Optimizing the Role of TIC in Mainstream Clinical Practice

In this course, a multidisciplinary group of experts will present on optimizing the role of trauma-informed care in mainstream clinical practice. Trauma is nearly universal, with approximately 70 percent of individuals worldwide experiencing at least one traumatic event in their lifetime. Yet only a fraction of trauma-exposed individuals present for care, with an estimated 23 percent of primary health care visits involving patients with trauma histories. This discrepancy highlights substantial under-recognition, under-representation of affected groups, and the need for improved outreach, screening, and stigma reduction. Traumatic exposures include adverse childhood experiences (ACEs) such as childhood abuse, gender-based violence, and community violence, as well as trauma associated with war, armed conflict, displacement, and forced migration. Many patients—whether veterans, first responders, security personnel, or individuals affected by global crises—carry moral injury and long-term psychological and physical consequences. 

Trauma-informed care must also incorporate the growing impact of environmental and occupational toxic exposures and ecological disasters. Wildfires, hurricanes, typhoons, tsunamis, flooding, contaminated water systems, industrial accidents, and chemical or particulate releases expose populations to hazards that are often invisible, cumulative, and incompletely characterized. These exposures are linked to respiratory illness, immune dysregulation, cancer risk, cognitive symptoms, anxiety, depression, PTSD, and moral injury. Uncertainty regarding such exposures can heighten psychological distress among affected communities, first responders, and the health care workforce. 

The majority of practitioners are aware of their patients’ traumatic experiences, yet few have been trained to elicit the trauma story, identify trauma-related illnesses, or provide effective counseling. Time constraints, high patient volume, and multitasking demands further complicate care, and highly traumatized patients can generate substantial empathic distress among healthcare workers. Clinicians themselves are at increased risk for secondary traumatic stress, burnout, and moral injury, particularly in high-acuity settings where exposure to suffering, systemic constraints, and ethical dilemmas are common. 

For four decades, the Harvard Program in Refugee Trauma (HPRT) has pioneered culturally grounded, evidence-based approaches to trauma care in the United States and globally. HPRT has collaborated with the founders of the Trauma-Informed Care Movement at SAMHSA and contributed to integrating trauma-informed principles into primary healthcare. This course provides a comprehensive introduction to the trauma-informed care model and presents culturally valid assessment tools, developmentally informed approaches across the lifespan, and practical strategies for working with individuals and families from diverse backgrounds. Counseling, the trauma story, coping with the challenges of nursing, preparing to engage forcibly displaced patients, and clinician self-care will also be addressed.