Trauma-Informed Care Toolkit for Title X Agencies
Welcome to the Toolkit
Title X agencies are expected to provide quality family planning services that are client-centered, culturally and linguistically appropriate, inclusive, and trauma-informed. A trauma-informed agency: understands the wide-spread impact of trauma and potential paths for healing; recognizes signs and symptoms of trauma in staff, clients, family, and others involved with the system of care; responds by integrating knowledge about trauma into policies, procedures, and practices; and actively resists re-traumatization. A trauma-informed organization addresses trauma not only for clients, but also for staff; when staff feel physically and psychologically safe, they are better able to deliver high-quality and trauma-informed family planning care to clients.
This toolkit was developed to guide family planning agencies in making achievable strides toward becoming trauma-informed and delivering trauma-informed services.
Building a trauma-informed culture at your family planning agency is an ongoing process. There is no single way to initiate or implement trauma-informed practices. There is also no expectation that an agency will accomplish every item in this toolkit.
The sections of this toolkit align with the Substance Abuse and Mental Health Services Administration’s (SAMHSA) ten implementation domains for trauma-informed care. Each section includes action steps and supportive resources.
Begin by assessing your organization's trauma-informed approaches, using the assessment below. Then, use the resources in this toolkit in any order, depending on your organization’s needs and priorities. Consider taking action steps in just one or two domains to start.
- Choose a domain with action steps that feel doable in your agency’s current context; OR
- Choose a domain in which you marked most of the assessment items as “just getting started.”
Once you have selected a domain, explore the action steps and resources that resonate most with your current organizational priorities.
The sections of this toolkit include:
- Organizational Assessment: Assess organizational trauma-informed approaches
- Governance and Leadership: Create an organizational culture that supports trauma-informed and equitable care
- Policy: Develop policies and procedures that support an organization-wide trauma-informed approach
- Physical Environment: Create a responsive environment
- Engagement and Involvement: Engage and involve people receiving services and people with lived experience
- Cross-Sector Collaboration: Collaborate with community organizations and referral partners that provide client-centered services
- Screening, Assessment, and Treatment Services: Ensure that counseling and clinical services are trauma-informed
- Training and Workforce Development: Provide ongoing training and comprehensive support for all staff to provide trauma-informed services
- Progress Monitoring and Quality Improvement; and Evaluation: Monitor and evaluate progress and conduct quality improvement processes focused on trauma-informed care (Note: This section aligns with two SAMHSA domains)
- Financing: Ensure that efforts to implement principles of a trauma-informed approach are adequately financed
No matter where your agency is on the trauma-informed care continuum, this toolkit offers implementation strategies for improving trauma-informed practices. If your organization is new to trauma-informed care, consider pausing here to watch the Providing Trauma-Informed Care in Family Planning Clinics Webinar.
The first step in understanding your agency’s place on the trauma-informed continuum is to conduct a systematic review of your agency’s practices. Use assessment results to determine which domains to address, and then skip to the relevant sections.
Review Title X expectations.
Review clinical practice guidelines and recommendations for trauma-informed care from respected national sources, such as Caring for Patients Who Have Experienced Trauma (ACOG).
Title X Program Handbook (pp. 11, 18, 25, 52, 54, and 56)
Conduct a trauma-informed care organizational assessment of current services and practices.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Using results of the assessment, identify initial gaps and opportunities to incorporate trauma-informed practices.
Create an organizational culture that supports trauma-informed and equitable care
Strengthening an agency’s trauma-informed approaches and practices requires commitment, investment, and action from agency leadership. Leadership can guide and support organizational changes that lay the foundation for providing trauma-informed services to clients. This includes fostering a culture of staff wellness, recognizing that staff who feel safe and supported are better able to provide trauma-informed family planning services.
If your team decided to focus on the Governance and Leadership domain, consider the action steps below.
Review assessment findings for the Governance and Leadership domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Consider how well your agency’s structure and systems reflect guidelines and recommendations for becoming a trauma-informed health care organization, such as Laying the Groundwork for Trauma-Informed Care (Center for Health Care Strategies).
Provide agency leadership with training on behaviors, attitudes, and actions that promote a positive diverse, equitable, and inclusive culture.
Leadership for a Diverse and Inclusive Family Planning Organization eLearning
Host a staff meeting to introduce trauma-informed care, centering anti-racism as a core tenet.
Understanding Trauma and the Six Core Principles of a Trauma-Informed Approach Meeting Package
Incorporate recruitment, hiring, and retention practices that develop and sustain a trauma-informed, resilience-oriented, and equitable (TIROE) workforce, and that build compassion resilience among staff.
Trauma-Informed, Resilience-Oriented, and Equitable (TIROE) Care: Developing a TIROE Workforce Meeting Package
Develop policies and procedures that support an organization-wide trauma-informed approach
Policies and procedures set the tone for organizational culture and practice. Documenting the expectation that the agency uses a trauma-informed approach and provides trauma-informed care assures that these values are not person-dependent, but rather embedded in agency practice.
If your team decided to focus on the Policy domain, consider the action steps below.
Review assessment findings for the Policy domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Review and, if necessary, revise your agency’s Patient Bill of Rights, which should provide a framework for quality family planning care, including trauma-informed care.
Sample Patient Bill of Rights
Review sample policies and procedures that support implementation of an organization-wide trauma-informed approach.
Title X Policy Templates (pp. 38 and 118)
Review and, if necessary, revise your existing internal organizational policies, including: general human resources policies; staff support and supervision policies; and staff training and workforce development policies. Consider whether these policies align with trauma-informed principles.
Create a responsive environment
An equitable, accessible, and trauma-informed environment is a cornerstone of quality care. Agencies can promote a sense of physical and psychological safety and well-being for clients and staff by establishing a welcoming and comfortable physical environment, providing care that is client-centered, and fostering a supportive and responsive work environment.
If your team decided to focus on the Physical Environment domain, consider the action steps below.
Review assessment findings for the Physical Environment domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Ensure family planning services are delivered in an environment that promotes a sense of security, physical and psychological safety, and well-being for staff.
Create space and opportunity for staff to practice self-care and build resilience. This could include providing adequate breaks, comfortable and relaxing break rooms, space for physical activity, etc.
Offer gender-affirming family planning services; incorporate mechanisms to address gender-related physical and psychological safety concerns; and foster an inclusive environment that acknowledges and supports LGBTQ+ client identities.
Support LGBTQ+ Clients with Affirming Language Job Aid
Establish mechanisms to address physical and psychological safety concerns related to intimate partner violence.
Preventing and Responding to Intimate Partner Violence in Reproductive Health Settings Webinar
Utilize signage, posters, and client education materials that are culturally relevant and responsive to the agency’s client population.
Engage and involve people receiving services and people with lived experience
A cornerstone of trauma-informed and equitable care is listening to clients and recognizing their agency, resilience, and wisdom. Agencies can facilitate meaningful client input and involvement—in program design, service delivery, cultural responsiveness, and quality assurance—by building in procedures for regularly soliciting client feedback and perspectives.
If your team decided to focus on the Engagement and Involvement domain, consider the action steps below.
Review assessment findings for the Engagement and Involvement domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Review your agency’s forums for ongoing client and community input, such as your I&E Advisory Committee and any community and youth advisory boards. Consider whether there is broad and diverse representation of your service population on these forums; and whether these forums facilitate their meaningful input and involvement in program design and service delivery.
Establish procedures to regularly solicit input from clients about their satisfaction with services. Consider mixed methods data collection to gain a fuller understanding of client perceptions of safety, support, and partnership in their interactions with the service site and with clinical services providers.
Add to client satisfaction surveys questions/items that address the key aspects of trauma-informed care: safety, trustworthiness, choice, collaboration, and empowerment.
Person-Centered Contraceptive Counseling (PCCC) Measure
Collaborate with community organizations and referral partners that provide client-centered services
Clients who have experienced trauma may have needs for services and support beyond what the Title X agency can provide. A key aspect of providing trauma-informed and equitable services is collaboration with community partners who offer: behavioral health services; wraparound services that address social determinants of health; and other supports, such as violence prevention services. Cross-sector collaboration can be built on a shared understanding of the principles of a trauma-informed approach, and may encompass activities beyond reciprocal referral relationships, such as community engagement and efforts to strengthen the local service system.
If your team decided to focus on the Cross-Sector Collaboration domain, consider the action steps below.
Review assessment findings for the Cross-Sector Collaboration domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Expand your agency’s network of community partners to include:
- Behavioral health services and trauma treatment programs
- Violence prevention hotlines, domestic violence shelters, IPV response programs, child protective services, and victim assistance programs
- Programs offering services that address social determinants of health
Engage in collaborative activities with community partners to: better understand community needs; cross-train staff; and strengthen the community service system.
Community Participation, Education, and Project Promotion Plan: Objectives, Activities, and Worksheet
Ensure counseling and clinical services are trauma-informed
Implementing universal precautions for trauma—i.e., approaching every client, every time, as if they have experienced trauma—is a best practice. This may or may not include universal screening, i.e., administering a trauma-specific screening tool to all clients, which might require offering the client effective and appropriate trauma treatment resources. If trauma-specific treatment services are not available, there should be a trusted, effective referral system in place that connects individuals with appropriate treatment.
If your team decided to focus on the Screening, Assessment, and Treatment Services domain, consider the action steps below.
Review assessment findings for the Screening, Assessment, and Treatment Services domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Implement universal precautions: Agency staff should approach all clients as if trauma has occurred or is possible. Be prepared to link the client with effective resources, interventions, and referrals.
SAMHSA’s Concept of Trauma and Guidance for a Trauma Informed Approach (see pp. 5-12)
Build staff awareness and competency in client-centered communication skills to engage the client as an active partner. This way, the client drives the direction of their care.
Build staff knowledge and competency in physical exam skills to give control to the client and to engage the client as an active partner in their care.
Clinician Guide for Trauma-Informed Care (CTC-SRH)
Provide ongoing training and comprehensive support for all staff to provide trauma-informed services
Training on the effects of trauma on health, and principles and practices for providing trauma-informed services, is essential for all staff—clinical and non-clinical. Yet such training is not enough. To be able to provide client-centered, trauma-informed, and equitable services, staff must feel safe, supported, valued, and heard. Family planning organizations can incorporate structures and practices that actively support staff who may have trauma histories, or who experience vicarious trauma, compassion fatigue, or burnout.
If your team decided to focus on the Training and Workforce Development domain, consider the action steps below.
Review assessment findings for the Training and Workforce Development domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Offer staff training to better understand the connection between trauma and social determinants of health.
Offer staff training on implicit bias, cultural humility, and cultural responsiveness in health care.
Advancing Sexual and Reproductive Health Equity in Family Planning Podcast Episode 3: Redistributing power to marginalized individuals and communities
Provide training for all staff on client confidentiality, mandatory reporting laws in your state, how to practice these, and how to explain them to clients.
Provide time and space for cultivating connection and community building at work/among staff.
Supporting Title X Staff Resiliency to Address Burnout Webinar
Incorporate reflective supervision for staff, or establish reflective practice groups to address burnout, compassion fatigue and vicarious trauma among staff.
Monitor and evaluate progress and conduct quality improvement processes focused on trauma-informed care
Building a trauma-informed culture is an ongoing process with no singular path. Regular evaluation and monitoring is critical to recognizing opportunities for growth. Developing a quality improvement (QI) plan based on program data and staff and client feedback increases the likelihood of successful QI initiatives to strengthen trauma-informed approaches.
If your team decided to focus on the Progress Monitoring and Quality Improvement domain and/or the Evaluation domain, consider the action steps below.
Review assessment findings for the Progress Monitoring and Quality Improvement and the Evaluation domains.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Solicit anonymous and confidential feedback from clients.
Patient Satisfaction Survey
Solicit anonymous and confidential feedback from staff, including about how safe and valued they feel.
Staff Satisfaction Survey
Develop a quality improvement plan to assess progress toward becoming trauma-informed. Begin by identifying measures or indicators. This plan should include revisiting your trauma-informed care organizational assessment at regular intervals (e.g., once per year).
Ensure that efforts to implement principles of a trauma-informed approach are adequately financed
It is important that Title X agencies ensure equitable, accessible, and trauma-informed services for all clients without creating a cost barrier. When considering this domain, agencies should confirm that the budget allows for ongoing professional development and training on trauma and trauma-informed approaches for all staff, including leadership. Funding provisions should support trauma-informed subject matter experts for ongoing education and consultation, and physical environment changes needed to ensure physical and psychological safety.
If your team decided to focus on the Financing domain, consider the action steps below.
Review assessment findings for the Financing domain.
Trauma-Informed Practices Assessment Tool for Title X Agencies
Provide staff training that includes a review of best practices to strengthen financial management recommendations using a trauma-informed lens. This includes how to: appropriately code and bill; collect Title X client fees using a fee schedule; and manage third-party payments. Training should include information on how to balance collections and customer service while maintaining confidentiality.
Facilitate discussion with appropriate staff on how to maximize financing opportunities and overcome financial barriers to trauma-informed care professional development opportunities and practices.
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