6 Principles all trauma-informed professionals know to be true.

How SAMHSA played fairy godmother and handed out an identity.

CATEGORY: GOVERNMENT PROJECTS

Psychologist Larke Huang, PhD

Source: SAMHSA
Read time: 2.5 minutes
 
This Happened
In 2014, the federal agency responsible for improving treatment quality in mental health published a report on trauma-informed care (TIC) that has become the central touchstone for the movement.

Who Did This?
The report’s lead author, Larke Huang, is a Yale-trained clinical psychologist and currently serves as Director of the Office of Behavioral Health Equity at the Substance Abuse and Mental Health Services Administration (SAMHSA). The report included six secondary authors. None of the authors have published on trauma in peer-reviewed journals.
Huang has long been celebrated as a social justice advocate. The American Psychological Association described her as someone who has “worked tirelessly her entire career as an advocate for social justice and a champion for diverse and underserved populations.” In 2024, leveraging her government platform once again, Huang published Guide to Equity Terminology: Promoting Behavioral Health Equity through the Words We Use—a document aiming to reshape discourse through prescriptive language.
​
The Premise
As discussed in earlier posts (see here and here), the TIC model was introduced in 2001 by Harris and Fallot. Despite no widespread demand for such a framework and no empirical evidence supporting it, within just four years, remarkably, SAMHSA established the National Center for Trauma-Informed Care based on little more than aspirational theory.
True to the nature of federal institutions, SAMHSA then began organizing conferences, funding academic and nonprofit initiatives, and publishing a stream of reports. Consistently concluding that trauma-informed care was essential to resolving a national crisis in service delivery, these efforts culminated in the infamous 2014 report, SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. It introduced six “key principles” of trauma-informed care:

1. Safety
2. Trustworthiness and Transparency
3. Peer Support
4. Collaboration and Mutuality
5. Empowerment, Voice, and Choice
6. Cultural, Historical, and Gender Issues

Despite being a non-peer-reviewed document, it has been cited over 1,100 times and now serves as the central touchstone for the movement of trauma-informed trainers, scholars, and activists. 

Analysis
The TIC movement began with no empirical evidence and achieved greater popularity from this report, still with no empirical evidence (see here)
How were these principles developed?
SAMHSA staff claimed to have conducted a literature review—though it remains unclear what meaningful studies could have informed it at the time. 

They then assembled a panel of “national experts,” including trauma survivors, clinicians, researchers, and policymakers. From this gathering, SAMHSA produced a draft document and posted it for public comment, drawing over 2,000 responses.

Do these principles align with Harris and Fallot’s original concept?
Harris and Fallot emphasized several key ideas, most of which were faithfully reproduced in the SAMHSA report: services should accommodate vulnerable survivors; environments should be inviting rather than threatening; staff should be empathic and trustworthy; and empowerment and autonomy were essential.
Both documents share the qualities of ambiguity and loose definitions. For example, the principle of Collaboration and Mutuality is described in the report to include “leveling power differences, including clerical and housekeeping staff... One does not have to be a therapist to be therapeutic.” These elaborations are vague and riddled with jargon, giving the illusion of depth while having zero evidence and offering little actionable guidance.

Why Did This Happen?
The TIC movement grew in tandem with the rising critical race theory (CRT) movement. Rooted in postmodernism, CRT claimed the moral high ground by championing the voices of the oppressed. Its adherents fashioned a political framework that fused identity-based grievance with institutional critique—often lacking empirical grounding but rich in rhetorical power.
Critics of both movements warned of the frameworks’ theoretical instabilities and manipulative tendencies. Yet, proponents of both skillfully outmaneuvered opposition and embedded their ideology within influential sectors of government, academia, and healthcare. They have reshaped some sectors of society to the extent that the social contract—the agreement between individuals and its government that defines and limits the rights of each—has been significantly influenced to reevaluate how rights are understood in relation to race and identity. Specifically, while CRT and identity movements claim to address systemic inequalities, their implementations often led to societal harm by fostering division, misunderstanding, and backlash against efforts for racial justice. The brilliance of both CRT and TIC lay not in intellectual coherence, but in strategic execution. And, if fully executed, will lead to nothing good.