Implementing a Trauma-Informed Public Health System in San Francisco, California

Health Educ Behav. 2019 Apr;46(2):251-259. doi: 10.1177/1090198118806942. Epub 2018 Oct 18.


Background: Trauma is a ubiquitous and harmful public health concern. Much like individuals, organizations experience trauma and can embed it within their culture. Left unaddressed, trauma inhibits staff from confronting problems, communicating effectively, and generating solutions, factors that undermine organizational functioning. In response to trauma's far-reaching impact, recent efforts have focused on creating "trauma-informed" systems that emphasize safety and avoid retraumatization. Trauma-informed systems are uniquely connected to relationships, as the impact of trauma both impairs relationships and is heightened in the absence of quality relationships. Developing trauma-informed relationships is therefore critical to creating a healing organizational culture.

Aims: The objective of this article is to describe the process through which the San Francisco Department of Public Health (SFDPH) developed and implemented their Trauma-Informed Systems (TIS) Initiative, an organizational model to address trauma at the systems level. The article highlights the centrality of trauma-informed relationships to the initiative's guiding principles, activities, and implementation process.

Discussion: Six core principles underlie the work of the SFDPH's TIS Initiative: (1) Understanding Trauma & Stress, (2) Compassion & Dependability, (3) Safety & Stability, (4) Collaboration & Empowerment, (5) Cultural Humility & Responsiveness, (6) Resilience & Recovery. Initiative components focus on creating and sustaining trauma-informed knowledge (i.e., foundational training, train-the-trainer program) and organizational practices (i.e., aligned efforts, leadership, and champion engagement).

Conclusion: Trauma-informed systems represent an emergent organization-level intervention designed to address trauma and its sequelae. SFDPH's TIS Initiative is creating a healing organization through its innovative response to the impact of trauma.

Keywords: health policy; trauma-informed systems; workforce development; worksite health; worksite health promotion.

MeSH terms

  • Female
  • Health Plan Implementation*
  • Health Policy
  • Humans
  • Leadership
  • Male
  • Models, Organizational
  • Organizational Culture
  • Public Health Practice*
  • San Francisco / epidemiology
  • Trauma and Stressor Related Disorders / epidemiology
  • Trauma and Stressor Related Disorders / therapy*