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Tra u m a-I n fo rm ed N ursin g P ra ctic e ^ m d
...uncertaint y is
both subjectiv e and
measures of stress
Tra u m a-I n fo rm ed N ursin g P ra ctic e ^ m d
...uncertaint y is
both subjectiv e and
measures of stress
system can be re-
Joan Fleishman, PsyD
Hannah K amsky, BSN, RN, CCCTM
Stephanie Sundborg, PhD
Trauma-informed care (TIC) is a patient -centered approach to healthcare that calls on health
professionals to provide care in a way that prev ents re-traumatization of patients and staff . TIC is
applied universally regardless of tr auma disclosure. Grounded in an understanding of the impact of
trauma on patients and the workforce, TIC is conceptualiz ed as a lens through which policy and
practice are reviewed and revised to ensure settings and services are safe and welcoming for both
patients and staff . The TIC framework is being implemented in healthcare and should be
incorporated in daily pr actice, especially in nursing. Nurses ha ve ample opportunities to influence
the experience of patients and colleagues, and nursing is a critical field in which to introduce a
tr auma-informed approach. Howev er, TIC implementation can be challenging if it ’s unclear what to
do . This article discusses trauma-informed care , and TIC in healthcare and pro vides str ategies for
trauma-informed nursing pr actice , followed by organizational consider ations for the nursing
Citation: Fleishman, J., K amsky , H., Sundborg, S ., (Ma y 31, 2019) "T rauma- Informed Nursing Pr actice" OJIN: The
Online Journal of Issues in Nursing Vol. 24, No . 2, Manuscript 3.
DOI: 10.3912/OJIN.V ol24No02Man03
Key Words: Trauma, tr auma-informed care, tr auma-informed nursing, nursing workforce, patient experience,
universal precautions, nursing pr actice, patient-centered care, adv erse childhood experiences, workforce wellness
Two-thirds of adults responding to the 2018 Stress in America Surv ey (n=3,458)
indicated significant levels of stress in a number of areas, including healthcare
(American Psychological Association [AP A], 2018 ). This reinforces a pattern that
has been steady or increasing for y ears,across all demographic groups. Stress
occurs when individuals are uncertain about how to ensure their own social,
physical, or mental wellbeing ( Peters, McEwen, & Friston, 2017 ). In fact,
uncertaint y is associated with both subjectiv e and physiological measures of stress
(De Berker et al., 2016 ). When a stressor is tempor ary or manageable, the stress
response system is efficient and effectiv e ( McEwen, 2007 ). However, when
stressors persist and uncertaint y continues, the stress response can become
maladaptive and lead to illness and disease ( Hackney, 2006 ; Peters et al. , 2017 ).
More than two decades of research ha ve contributed to the knowledge that stress and adv ersity is associated with
poor social, emotional, and ph ysical outcomes later in life (see the seminal manuscript b y Felitti et al. , 1998 ).
Specifically , childhood adv ersity or tr auma is associated with increased risk of heart disease, diabetes,
autoimmune disorders, and ev en premature mortality ( Brown et al., 2009 ).
Stress and tr auma also affect beha vior and engagement with services. The healthcare system can be re-
traumatizing for patients with tr auma history ( Dubay, Burton, & Epstein, 2018 ).
Trauma Informed Car e
conceptualized as a
lens through which
policy and pr actice
are reviewed and
revised to ensure
services are safe
and welcoming for
both patients and
TIC in Healthcar e
When individuals feel threatened they rely on the parts of their br ain aimed at survival, or the flight, fight, or
freeze system ( McEwen, 2007 ). As a result, the r ational parts of the br ain involv ed in memory , planning, decision
making, and regulation become less important. In healthcare settings, this can impact the patient ’s engagement
with services and abilit y to adhere to treatment plans ( Sansone, Bohinc, & Wiederman, 2014 ). Healthcare
organizations are striving to incorpor ate this understanding into their own settings and pr actices, recognizing the
potential for re-traumatization and its impact on care ( Schulman & Menschner , 2018 ). They are turning to
approaches like trauma-informed care (TIC) for guidance.
This article begins with an o verview of TIC, and then discusses implications of a TIC fr amework in healthcare,
generally, and then specifically as it relates to nursing pr actice. Nurses have ample opportunities to influence the
experience of patients and colleagues and nursing is a critical field in which to introduce a tr auma-informed
approach. To assist in TIC implementation we will pro vide strategies for nurses to use in pr actice, followed by
considerations for organizations and the workforce.
Since the 2001 report Crossing the Quality Chasm: A New Health System for the 21 st Century (Institute of
Medicine, 2001 ), healthcare professionals ha ve deliv ered patient -centered care as a w ay to impro ve engagement
and qualit y ( Levinson, Lesser , & Epstein, 2010 ). Inherent in this approach is an understanding that trusting,
emotionally supportiv e, and collaborative relationships with patients can affect patient knowledge, decision-
making, and adherence to care ( Levinson et al. , 2010 ). Trauma-informed care (TIC) is a patient -centered approach
to healthcare that not only attends to these elements of qualit y, but also requires healthcare professionals to
attune to the distinct experience of tr auma survivors.
Grounded in an understanding of the impact of tr auma on patients and the
workforce, TIC is conceptualized as a lens through which policy and pr actice are
reviewed and revised to ensure settings and services are safe and welcoming for
both patients and staff. As an example, a clinic ma y implement a more lenient
appointment cancellation policy with the understanding that man y patients have
barriers prev enting them from getting to appointments on time. P erhaps a clinic
revises its intake protocol, noting that sensitiv e questions are best asked face to
face. For the workforce, a tr auma-informed workplace ma y include adequate
supervision and support for self -care.
Healthcare professionals demonstr ate TIC in interpersonal interactions when they provide direct and clear
communication, empower patients and other staff , and work to create emotional safety for others. The Substance
Abuse and Mental Health Administration ( SAMHS A, 2014 ) offered the following principles for a tr auma-informed
Safety (ph ysical and emotional)
Trustworthiness and tr ansparency
Empowerment, voice, choice
Use of peer support
Cultural, historical, and gender responsiv eness
Supporters of a trauma-informed approach recogniz e the prevalence of tr auma surviv ors within healthcare
settings, and are a ware that the service setting can also be a source of tr auma ( Reev es, 2015 ; SAMHS A, 2014 ).
Whether a patient inter action with providers in a healthcare setting is directly or indirectly related to tr auma they
have experienced, the potential to be re-tr aumatized is high. “Understanding how tr auma has affected patients’
lives and their inter actions with and perceptions of the health care system is fundamental to structuring a
healthcare system that responds to these patients’ needs and promotes better ph ysical and mental health
outcomes” ( Dubay et al. , 2018 , p. 2).
trauma surviv ors,
tr auma are less
lik ely to follow
through with a
medical pro vider’s
staff is reflected in
turno ver and
...deliv ery of
universal tr auma
precaution does not
require knowing an
individual’ s trauma
history , but can
benefit all patients
and staff .
Trauma-Informed Nursing Practice
nursing pr actice
requires cultiv ating
nurses who are
The healthcare system is populated b y trauma surviv ors, both those pro viding and
receiving care. Among 1,784 patients participating in a Philadelphia health surv ey,
73% indicated they had experienced at least one adv erse childhood experience
(ACE) as described by Felitti et al. ( 1998 ), while an additional 14% reported
trauma related to communit y violence, including racism ( Cronholm et al., 2015 ).
In another sample at a primary care setting in an urban area (n=509), 23% were
shown to have post -traumatic stress disorder (PT SD). This rate was higher among
those with other risk factors such as chronic pain, irritable bowel syndrome (IBS),
and anxiet y disorders ( Liebschutz et al. , 2007 ). Although the prev alence of work-
related stress, such as vicarious tr auma, secondary traumatic stress, and burnout,
is not generally well understood among healthcare professions ( van Mol,
K ompanje, Benoit, Bakk er, & Nijkamp , 2015 ), rates are known to be high among
emergency department, oncology , pediatric, and hospice nurses (see Beck, 2011
for a review).
Engagement in healthcare, for both patients and staff , is impacted by trauma
(Marsac et al. , 2016 ). For patients, the findings are mix ed. Some research points
to an increase in healthcare utilization among tr auma survivors ( Sansone et al. ,
2014 ), especially for emergency services ( Walk er et al. , 1999 ); while other studies
point to a lower use of prev entive care and screening ( Yanos, Czaja, & Widom,
2010 ). Sansone et al. ( 2014 ) noted childhood tr auma is generally associated with
increased utilization, but not adherence to treatment. Specifically , patients who
have experienced tr auma are less lik ely to follow through with a medical
provider ’s instructions. Engagement for staff is reflected in turno ver and
absenteeism. The turno ver r ate for nurses is significant, at times leading to
worldwide shortages of these professionals, and impacting healthcare qualit y,
cost, and effectiv eness ( Flinkman, Leino-Kilpi, & Salanterä, 2010 ).
In response, the medical field has called for tr auma informed care ( Machtinger,
Cuca, Khanna, R ose, & Kimberg, 2015 ). Noting that the principles of TIC are
congruent with the ethics of medicine and the expectation to “do no harm, ”
Kassam- Adams and Butler ( 2017 ) praised TIC for its focus on prev enting re-
traumatization. R aja, Hasnain, Hoersch, Go ve- Yin, and R ajagopalan ( 2015 )
identified two w ays medicine is able to focus on tr auma in the provision of care.
First, when necessary , trauma-specific care is pro vided; this type of care is aimed
at reducing the impact of tr auma and involv es pr actices such as screening for
ACEs and referring for mental health services and other care. W orking with
patients who have experienced tr auma can have an impact on healthcare professionals, causing secondary
tr aumatic stress or burnout ( van Mol et al. , 2015 ; see section titled Organizational Consider ations and the Nursing
Workforce). It is important when pro viding trauma-specific care to understand how one’ s own history is impacting
patient care, and to know the signs of vicarious tr aumatization.
The second type of trauma-related care focuses on univ ersal precaution. With a
foundation of patient-centered care and communication, this t ype of care
incorporates an understanding of the health implications of tr auma. For example,
healthcare professionals understand that maladaptiv e coping strategies may be
related to a history of tr auma, and they work with patients to identif y alternative
strategies. They pro vide education and advice in a non-judgmental, non-shaming
manner that seeks to build trust and r apport. According to Raja et al. ( 2015 ),
delivery of univ ersal trauma precaution does not require knowing an individual’ s
trauma history , but can benefit all patients and staff .
For TIC to be thoroughly implemented and embodied b y a healthcare system, policies, procedures, and culture
need to be trauma-informed. This work requires multi-lev el commitment and can take substantial time and effort.
There is value and utilit y in individual understanding of the principles of TIC and learning to apply them in all lev els
of nursing practice. Nurses who utiliz e a trauma-informed lens in pr actice can enhance job satisfaction, reduce risk
for burnout, and improve patient experiences and outcomes ( Schulman & Menschner , 2018 ).
Principles of TIC can be applied on a macro-lev el to systems of care and on a
micro-level to nurses’ daily inter actions with all patients. T rauma-informed nursing
pr actice requires cultiv ating nurses who are aware , sensitive , and responsive . In
alignment with the principles of safet y, respect and trust, we suggest that nurses
can begin to ask themselv es, and their colleagues, three simple questions as a
first step to applying a trauma-informed lens to their pr actice, as follows:
Past tr auma has
surprises and ma y
aware , sensitive ,
and responsive .
They [P atients]
may recogniz e you,
but ma y not
remember y our
Both nurse and
patient should ha ve
access to the exit
so that neither
feels tr apped.
1. Safety : Does this cultiv ate a sense of safet y?
2. Respect : Am I, and others, showing respect?
3. Trust : Does this build trust?
Based on many years of nursing experience and sev eral y ears of implementing TIC in medical settings, we ha ve
come to understand how nuanced and impactful TIC is on patient and staff experience. W e have outlined sev eral
pr actical tips to apply TIC principles to nursing pr actice. These suggestions help nurse to incorpor ate a trauma-
informed lens into their nursing pr actice. We would lik e to acknowledge man y nurses already incorpor ating these
approaches in their work; howev er, we ha ve outlined how and wh y they are considered tr auma-informed for those
who may not yet know .
Introduce Yourself and Your Role in Every Patient Interaction
Introductions are important ev en if you think that the patient already knows y ou
and your role. P atients often inter act with many medical team members during
their care. They [P atients] may recognize you, but ma y not remember y our role.
This may lead to confusion and misunderstanding. When a patient understands
who you are and your role in their care, they can feel empowered to be
more actively engaged in their own care. An example of this str ategy might
be: “I know we have met before and I wanted to remind you that I’m Hannah,
your Maternity RN and I work with your primary care provider.”
Use Open and Non-Threatening Body Positioning
It is important to have a wareness of y our body position when working with patients. Open body language con veys
trust and a sense of v alue. Trauma surviv ors often feel powerless and tr apped. This can trigger past experiences of
inability to escape or lacking control. Using non-threatening body positioning helps prevent the threat
detection areas of the brain from taking over, which helps patients stay regulated.
A trauma-informed approach to body position includes attempting to ha ve y our
body on the same lev el as the patient, often sitting at or below the patient. It
could also include raising a hospital bed in order for the nurse and the patient to
be on the same level, reducing the likelihood of creating a perceiv ed power
differential through positioning. Additionally , it is important to think about where
you and the patient are positioned in the room in relation to the door or exit. Both
nurse and patient should ha ve access to the exit so that neither feels tr apped.
Provide Anticipatory Guidance
Verbaliz e what the patient can expect during a visit or procedure or what paperwork will co ver . F or example, fr ame
the visit flow and/or the course of care (e.g. , laboratory tests toda y, sev eral visits in the next month, ultr asound in
two months). Knowing what to expect can reassure patients ev en if it is something that may cause discomfort.
Past tr auma has often been associated with surprises and ma y have been unpredictable. Often tr auma survivors
will expect the worst if left to their imagination.
Anticipatory guidance ma y be used to prepare patients for in vasiv e procedures, such as a v aginal ultrasound or a
thoracentesis. When working in an inpatient setting, anticipatory guidance for
patients ma y include sharing the time of team rounds, or when he or she might
expect to see the doctor or a different nurse. Knowing details such as who will be
part of their care, what they can expect of their da y, or the hours of the cafeteria
can giv e patients a sense of control during a hospitalization. Knowing what to
expect reduces the opportunity for surprises and activation. It also helps
patients feel more empowered in the care planning process with their
care team. One example of anticipatory guidance might be: “The dressing on
your wound needs to be changed and your skin cleaned every morning and
evening. I will do the dressing change with you this morning, and you can expect
your night shift nurse to do your evening change.”
Ask Before Touching
For man y trauma surviv ors, inappropriate or unpleasant touch w as part of a traumatic experience. T ouch, even
when appropriate and necessary for pro viding care, can easily activate a fight, flight, or freeze response. Nurses
are often required to touch patients, sometimes in sensitiv e areas. This may include helping patients sit up in bed,
applying their hospital identification band, listening to their lungs, or examining a wound. An y touch can be
interpreted as unwanted or threatening and it is important to ask permission to touch someone and obtain v erbal
consent before doing so. Touch ma y be activ ating for a patient and ma y bring up difficult feelings or memories.
This may lead to increased anxiet y and activation of the stress response which can result in disruptiv e behaviors
and even lead to the patient dissociating. Asking permission before you touch patients gives them a choice
and empowers them to have control over their body and physical space .
Patients ma y not
feel empowered or
safe asking others
to step out.
Trust is built when
care pro viders who
are forthright and
jargon and using
clear , simple
Touch ma y be
activating for a
patient and ma y
bring up difficult
For routine tasks that ma y be performed multiple times during a hospitalization,
we recommend asking ev ery time you perform the task. F or example, even if you
have measured a patient ’s blood pressure sev eral times already that da y, it is
important to ask permission again, ev ery time you are going to touch him or her .
You might sa y: “I’m going to need to listen to your lungs. Is it ok if I put my hand
on your shoulder?” or “I am going to place my stethoscope here. It may feel a bit
Protect Patient Privacy
When caring for patients there are often others in the room in addition to y ourself
and the patient. Family members and other members of the medical team ma y be
present when you care for a patient. It is important to protect patient privacy
and ensure safety by making sure that the patient desires that the people
present hear about his or her care . It is crucial that nurses do not put the
responsibility on the patient to ask others to lea ve. P atients ma y not feel
empowered or safe asking others to step out. As part of nurse role to protect
patient safet y, it is the responsibilit y of the nurse to ask the patient (in priv ate)
who they would like present during care.
In an outpatient setting this might be accomplished b y bringing the individual patient back to a room and asking
whom they would like present for the visit. If patients do not feel safe with those who accompan y them, this
allows them to continue the visit alone. In an inpatient setting, visitors should be ask ed to leave the room to allow
opportunit y to speak with patients directly about whom they would permit to hear health information before
discussing an y information or care plan.
Provide Clear and Consistent Messaging About Services and Roles
Consistent messaging and tr ansparency are important to foster realistic
expectations. Dependability, reliabilit y, and consistency are important when
working with tr auma survivors because tr auma is often unexpected or
unpredictable. T rust is built when patients experience care pro viders who are
forthright and honest. We recommend that nurses are clear about what can and
cannot be done. Providing consistency from the nurse team about such
information as expectations and/or hospital rules can help patients feel
secure and decrease opportunities for unmet expectations that might lead
to activation and disruptive behavior. Transparency about limits of one’s
role or what can be done in the context of a visit will decrease
opportunities for confusion and activation or dysregulation.
Use Plain Language and Teach Back
We recommend a voiding medical jargon and using clear , simple language. When
using medical language, explain what y ou are talking about with simple non-
medical words. When patients are feeling activ ated (i.e., using their fight, flight, or
freeze system), information processing and learning parts of the br ain do not
function optimally and it is hard to remember new information. When pro viding
education, information, or instructions, break the information you share into small
chunks and check for understanding. Using clear language and teach back
empowers patients with knowledge and understanding about their care.
An example of this recommendation might be: After demonstrating how to test
blood glucose at home, for a patient newly diagnosed with diabetes, ha ve the
patient demonstr ate and explain how and when they will perform the test.
Practice Universal Precaution
With universal precaution, TIC is pro vided to patients regardless of a tr auma history, and in many cases, this is not
known. Although man y providers adv ocate for ACE screening as part of routine care (see Purewal, et al. , 2016 as
an example for screening children and y outh in pediatric settings), this practice is not without concerns, including
the potential negative effects for patients ( Finkelhor , 2018 ). Unless a tr auma-focused interv ention is needed to
ameliorate the impact of tr auma, many TIC experts propose univ ersal precaution rather than direct screening
(Elliott, Bjelajac, Fallot, Markoff, & R eed, 2005 ). Using universal precaution encourages a trauma-informed
system of care and nursing practice instead of relying on screening or trauma disclosures. Using these
practical tips listed abo ve, nurses can begin to implement the univ ersal precaution approach in their daily practice.
The universal precaution approach is well known and widely used in nursing
mitigate exposure to bloodborne pathogens (e.g. , applying gloves before
preforming a procedure in which one could be exposed to blood). In this case, it is
not necessary to know if a patient has a bloodborne illness. Glo ves are applied
because it is possible for blood to carry disease and glo ves reduce risk of the
Organizational Considerations and the Nursing W orkforce
workforce is at
significant risk for
secondary tr auma,
also referred to as
need to create a
to address trauma
exposure as part of
Often, systems and
with TIC principles. Summary
spread of bloodborne illnesses for nurses and patients. Just lik e the gloves, we
apply TIC principles to our pr actice, regardless of trauma disclosure, because we
want to reduce the risk of re-tr aumatization.
Although the patient experience is important, this work often begins with an examination of how principles of TIC
are applied to the workforce. Nurses can begin to use TIC principles to recogniz e opportunities for activation and
re-traumatization in themselv es and their colleagues. This a wareness can require the examination of policies and
procedures that inform personnel management, clinical pr actice, and workplace culture. The following are tips for
organizations and systems for addressing TIC in the workforce.
Recognize Exposure to Trauma
Healthcare settings can be inherently stressful environments. The nursing
workforce is at significant risk for secondary trauma, also referred to as vicarious
trauma ( Beck, 2011 ). There are opportunities for impro vement in medical settings
to address nurse exposure to tr aumatic events and secondary tr auma ( Bell,
Kulkarni, & Dalton, 2003 ). The first step in this work is to recogniz e and normalize
the routine exposure b y nurses to difficult, scary , and traumatic ev ents. With
training, nurses can dev elop common language for tr auma exposure and can
support each other by recognizing when this happens.
Reduce Opportunities for Activation
Nurse Managers and Chief Nursing Officers ma y wish to consider how they might support their nursing staff to
reduce opportunities for activation on the job and establish pr actices that support a nurse once activ ation has
occurred. When nurses and their leadership share a common language and understanding about tr auma and
activation, it can be helpful to lead staff through an ex ercise where together they identify circumstances in their
work when they feel most activated. These “hot spots” can then be ev aluated and addressed to create a more safe
and supportive work environment.
Create Systems for Addressing Trauma Exposure
Healthcare settings need to create a mechanism/v enue to address work-related
trauma exposure. One recommendation is to create policies and pr actices to offer
and encourage help for staff . This includes making the emplo yee assistance
progr am available and accessible; offering daily stress reduction opportunities
(e.g. , sufficient staffing to support breaks for nurses with remo val from a
stimulating en vironment and time to meet biologic needs); and recognizing the
need for support or a break to reset the nerv ous system.
Evaluate Policies and Leadership Practices
When nursing leadership and staff begin to examine systems, policies, and procedures, there often is a need for
systems level change and application of tr auma-informed principles in leadership and policies. This can be
challenging and difficult work. Often, systems and culture ha ve foundational ideologies that directly conflict with
TIC principles. Nursing culture has long had strong hier archical power dynamics. Self-sacrifice may be seen as
necessary to be a “good nurse, ” and breaks are not valued.
While nursing culture is changing, structures are often lacking to support self -care
during a shift. Many hospital cultures use the buddy system to implement breaks
for nurses; this results in insufficient break time for nurses on the floor . Cultural
practices lik e the buddy system de-incentiviz e nurses to tak e breaks from stressful
situations or meet their own biologic needs because they ma y feel they are
compromising patient care or burdening colleagues.
Our knowledge is growing about providing TIC to patients, and how doing so first requires those pro viding the care
to have a tr auma-informed workplace. It is important that nursing leaders and educators consider the first step as
addressing the workforce. If staff feel safe, respected, and empowered, they will lik ely more easily provide
trauma-informed care for patients.
TIC is much like
putting on an
oxy gen mask in an
airplane. Y ou must
first put on y our
Implementation of TIC is much lik e putting on an oxygen mask in an airplane. Y ou
must first put on your mask before assisting others. If nurses do not care for
themselves, they will not be able to properly care for patients. W e must advocate
for systems change at all lev els to promote a trauma-informed workplace in order
to provide the best patient care.
While systems lev el changes take time, nurses can begin now to implement the tips outlined abo ve to work tow ard
a more trauma-informed pr actice. These simple, y et powerful, behaviors can begin to tr ansform both the patient
and nurse experience, ensuring safe and empowering inter actions for all.
Joan Fleishman, PsyD
Email: [email protected]
Dr. Fleishman completed a Doctor ate in Clinical Psychology (PsyD) at P acific University School of Professional
Psychology in 2012 and went on to complete a fellowship in Primary Care Psy chology at University of
Massachusetts Medical School Department of Communit y and Family Medicine in 2014. She is the Beha vioral
Health Clinical Director for Oregon Health & Science Univ ersity Department of F amily Medicine, leading the
expansion of beha vioral health services across six primary care clinics. Dr . Fleishman has focused her work on
integrating beha vioral health services into primary care. She has partnered with regional leaders in tr auma-
informed care to implement TIC across her clinical system. She has lead the strategic planning, program
development, clinician tr aining, and workflow implementation for the widespread use of TIC principles in clinic
practice in healthcare settings.
Hannah Kamsky, BSN, RN, CCCTM
Email: [email protected]
Hannah K amsky completed a BA in Spanish and Cross-Cultur al Studies at Beloit College in 2009. She then spent 5
years working in research, including exploring the impact of health insur ance status on individual health within the
Medicaid population (with Providence Health and Services) as well as clinical trials in contr aception (with the
Women’ s Health R esearch Unit at Oregon Health & Science Univ ersity). Hannah earned a BSN at Oregon Health &
Science Univ ersity in 2015. She work ed on the trauma unit at Oregon Health & Science Univ ersity, a lev el 1
trauma facilit y for the region. Since 2016, Hannah has work ed as a maternity nurse for Family Medicine at
Richmond and in progr am development with Project Nurture. Hannah’ s work with Project Nurture focuses on
trauma-informed care deliv ery as well as systems impro vement for pregnant people with substance use disorders.
Stephanie Sundborg, PhD
Email: [email protected]
Stephanie Sundborg is Director of R esearch and Evaluation for Trauma Informed Oregon, a statewide collabor ative
funded b y the Addictions and Mental Health Division of Oregon Health A uthority, and housed at the R egional
Research Institute (RRI) at P ortland State University. Since 2014, Dr . Sundborg has been working with T rauma
Informed Oregon to pro vide training, consultation, and research related to tr auma and trauma-informed care. In
particular, she focuses on the implementation of TIC in systems, including healthcare, and the impact tr auma has
on service utilization and satisfaction. Dr. Sundborg holds a Master’s of Science in Cognitiv e Neuroscience (focused
on attention and memory), and a PhD from P ortland State University in Social W ork Research, focused on
commitment to TIC.
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