The National Center for PTSD estimates that over 12 million Americans struggle with trauma. Trauma-informed care is an organizational approach and process that requires leadership, staff, procedures, and protocols to recognize the impact trauma has on individuals and communities [1].
The four foundational pillars (“4 Rs”) that help guide trauma-informed care are: realize, recognize, respond, and resist retraumatization. Their goal is to reduce the emotional impact of trauma, increase patient engagement, and improve treatment outcomes.
What is Trauma-Informed Care?
Trauma-Informed Care (TIC) is a foundational change in organizational processes requiring individuals, protocols, and leadership to operate with an awareness of trauma. This means recognizing how someone’s unique experiences with trauma can shape their behaviors, mental health, and social interactions.
According to the Institute on Trauma-Informed Care, for an organization to be trauma-informed, all levels from patient-facing staff to leadership must actively commit to maintaining a basic understanding of trauma [2].
What Is Trauma and Who is Affected?
According to the American Psychological Association, trauma is defined as “an emotional response to a terrible event like an accident, crime, natural disaster, physical or emotional abuse, neglect, experiencing or witnessing violence, death of a loved one, war, and more [3].”
Feelings such as shock, denial, and anxiety are common after experiencing trauma, but long-term effects can lead to a decline in emotional well-being and quality of life, affecting both individuals and communities.
On a personal level, trauma can increase the risk of mental health issues such as anxiety, depression, chronic pain, addiction, self-harm, and suicide. For communities, trauma can increase violence, economic hardships, and weaken social systems [4].
People who have suffered from trauma often feel afraid, powerless, and struggle to put their trust in either individuals or social systems. TIC aims to reduce this by implementing structural and organizational changes in sectors such as education, healthcare, and social work.
The 4Rs of Trauma-Informed Approaches
Variations of the 4Rs were first proposed as part of an early care concept by Maxine Harris and Roger Fallot in 2001, when they developed foundational trauma care principles. Today, SAMHSA officially recognizes the 4 Rs as “foundational assumptions of trauma-informed care” to develop environments that support healing for people affected by trauma [5].
The 4Rs of trauma-informed approaches, as laid out by SAMHSA, include [5]:
- Realize: Realize the widespread impact of trauma and understand potential paths for recovery.
- Recognize: Recognize the signs and symptoms of trauma in clients, families, staff, and others involved with the system.
- Respond: Respond by fully integrating knowledge about trauma into policies, procedures, and practices.
- Resist Retraumatization: Resist re-traumatization of patients, children, and the adults who care for them.
How Are They Different Than The Principles of Trauma-Informed Care?
SAMHSA’s framework incorporates the 4 Rs alongside core principles of TIC. Basically, the 4 Rs guide awareness and organizational responses to trauma, while the principles describe the values and practices of implementing TIC into patient care [6].
The six principles of trauma-informed care include:
- Safety
- Trust and Transparency
- Voice and Choice
- Empowerment
- Collaboration
- Cultural Awareness
Trauma-Informed Care Training and Why It’s Important
TIC training is not the same as being a trauma therapist or providing trauma therapy. Non-clinical staff, such as social workers, recovery specialists, peer support partners, and wellness professionals like yoga teachers, massage therapists, and Reiki practitioners, can all receive training in trauma-informed care if they choose.
There is no standard degree for being trauma-informed, but certifications often involve several courses focused on what trauma is, how it affects the brain, body, and behavior, and effective strategies to implement at both leadership and non-leadership levels.
Organizations, treatment centers, hospitals, and programs that invest in trauma-informed care should have:
- Investment from leadership
- Ongoing education and training for trauma-sensitive patient care
- Mental health support for staff and workforce wellness programs
- Input from the workforce, patients, and even the local community on leadership decisions
- A focus on creating safe environments that reduce symptoms of trauma
- An oversight committee to regularly review policies, procedures, and protocols to make sure they are up to date and truly effective
End The Cycle of Suffering and Heal from Trauma at Maple Mountain
Our staff and leadership understand the powerful impact trauma can have on the lives of the patients we serve. At Maple Mountain Mental Health and Wellness, we are committed to following the principles of trauma-informed care to address the physical, mental, and spiritual needs of our clients.
Our PTSD and complex trauma inpatient treatment combines evidence-based therapies, including EMDR, Accelerated Resolution Therapy, and Somatic Experience, with integrated wellness activities such as ceramics, painting, dance, and trauma-informed yoga.
We work with you to address the individual and collective impacts of trauma to achieve lasting emotional growth and well-being. Contact our admissions team today to regain control and begin your healing journey.
Sources
[1] National Center for PTSD. 2025. How Common Is PTSD in Adults?
[2] Koury, S. et al. (2022). Trauma-informed organizational change manual. The Institute on Trauma and Trauma-Informed Care.
[3] APA. 2025. Trauma.
[4] Center for Substance Abuse Treatment (US). Trauma-Informed Care. Treatment Improvement Protocol (TIP) Series, No. 57.
[5] University of Portland. 2024. Trauma-Informed Educational Practice: The Four Rs of Trauma-Informed Care.
[6] CDC. 2022. 6 Guiding Principles to a Trauma-Informed Approach Infographic.