Center for Injury Research and Prevention

On-the-job Training for Trauma-informed Care

November 16, 2015
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Imagine a teenager yelling and refusing to have an IV placed when admitted to the hospital for an appendectomy; a child walking into her pediatrician’s office after witnessing a shooting in her neighborhood; a parent collapsing into tears after hearing her child’s cancer diagnosis. How can we best support our families during medical care?

Healthcare professionals have the unique opportunity to help children who have been exposed to potentially emotionally traumatic events.This can require being sensitive to a family’s response to events occurring prior to their medical appointment/treatment, as well as new medically-related traumas. We call this approach Trauma-informed Care.

Trauma-informed Care (TIC) involves the three R’s:realizing the impact of trauma, recognizing emotional symptoms, and responding by putting knowledge into practice[1]. Although only 20 percent of US level 1 trauma centers conduct specialized screening for posttraumatic stress symptoms (PTSS) and intervention services for children and families[2], easy-to-implement, systematized training in trauma-informed care may help to target this gap.

This approach, published today in JAMA Pediatrics, suggests a framework for training pediatric healthcare networks in trauma-informed care practices, one that addresses barriers to routine integration of TIC into pediatric care, including lack of available training and unclear best practice guidelines.

Previous CHOP research found that pediatric medical providers would likely embrace the opportunity for training in trauma-informed care if it were offered and that there is currently a large gap in this training being integrated into standard professional development. On-the-job training is necessary, but to facilitate TIC in the hospital setting, three factors are important:1) organizational readiness, 2) assessment of unique organizational characteristics, and 3) shifts in culture.

At The Children’s Hospital of Philadelphia (CHOP), we have begun to implement TIC as part of our organization’s training goals.Since July 2013, we have trained over 1,000 staff members in TIC, with plans to train many more departments this upcoming year.

To implement TIC in the healthcare setting, we recommend the following tips based on best practices:

  • establish a leader to develop a strategy and partner with units/groups to deliver training
  • start with departments or teams with strongest motivation for implementing TIC
  • identify TIC champions throughout the healthcare network
  • identify institutional assets and barriers
  • start small, allow for natural growth
  • consider sustainability from the beginning planning stages
  • partner with departments/groups to meet their unique needs
  • use technology, such as webinars or learning links
  • integrate TIC knowledge and practices into existing trainings
  • incorporate “Train the Trainer”

While TIC practices have the potential to improve patient care as well as patient satisfaction with their care, more research is necessary to determine the effect of network-wide implementation on patient and staff outcomes. More and more pediatric hospitals like CHOP are committed to providing training in TIC with the goal of providing optimal patient care and supporting staff, dispelling the myth that it’s too time-consuming and expensive to implement.


[1]Substance Abuse and Mental Health Services Administration. A Trauma-Informed Approach. 2014;

[2]Zatzick DF, Jurkovich G, Wang J, Rivara FP. Variability in the characteristics and quality ofcare for injured youth treated at trauma centers. The Journal of Pediatrics. Dec 2011: 159(6):1012-1016.