IRETA staff member Dr. Holly Hagle shares her thoughts on trauma-informed care

The thought that’s always at the top of my mind when I look at our training planning is: are we meeting the needs of the counselors we educate and the people they serve?

One area where we can do more is that of trauma and providing trauma-informed care. As the Director of the National Screening, Brief Intervention and Referral to Treatment Addiction Technology Transfer Center (N-SBIRT ATTC) and head of IRETA’s training and educational activities, I want to offer the best educational topics to our workforce and right now, we do not do enough trauma training.

What is trauma-informed care? It is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role trauma has played in their lives.  And further, for agencies to be trauma-informed means to universally screen clients for trauma.

According to the National Council Magazine, approximately 25 percent of children and adolescents experience at least one potentially traumatic event, including life-threatening accidents, disasters, maltreatment, assault, and family and community violence (p. 28). In fact, trauma is now considered a near-universal experience of individuals with behavioral health problems.

Facts about trauma

We now know that:

Trauma is widespread.  

  • 1 in 4 children and adolescents in the U.S. experiences at least one potentially traumatic event before the age of 16[1]
  • Sexual violence affects up to 1/3 of women during their lifetime[2]
  • An estimated 1.8 million men will severely assault their partner in a given year[3]

The effects of trauma are as complex as the causes of trauma. It has been found that experiencing trauma increases adverse events such as homelessness, incarnation, an increased risk for alcoholism, alcohol abuse, depression, illicit drug use, risk for intimate partner violence, sexually transmitted diseases, suicide attempts, and unintended pregnancies, fueling cycles of traumatic experiences. This is based on the findings of the Adverse Childhood Experiences (ACE) study, which surveyed  over 17,000 individuals and connected adverse childhood and later-in-life well-being.

View the ACE Questionaire Instrument

Trauma-Informed Approaches

When we think about what constitutes trauma–acts of violence, assault, abuse, accidents, war, incarnation, sexual assault, domestic violence, child abuse, neglect–the concept can be overwhelming for us as practitioners, let alone for those experiencing trauma.

In her interview in the National Council Magazine, Tonier Cain said, “Someone finally asked me ‘What happened to you?’ instead of ‘What’s wrong with you?’”

This question led to a breakthrough in her recovery. It was the first time someone focused on what brought her to this point, not what she did to come to this point, which for her was jail. I am personally moved by this topic not only as an educator, but as a woman, wife and mother. I know (and you probably do, too) many adults who experienced traumatic events in their childhood and they carry that with them today, every day. I hope that we can learn more about how to address these histories as practitioners and educators.

My only hope is that we are asking the right questions.

Recommended Resources

The Substance Abuse and Mental Health Services Administration (SAMHSA) is a leader in developing and disseminating information on trauma and trauma informed care. SAMHSA’s National Center for Trauma-Informed Care (NCTIC) increases awareness of trauma-informed care, promotes the implementation of trauma-informed practices in programs and services, offers technical assistance, offers training, and lists referral and support services.

This 54-minute Tonier Cain video is fantastic.


[1] Costello, E., Erkanli, A., Fairbank, J., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress,15(2), 99–112.
[2] Luce, H., Schrager, S., & Gilchrist, V. (2010). Sexual assault of women. American Family Physician, 81(4), 489–495.
[3] SAMHSA/CSAP Prevention Pathways Online Course

Holly Hagle, PhD is the Director of the National SBIRT Addiction Technology Transfer Center.  Dr. Hagle has been actively working with providers since joining the Institute for Research, Education and Training in Addictions (IRETA) in 2003. She is the Director of the National Screening, Brief Intervention and Referral to Treatment Addiction Technology Transfer Center (National SBIRT ATTC) and as such oversees all of the training and educational initiatives.  Dr. Hagle has overseen the curriculum development and project coordination for three Heath Resources and Services Administration (HRSA)-funded  SBIRT projects with the University of Pittsburgh School of Nursing since 2006.  She is an Adjunct Assistant Professor of Health and Community Systems, University of Pittsburgh, School of Nursing and has a BS in Psychology, MA in Education, Curriculum and Instruction and PhD in Education, Instructional Management and Leadership. See Dr. Hagle’s selected publications