Trauma and violence-informed approaches to policy and practice

Table of Contents


Trauma-informed approaches are familiar to many organizations and service providers. Recently, this term has been expanded to include "and violence", an important change in the language which underscores the connections between trauma and violence.

Trauma and violence-informed approaches are policies and practices that recognize the connections between violence, trauma, negative health outcomes and behaviours. These approaches increase safety, control and resilience for people who are seeking services in relation to experiences of violence and/or have a history of experiencing violence.

Trauma and violence-informed approaches require fundamental changes in how systems are designed, organizations function and practitioners engage with people based on the following key policy and practice principles:

  1. Understand trauma and violence, and their impacts on peoples' lives and behaviours
  2. Create emotionally and physically safe environments
  3. Foster opportunities for choice, collaboration, and connection
  4. Provide a strengths-based and capacity-building approach to support client coping and resilience

Service providers and organizations who do not understand the complex and lasting impacts of violence and trauma may unintentionally re-traumatize. The goal of trauma and violence-informed approaches is to minimize harm to the people you serve—whether or not you know their experiences of violence.

Embedding trauma and violence-informed approaches into all aspects of policy and practice can create universal trauma precautions, which provide positive supports for all people. They also provide a common platform that helps to integrate services within and across systems and offer a basis for consistent ways of responding to people with such experiences.

Why we need trauma and violence-informed approaches

Violence is pervasive in society (for example, globally 1 in 3 of women experienced physical and/or sexual violence by a partner or sexual violence by a non-partnerEndnote i; in Canada 32% adults report that they experienced abuse in childhoodEndnote ii; and 25% of students in grades 6-12 report being bulliedEndnote iii). Because of this, many people seeking services—in health care, housing, justice or other systems—will have histories of violence and trauma.

The goal is to minimize harm, not to treat trauma

Trauma and violence-informed approaches are not about 'treating' trauma, for example, through counselling or chronic pain interventions. Instead, the focus is to minimize the potential for harm and re-traumatization, and to enhance safety, control and resilience for all clients involved with systems or programs. These approaches benefit everyone, whether or not they've experienced trauma in their lives or their personal history is known to service providers.

The connections between trauma and violence

  • Trauma is both the experience of, and response to, an overwhelmingly negative event or series of events, including violence
  • Violence can take many forms, and can occur once or many times during someone's life
  • Violence can have traumatic long-term effects, whether the violence is ongoing or in the past.

Three important reasons to implement trauma and violence-informed approaches

1. To increase attention on the impact of violence on people's lives and well-being

Concepts of trauma-informed practice or care have been emerging over the past 15 years. The addition of "and violence" is a recent and important change in language that helps to:

Understand violence and its relationship to trauma

  • Recognize that, like past violence, ongoing violence may be a primary cause of trauma responses
  • Reduce the tendency to blame/judge people for their psychological or behavioural reactions to experiences of violence, and recognize that these responses may be a result of trauma
  • Distinguish how trauma that results from violence is different from trauma caused by other negative events, such as natural disasters

Connect to broader systems

  • Draw attention to the cumulative effects of multiple forms of violence including systemic violence, such as racism or discrimination
  • Direct attention to the importance of organizational-level actions, such as changes to policies that take clients' safety and experiences of violence into account and that recognize how broader conditions of people's lives (e.g. poverty or unstable housing) increase risk of multiple forms of violence. These could include staff/client ratios, waiting area policies and social policies.

2. To reduce harm

Service providers, organizations and systems may not be aware that they can cause unintentional harm to people who have experienced violence and trauma.

People who interact with systems such as justice, health, housing and child protection can be re-traumatized by their experiences in these systems. Re-traumatization can happen each time an adult or child needs to re-tell their story of abuse when seeking help across sectors, organizations or service providers, or when people experience discrimination, marginalization or stigma.

Service providers can inadvertently re-traumatize or trigger their clients when they:

  • touch without warning or permission
  • speak in a way that conveys negative judgement or blame, such as, "Oh, you're back again", or, "Why don't you just leave your partner?"
  • interpret a client's reaction or behaviour as being out of proportion or unwarranted without considering the experiences which may have contributed to the reaction or behaviour
  • use forceful or demanding language to tell a client to complete a task—such as fill out a medical history form or remove clothing for an examination

3. To improve system responses for everyone

Trauma and violence-informed approaches can help make systems and organizations more responsive to the needs of all people and provide opportunities for practitioners to provide the most effective support to their clients.

These approaches aim to increase the safety, control and resilience of all clients, regardless of whether or not they have experienced violence or trauma sometime in their lives.

Universal trauma precautions provide safe care for all

Embedding trauma and violence-informed approaches into all aspects of policy and practice create universal trauma precautions that reduce harm and provide positive supports for all people.

Disclosure of violence and trauma is not the goal in trauma and violence-informed approaches. Service providers do not necessarily need to know peoples' violence histories to provide appropriate support.

By practicing universal trauma precautions, service providers can offer safe care or support, even when individuals choose not to disclose their trauma history. Here are some of the many reasons why individuals may choose not to disclose:

  • it is unsafe to disclose
  • the history is not central to the immediate service being provided
  • a client has limited or no memory of their history
  • the client finds it too distressing to disclose

How trauma and violence are connected

Trauma occurs when people experience an overwhelmingly negative event or series of events, including violence.

Violence can take many different forms and can be experienced once or many times. Violence is often the result of intentional actions to control or abuse someone, but can also have unintended consequences, such as when children are exposed to intimate partner violence. Experiences of violence can also be systemic and less visible. For many marginalized populations, discrimination and systemic violence are everyday experiences.

Different forms of violence can have interrelated traumatic effects


  • Child maltreatment can increase a person's vulnerability to interpersonal violence in adulthood
  • Children's exposure to intimate partner violence can result in negative health and social outcomes similar to those resulting from more direct forms of abuseEndnote iv
  • Exposure to systemic violence (such as racism) can increase a person's vulnerability to all other forms of violence
  • Over time, experiences of systemic violence can result in historical and intergenerational trauma
  • Self-directed violence often arises in the context of exposure to interpersonal  forms of violence

Trauma can cause neurobiological changes which impact health and behaviour across the lifespan

While people are capable of recovering from adverse events, the trauma they experience at the time of the event, and throughout their lifetime, can contribute to a range of negative outcomes.Endnote v

  • For example, child abuse, including neglect and exposure to intimate partner violence, can impact children's emotional and social development— including lifelong patterns of anxiety, chronic pain, substance use or difficulty controlling anger.

Triggers can reactivate trauma

Neurobiological changes caused by trauma can result in triggers, whereby present day events can recreate past traumatic experiences so that potential threats are perceived as real— whether they are real or not.

  • Commands, touches, sounds, smells or other physical sensations can remind people of early trauma and trigger a response
  • For example, touching a person without warning or permission can trigger an automatic flight or fight response

How gender and culture are connected to trauma and violence

Trauma and violence-informed approaches recognize that experiences and effects of violence are strongly linked to gender and culture.


Trauma and violence-informed policies and practices recognize that violence and trauma are shaped by gender stereotypes and inequities, and thus tailor services and programming to individual needs. Adults, children and youth of all gender identities face different levels and types of risks, as well as varying access to service and support.

  • Overall, rates of intimate partner violence are higher for women compared to men in every age group. Certain groups of women experience higher rates of violence than other women, particularly Indigenous women and women with disabilitiesEndnote vi. Violence against women is rooted in gender inequity and women are more likely to:
    • report ongoing violence, physical injury, more serious types of injuries and greater health issues
    • experience coercive control
    • have greater fear of physical injury and death
    • experience sexual violenceEndnote vi
  • Girls have a higher risk than boys of being sexually abusedEndnote viii
  • Boys have a higher risk than girls of being physically abusedEndnote ix
  • Men are socialized away from disclosing family violence and seeking helpEndnote x
    • While women and men experience emotional/psychological intimate partner violence at similar rates, men experience it along with fear of ridicule, humiliation and degradationEndnote xi
  • Transgender people, which includes people who may also identify as lesbian, gay, bisexual, and two-spirited, experience much higher rates of domestic and community violence than the general population and face extensive barriers to serviceEndnote xii


Culture is also important in the Canadian context where Indigenous people experience multiple forms of disadvantage, interrelated with disproportionately high rates of violence. Newcomers, some people of colour and people from other groups that are marginalized in Canada, face assumptions about how their culture contributes to experiences of violence. Such assumptions can create barriers to effective service and support. For example, service providers may assume that women from racialized ethnic communities who experience intimate partner violence will have high levels of support from their communities, whereas in reality, the women may be ostracized.

Cultural safetyEndnote xiii is an approach to working across ethnic and other differences to make systems and organizations responsible to ensure that service environments are safe for everyone—regardless of their expressed or assumed culture. This approach to policy and practice is compatible with, and often an embedded component of, trauma and violence-informed approaches.

For example, service providers support cultural safety when they

  • reduce power differences between themselves and clients
  • stop making assumptions based on people's appearance or presumed ethnicity
  • avoid actions which demean, disrespect, or disempower clients

How to implement trauma and violence-informed approaches

Trauma and violence-informed approaches require fundamental changes in how practitioners engage with people, how organizations function and how systems (such as the health system and the justice system) are designed. These approaches can result in more beneficial ways to view and treat people, which can lead to more successful outcomes for clients.

For individual practitioners, a change in strategy means attempting to eliminate assumptions about people who experience violence and trauma and their actions. For organizations and systems, it means supporting a culture of learning and capacity-building to create safe environments for clients and staff.

Four principles for implementing trauma and violence-informed approaches

The following information outlines four key principles and sample implementation strategies for service providers and organizations.  These strategies can be applied to many different sectors, including justice, health, anti-violence, social work and housing.Endnote xiv

1. Understand trauma and violence and their impacts on peoples' lives and behaviours

Service providers
  • Acknowledge the root causes of trauma without probing. Your clients do not necessarily need to disclose what may have happened to them for you to help them

    "I know that people who have had difficult experiences often have difficulty trusting people in authority, or have chronic pain."

  • Pause and reflect when someone acts or reacts in an unexpected way

    "What happened to this person?" vs. "What's wrong with this person?"Endnote xv

  • Listen, believe and validate victims' experiences

    "That sounds like a horrible experience."  or "No one deserves to be treated like that."

  • Recognize their strengths

    "You have really survived a lot."

  • Express concern

    "I am really concerned for your safety."

Organizations and systems
  • Develop organizational structures, policies and processes that foster a culture built on an understanding of how trauma and violence affect peoples' lives
    • Develop hiring practices that seek people who understand trauma and violence and reward systems that compensate employees for building their competencies in this area
    • Train all staff on the connections between violence, trauma and health outcomes and behaviours, including vicarious or secondary trauma

See this principle in action.

2. Create emotionally and physically safe environments

Service providers
  • Communicate in non-judgemental ways so that people feel deserving, understood, recognized and accepted

    "I am happy to see you came in today."

  • Foster an authentic sense of connection to build trust

    "I can see from your body language/face/comments that you don't agree with what I've said. What are you thinking about right now? What are you worried about?"

  • Provide clear information and consistent expectations about services and programs

    "I can't give/provide you with [that service] because of the rules I have to follow. But I'd like to help you find other ways to help manage your situation."

  • Encourage clients to bring a supportive person with them to meetings or appointments

    "If bringing a family member or friend or someone else would help you feel more comfortable at our next meeting, you are more than welcome to do so."

Organizations and systems
  • Walk through your practice setting to see and assess how a client might experience each moment. This simulation can help identify where improvements can be made. For example:
    • Travel to the site on bus and see what it feels like to arrive at the service site.  Is it difficult to access?
    • Spend time in the waiting area, fill out the forms and experience how long a client might wait to be seen.
    • Go through all client activities, such as being asked to undress/put on a gown, being physically examined or asked sensitive questions.
  • Pay attention to welcoming intake procedures and signage, comfortable physical space, consideration of confidentiality
    • Seek client input for inclusive and safe strategies
    • Create policies and structures to allow clients to bring a support person with them to meetings
  • Provide support for service providers at risk of secondary trauma and facilitate their self-care.
  • Consider peer support, regular clinical supervision and self-care programs.

See this principle in action.

3. Foster opportunities for choice, collaboration, and connection

Service providers
  • Provide choices for treatment and services, and consider the choices together

    "Last time you were here, we had a plan to try [strategy x]. How did that work out for you? What about our plan would you like to change?"

  • Communicate openly and without judgement

    "In order to provide the best care possible, it's helpful for me to know about people's alcohol use. Could you tell me how much you drink? IF YES, "okay, and can you tell me how often you drink? for example, most days? once a week? once a month?" NOTE: Start with most days.

  • Provide the space for clients to express their feelings freely

    "Is there anything you would like to tell me that might be helpful for our work together?"

  • Listen carefully to the client's words and check in to make sure that you have understood correctly

    "So it sounds like your living situations is ... difficult, stressful, etc."

Organizations and systems
  • Offer training and professional development opportunities for staff on:
    • the importance of critical self-reflection on power differences between practitioners and clients
    • how experiences of violence can influence the way that clients engage with providers
  • Set expectations, create opportunities and provide the time and space for collaborative relationships to be formed between (e.g. generous appointment time allocations, clients' advisory mechanism)

See this principle in action.

4. Provide a strengths-based and capacity-building approach to support client coping and resilience

Service providers
  • Help clients identify their strengths, through techniques such as motivational interviewing, a communication technique that improves engagement and empowerment

  • Acknowledge the effects of historical and structural conditions on peoples' lives

    "Life circumstances often make it difficult to move forward in your life, like finding housing or getting a job."

  • Help people understand that their responses are normal

    "It's understandable that you feel angry about being treated unfairly. It sounds like you feel you were dismissed."

  • Teach and model skills for recognizing triggers, such as calming, centering and staying present
Organizations and systems
  • Provide sufficient time and resources to support meaningful engagement between practitioners and clients
  • Offer a range of services and interventions that respond to people's needs, strengths and contexts
  • Foster an organizational culture that recognizes the importance of emotional intelligence and social learning in the workplace

See this principle in action.

Addressing the impact on service providers who work with people who have experienced violence and trauma

Service providers who work directly with people who have experienced violence often hear difficult stories and witness the impact of these experiences.

Second-hand exposure to experiences of violence can result in vicarious or secondary traumaEndnote xvi, with negative health impacts which are similar to those experienced by people with first-hand experiences of violence, such as:

  • depression, emotional exhaustion and anxiety
  • sleep disturbances and intrusive thoughts
  • trigger responses to external events, some of which may seem harmless to others

Organizations can help reduce secondary trauma for service providers

The negative impacts of secondary trauma are associated with employee burnout and high turnover, both common in sectors where service providers work directly with people who experience violence.

Organizations can help reduce secondary trauma for their employees with trauma and violence-informed policies and practices that:

  • actively support the well-being and self-care of service providers who are repeatedly exposed to others' stories of violence
  • help providers to understand peoples' responses to violence, including their own
  • help to prevent 'trigger responses' for both clients and providers

When they are well-supported by trauma and violence-informed approaches and workplace wellness programs, service providers can find satisfaction and growth in their work, despite the challenges.

Examples of trauma and violence-informed approaches

Principles in action

The following examples of trauma and violence-informed programs and policies have been implemented in a wide range of sectors in Canada. They are organized according to the four guiding principles for implementing trauma and violence-informed approaches.

Principle 1— Understand trauma and violence and their impacts on peoples' lives and behaviours


Supportive policies for women mean better access to safe and affordable housing

Atira Women's Resource Society provides housing across the lower mainland of BC to women who have experienced violence. The Society serves women with a range of health and other support needs, and women who experience multiple forms of marginalization and systemic violence.

A core premise of Atira's policy and practice is recognition that violence and trauma contribute to many of the challenges women face to secure safe and affordable housing.

Here are some ways that Atira has changed its policies:

  • It does not require women to disclose experiences of abuse in order to access housing
  • It creates opportunities for extended and specialized forms of housing for women, rather than an earlier policy which had a 30-day limit for women in shelters
  • It hires women with lived experienceEndnote xvii of violence and homelessness
  • It is inclusive of women who use substances

This program is trauma and violence-informed because...

  • It creates safe and supportive environments by acknowledging the root causes of trauma without probing or requiring women to disclose their histories of abuse, and allows for longer-term and specialized forms of housing to meet their needs
  • It helps women make connections, by employing women with lived experience of violence and homelessness who may be better able to understand the women being served
  • It recognizes the relationship between violence, trauma and substance use

Community Health Centre

Reducing stress for clients and staff through a change in clinic practices

Cool Aid Community Health centre, which serves clients who live on low-incomes, used a trauma and violence-informed approach to review their practices.

They recognized that when clients had to line up on the street to wait for the clinic to open, they were exposed to forms of violence, including demeaning behaviour by people passing by.  For example, vulnerable clients were intimidated by drug dealers, asking to 'share' their prescriptions. Clients often had inadequate clothing to protect them from the elements, particularly in winter. Additionally, clinic receptionists were negatively impacted when witnessing these situations and felt responsible for the clients' well-being.

To create a safer environment for their clients and workers, the centre changed its clinic opening procedures to allow people to wait indoors.Endnote xviii

This program is trauma and violence-informed because...

  • It identified an environment that was emotionally and physically unsafe for their clients—particularly the most traumatized— and changed it
  • It reduced the vicarious trauma experienced by clinic receptionists who witnessed clients being victimized every day, and felt responsible for the line-up

Principle 2—Create emotionally and physically safe environments for both clients and service providers

Integrated Service Provision

Children's Advocacy Centres provide child-centred approaches for victims of abuse

Children's Advocacy Centres (CACs) are child-friendly centres that coordinate the investigation, intervention and treatment of child abuse, while helping abused children and their non-offending family members navigate service systems and recover from experiences of violence. CACs provide a comprehensive response by a multidisciplinary team of service providers who work in areas including:

  • child protection
  • health
  • victim advocacy
  • justice

By conducting joint interviews during the investigative phase of the work, this multidisciplinary team is able to minimize the number of times a child needs to re-tell their story of abuse. Overall, the CAC approach creates a more efficient and effective investigation of child abuse cases than traditional approaches. CACs also offer a range of treatment and support services for children, youth and their families, with fewer services overlapping or conflicting. Child-friendly space is included in the design of CAC offices to help children feel comfortable and safe.

Child and Youth Advocacy Centres is the national network of CACs, and include the Regina Children's Justice Centre, BOOST Child and Youth Advocacy Centre, Zebra Child Protection Centre and the Sheldon Kennedy Child Advocacy Centre.

This program is trauma and violence-informed because...

  • It minimizes the potential for re-traumatization of children by conducting joint and fewer investigative interviews
  • It creates a capacity-building approach through related healing and support services
  • It creates a safe physical and emotional environment for children

Sexual Assault Centre

Self-care for service providers as an integral component of ethical care and case management

Fredericton Sexual Assault Centre (FSAC) provides trauma support and counselling to people affected by sexual and dating violence.  The Centre is grounded in the concept of trauma stewardship, a trauma and violence-informed approach that ensures that service providers care for themselves while they are providing ethical care and management of other people's trauma.

Being a steward of other people's trauma can have real consequences for the service provider, including vicarious or secondary trauma, compassion fatigue and burnout. It can also lead to serious physical and mental health issues and can compromise the ability of staff and volunteers to provide optimal care and support. The focus of trauma stewardship is to recognize the impacts of working with survivors of trauma. It identifies strategies for individual service providers and for the organization to mitigate these adverse consequences and promote staff well-being.

FSAC uses three strategies under their trauma stewardship program:

  1. Debriefing that limits staff and volunteer exposure to stories of trauma. This low-impact approach encourages people to:
    • ask permission from colleagues before sharing information, to warn them that they may be hearing something difficult
    • talk about a situation as part of their self-care
    • start from the "outside edges of the story", and work their way in, focusing on their feelings about the interaction with a client rather than on the intense details of the incident
  2. Weekly, trauma-informed Yin yoga sessions for staff, during staff hours and at no cost
  3. A mandatory crisis line report form requires volunteers to indicate how they are feeling after a call and what self-care practices they plan to use. If a more active debrief is necessary, they are encouraged to contact a peer support system

This program is trauma and violence-informed because...

  • It is based on an understanding of the effects of violence and trauma, particularly as related to vicarious/secondary trauma of service providers
  • It creates a safe space for service providers who are regularly exposed to other peoples' stories and responses to traumatic events
  • It fosters opportunity for choice, connection, and collaboration for staff, as they support each other in a way that is safe and mutually respectful

Principle 3—Foster opportunities for choice, collaboration and connection

Corrections Services

Giving back promotes meaningful engagement for men in prison

Work to Give is a program that supports men in prison to produce needed items for First Nations families and children who live in poverty in central BC.  The men produce food, furniture, clothing, toys and cultural items—such as drums, rocking ravens, orcas and keepsake boxes.

This program is a partnership between Correctional Service Canada (Pacific Region), the Tsilhqot'in National Government, their communities and the Punky Lake Wilderness Camp Society.

Work to Give is based on a recognition that Canada's colonial history, policies and practices have led to the significant overrepresentation of Indigenous people in prisons.

The program acknowledges that:

  • incarcerated people often have histories of being abused
  • resilience, rehabilitation and re-offending rates are improved through meaningful work opportunities to give back to communities

This program is trauma and violence-informed because...

  • It is based on understanding the effects of violence and interrelationships among different structural forms of violence
  • It fosters indirect opportunities for increased collaboration and connections between the men and communities

Emergency Room Care

Collaborating with Indigenous communities to create a welcoming environment

An Australian emergency room (ER) that serves a large suburban area is making a commitment to provide equitable, respectful care to all patients, including the Indigenous communities they serve.

Research evidence from other contexts suggests that displaying Indigenous art may improve access to services, since the art demonstrates openness to Indigenous people and an acceptance of diversity.Endnote xix Based on this evidence, ER leaders partnered with local Indigenous communities to select Indigenous art to create a welcoming environment for Indigenous people.

As a step toward reconciliation, ER leaders hope that this process will help to develop meaningful relationships with the Indigenous communities they serve.

This program is trauma and violence-informed because...

  • It is part of an effort to create an emotionally safe environment
  • It also has potential to foster increased collaboration and connections between service providers and Indigenous leaders and communities

Principle 4—Provide strengths-based and capacity-building approaches to support client coping and resilience

Treatment Program

Addressing structural violence for Inuit people through collective healing

Mamisarvik Healing Centre in Ottawa is the only Inuit-run residential trauma and addictions treatment program in Canada and addresses trauma within Inuit healing approaches. The word Mamisarvik means, A Place of Healing.

The Centre not only considers the histories of individuals and families, but also addresses structural violence— how Inuit people have suffered historical experiences of colonization and cultural oppression. The program helps clients understand how these experiences continue to contribute to "present-day suffering, preventing the resolution of grief and trauma and driving many people to alcohol and drug abuse 'to numb the pain'."Endnote xx

Mamisarvik clients say that the collective experience of reconstructing their shared histories is healing.

This program is trauma and violence-informed because...

  • It draws directly on Inuit people's resilience in a strengths-based approach
  • It is based on an understanding of trauma and violence, particularly the links between structural violence and substance use
  • It increases opportunities for connections among people, and enhances capacity— particularly to analyze the root causes of substance use

Health Promotion

Trauma-sensitive yoga supports positive body movement in safe spaces

Yoga Outreach is a non-profit organization in British Columbia which trains volunteers to offer strength-based, trauma-sensitive yoga programs for people without resources who otherwise would be unable to participate. Its work is inspired by research conducted by the Trauma Center at the Justice Resources Institute.

In trauma-sensitive yoga, teachers adapt how they lead their classes to help participants build a sense of safety and control over their bodies. This approach is particularly important for people who have 'disassociated' from their bodies after experiences of violence and trauma.

There are no physical assists or touching in trauma-sensitive yoga. To minimize visual triggers, the lights are kept on, curtains are drawn and there are no mirrors. Teachers stay on their mats to avoid 'lurking above' participants. Rather than offer direct instruction such as, "Put your hand on your hip," teachers offer an invitation to participants by saying, "If this feels good for you, I invite you to put your hand on your hip."

This program is trauma and violence-informed because...

  • It is based on an understanding of the effects of violence and trauma, particularly the dynamics of triggers
  • The training directly takes a capacity-building approach to support client coping and resilience as clients develop better control over their bodies
  • It provides safe spaces where participants can experience positive movement

References and resources


Trauma- and violence-informed care: A tool for health and social service organizations and providers
Equip Health Care: Research to Equip Primary Health Care for Equity (University of British Columbia, University of Victoria, University of Northern British Columbia, Western University)

Trauma-informed Practice Guide
BC Centre of Excellence in Women's Health

Trauma-informed: A resource for service organizations and providers to deliver services that are trauma-informed
Klinic Community Health Centre

Books and journal articles

Browne, A.J., Varcoe, C., Ford-Gilboe, M. & Wathen, N. (2015). EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. International Journal for Equity in Health, 14, 152.

Covington, S. (2008). Women and addiction: A trauma-informed approach.  Journal of Psychoactive Drugs: 377-385.

Elliot, D.E., Bjelajac, P., Fallot, R.D., Markoff, L.S. & Reed, B.G. (2005). Trauma-informed or trauma-denied: principles and implementation of trauma-informed services for women. Journal of Community Psychology 33 (4), 461-477.

Green, B.L., Saunders, P.A., Power, E., Dass-Brailsford, P., Bhat Schlbert, K., Giller, E., Wissow, L., Hurtado-de Mendoza, A., &  Mete, M. (2015). Trauma-informed medical care: CME communication training for primary care providers. Family Medicine, 47 (1), 7-14.

Harris, M. & Fallot, R.D. (2001). Envisioning a trauma-informed service system: A vital paradigm shift. New Directions for Mental Health Services 89, 3-22.

Hopper, E.K., Bassuk, E.L. & Oliver, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal 3, 80-100.

Kirmayer, L. (2013). Embracing uncertainty as a path to competence: Cultural safety, empathy, and alterity in clinical training. Culture, Medicine & Psychiatry, 6, 365-372.

Middleton, J.S. & Potter, C.C. (2015). Relationship between vicarious traumatization and turnover among child welfare professionals. Journal of Public Child Welfare, 9 (2), 195-216.

Ponic, P., Varcoe, C. and Smutylo, T. (2016). Trauma- (and violence-) informed approaches to supporting victims of violence: Policy and practice considerations. Victims of Crime Research Journal, 9, 3-15.

Poole, N. & Greaves, L. (Eds). (2012). Becoming Trauma Informed. Toronto: Centre for Addiction and Mental Health.

Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S. & Rajagopalan, C. (2015). Trauma informed care in medicine: Current knowledge and future research directions. Family and Community Health, 38 (3), 216-236.

Savage, A., Quiros, L., Dodd, S. & Bonavota, D. (2007). Building trauma informed practice: appreciating the impact of trauma in the lives of women with substance abuse and mental health problems. Journal of Social Work Practice in the Addictions, 7(1-2), 91-116.

Strand, V., Popescu, M., Abramovitz, R. & Richards, S. (2015). Building agency capacity for trauma-informed evidence- based practice and field instruction.  Journal of Evidence-Informed Social Work, 13(2), 1-19.

Van der Kolk, B. (2000). Posttraumatic stress disorder and the nature of trauma. Dialogues in Clinical Neuroscience 2 (1), 7-22.

van Mol, M., Erwin, M.C., Kompanje, J.O., Benoit, D.D., Bakker, J. & Nijkamp, M.D.  (2015). The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: A systematic review. PLoS ONE, 10 (9), 1-22.

Varcoe, C. & Browne, A.J. (2015). Culture and cultural safety: Beyond cultural inventories. In Fundamentals: Perspectives on the Art and Science of Canadian Nursing. C. D. Gregory, L. Raymond- Seniuk, L. Patrick and T. Stephen (Eds.), 216-231. Philadelphia: Lippincott Williams & Wilkins.

Watt, M. E. & Scrandis, D.A. (2013). Traumatic childhood exposures in the lives of male perpetrators of female intimate partner violence. Journal of Interpersonal Violence, 28 (14), 2813-2830.


Definitions related to violence

Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.

Interpersonal violence refers to violence between individuals, and is subdivided into family and community violence. Family violence includes child maltreatment; intimate partner violence; and elder abuse. Community violence includes acquaintance and stranger violence, youth violence; violence related to property crimes; and violence in workplaces and other institutions.

Collective violence refers to violence committed by larger groups of individuals and can be subdivided into social, political and economic violence.

Self-directed violence refers to violence in which the perpetrator and the victim are the same individual and is subdivided into self-abuse and suicide.

Systemic violence is violence perpetrated against people through systems often as a result of widespread beliefs and socio-political systems, for example, ethnic-based genocide such as the Holocaust, the colonization of Indigenous peoples, or the normalization of gender-based sexual violence. The terms systemic and structural violence are often used interchangeably.

Definitions related to trauma

Trauma is both the experience of, and a response to, an overwhelmingly negative event or series of events, such as interpersonal violence, personal loss, war or natural disaster. In the context of violence, trauma can be acute (resulting from a single event) or complex (resulting from repeated experiences of interpersonal and/or systemic violence).

Historical trauma refers to the ways in which political processes and systemic violence (such as the Holocaust or forced relocations of Indigenous people) impact individual experience, and in turn the effects of individual experiences on those political processes. Some researchers suggest that the idea of historical trauma has been used both to recognize the impact of historical violence on Indigenous people and to pathologize Indigenous people.

Intergenerational trauma refers to the ways that multiple generations are impacted by trauma both through the effects of one generation of people on the next, as well as by the ongoing conditions in which people live.

Other related definitions

Resilience is a dynamic process that enables an individual to develop, maintain, or regain their health and well-being despite experiences of significant adversity or trauma. Resilience is developed through a range of individual (i.e. psychological, biological) and environmental (i.e., social, political, and cultural) factors that can help people positively adapt to difficult life circumstances.


Endnote i

World Health Organization (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence, Department of Reproductive Health and Research, 51 pages.

Return to endnote i referrer

Endnote ii

Afifi, T. O., MacMillan, H. L., Boyle, M., Taillieu, T., Cheung, K., & Sareen, J. (2014). Child abuse and mental disorders in Canada. Canadian Medical Association Journal, 186(9);E324-E332.

Return to endnote ii referrer

Endnote iii

Centre for Chronic Disease Prevention (2017). Positive Mental Health Surveillance Indicator Framework: Quick Stats, youth (12 to 17 years of age). Health Promotion and Chronic Disease Prevention in Canada, 37(4); 131-2.

Return to endnote iii referrer

Endnote iv

Afifi, T. O., MacMillan, H. L., Boyle, M., Taillieu, T., Cheung, K., & Sareen, J. (2014). Child abuse and mental disorders in Canada. Canadian Medical Association Journal, 186(9); E324-E332.

Return to endnote iv referrer

Endnote v

Bethell, C.D., Newacheck, P., Hawes, E., & Halfon, N. (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 33(2), 106-2115.

Lamers-Winkelman, F., Schipper, J.C.D, & Oosterman, M. (2012). Children's physical health complaints after exposure to intimate partner violence. British Journal of Health Psychology, 17, 771-784.

Bombay, A., Matheson, K., & Anisman, H. (2011). The impact of stressors on second generation Indian residential school survivors. Transcultural Psychiatry, 48, 367-391.

Felitti, V.J., & Anda, R.F. (2010). The Relationship of Adverse Childhood Experiences to Adult Health, Well-being, Social Function, and Healthcare. Cambridge: Cambridge University Press.

Return to endnote v referrer

Endnote vi

Brownridge, D. A. (2008). Understanding the elevated risk of partner violence against Aboriginal women: A comparison of two nationally representative surveys of Canada. Journal of Family Violence, 23(5), 353-367.

Brownridge, D. A., Ristock, J., & Hiebert-Murphy, D. (2008). The high risk of IPV against Canadian women with disabilities. Medical Science Monitor, 14(5), 27-32.

Return to first endnote vi referrer

Endnote vii

Mihorean, K. (2005). Trends in self-reported spousal violence. In K. AuCoin (Ed.), Family violence in Canada: A statistical profile 2005. Ottawa, Canada: Canadian Centre for Justice Statistics, Statistics Canada, 13-32.

Tjaden, P., & Thoennes, N. (2000). Prevalence and consequences of male-to-female and female-to-male intimate partner violence as measured by the National Violence against Women Survey. Violence against Women, 6, 142-161.

Return to endnote vii referrer

Endnote viii

Stoltenborgh M., van Ijzendoorn M.H., Euser E.M., Bakermans-Kranenburg, M.J. (2011). A global perspective on child sexual abuse: meta-analysis of prevalence around the world. Child Maltreatment; 16(2), 79-101

Return to endnote viii referrer

Endnote ix

Afifi, T. O., MacMillan, H. L., Boyle, M., Taillieu, T., Cheung, K., & Sareen, J. (2014). Child abuse and mental disorders in Canada. Canadian Medical Association Journal, 186(9);E324-E332.

Return to endnote ix referrer

Endnote x

Nybergh, L., Enander, V., & Krantz, G. (2016). Theoretical considerations on men's experiences of intimate partner violence: An interview-based study.  Journal of Family Violence, 31, 119-202.

Return to endnote x referrer

Endnote xi

Ansara, D., & Hindin, M. (2010). Exploring gender differences in the patterns of intimate partner violence in Canada: A latent class approach. Journal of Epidemiology and Community Health, 64, 849-854.

Nybergh, L., Enander, V., & Krantz, G. (2016). Theoretical considerations on men's experiences of intimate partner violence: An interview-based study.  Journal of Family Violence, 31, 119-202.

Return to endnote xi referrer

Endnote xii

Wathen, C. N., MacGregor, J.C.& MacQuarrie, B.J. (2015). The Impact of Domestic Violence in the Workplace: Results from a Pan-Canadian Survey. American College of Occupational and Environmental Medicine, 57, (7), E65-71.

Return to endnote xii referrer

Endnote xiii

Varcoe, C., & Browne, A. J. (2015). Culture and cultural safety: Beyond cultural inventories. In C. D. Gregory, L. Raymond-Seniuk, L. Patrick, & T. Stephen (Eds.), Fundamentals: Perspectives on the Art and Science of Canadian Nursing, 216-231. Philadelphia: Lippincott.

Return to endnote xiii referrer

Endnote xiv

Ponic, P., Varcoe, C. and Smutylo, T. (2016). Trauma- (and Violence-) Informed Approaches to Supporting Victims of Violence: Policy and Practice Considerations. Victims of Crime Research Journal, 9, 3-15.

Return to endnote xiv referrer

Endnote xv

Williams, J. & Paul, J. (2008). Informed Gender Practice: Mental health acute care that works for women. National Institute for Mental Health in England.

Return to endnote xv referrer

Endnote xvi

Cohen, K. & Collens, P. (2013). The impact of trauma work on trauma workers: A metasynthesis on vicarious trauma and vicarious posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy, 5(6), 570-580.

Return to endnote xvi referrer

Endnote xvii

Dechief, Lynda, and Janice Abbott. 2012. "Breaking out of the mould: Creating trauma-informed anti-violence services and housing for women and their children." In Becoming Trauma-informed, N. Poole and L. Greaves (Eds.), 329-338. Toronto: Centre for Addiction and Mental Health.

Return to endnote xvii referrer

Endnote xviii

Browne, A.J., Varcoe, C., Ford-Gilboe, M. & Wathen, N. (2015). EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. International Journal for Equity in Health, 14, 152.

Return to endnote xviii referrer

Endnote xix

Chapman, R., Smith, T., & Martin, C. (2014). Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian Emergency Department. Contemporary Nurse, 48(1), 48-58.

Return to endnote xix referrer

Endnote xx

Maxwell, K. (2014). Historicizing historical trauma theory: Troubling the trans-generational transmission paradigm. Transcultural Psychiatry, 51, 407-435.

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