed care. It feels important to acknowledge that policy styles will vary, so rather than offering a prescriptive way of carrying out or reviewing policies, we offer some helpful ideas and considerations.

Before we delve in let’s take a moment to reflect.

• Take a moment to notice how many policies in your organization you can name. Some of you will have many – especially if you are a governmental agency – and some, including newly formed organizations, may have very few.
• Do you have a large binder of policies and procedures?
• When was the last time you looked at this binder? How up to date is it?
• Have you had the experience of hearing about a policy you never knew existed?
• How aligned with real-world practice are the policies?

We rarely make time to monitor, update, change and review policies. However, not attending to policies can cause harm.

Purpose of Policies

Policies, in general, provide guidelines and expectations for decision-making (hiring processes, eligibility, promotions) and for behavior (expected work hours, time off, the number of services to offer, etc.). Policies that impact trauma-informed care are found at multiple levels, including the organizational, local or community, and state or federal levels. Often, policies influence, intersect with, complement, or conflict across these levels. Some examples may be:

• An organization has a policy to practice harm reduction in response to substance use but the local judiciary has a policy of incarceration and mandated treatment.
• Policies to hire people with lived experiences are in contrast to policies that respond to a staff member who has a relapse.
• Eligibility for a service is changed based on newly elected politicians.
• A change to an insurance policy regarding pre-existing conditions conflicts with an organization’s policy to serve all who come.
• Behavioral response policies (e.g. restraints, zero tolerance, exclusion, suspension, etc.) are not focused on connection before correction, co-regulation, and de-escalation, etc.

It is important to note that many policies that impact these areas are bound by the law: for example, mandatory reporting for child abuse, dual relationships with a patient, confidentiality, employee records, etc.

Policies are intended to ensure predictable and consistent care and often focus on the following three areas:

• Administrative areas (governance, budgets, facilities, benefits, data protection)
• Workforce areas (hiring, leave, supervision, complaints, conduct, advancement)
• Service delivery (eligibility, length/type of service, equity, cultural responsiveness)

Policies are helpful in trauma-informed efforts to sustain the work beyond a person or moment in time. For instance, an organization may have a person who is passionate about trauma-informed care and regularly trains staff, but when they leave the agency, the training stops. If there were a policy requiring all staff to receive foundational trauma-informed care education, the agency would be held accountable for providing the training.

There are three general policy categories where a trauma-informed lens is essential:

1. Creating policies that are specific to implementing and sustaining trauma-informed care. Examples include a policy to fund a position to champion the work; a commitment to being a trauma-informed organization; trauma-informed education in new staff training; trauma-informed supervision; physical space annual reviews, etc.
2. Editing or sunsetting policies that are not trauma-informed and cause harm, othering, or systemic trauma. For example, a policy that requires all students to be asked about their Adverse Childhood Experiences would be deleted completely or altered to reduce trauma by making it clinically sound rather than mandated. Another example includes changing a policy of using person-administered body searches for those incarcerated to using scanners instead.
3. Creating new policies that are not directly related to trauma-informed implementation work but are absolutely trauma-informed or need a trauma-informed lens. For example, many people found hybrid work beneficial during COVID. An organization may opt to make hybrid work a policy, or make sure parental leave is inclusive for all, or support culturally relevant and inclusive healthcare benefits.

Reviewing Policies

A trauma-informed organization needs to have a way to routinely review policies and procedures through a trauma-informed lens. Though this is essential, it is a new practice. Two decisions have to be made: 1) how to determine if a policy is trauma-informed, and 2) administratively, how to implement the policy review.

The most thorough way to determine whether something is trauma-informed is to assess it against the principles and values of trauma-informed care. Ask: Does this policy impact psychological safety, physical safety, transparency, voice and choice, cultural responsiveness, etc.? It is important to assess this for those served and the workforce. The “4Rs” could also be used to determine whether a policy is trauma-informed: Does it Recognize, Respond to, Resist, and Reduce trauma? Or elements of both could be combined.

Reviewing policies spanning years can feel overwhelming. Many organizations have existing policy teams, committees, or positions committed to policy development, implementation and review. Utilizing these existing entities can be quite helpful. We also don’t recommend attempting to review all policies at once. Instead, maybe have a protocol for reviewing all new policies and then review existing ones on a schedule – like conducting yearly reviews based on when the policy was adopted; reviewing 3 policies per quarter, starting with the eldest; or starting with a particular program. Just make sure to decide on a process that is doable and sustainable.

The following are considerations when developing a review process:

• It must not be burdensome and take too long. If a review of a policy takes months, this process will likely be abandoned.
• Those involved in the review process need to know enough about trauma and trauma-informed care to be effective.
• Consider who is involved in the process – is it an existing department, a new trauma-informed focus team, or a person? Do they have enough authority to make recommendations?

See this resource from Trauma Informed Oregon:

Trauma Informed Care Review Board: Policies and Procedures

Developing and Implementing Policies

If an organization has been started and built, from the beginning, with trauma-informed values and principles centered, then all policies will have hopefully been created, written, and shared in trauma-informed ways. That is not the experience for most organizations. Instead, we are rebuilding, adapting, destroying, and restructuring our policies and procedures to align with trauma-informed practices. Here are some considerations for writing and creating new policies:

• Language matters. Be mindful of the harm and hurt that can happen with the words used in a policy, and how the language we choose can include or exclude people from supports and services.
• Policies need to be consistent but also flexible and adaptable. In trauma-informed organizations, we value predictability and consistency because they support equity and trust. Sometimes, depending on the context, they are a compass rather than a script. However, we also recognize that we are human, and sometimes a policy may not fully fit or feel adequate for a particular situation. We need policies that build in both agency and flexibility whilst allowing staff to use professional judgment and compassion, and to uphold fairness and accountability.
• How can policies be more interactive and alive, so that they are felt as helpful and guiding, and a part of the fabric of the organization? Policies might also be displayed or communicated in different formats, such as an infographic, a video, an animation, with images etc.
• Can those accessing an organization’s services comment on policies or interact with them in a creative way?

Trauma-informed care is a movement that advocates for policies promoting the health and wellness of all individuals. There are many ways to engage in policy work, and being mindful of your sphere of influence can help you stay energized especially since this work requires long-term commitment. You may find that you have more agency in shaping local or organizational policies, or you might choose to join campaigns focused on broader governmental initiatives. You could also be in a position to educate policymakers about trauma and trauma-informed care. This educational role is both critical and powerful, and many trauma-informed champions find it to be a deeply meaningful way to contribute.

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