We are still falling short of trauma-informed care (yes, all these years later)

By Dr. Kate Watson

Over the past decade, trauma-informed care has become the gold standard across victim services. It has shaped how we think about safety, trust, choice, collaboration, and empowerment. And even though this shift has moved the field forward in meaningful ways, there is a problem: Trauma-informed care is still taught as a framework, not a skill set. Most workshops about trauma-informed care give us a way to understand what people have been through. They remind us to avoid retraumatization, prioritize safety, and respect autonomy. Great. But knowing these principles is not the same as knowing what to do in the moment. An advocate can fully believe in empowerment AND and still struggle to respond when a client says, “I know this relationship is dangerous, but I don’t want to leave.” They can value autonomy AND still feel unsure how to navigate a conversation when a client is making choices that carry real risk.

So what’s the problem? Focusing on a framework instead of a skill set can create a false sense of competence among professionals. It can give organizations the impression that staff are fully prepared. But many advocates are trained in the principles of trauma without being trained in the micro-skills required to apply those principles under pressure.

So advocates are left trying to translate vague ideas like:

• “Be empowering”

• “Avoid judgment”

• “Meet clients where they are”

• “Respect boundaries”

So much of this relies on “therapy speak” that the vast majority of people do not understand. So, advocates can benefit from training that goes beyond principles and into practice:

• How to respond to ambivalence in real time

• How to ask questions that invite reflection instead of resistance

• How to manage the urge to fix

• How to stay present in emotionally intense conversations

• How to regulate their own nervous system while supporting others

These are learnable skills. But they require intentional training, practice, and feedback. Without them, advocates are left relying on instinct—and instinct, while valuable, is not always enough in high-stakes situations.

We Also Need to Look at Systems

Even the most skilled advocate will struggle in an environment that doesn’t support the work.

Trauma-informed care emphasizes safety and empowerment for clients. But we also need to ask:

• Are advocates working in conditions that feel psychologically safe?

• Do they have time to reflect, debrief, and recover?

• Are caseloads aligned with the complexity of the work?

• Is supervision focused on growth, not just compliance?

If the system isn’t trauma-informed for staff, the impact will show up in the work.