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REPORT: 2023 State & Federal Trauma-Informed Policy Review


2023PolicyReview
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RESOURCES:


INTRODUCTION


The impact of and energy embodied by CTIPP’s network of advocates, activists, and partners in trauma-informed, resilience-building, healing-centered, prevention-oriented, and community-led change throughout 2023 was remarkable. 


From growing grassroots efforts to continuing to expand our understanding of what helps and what hurts in preventing and addressing trauma and adversity to co-building capacity to support well-being and resiliency in our communities, it is no doubt that dedicated work and a shared vision are bringing us closer to fostering a just, healthy, and nurturing world for all.


To maintain a high level of momentum and morale in an effort that seeks sweeping, multifaceted transformation, it is essential to recognize that progress comes in many forms and that every step forward – no matter the size – deserves celebration. 


While there are many possible markers for positive progress to uplift, the evolution of trauma-informed policy stands out as a critical reflection of the impacts of collective action continues happening on the ground across sectors, systems, and state lines. 


It is clear as we see more and more meaningful action revealed in CTIPP’s annual landscape analysis that the movement’s messages are not only being heard but are being actively and enthusiastically embraced in greater numbers within our systems and institutions.


This resource intends to facilitate a deep dive into the discourse and strategies shaping trauma-informed public policy action. In presenting our comprehensive analysis, we remain anchored in the belief that the steady progress we are continuing to notice presents further opportunities to fortify change efforts and infuse greater clarity, depth, and values alignment into the conversations constituents have with their representatives about addressing the complex challenges facing their community, the state that they live in, and our broader society. 


Some of the activities that we have engaged in to achieve our best hopes of creating an expansive yet useful tool to support those doing the work on the ground include:


  • tracking trends


  • offering a summary of legislative milestones


  • providing examples of what trauma-informed policy can look like and accomplish


  • helping advocates, activists, and partners in trauma-informed change identify champions, allies, and other potential advocacy targets in the public policy space 


  • uplifting areas of advancement and opportunities for more alignment and growth


  • strengthening the case for emulating policies and change implementation in other communities, systems, and institutions


  • providing ideas for ongoing efforts toward trauma-informed transformation to pursue that advocates, activists, and partners in change may adapt based on localized context, needs, preferences, and priorities


As we reflect on the year’s achievements, it is vital that we acknowledge the collective wisdom and persistent efforts that continue to propel this important work forward. 


The initiatives and insights detailed in this resource underscore an ongoing commitment to transforming our society and offer a roadmap for sustained engagement and advocacy, ensuring that what we know and continue to learn about individual and collective healing, growth, resiliency, and well-being guides systemic and institutional change in meaningful ways moving forward.


We at CTIPP invite all who engage with this resource to join us in pausing to intentionally notice and celebrate the impacts of the good work accomplished in years past and also in walking along the pathways of hope, possibility, and impact in the work ahead illuminated in what is explored and uplifted. 


It is through the act of building on this positive progress that we may co-construct the most impactful plan to enliven our collective vision for a nurturing and resilient world that bolsters and ignites the inherent capacity of every individual, family, group, community, and system to flourish and thrive.


Whitney Marris, LCSW

Author and CTIPP’s Director of Practice and System Transformation


WHAT INFORMS THIS ANALYSIS


There are many considerations and resources that give shape to what you will find presented in this year’s trauma-informed policy analysis.


The most critical component of this analysis is an annual policy report put forth by the Institute on Trauma and Trauma-Informed Care (ITTIC)


In the spirit of its mission to support individuals, organizations, and systems in engaging in universal precautions for individual, historical, and collective trauma, ITTIC creates this report to keep current with how trauma-informed approaches are being recognized, conceptualized, and embedded into the public policy landscape. 


It is important to note that ITTIC’s report has evolved through the years based on the continual increase in support for trauma-informed policy proposals since its humble 2015 beginnings. 


In parallel with a building understanding of and increased interest in trauma within the discourse of our broader society, public policy proposals have become more specific and sophisticated about the what, why, and how of addressing and preventing trauma and building resilience over time. 


In earlier versions of the policy report, any mention, however brief, of “trauma-informed” within legislative text would warrant enthusiastic inclusion given the scarcity of proposals explicitly utilizing a trauma-informed framework at the time. 


Even when including every instance of the use of the simple phrase “trauma-informed” in many past years, chronicling the year’s fullest exploration of relevant policy measures would span a maximum of tens of pages.


This year’s report, in contrast, spans nearly 200 pages – meaning trauma-informed policy action has increased more than tenfold in less than a decade. In light of this exciting development, the ITTIC team has taken a more selective approach about what is and is not included in the report, as momentum has increased through the years.


Rather than simply including bills that merely mention “trauma-informed” in passing, the most recent report is the result of intentional analysis that considers factors such as SAMHSA’s “4 Rs” framework, the principles of a trauma-informed approach, as well as allied frameworks connected to redressing cycles of collective and historical trauma such as principles CTIPP includes under the umbrella of ABDEIJ (Accessibility, Belonging, Diversity, Equity, Inclusion, and Justice).




That means that the 310 bills and resolutions that saw movement in 2023 explored in the report are substantially and meaningfully aligned with the spirit and key principles of a trauma-informed approach. This diligence and discernment create a more accessible, targeted analysis for advocates, activists, and partners in trauma-informed change to reference when determining the direction of the work ahead toward further transformation.


Once ITTIC’s report is complete for the year, the CTIPP team engages in further, deeper analysis based on our guiding comprehensive vision, values, and priorities. We set the course for our exploration based on what we learn from being in community with our network of advocates, activists, and partners in change, the broader sociopolitical landscape, as well as emerging insights and knowledge from the field.


As we look to 2024 and beyond, this year’s analysis shines a spotlight both on strides already made as well as the pathway ahead as we forge forward together in this important work.


POLICY ALIGNMENT WITH CTIPP'S VISION


In our examination of the ITTIC’s latest policy report, we have evaluated the scope and substance of each legislative initiative uplifted. In doing so, we have noted which of the dimensions of our comprehensive vision for a trauma-informed world are substantially represented.



Dimension Representation in 2023 Policy Report At-A-Glance


Noticing what dimensions already have significant momentum as well as which dimensions are less prominent in the progress made this past year are important considerations for advocates, activists, and partners in trauma-informed change to draw from. 


In assessing alignment with each dimension, CTIPP carefully examined each policy and determined that no fewer than one or more than five relevant dimensions apply. Most proposed measures include concepts meaningfully aligned with more than one dimension, as outlined in the chart.


Our findings describe what constitutes a policy that addresses each dimension for reference, along with an example of the 2023 legislative proposal(s) uplifted in the ITTIC report related to that dimension.


In doing so, we have worked to uplift policy proposals representing various regions and political party sponsorship to showcase the breadth and depth of policy action in 2023 and demonstrate how universally relevant this framework is to all. 


The uplifted policy measures are accordingly not necessarily always the “strongest” representations for each dimension, yet all serve as examples of progress within each dimension through a lens that is inclusive of a variety of legislative settings and actors.


Texas House Bill 4111

Mandates specialized trauma-informed workforce training to enhance access to holistic, high-quality, trauma-informed services and supports for those who participate in the state’s Medicaid managed care program.

 

U.S. House Bill 1405 & Senate Bill 670

Enhances trauma-informed training for the workforce that engages with human trafficking to facilitate providing compassionate, comprehensive support, and also implements formal supervision structures as well as knowledge-building requirements regarding building professional resiliency while mitigating the impact of occupational hazards such as vicarious trauma, compassion fatigue, and burnout.

Hawaii House Bill 850

Establishes the Trauma-Informed Education Pilot Program, focusing on mental health education for all who interface with the school environment, and implementing trauma-informed strategies within the school system as backed by the success of similar prior initiatives to foster supportive, trauma-responsive schools and communities.

 

Nevada Assembly Bill 285

Proposes amendments to public school disciplinary standards, mandating the creation of progressive discipline plans that incorporate restorative justice, alternative approaches to conflict resolution and de-escalation, and social-emotional learning interventions, alongside comprehensive training for educational staff on multi-tiered support systems, positive behavioral interventions and supports, trauma-informed practices, collaboration among school staff and community partners, and effective responses to trauma and chronic stress, aiming to positively enhance school climate for all who interface with the school system.

Minnesota House File 2058 & Senate File 1891

Champions culturally-specific and -responsive behavioral health services, encompassing making traditional healing practices more accessible, infrastructure support for health services for people with marginalized identities, expanded assistance for medical interpreter services, and comprehensive training for community health workers.

 

Washington House Bill 1622

Revamps the state’s Homeless Student Stability Education Program to provide holistic support for unhoused students and their families, integrating direct academic assistance, access to basic necessities, supportive health services, and help securing stable housing, while requiring collaboration among community-based organizations and emphasizing a trauma-informed, culturally-responsive approach.

Vermont House Bill 438

Transforms the legal and correctional landscape in the state into a more trauma-informed, justice-centered system by shifting the focus from incarceration to a community-based, holistic approach addressing social determinants of health and mental health such as housing, education, and healthcare to mitigate recidivism, trauma, and social harm, while fostering recovery, economic security, and healthy relationships through accessible, supportive services.

 

California Senate Bill 35

Expands the Community Assistance, Recovery, and Empowerment (CARE) Court Program, enhancing mental health and substance use recovery services as an alternative to incarceration, initiating in a select cohort of communities, and mandating comprehensive training for county behavioral health agencies and judicial officers on the CARE process, trauma-informed approaches, bias-free interventions, providing family psychoeducation, and evidence-informed models of care.

Washington, D.C. Council Bill 25-0321

Broadens Medicaid coverage to include home visiting services, emphasizing evidence-based, culturally-responsive, trauma-informed, and multi-generational support for families.

 

Minnesota House File 912 & Senate File 716

Enhances the operations of child- and family-strengthening systems by introducing bias-reducing accountability practices, mandating cultural competency and humility training, including information on historical trauma, and outlining remediation plans to address systemic disparities, emphasizing strengths-affirming, community-based, culturally-appropriate, and trauma-informed services to support family well-being and functioning.

New Jersey Assembly Bill 4725 & Senate Bill 3009

Establishes the Office of Resilience within the Department of Children and Families, focusing on leveraging NEAR concepts and research to address trauma and build resilience, and outlining plans to develop and disseminate trauma-informed strategies, foster collaboration for a statewide support system, launch a public awareness campaign on ACEs and TIC, and produce research-based resilience tools.

 

Pennsylvania Senate Resolution 102

Designates May 2023 as "Trauma Awareness Month" and May 25, 2023, as "Trauma Awareness Day," uplifting a comprehensive NEAR-based framework to reaffirm the state’s commitment to recognizing and addressing trauma's broad impacts, emphasizing the importance of trauma-informed approaches at individual and collective levels to foster healing and redress historical harms.

 

Washington House Bill 1177 & Senate Bill 5137

Establishes a Missing and Murdered Indigenous Women and People Cold Case Investigations Unit, emphasizing a culturally-attuned, trauma-informed, survivor-centered approach with a dedicated advocate role to ensure sensitive, transparent communication with impacted families.

 

West Virginia House Bill 3033

Proposes the creation of an Intergenerational Poverty Task Force aimed at breaking the cycle of poverty through data analysis, strategic planning, and collaborative efforts to address needs and improve outcomes among those at-risk of perpetuating intergenerational poverty.

Oregon House Bill 2513

Requires the state’s substance use recovery strategy to integrate accountability and holistic, trauma-informed supports across systems and sectors to prioritize choice and autonomy, promote early intervention, remain anchored in cultural humility, as well as to improve individual and community outcomes.

 

U.S. H.R. 4541 & S. 1426

Through a wide variety of trauma-informed, healing-centered, and resilience-building provisions, enhances the trauma-informed workforce and bolsters community resources to support people and communities impacted by trauma, thereby fostering a comprehensive, strategic approach to preventing and addressing trauma while building resilience at the community level across the nation.

New York Assembly Bill 2441 & Senate Bill 3516

Proposes a State Constitution amendment mandating state and local policymakers to prioritize the prevention and mitigation of ACEs as a matter of public concern, setting a precedent by recognizing their profound impact across the lifespan and aiming to disrupt generational trauma to address societal issues like poverty, healthcare, education gaps, economic growth, child- and family-strengthening practices, substance use recovery, and recidivism.

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Hawaii House Bill 486/487 & Senate Bill 894 

Extends the operational timeline of the Trauma-Informed Care Task Force and relocates the Office of Wellness and Resilience to the Department of Human Services, empowering the Task Force to function as an advisory board and develop a comprehensive, culturally-attuned framework for trauma-informed practices across the state, while researching preventing secondary traumatic stress, leveraging federal funds to bolster the resilience of trauma-impacted communities, and integrating trauma-informed principles into state and county contracts.

Illinois House Bill 342

Creates a Children's Adversity Index by the Board of Education to quantify exposure to childhood trauma among those aged 3-18, fostering a collaborative effort among various state agencies to collect critical data on factors affecting child well-being, with the intent to address collective trauma, especially among marginalized communities.

 

California Assembly Bill 1110

Tasks the Office of the Surgeon General with leading a public education effort on toxic stress and ACEs, works to standardize trauma-informed, culturally-sensitive ACEs screening procedures, seeks to pursue enhanced data collection methods and explore best practices for data management, and emphasizes the health vulnerabilities related to ACEs and the need for targeted support to address unequal burdens among marginalized communities and groups.

New Hampshire Senate Bill 175

Mandates Medicaid coverage for comprehensive pregnancy, birthing, and post-partum care, including doula support, lactation services, and access to donor breast milk, while also directing significant resources towards establishing a robust network of early childhood behavioral health supports, all underpinned by a commitment to implement trauma-informed home visiting programs and expanding research efforts.

 

Hawaii House Bill 1053 & Senate Bill 1351

Establishes a program to address the mental health of children under five, with a focus on early intervention and prevention to mitigate future costs associated with education, mental health, and the legal system, while also addressing the compounded impacts of COVID-19 on child development and experiences of family stress, adversity, and trauma, proposing flexible service delivery and workforce training strategies to enhance holistic, trauma-informed early care.

Illinois Senate Bill 646

Establishes a multi-disciplinary body to guide the state towards becoming more trauma-informed and healing-centered by developing uniform language and standards, fostering inclusive practices, assessing training needs, and recommending necessary policy reforms, all grounded in trauma science to ensure equitable, effective, and sustainable service delivery and support systems across the state.

 

Pennsylvania House Bill 813

Establishes the Office of Child Advocate with comprehensive oversight powers and accountability processes concerning child well-being, while also forming the HEAL PA Coalition under the Office to spearhead a statewide plan focusing on network building, implementing trauma-informed change, and supporting healing from collective trauma, such as COVID-19 as well as ongoing systemic inequalities.

U.S. House Bill 3073 & Senate Bill 1452

Supports a public health approach to mental wellness and resilience, proposing CDC-led grants to fuel community-based programs aimed at preventing and addressing issues stemming from toxic stresses and disasters, with a particular focus on enhancing capacity for wellness, rectifying access disparities, as well as building community- and population-level resilience.

 

California Senate Concurrent Resolution 77

Designates June 24, 2023, as a day to celebrate the promising research on the benefits of play for mental and physical health, academic achievement, and leadership development, while acknowledging and calling for solutions to the "play equity gap,” which is described as the unequal access to opportunities for safe and enriching play experienced by communities of color, families that are economically insecure, and people living with disabilities.

Massachusetts Senate Bill 1049

Advocates for pretrial diversion options for justice-involved people who are either pregnant or primary caretakers of children or of older adults, barring clear evidence of public safety risks.

 

Minnesota House File 1494 & Senate File 1489

Funds grants for training in trauma-informed supports to enhance safety in social service environments by offering assistance to providers working with vulnerable and older adults, among other populations, with an emphasis on supporting those who have encountered trauma or safety concerns professionally.

Pennsylvania Senate Resolution 196

Mandates a detailed study to be completed by the Commission on Sentencing to better understand the impact of PTSD, military sexual trauma, and traumatic brain injury on service members, veterans, and their families.

2023 TRENDS & TRIUMPHS


We witnessed unprecedented progress in the enactment and promotion of trauma-informed legislation at both federal and state levels in 2023, building upon the foundations laid in previous years. The steady increase in legislative activity over time underscores a deepening collective consciousness and commitment to addressing and mitigating trauma.

 

The continuous learning and adaptation that a trauma-informed approach requires is reflected in the ever-evolving policy landscape, with 2023’s legislative activities encompassing a broad array of trends and themes.

 

What Policy Proposals Became Law?


As ITTIC’s report notes, the rate at which trauma-informed policies are signed into law is higher than the average rate, indicating that many legislators already recognize the merit and potential of this approach to reckon with our society’s most pressing issues.


Among the 83 trauma-informed measures signed into law in 2023, five CTIPP dimensions appeared most frequently:


  1. Harness NEAR Science for Developmental Resilience

  2. Build a Just and Equitable Legal System for All

  3. Drive Collective Well-Being with a Public Health Approach

  4. Cultivate Well-Being and Resilience in Schools

  5. Increase Positive Experiences in Early Years


This does not differ significantly from our 2022 report’s results – some takeaways include:


  • Underpinning trauma-informed policy proposals with explicit evidence grounded in NEAR Science remains a compelling support and, based on both 2022 and 2023’s results, including this evidence support may increase the likelihood that a policy proposal garners enough enthusiasm to become law.

  • Following in last year’s footsteps, an awareness around the need for reform within the legal system remains present, and trauma-informed solutions appear to be prominently featured as viable alternatives to the inefficient and oftentimes harmful status quo among policymakers.

  • While there was less action in the Drive Collective Well-Being with a Public Health Approach in 2022, last year’s report observed an emerging and growing policy interest in investing in upstream strategies that look more holistically at interrupting cycles of intergenerational trauma and preventing future harm. It is clear that the public health lens has caught on in the last year, with the third most popularly-appearing dimension focusing on this essential element of broad-scale trauma-informed transformation.



Navigating The Language Landscape


Words carry power—the power to validate experiences, anchor in strengths, and set the precedent for how a particular word, term, or phrase is interpreted in future legislative efforts.

 

Many policy proposals considered in 2023 included specific definitions of key concepts and terms. On the one hand, the significantly varied definitions used for certain terms in different venues might lead to the dilution of what a particular term means based on established frameworks and evidence-informed definitions; on the other hand, some definitions explored reflect a nuanced and contextualized understanding of the populations and needs represented within a particular venue.

 

Definitions found throughout legislation uplifted in ITTIC’s 2023 report attend to this duality, and the exploration below highlights how sometimes terms were defined in a consistent, unified fashion, and other times more diverse definitions emerged to shape future trauma-informed proposals.

ACEs, PACEs, and Childhood Trauma

There are a variety of ways that Adverse Childhood Experiences are defined, ranging from creative and novel legislative language, to an outline of the original ACEs study factors, to integrating learnings from research and the field, such as by including elements of the Philadelphia Expanded ACEs Study and/or other frameworks that examine specific contextual factors demonstrated to influence experiences and outcomes along the life course.

 

Notably, PACEs (sometimes defined in the field as “Protective and Compensatory Experiences” and other times as “Positive and Adverse Childhood Experiences”) also appeared in legislative language in 2023.

 

U.S. Senate Bill 3085 (“Preventing Adverse Childhood Experiences [PACE] Act”)

“The term ‘adverse childhood experiences’ means preventable, potentially traumatic events that occur in childhood, and include: experiencing violence, abuse, or neglect; witnessing violence in the home or community; having a family member attempt or die by suicide; and aspects of a child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household where a parent or caregiver struggles with substance use, mental health challenges, or instability due to parental separation or household members being in jail or prison”

 

“The term ‘positive childhood experiences’ means experiences in a child’s home or community and can create or enhance safe, stable, nurturing relationships and environments, and include positive interpersonal experiences with family and friends, and early care settings, schools, and community such as positive parenting and discipline methods, mentoring, and trauma-informed care approaches.”

 

Arkansas House Bill 1791

“As used in this section, an ‘adverse childhood experience’ means a stressful or traumatic event experienced by a minor child. An ‘adverse childhood experience’ may include without limitation a minor child witnessing, or being the victim of: physical abuse; sexual abuse; emotional abuse; physical neglect; emotional neglect; domestic violence; substance abuse; mental illness; parental separation or divorce; and incarceration.”

 

West Virginia House Bill 2143

"’Adverse Childhood Experiences’ are traumatic experiences occurring in childhood which create real and lasting physiological changes to the brain, immune system, stress response, and behavior patterns; the result of which is higher risk for certain chronic diseases such as obesity, heart disease, respiratory illness, and even lung cancer.”

 

Virginia Senate Bill 1300

“’Childhood trauma’ means any emotionally disturbing or distressing event or experience occurring during childhood that could have a lasting negative effect on a child's physical, emotional, and behavioral development and health, including adverse childhood experiences, or childhood physical or emotional abuse or neglect, sexual abuse, alcohol or substance abuse in the home, mental illness in the home, incarceration of a family member, witnessing domestic violence, and parental divorce or separation.”

Trauma-Informed

What it means to commit to the ongoing journey that is aligning oneself or a collective with the principles of a trauma-informed approach is also explored in a variety of ways in the legislation considered in 2023. One of the most common frameworks represented in legislative language is SAMHSA’s conceptualization of “trauma-informed care,” including both mentions of the “Four Rs” as well as the six principles – factors that also informed the creation of ITTIC’s policy report and this CTIPP resource.

 

New Jersey Assembly Bill 1248 & Senate Bill 2545

“’Trauma-informed care’ or ‘trauma-informed interviewing’ means care or services provided pursuant to an approach that: recognizes the presence of trauma symptoms in a person; acknowledges the role trauma may play in an individual’s life; integrates knowledge about trauma into policies, procedures, and practices; is guided by principles of establishing safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and an understanding of cultural, historical, and gender issues; and actively avoids re-traumatization.”

 

Washington, D.C. B25-0234

““Trauma informed services” means a service delivery approach that recognizes and responds to the impacts of trauma with evidence-based supports and intervention, emphasizes physical, psychological, and emotional safety for both providers of services and survivors of trauma, and creates opportunities for survivors of trauma to rebuild a sense of healing and empowerment.”

 

New York Assembly Resolution 432 & Senate Resolution 764

“Trauma-informed care is not a therapy or an intervention, but a principle-based, culture-change process aimed at recognizing strengths and resiliency, as well as helping people who have experienced trauma to overcome those issues in order to lead healthy and positive lives.”

 

Connecticut Senate Bill 5

“’Trauma-informed services’ are services directed by a thorough understanding of the neurological, biological, psychological, and social effects of trauma and violence on a person.”

Historical and Collective Trauma

The trauma-informed principle of being attentive to Cultural, Gender, and Historical issues is explored in several measures presented in the ITTIC report, with some policy proposals establishing language for experiences of trauma within a broader sociopolitical context.

 

Illinois House Bill 342

“Collective trauma is a psychological reaction to a traumatic event shared by any group of people. This may include, but is not limited to, community violence, experiencing racism and discrimination, and the lack of the essential supports for well-being, such as educational or economic opportunities, food, health care, housing, and community cohesion. Trauma can be experienced by anyone, though it is disproportionately experienced by members of marginalized groups. Systemic and historical oppression, such as racism, is often at the root of this inequity. Symptoms may vary at different developmental stages and across different cultural groups and different communities.”

 

U.S. Senate Bill 3085

“The term ‘historical trauma’ means the cumulative, transgenerational, collective experience of emotional and psychological injury in communities.”

Play Equity Gap

It is also striking to notice legislation incorporates a prevention-oriented, equity-centered, justice-advancing, public health lens in establishing legislative language to inform the way that related experiences and conditions are addressed. One example to illustrate how framing within policies can significantly shape healing trajectories in response to societal challenges based on how terms and concepts are defined is the establishment of language about the “play equity gap,” outlined below.

 

California Senate Concurrent Resolution 77

“The play equity gap refers to the inequitable access to sport, play, and movement because of certain barriers, such as the high cost of youth sports, the lack of facilities or safety in their neighborhoods, a lack of trauma-informed coaches, or exclusion based on disability.”

Harmonizing Healing Efforts and Rising Above Partisanship


Much like in last year’s policy analysis, in addition to noting policy dimensions represented among party-led initiatives as depicted below, we continue to see a promising number of trauma-informed policy measures reflecting cooperation and collaboration across party lines.

 

Democrat-Sponsored Legislative Initiatives


Out of the 152 measures sponsored/co-sponsored exclusively by Democrat legislators, the most commonly represented CTIPP dimensions include:



Republican-Sponsored Legislative Initiatives


Out of the 26 measures sponsored/co-sponsored exclusively by Republican legislators, the most commonly represented CTIPP dimensions include:



Initiatives that Cut Across Partisan Divides


There are 107 trauma-informed measures in 2023 that were sponsored/co-sponsored by both Democrats and Republicans and/or those that also were endorsed by Independent legislators or nonpartisan representatives (as in Nebraska, where there are no official political parties within the legislature), with the most commonly-represented dimensions including:



Examining the robust cross-party support for trauma-informed policy that continues to emerge illuminates elements of the shared values and common humanity that exists among decision-makers, and also underscores the universal relevance of trauma-informed approaches when seeking to address and prevent challenges that threaten well-being.

 

Particularly in what is projected to be a contentious election year that is reminiscent of 2020 in many notable and potentially activating ways, being attentive to the ways in which policymakers and other leaders who are positioned in decision-making roles in our society-shaping systems and institutions may bridge divides and foster unity to move us all collectively toward greater well-being will remain an important priority.

 

A Surge in Collaborative and Partnership-Based Policy Proposals 

 

Cross-sector, cross-system partnership and action is a core component of comprehensive trauma-informed transformation. Encouragingly, many policies appearing in ITTIC’s 2023 report call for collaboration with recognition that sweeping trauma-informed change efforts require coordination that transcends the traditional silos that currently exist.

 

The conversations that take place within the many task forces, working groups, and others convened for the shared purpose of better understanding the nature and impact of trauma as well as building solutions relevant to localized context and population preferences are deeply important, and that more of this dialogue will continue holds promise to shape a resilient, healthy future.

 

Having said that, it remains crucial to ensure that these partnerships translate into concrete action. The reality of the limited funding available to dedicate to trauma-informed approaches in a sea of competing demands and policy priorities calls for us to think about how to move beyond funding groups whose solutions often remain unimplemented. After all, it is not uncommon that there are several consecutive legislative sessions where similar measures to fund groups whose solutions may not have the opportunity to be implemented are continually enacted.

 

This not only hinders real progress, but also only gathers evidence for communities that may not necessarily have much in common with the localized context in which solutions are being implemented. Rather than basing recommendations solely on established evidence-based interventions, tapping into the promise of real-world solution-building to begin implementing real change, inform best practices based on unique localized factors, and evaluate progress to further shape the evidence base is a trauma-informed strategy to both continue leveraging the power of cross-sector, cross-system partnerships while simultaneously building community will and capacity to spearhead meaningful change.

 

While there are some legislative efforts that do incorporate pilot programming in this vein, the majority of measures convening groups do not include action steps for implementing the recommendations derived from the ongoing dialogue. With the nature of rotating legislatures and the rapidly shifting sociopolitical landscape, this means that solutions presented in the final reports often go unimplemented as other policy priorities take precedence, and by that point the momentum and excitement around trauma-informed approaches may have petered out.

 

To help translate planning and partnerships into on-the-ground, operational programs and practices that have a tangible positive impact on individuals, families, communities, and systems, it is first vital to ensure that voices of those who will be most impacted by potential changes based on the issue being explored are meaningfully engaged and actively incorporated into implementation processes.

 

This also entails establishing clear change implementation goals and metrics that go beyond the number of meetings held by the group or the amount of reports produced over three years of existence. Adding legislative language to expand the partnership beyond convening professionals and administrators toward including working alongside individuals and communities with lived experience of trauma to also implement the recommendations within a particular time frame while layering and looping learning to continue to inform future action is one possible method of moving this work forward.

 

It is essential that priorities and benchmarks for success are framed flexibly enough that data collection may be shaped in partnership with individual communities, and that evaluation methods are participatory and center community perspective in addition to what practical policy-related metrics might be included in legislation.

 

When change is community-led, positive outcomes are likely to be more significant and sustainable, which also has the potential to further expand the evidence base and create a case for more policies funding for community-led trauma-informed initiatives anchored in cross-sector, cross-system partnerships. By encouraging legislators to include a roadmap proactively aligning research and resulting recommendations with beginning implementation action informed by lived experience of trauma and adversity, we can ensure that these promising partnerships move accountably from devising plans into implementing lasting positive change.

 

Addressing the Syndemic: Supporting Recovery and Bolstering Resilience in Relation to Converging Crises


There is no denying that the COVID-19 pandemic ushered in a time of turmoil, uncertainty, and upheaval across the globe, marked by complex, compounding crises deepening divisions as well as laying bare systemic shortcomings and institutional inequities.

 

Amidst this backdrop of ongoing racial reckonings, eroding social cohesion, constricted access to necessary services and supports, widening disparities and socioeconomic stratification, as well as a surge in identity-based violence perpetrated at individual, family, community, and systemic levels, it is unsurprising that we are collectively continuing to explore ways to promote healing ongoing impacts of the last several years while also seeking to build resilience to withstand similar complex, intersecting public health crises that may occur in the future.

 

Similarly to trends in 2022’s trauma-informed policy analysis, many trauma-informed policy proposals in 2023 mention continuing to learn more about and working to address the continuously unfolding impacts of the syndemic as a significant priority.

 

One notable possibility is that this recognition could be a major factor in elevating CTIPP’s trauma-informed policy dimension of “Drive Collective Well-Being with a Public Health Approach” from being included in just 12% of measures explored in 2022, to being included in 29% of measures explored in 2023 – an increase of over 140% year over year.


Additional Opportunities to Sustain and Leverage This Momentum

 

The increased attention to trauma-informed public health approaches to promoting healing and resiliency in relation to COVID-19 presents advocates, activists, and partners in change with myriad opportunities to broaden the focus from merely addressing one public health crisis to encompassing the advancement of individual-, community-, and population-level resilience in a more comprehensive, holistic manner.

 

For example, there is space to advocate to embed the principles of a trauma-informed approach more explicitly into public health campaigns as well as the systems and institutions that administer them, such as through ensuring messaging destigmatizes and normalizes trauma responses while also providing clear steps to connect to appropriate services, supports, and resources.

 

As another related area of many to consider, it is also a ripe time to advocate for expanding trauma-informed services in rural and remote communities, emphasizing how tailoring delivery models – such as through mechanisms like expanding telehealth capabilities and reimbursement policies as well as deploying mobile service units – can reduce barriers to access and improve outcomes.

 

One final possible area for advocacy action to build on this momentum involves helping policymakers recognize the cyclical relationship between poverty/economic insecurity and trauma. Integrating trauma-informed approaches into economic development policies, financial assistance programming, and employment practices can help break the cycle. As the global economy’s stability continues to be characterized by uncertainty and change, demonstrating the need for economic initiatives to be inclusive, supportive, equitably conducive to long-term resilience, and anchored in the principles of a trauma-informed approach could play a significant role in laying the groundwork for enduring well-being in spite of potential disasters, crises, and other collectively traumatic events in the future.

 

LESSONS LEARNED & FORGING FORWARD

 

Reflecting on the insights garnered from 2023’s policy analysis, it is clear that the collective journey toward trauma-informed transformation continues to make significant strides.

 

Leveraging lessons learned from noticing what is already working well as well as where growth edges lie reveal many trailheads leading to deeper engagement and innovation toward transformation upon which advocates, activists, and partners in trauma-informed change may choose to embark.

 

While there are a variety of factors that will determine what direction for the work ahead fits for each advocate, activist, community, and partner in change, some notable areas that this year’s analysis reveals to be ripe for action are presented below.

 

Elevating Underexplored Dimensions


While this only constitutes CTIPP’s second annual policy analysis process, a clear pattern reveals that certain areas remain in the periphery of trauma-informed public policy’s focus.

 

To this point: the same three CTIPP dimensions – “Champion Veterans, Service Members, and Their Families,” “Fortify Resilient Aging and End-of-Life Experiences,” and “Advance Climate and Environmental Justice” – appeared least frequently across trauma-informed legislation explored in both 2022 and 2023.

 

When charting a course for the work ahead, it will be important to grow the collective voice of advocates, activists, and partners in change uplifting how critical these dimensions are to a comprehensive vision of a trauma-informed world.


Champion Veterans, Service Members, & Their Families

 

In a world marked by instability and escalating conflict both at home and abroad, the holistic well-being of veterans, service members, and their families demands advocacy attention in 2024. From exposure the omnipresent nature of media coverage of war to service members and their families navigating cycles of deployment, there are many factors that pose threats to well-being to consider in meeting the multifaceted needs among those related to this dimension. More intentionally integrating

 

Bolstering support structures to address immediate needs while also building a foundation for long-term resilience and well-being remains an important priority. There are many considerations worthy of bringing awareness to and demanding action on when connecting with policymakers, including but not limited to efforts establishing or expanding coordinated, integrated resources, services, and supports that unlock flourishing beyond visible and invisible wounds, assist in transition to civilian life, and help foster meaning-making, along with policies that seek to increase choice and accessibility of providers, settings, and types of healing modalities covered.

 

For more insights and ideas on potential directions for trauma-informed policy advocacy within this dimension, click here.

 

Advance Climate & Environmental Justice

 

Despite the limited representation of policy proposals related to this dimension in 2023’s report, the urgency of addressing climate and environmental justice through a trauma-informed lens remains high.

 

The escalating frequency and severity of weather- and climate-related events not only pose a direct threat to our physical environment but also bear profound psychological and spiritual impacts on communities through the loss, uncertainty, and displacement they engender. This is particularly true for those historically marginalized and disproportionately impacted by environmental injustices.

 

It is vital to anchor in an ABDEIJ framework in considering trauma-informed policy to advance climate and environmental justice. Every community has an inherent right to inhabit spaces that are not only safe and sustainable but also well-resourced and supportive of connectivity and belonging.

 

Ensuring communities are structurally supported to experience flourishing, and that community members feel a sense of belonging and collective care, entails directly redressing and implementing reparations for the injustices of the past. It also means reimagining environments through a trauma-informed lens to lay the groundwork for resilience, well-being, as well as environmental stewardship to emerge.

 

Advocacy for trauma-informed community planning and design serves as a powerful tool, providing a pathway for policymakers to better grasp the significance of creating spaces that are not only environmentally sustainable but also supportive of the psychological well-being of community members. For instance, incorporating green spaces into communities not only mitigates environmental hazards, but also offers a healing refuge for those grappling with the aftermath of climate-related traumas. This also provides opportunities for physical and social engagement and has been demonstrated both to generate positive emotions such as creativity and calmness as well as to promote a sense of community connectedness and pride.

 

For more insights and ideas on potential directions for trauma-informed policy advocacy within this dimension, click here.

 

Fortify Resilient Aging & End-of-Life Experiences

 

As the global population ages into older adulthood in numbers greater than ever before, the complexities of these years – often marked by a broad range of activities such as reflection on life’s journey, meaning-making, experiences of grief and loss, and inevitable physical, emotional, social, professional, cognitive, and spiritual transitions that accompany aging – require compassionate, comprehensive approaches that honor the dignity and worth of every person.

 

In response to the gaps noted in this year’s policy report, the principles of a trauma-informed approach offer a useful blueprint to reshape how policymakers and our society-at-large support aging individuals and the people who care about them while navigating this life stage.

 

Advocacy efforts related to this dimension may entail, among other activities, ensuring access to care throughout all stages of older adulthood that respects choice, increasing funding for accessible resources and services that support aging in place as well as sustained community connection, and establishing supports for caregivers others who care about aging adults in their lives to access respite care and mental health supports, as well as to learn about the aging process and caretaking through a trauma-informed lens.

 

For more insights and ideas on potential directions for trauma-informed policy advocacy within this dimension, click here.


Increasing the Commitment to Fostering Protective Factors, Fortifying Resilience, and Fomenting Positive Experiences

 

When framing the journey of trauma-informed transformation, it is vital to be intentional regarding the delicate balance of speaking transparently to the depth of trauma without casting shadows on the lived experiences that have shaped human stories, while also focusing on bolstering protective factors and conditions that help positive experiences and resiliency emerge.

 

The mantra “name it to tame it” underscores the significance of explicitly acknowledging trauma, demonstrating how radical honesty about what has happened and how it has manifested has the power to counter the stigma and silence that often envelop traumatic experiences. It is important to recognize that using terms like “trauma-informed” and “trauma-responsive” aims not to dwell on trauma or pathologize pain, but to anchor in truth-telling to highlight the capacity, strength, adaptivity, and wisdom those with lived experiences of trauma and adversity have demonstrated through their enduring survival.

 

While the breadth, depth, and scope of 2023’s collection of trauma-informed legislation is more robust and multidimensional than ever before, it remains true that the majority are focused solely on redressing harm that has already happened. This level of acknowledgment is certainly worth a celebration, particularly given the context of the here and now characterized by a great deal of residual pain and ongoing challenges!

 

It is fundamental, however, that our policies seek not only to provide pathways to heal trauma, but that they also explicitly demonstrate a commitment to enhancing holistic well-being, positive enrichment, and joy so that all may live a self-actualized life. This involves promoting the proactive cultivation of the context and conditions that facilitate empowerment, positive experiences, and flourishing emerging.

 

For healing-centered engagement and relationship-building to have the most significant impact, it is critical that policymakers are equally focused on recognizing, realizing, and responding to trauma and engaging in prevention efforts at the systemic and institutional levels to reduce vulnerability to re-traumatization, as well as on creating and reinforcing protective factors known to actively support well-being, resiliency, and thriving at the individual, family, community, and systemic levels. This dual focus affirms the significance of every individual's story, witnessing and embracing the shadows while also striving towards the light.

 

Limited Recognition of Racial, Cultural, and Historical Trauma

 

To move toward our comprehensive vision of a trauma-informed world, addressing cultural, gender, and historical issues is critical. Based on analyzing 2023’s policy report, it appears that policies often fail to deeply engage with the types of collective and intergenerational trauma – especially absent are those experienced by marginalized communities such as racial, cultural, and historical trauma – and thus miss opportunities to mobilize a trauma-informed framework to address the ongoing impacts.

 

Repairing harm involves being radically honest about historical injustices, amplifying voices of lived experience of collective and intergenerational trauma to shape pathways forward, investing in authentically community-led initiatives, and engaging robust efforts to restore trust and foster reconciliation. Attending to collective and intergenerational trauma also means implementing policies that address the root causes of the cascading and compounding pain and challenges experienced, such as poverty, discrimination, limited access to supportive resources to promote well-being, as well as disparities and inequities.

 

In pursuing policy change in this realm, it is essential ensure that legislative language incorporates the flexibility needed to facilitate equitable access to traditional and culturally-specific healing practices and other culturally-sustaining practices based on what resonates with the unique context of each community. In addition to uplifting policy solutions to heal past wounds as well as disrupt ongoing cycles of pain and trauma, there is an opportunity to celebrate the rich heritage and resilience inherent in each community that has endured these experiences as well as to bolster individualized supports and resources that uplift and increase access to well-being, solidarity, collective wisdom, and cultural celebration.

                                                            

Correcting the Record

 

The role of advocates, activists, and partners in trauma-informed change in clarifying and promoting accurate understanding of trauma-informed and allied concepts is crucial, particularly in the context of policy-making where misinterpretation may not only lead to the enactment of legislation that inflicts harm in the immediate future, but that also has the potential to set the precedent for the same harmful misinterpretation in future legislative efforts.

 

One example to illustrate comes from a “sneak peek” at 2024’s policy report as it is concerning a bill that is currently under consideration: Kentucky Senate Bill 93.

 

This measure seeks to strike language regarding requirements to integrate a trauma-informed approach into schools within a bill initially signed into law in 2019 following a fatal school shooting. The original language has been reaffirmed in subsequent bills, including a measure that was signed into law in 2022 – which was explicitly uplifted and celebrated as a strong representation of progress aligned with CTIPP’s vision on p. 8 of our 2022 Policy Review.

 

This significant of a pivot taking course after the passing of a relatively short period of time indicates that there are misunderstandings around what integrating trauma-informed into school settings does and does not do, fueled by political conversations happening on a more macro-level scale. That assertion seems to be supported based on the divided discourse around the measure, which has been featured in several local news articles.

 

Like so many instances of trauma and re-traumatization, it is important to note the gap between intent and impact. Certainly, while this measure may very well be a well-intentioned effort to maintain what, from someone’s value system and perspective, constitutes a safe and inclusive learning environment, it appears to be premised on a misinterpretation of how a trauma-informed approach operates based on localized context, and in doing so increases vulnerability to harm. There is a potential to suppress and discourage diverse perspectives and open, authentic conversations crucial to developing into adults who are able to navigate the world with curiosity, compassion, critical thinking, and citizenship.

 

Further, the prohibition of virtually anything aligning with principles of (A)BDEI(J) threatens safety for many learners and members of the education workforce alike. The policy proposal also does not fully engage with the complexities of cultural, gender, and historical issues in relation to trauma and how these experiences impact may learning and healthy development.

 

The trauma-informed principle of trustworthiness and transparency illuminates an opportunity for those engaged in advocacy in venues where this is happening or at-risk of happening to support legislators in developing a more integrated understanding of trauma-informed principles, correcting misunderstandings that will result in the passage of policy that runs counter to what helps students learn and grow.

 

One of many examples of how advocates might think about framing this is rooted in helping clarify what concepts that underpin a commitment to a trauma-informed approach such as equity truly mean through a lens that magnifies common values. For legislators in communities with constituents heavily impacted by substance use, to counter misconceptions about trauma-informed, equity-centered approaches, it might be useful to uplift what an equitable distribution that prioritizes communities disproportionately impacted by opioid use in granting access to State Opioid Settlement funds.

 

This example is one of many that could demonstrate how the concept of equity – critical in a trauma-informed approach yet often misconstrued as preferential treatment or politically polarized – is fundamentally about addressing needs based on factors such as their intensity, prevalence, and historical underservicing to support thriving and flourishing for all operating through an abundance mindset versus a scarcity one. With this frame in mind, it is easier to help a skeptical legislator see the potential of a trauma-informed approach to help be sensitive to localized context to ensure justice for all.


Engaging Beyond Legislative Bodies & Reaching Key Decisionmakers

 

The analysis of 2023’s trauma-informed policy landscape reveals several instances where governors vetoed important bills that align significantly with trauma-informed transformation, often citing duplication of efforts or, most frequently, excessive costs of implementing trauma-informed approaches.

 

For bills to have made it to an Executive’s desk in the first place implies that they are likely to have merit, highlighting the importance that all who have significant influence and decision-making power when it comes to trauma-informed policy have a foundational contextual understanding of trauma-informed concepts and principles.

 

This may help overcome barriers that lead to promising and powerful trauma-informed legislation being vetoed rather than signed into law.

 

One new and important finding in recent research on the economic burden of ACE-related adult health conditions, presenting a newly-calculated figure estimating costs at $14.1 trillion annually. Presenting this figure highlights the urgency of addressing ACEs and, more broadly, trauma, while proactively institutionalizing supports and structures to advance holistic health and well-being to reduce this societal burden.

 

This attention-grabbing statistic is a powerful lead-in to describing the significance and merit of trauma-informed, healing-centered, resilience-building, prevention-oriented, and community-led approaches. It is through seizing these opportunities of presenting emerging and evolving insights from the field highlighting the long-term cost savings of investing in solutions aligned with CTIPP’s vision.

 

This also presents advocates, activists, and partners in change to help policymakers and leaders know that implementing trauma-informed approaches is more about the “how” than the “what” and is thus not duplicative but instead presents potential to further enhance the success of what good work to address seemingly intractable societal challenges already underway.

 

Notably, champions among state governors do already exist, and many are already enthusiastic and eager to sign trauma-informed proposals into law. Case in point: the National Governor’s Association (NGA) has shown a promising awareness of the importance of addressing ACEs and trauma, a commitment which can be explored more deeply on the page of their website dedicated to this issue topic.

 

This indicates a growing recognition among state leaders of the indelible impacts of trauma and the potential of trauma-informed approaches to promote recovery and growth, and an opportunity to bring other leaders along toward standing in support of rather than in the way of trauma-informed transformation.

 

While scheduling meetings with governors and their staff can indeed be more challenging than arranging a meeting with a federal representative or state legislator, there are strategies to increase your likelihood of getting in contact to help fill in gaps and advocate for them to consider legislation through a trauma-informed lens in the future. One example is recognizing the power in numbers and bringing together a group of people with shared goals rather than attempting to secure an individual visit to advance trauma-informed policy priorities.

 

Another approach might involve leveraging relationships and connections with mutual contacts who are aligned with a trauma-informed vision, such as local politicians or business leaders, who have existing relationships with the governor’s office and may assist in arranging a meeting.

 

In lieu of engaging directly with others who play key roles in the decision-making processes when it comes to trauma-informed policy implementation, raising consciousness throughout the state can be an effective strategy to elevate visibility and generate greater awareness and enthusiasm. Arranging campaigns, holding town halls, submitting press releases, and other similar strategies all can play a role in garnering the attention and support of governors, the President, and other leaders.

 

The best hope is that this exposure will lead to fewer vetoes and more robust support pertaining to trauma-informed measures that make it to their desks.


CONCLUDING CALL TO ACTION

 

We have witnessed and ought to celebrate meaningful progress in 2023, and there is a wellspring of hope illuminating the path ahead for bold, collaborative action toward a trauma-informed society. The potential for impactful, lasting change through continued action is immense, and each step forward – no matter how small or large – is a stride toward recovery, resilience, and well-being for all.

 

Let us move forward together with the clear conviction that our vision is vibrant and that the work we do matters. Together, we may harness the momentum of 2023’s successes as both a validation of the efforts of collective action taken toward trauma-informed transformation and as a call to action to build upon the foundation of progress laid thus far, amplify our advocacy, align our strategies with emerging opportunities.

 

CTIPP extends heartfelt gratitude to our dedicated network of advocates, activists, and partners in change. It is with great anticipation that we look forward to continuing on this journey toward realizing a vision of a compassionate, resilient, and holistically well world.


Possible Next Step to Keep Momentum Moving Forward


Find a 2023 policy proposal from the ITTIC report that achieves progress in relation to something you care deeply about, whether that policy was considered in a venue of which you are a constituent or not. (Consider utilizing the search feature within the document for this.)

 

Once you have found a policy summary that resonates with you, visit the webpage listed for that measure. Notice who submitted the measure for consideration, and see if you can find that legislator’s contact information through the legislature website.

 

Write a short email thanking the legislator for their leadership. Keep your message respectful, concise, and honest, focusing on the positive impact their work has had on the issue you care about. Be sure to share the “why” of this policy proposal being so meaningful to you, doing your best to stay within your circle of comfort and capacity when it comes to determining what you do and do not disclose about your story.

 

Relationship-building is a critical component of advancing trauma-informed change. While your message may indeed have the most power if you are a constituent of the legislator to whom you reach out, by acknowledging and affirming the work aligned with a trauma-informed approach that is already happening even beyond our own district, we are expanding our collective impact by demonstrating broader public support for this cause and creating further positive momentum for the issue.

 

Knowing their work has wider relevance and resonance, a legislator’s continued commitment to trauma-informed principles may be strengthened, increasing the likelihood that they will submit more trauma-informed policy proposals. Additionally, this is a kind thing to do, and models the model of being trauma-informed by anchoring a culture of recognition and noting progress toward broader change!

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