Trauma-Informed Care Part 1: Becoming Trauma-Informed (Video 2)

This online module is intended for physicians and other health care professionals.

Author:

Laneita Williamson, RN, BSN
Trauma Informed Care Manager
Atrium Health, Wake Forest Baptist
Winston Salem, NC

Planners:

Candice McNeil, MD
Associate Professor, Infectious Diseases
Wake Forest School of Medicine
Winston-Salem, NC

Aiesha Gentry, BA
Program Manager, Department of Medicine,
Div. of Infectious Diseases
University of Alabama at Birmingham
Birmingham, AL

Disclosures:

The planners have no financial relationships related to the content of this activity to disclose.

Dr. McNeil discloses grants/research support from BD, Cepheid, GSK/BARDA, Gilead, and Lupin.  She also discloses receipt of honoraria from IDSA, Contraceptive Technology, Core Concepts in Health, and AHEC.

All of the relevant financial relationships listed for Dr. McNeil have been mitigated.

There is no commercial support for this activity.

Because of the nature of preliminary studies, some products mentioned are unlabeled and investigational. Dosages, indications, and methods of use of drugs mentioned in this publication may reflect the experience of the authors, clinical literature, or other resources. Therefore, please see the full prescribing information before using any licensed product mentioned.

Learning Objectives:

Upon completion of this CME activity, participants should be able to:

• Define Trauma-Informed Care (TIC)
• Illustrate how adult health is impacted due to adverse childhood experiences
• Review the impact of trauma on behaviors and poor health outcomes due to biological changes
• Review the organizational approach to Trauma-Informed Care

References:

1. Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics. 2003 Mar;111(3):564-72. doi: 10.1542/peds.111.3.564. PMID: 12612237.
2. Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. Cumulative childhood stress and autoimmune diseases in adults. Psychosom Med. 2009 Feb;71(2):243-50. doi: 0.1097/PSY.0b013e3181907888. Epub 2009 Feb 2. PMID: 19188532; PMCID: PMC3318917.
3. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. REPRINT OF: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 2019 Jun;56(6):774-786. doi: 10.1016/j.amepre.2019.04.001. PMID: 31104722.
4. Brown DW, Anda RF, Tiemeier H, Felitti VJ, Edwards VJ, Croft JB, Giles WH. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med. 2009 Nov;37(5):389-96. doi: 10.1016/j.amepre.2009.06.021. PMID: 19840693.
5. Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord. 2004 Oct 15;82(2):217-25. doi: 10.1016/j.jad.2003.12.013. PMID: 15488250.
6. Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, Dube SR, Giles WH. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):174-86. doi:10.1007/s00406-005-0624-4. Epub 2005 Nov 29. PMID: 16311898; PMCID: PMC3232061.
7. Felitti VJ. Origins of the ACE Study. Am J Prev Med. 2019 Jun;56(6):787-789. doi: 10.1016/j.amepre.2019.02.011. PMID: 31104723.
8. Felitti VJ. Adverse childhood experiences and adult health. Acad Pediatr. 2009 May-Jun;9(3):131-2. doi: 10.1016/j.acap.2009.03.001. Epub 2009 Apr 9. PMID: 19450768.
9. Felitti VJ, Jakstis K, Pepper V, Ray A. Obesity: problem, solution, or both? Perm J. 2010 Spring;14(1):24-30. doi: 10.7812/TPP/10.996. PMID: 20740128; PMCID: PMC2912711.
10. Whitfield CL, Dube SR, Felitti VJ, Anda RF. Adverse childhood experiences and hallucinations. Child Abuse Negl. 2005 Jul;29(7):797-810. doi: 10.1016/j.chiabu.2005.01.004. PMID: 16051353.
11. Edwards VJ, Dube SR, Felitti VJ, Anda RF. It's ok to ask about past abuse. Am Psychol. 2007 May-Jun;62(4):327-8; discussion 330-2. doi: 10.1037/0003-066X62.4.327. PMID: 17516786.
12. Felitti VJ. Health Appraisal and the Adverse Childhood Experiences Study: National Implications for Health Care, Cost, and Utilization. Perm J. 2019;23:18-026. doi: 10.7812/TPP/18-026. PMID: 30624193; PMCID: PMC6326558.
13. Anda R, Tietjen G, Schulman E, Felitti V, Croft J. Adverse childhood experiences and frequent headaches in adults. Headache. 2010 Oct;50(9):1473-81. doi: 10.1111/j.1526-4610.2010.01756.x. PMID: 20958295.
14. Brown DW, Anda RF, Edwards VJ, Felitti VJ, Dube SR, Giles WH. Adverse childhood experiences and childhood autobiographical memory disturbance. Child Abuse Negl. 2007 Sep;31(9):961-9. doi: 10.1016/j.chiabu.2007.02.011. Epub 2007 Sep 14. PMID: 17868865.
15. Van Niel C, Pachter LM, Wade R Jr, Felitti VJ, Stein MT. Adverse events in children: predictors of adult physical and mental conditions. J Dev Behav Pediatr. 2014 Oct;35(8):549-51. doi: 10.1097/DBP.0000000000000102. Erratum in: J Dev Behav Pediatr. 2014 Nov-Dec;35(9):581. PMID: 25225793.
16. Anda RF, Brown DW, Felitti VJ, Bremner JD, Dube SR, Giles WH. Adverse childhood experiences and prescribed psychotropic medications in adults. Am J Prev Med. 2007 May;32(5):389-94. doi: 10.1016/j.amepre.2007.01.005. PMID: 17478264; PMCID: PMC3233770.
17. Anda RF, Butchart A, Felitti VJ, Brown DW. Building a framework for global surveillance of the public health implications of adverse childhood experiences. Am J Prev Med. 2010 Jul;39(1):93-8. doi: 10.1016/j.amepre.2010.03.015. PMID: 20547282.
18. Anda RF, Brown DW, Dube SR, Bremner JD, Felitti VJ, Giles WH. Adverse childhood experiences and chronic obstructive pulmonary disease in adults. Am J Prev Med. 2008 May;34(5):396-403. doi: 10.1016/j.amepre.2008.02.002. PMID: 18407006; PMCID: PMC8214869.
19. Anda RF, Dong M, Brown DW, Felitti VJ, Giles WH, Perry GS, Valerie EJ, Dube SR. The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health. 2009 Apr 16;9:106. doi: 10.1186/1471-2458-9-106. PMID: 19371414; PMCID: PMC2674602.
20. Dube SR, Anda RF, Whitfield CL, Brown DW, Felitti VJ, Dong M, Giles WH. Long-term consequences of childhood sexual abuse by gender of victim. Am J Prev Med. 2005 Jun;28(5):430-8. doi: 10.1016/j.amepre.2005.01.015. PMID: 15894146.
21. Dube SR, Miller JW, Brown DW, Giles WH, Felitti VJ, Dong M, Anda RF. Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. J Adolesc Health. 2006 Apr;38(4):444.e1-10. doi: 10.1016/j.jadohealth.2005.06.006. PMID: 16549308.
22. Anda RF, Fleisher VI, Felitti VJ, Edwards VJ, Whitfield CL, Dube SR, Williamson DF. Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance. Perm J. 2004 Winter;8(1):30-8. doi: 10.7812/TPP/03-089. PMID: 26704603; PMCID: PMC4690705.
23. Dong M, Anda RF, Felitti VJ, Dube SR, Williamson DF, Thompson TJ, Loo CM, Giles WH. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse Negl. 2004 Jul;28(7):771-84. doi: 10.1016/j.chiabu.2004.01.008. PMID: 15261471.
24. Brown DW, Anda RF, Felitti VJ, Edwards VJ, Malarcher AM, Croft JB, Giles WH. Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study. BMC Public Health. 2010 Jan 19;10:20. doi: 10.1186/1471-2458-10-20. Erratum in: BMC Public Health. 2010;10:311. PMID:20085623; PMCID: PMC2826284.
25. Anda RF, Chapman DP, Felitti VJ, Edwards V, Williamson DF, Croft JB, Giles WH. Adverse childhood experiences and risk of paternity in teen pregnancy. Obstet Gynecol. 2002 Jul;100(1):37-45. doi: 10.1016/s0029-7844(02)02063-x. PMID: 12100801
26. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Supplemental Report 2021;26(No. 1). http://www.cdc.gov/ hiv/library/reports/hiv-surveillance.html. Published May 2021. Accessed June2023.
27. Centers for Disease Control and Prevention (CDC). (2019, October 2). TOOLKIT FOR PROVIDING HIV PREVENTION SERVICES TO TRANSGENDER WOMEN OF COLOR. Atlanta; Centers for Disease Control and Prevention (CDC).
28. Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, Anda RF. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004 Sep 28;110(13):1761-6. doi: 10.1161/01.CIR.0000143074.54995.7F. Epub 2004 Sep 20. PMID: 15381652.
29. Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. Adverse childhood experiences and personal alcohol abuse as an adult. Addict Behav. 2002 Sep-Oct;27(5):713-25. doi: 10.1016/s0306-4603(01)00204-0. PMID: 12201379.
30. Edwards VJ, Anda RF, Gu D, Dube SR, Felitti VJ. Adverse childhood experiences and smoking persistence in adults with smoking-related symptoms and illness. Perm J. 2007 Spring;11(2):5-13. doi: 10.7812/TPP/06-110. PMID: 21461087; PMCID: PMC3057738.
31. Anda RF, Whitfield CL, Felitti VJ, Chapman D, Edwards VJ, Dube SR, Williamson DF. Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatr Serv. 2002 Aug;53(8):1001-9. doi: 10.1176/appi.ps.53.8.1001. PMID: 12161676.
32. Dong M, Anda RF, Dube SR, Giles WH, Felitti VJ. The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse Negl. 2003 Jun;27(6):625-39. doi: 10.1016/s0145-2134(03)00105-4. PMID: 12818611.
33. Brown DW, Young KE, Anda RF, Felitti VJ, Giles WH. Re: asthma and the risk of lung cancer. findings from the Adverse Childhood Experiences (ACE). Cancer Causes Control. 2006 Apr;17(3):349-50. doi: 10.1007/s10552-005-0420-5. PMID: 16489542.
34. Dong M, Dube SR, Felitti VJ, Giles WH, Anda RF. Adverse childhood experiences and self-reported liver disease: new insights into the causal pathway. Arch Intern Med. 2003 Sep 8;163(16):1949-56. doi:10.1001/archinte.163.16.1949. PMID: 12963569.
35. Felitti VJ. The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. Perm J. 2002 Winter;6(1):44-47. doi: 10.7812/TPP/02.994. PMID: 30313011; PMCID: PMC6220625.
36. Felitti VJ. Ursprünge des Suchtverhaltens: Evidenzen aus einer Studie zu belastenden Kindheitserfahrungen [Origins of addictive behavior: evidence from a study of stressful chilhood experiences]. Prax Kinderpsychol Kinderpsychiatr. 2003 Oct;52(8):547-59. German. PMID: 14619682.
37. Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004 Feb;113(2):320-7. doi: 10.1542/peds.113.2.320. PMID: 14754944.
38. Felitti VJ. Belastungen in der Kindheit und Gesundheit im Erwachsenenalter: die Verwandlung von Gold in Blei [The relationship of adverse childhood experiences to adult health: Turning gold into lead]. Z Psychosom Med Psychother. 2002;48(4):359-69. German. doi: 10.13109/zptm.2002.48.4.359. PMID:12407494.
39. Dong M, Anda RF, Felitti VJ, Williamson DF, Dube SR, Brown DW, Giles WH. Childhood residential mobility and multiple health risks during adolescence and adulthood: the hidden role of adverse childhood experiences. Arch Pediatr Adolesc Med. 2005 Dec;159(12):1104-10. doi: 10.1001/archpedi.159.12.1104. PMID: 16330731.
40. Dube SR, Anda RF, Felitti VJ, Edwards VJ, Williamson DF. Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services. Violence Vict. 2002 Feb;17(1):3-17. doi: 10.1891/vivi.17.1.3.33635. PMID: 11991154.
41. Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. 2003 Aug;160(8):1453-60. doi: 10.1176/appi.ajp.160.8.1453. PMID:12900308.
42. Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Prev Med. 2003 Sep;37(3):268-77. doi: 10.1016/s0091-7435(03)00123-3. PMID: 12914833.
43. https://www.samhsa.gov/trauma-violence#:~:text=What%20is%20Trauma%3F,and%2For%20life%2Dthreatening%20harm
44. https://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html
45. https://www.cdc.gov/violenceprevention/aces/index.html
46. Felitti VJ & Anda RF & Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. Am J Prev Med. 1998; 14: 245-258 https://doi.org/10.1016/S0749-3797(98)00017-8
47. Felitti VJ & Jakstis K & Pepper V & Ray A. Obesity: problem, solution, or both?. Perm J. 2010; 14: 24-30 https://doi.org/10.7812/TPP/09-107
48. Centers for Disease Control and Prevention (CDC), Violence Prevention. About behavioral risk factor surveillance system ACE data https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/ace-brfss.html. Updated 2016. Accessed March 15, 2019.
49. Toxic Stress Derails Healthy Development (harvard.edu)
50. https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects
51. https://www.cdc.gov/vitalsigns/aces/index.html#:~:text=ACEs%20can%20include%20violence%2C%20abuse,and%20substance%20misuse%20in%20adulthood
52. Childhood Maltreatment and Psychopathology: A Case for Ecophenotypic Variants as Clinically and Neurobiologically Distinct Subtypes
53. Martin H. Teicher, M.D., Ph.D., and Jacqueline A. Samson, Ph.D. Published Online:1 Oct 2013
    https://doi.org/10.1176/appi.ajp.2013.12070957
54. Child Welfare Information Gateway. (2015). Understanding the effects of maltreatment on brain development. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. https://www.childwelfare.gov/pubpdfs/brain_development.pdf
55. Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH. Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. J Neuropsychiatry Clin Neurosci. 2008 Summer;20(3):292-301. doi: 10.1176/jnp.2008.20.3.292. PMID: 18806232; PMCID: PMC4270804
    https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.2008.20.3.292
56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968319/
57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232061/
58. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/ace-graphics.html
59. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experience Study (ACE Study). American Journal of Preventative Medicine 1998; 14:245-258.
60. https://www.cdc.gov/violenceprevention/aces/resources.html
61. Felitti VJ. The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. Perm J. 2002 Winter;6(1):44-47. doi: 10.7812/TPP/02.994. PMID: 30313011; PMCID: PMC6220625
62. Rich-Edwards JW, Spiegelman D, Lividoti Hibert EN, Jun HJ, Todd TJ, Kawachi I, Wright RJ. Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. Am J Prev Med. 2010 Dec;39(6):529-36. doi: 10.1016/j.amepre.2010.09.007. PMID: 21084073; PMCID: PMC3003936.
63. Geracioti TD Jr, Carpenter LL, Owens MJ, Baker DG, Ekhator NN, Horn PS, Strawn JR, Sanacora G, Kinkead B, Price LH, Nemeroff CB. Elevated cerebrospinal fluid substance p concentrations in posttraumatic stress disorder and major depression. Am J Psychiatry. 2006 Apr;163(4):637-43. doi: 10.1176/ajp.2006.163.4.637. PMID: 16585438.
64. Prangnell, Pauline Voon, Hennady Shulha, Ekaterina Nosova, Jean Shoveller, M.-J. Milloy, Thomas Kerr, Kanna Hayashi, The relationship between childhood emotional abuse and chronic pain among people who inject drugs in Vancouver, Canada, Child Abuse & Neglect, Volume 93, 2019, Pages 119-127, ISSN 0145-2134, https://doi.org/10.1016/j.chiabu.2019.05.006.
65. https://www.sciencedirect.com/science/article/pii/S0145213419301681
66. https://www.ncbi.nlm.nih.gov/books/NBK554583/
67. FN1 Felitti, Vincent J. , MD, “The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study,
68. English version of the article published in Germany as: Felitti VJ, “Ursprünge des Suchtverhaltens – Evidenzen aus einer Studie zu belastenden Kindheitserfahrungen,” Praxis der Kinderpsychologie und Kinderpsychiatrie, 2003; 52:547-559. http://attachmentdisorderhealing.com/resources/key-articles/
69. Felitti VJ. The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. Perm J. 2002 Winter;6(1):44-47. doi: 10.7812/TPP/02.994. PMID: 30313011; PMCID: PMC6220625
70. Ports KA, Ford DC, Merrick MT. Adverse childhood experiences and sexual victimization in adulthood. Child Abuse Negl. 2016 Jan;51:313-22. doi: 10.1016/j.chiabu.2015.08.017. Epub 2015 Sep 19. PMID: 26386753; PMCID: PMC4713310.
71. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine. 1998;14(4):245–58
72. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine. 1998;14(4):245–58
73. https://www.tfc.bm/wp-content/uploads/2019/08/The-Economics-of-ACEs-Conference-Bermuda-2019-The-Repressed-Role-of-Adverse-Childhood-Experiences-in-Adult-Well-being-Disease-and-Social-Function-by-Dr.-Vincent-Felitti.pdf
74. Felitti VJ. The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. Perm J. 2002 Winter;6(1):44-47. doi: 10.7812/TPP/02.994. PMID: 30313011; PMCID: PMC6220625
75. https://www.cdc.gov/violenceprevention/aces/about.html
76. Kanherkar RR, Bhatia-Dey N, Csoka AB. Epigenetics across the human lifespan. Front Cell Dev Biol. 2014 Sep 9;2:49. doi: 10.3389/fcell.2014.00049. PMID: 25364756; PMCID: PMC4207041
77. https://www.pacesconnection.com/blog/3-realms-of-aces-updated
78. Perroud N, Paoloni-Giacobino A, Prada P, Olié E, Salzmann A, Nicastro R, Guillaume S, Mouthon D, Stouder C, Dieben K, Huguelet P, Courtet P, Malafosse A. Increased methylation of glucocorticoid receptor gene (NR3C1) in adults with a history of childhood maltreatment: a link with the severity and type of trauma. Transl Psychiatry. 2011 Dec 13;1(12):e59. doi: 10.1038/tp.2011.60. PMID: 22832351; PMCID: PMC3309499.
79. Nguyen JK, Thurston RC. Association of Childhood Trauma Exposure with Inflammatory Biomarkers Among Midlife Women. J Womens Health (Larchmt). 2020 Dec;29(12):1540-1546. doi: 10.1089/jwh.2019.7779. Epub 2020 May 4. PMID: 32364816; PMCID: PMC7757571
80. Trauma-informed approaches toolkit. NASTAD. (2022, December). https://nastad.org/trauma-informed-approaches-toolkit
81. Craig F, Mascheroni E, Giorda R, Felline MG, Bacco MG, Castagna A, Tenuta F, Villa M, Costabile A, Trabacca A, Montirosso R. Exploring the Contribution of Proximal Family Risk Factors on SLC6A4 DNA Methylation in Children with a History of Maltreatment: A Preliminary Study. Int J Environ Res Public Health. 2021 Dec 2;18(23):12736. doi: 10.3390/ijerph182312736. PMID: 34886461; PMCID: PMC8657512.
82. Kageyama K, Iwasaki Y, Daimon M. Hypothalamic Regulation of Corticotropin-Releasing Factor under Stress and Stress Resilience. Int J Mol Sci. 2021 Nov 12;22(22):12242. doi: 10.3390/ijms222212242. PMID: 34830130; PMCID: PMC8621508.
83. https://www.jupiterflchiropractors.com/our-services/functional-medicine/the-hpa-axis
84. Veldhuis JD, et al. Endocrinol Metab Clin North Am. 2013 Jun;42(2):201-25.
85. Seeman TE, et al. Psychoneuroendocrinology. 2001;26(3):225
86. https://pin.it/3sjHAI
87. https://www.pinterest.com/pin/645633296574495178/
88. https://healthandlearning.org/wp-content/uploads/2017/11/Historical-Trauma-SAMHSAs-Gains-Center.pdf
89. Guillette, , L., & Iguchi, T. (2012, September 28). Life in a Contaminated World Exposure to pesticides and other chemicals can have complex long-term health effects. Science, 337(6102), 1614–1615.
90. https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884
91. SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach788.65 KB
92. http://www.spectrumes.org/2016/06/using-halt-strategy.html
93. https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm
94. Racine N, Killam T, Madigan S. Trauma-Informed Care as a Universal Precaution: Beyond the Adverse Childhood Experiences Questionnaire. JAMA Pediatr. 2020;174(1):5–6. doi:10.1001/jamapediatrics.2019.3866
95. https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/
96. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf
97. https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4958.pdf
98. https://usq.pressbooks.pub/traumainformedpractice/chapter/3-6-using-the-window-of-tolerance-in-the-school-context/
99. https://acestoohigh.com/got-your-ace-score/
100. https://dana.org/article/wounds-that-time-wont-heal/
101. Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, Dube SR, Giles WH. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):174-86. doi: 10.1007/s00406-005-0624-4. Epub 2005 Nov 29. PMID: 16311898; PMCID: PMC3232061.
102. LeGrand S, Reif S, Sullivan K, Murray K, Barlow ML, Whetten K. A Review of Recent Literature on Trauma Among Individuals Living with HIV. Curr HIV/AIDS Rep. 2015 Dec;12(4):397-405. doi: 10.1007/s11904-015-0288-2. PMID: 26419376; PMCID: PMC4837695.
103. The toolkit was developed by Sentient Research (www.sentientresearch.net) under a contract from CDC Contract #75D30118C01854. Sentient Research staff led all project activities and enlisted assistance from the consultants and contractors named below
104. HIV essentials. HIV Essentials Training, Coldspring Center. (n.d.). https://www.coldspringcenter.org/training/HIVEssentials.aspx
105. Sales, J. M., Swartzendruber, A., & Phillips, A. L. (2016). Trauma-informed HIV prevention and treatment. Current HIV/AIDS Reports, 13(6), 374–382. https://doi.org/10.1007/s11904-016-0337-5