Trauma Informed Care Training for Clinic Staff: Facilitator Guide

Training Overview

The Pediatric Approach to Trauma, Treatment, and Resilience (PATTeR) Training for Clinic Staff aims to build a trauma-informed workforce in pediatrics. This training is adapted from the PATTeR training, developed by the American Academy of Pediatrics (AAP), in collaboration with University of California Los Angeles (UCLA) and UMass Chan Medical School. It encompasses practical strategies from evidence-based mental health treatment and parenting and resilience literature to pediatric care and workflow. The clinic staff training equips learners with clinical skills in identifying, evaluating, and responding to trauma, as well as providing intervention and support resources to foster secure attachment and resilience. This comprehensive training program aims to develop the competence necessary to implement trauma-informed care (TIC) in practice for all members of the clinical team. The Trauma-Informed Care and Resilience Promotion PediaLink Course is a great starting point for pediatricians to learn the basics of TIC and help prepare them to better facilitate this clinic staff training. The PATTeR Clinic Staff training was developed to be consistent with American Academy of Pediatrics (AAP) policy statements, clinical reports, clinical practice guidelines, and technical reports.  

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Important Consideration

The PATTeR Clinic Staff training discusses adversity and trauma, stress responses systems, and trauma-informed care. The course aims to provide insight into the challenges faced by pediatricians and clinic staff when addressing trauma-related issues in clinical practice. These topics may elicit various emotions or concerns among learners. The aim is to provide a psychologically and physically safe training space. Learners are encouraged to reach out to their training facilitators if any apprehensions arise.  

Targeted Learners

The PATTeR Training for Clinic Staff is designed for all personnel who may interact with patients and families, including front desk staff, nurses, medical assistants, billing personnel, and security. Clinic sites may consider training their entire workforce, even those who do not interact directly with patients and families; this is an important consideration for the team-based nature of TIC.  

Training Goals

• To develop a working understanding of trauma and its effects and the importance of using TIC responses with colleagues, families, and patients. 
• To equip learners with practical trauma-informed care skills in pediatric healthcare settings to promote safety, trust, and engagement. 

Training Objectives

By the end of the training series, participants will be able to: 

• Describe core principles of trauma and trauma-informed care, and explain how they impact children, families, and healthcare teams in clinical settings.
• Recognize stress responses in patients, caregivers, and healthcare providers and apply this understanding to guide clinical interactions.
• Integrate a trauma-informed lens into everyday clinical workflows and team practices.
• Apply practical trauma-informed communication strategies to promote psychological safety, trust, and collaboration with patients and families during clinical encounters.
• Demonstrate skills to promote resilience and relational health in patients, families, and care teams, including strategies for co-regulation, validation, and strength-based engagement. 

Pre-Training Considerations

• How will you deliver this training? (see suggested training structure below) 
• What is your setting for the training? 
• How much time do you need for set-up and take-down? 
• What/who do you need for technical support for PowerPoint, videos, audio, etc.? 
• Who will assist you with teaching, facilitating discussion, and/or supporting learners who may experience stress activation during training? 
• How will you allocate time for preparation, discussions, Q+A sessions, and homework review? 
• Have you assessed practice readiness for TIC? Have you identified a practice team to participate in the training? This training is intended for personnel interacting with patients and families (i.e., nursing, medical technicians, front desk, security, office staff, office manager, etc.). Ideally, learners should take the course as a team and meet between sessions to discuss and reinforce training activities and concepts. 

Facilitator Responsibilities

• Review the course overview, teaching materials, and learning objectives to familiarize oneself with the goals and structure of the PATTeR clinic staff training. (An example of curriculum delivery is viewable on aap.org/tic, linked in the list of additional resources at the end of this guide). 
• Review the video vignettes that demonstrate specific skills (such as welcoming and engaging families, offering simple choices).
• Ensure all teaching materials are downloaded and accessible to participants prior to the start of each session.
• Review speaking notes and discussion prompts for synchronous (live) sessions in preparation for delivering content and facilitating discussions.
• Encourage participation and create a safe learning environment where learners feel comfortable sharing their thoughts and experiences.
• Allocate time for discussions during synchronous sessions to promote active engagement and reinforce key concepts. 
• Provide feedback to participants when they are describing how they use their skills effectively.
• Provide feedback on strengths and improvements when noted. 
• Address any questions or concerns raised by learners.  

Training Structure

This course is designed to be delivered to healthcare teams since TIC is a collaborative effort. The course is designed as a multi- session series that can be delivered in one sitting or over several sessions.  

• Begin each session by providing an overview of the topics to be covered and the learning objectives for the session.
• Utilize the teaching materials, including slide decks, videos, and infographics, to guide the delivery of content and activities.
• Facilitate follow-up discussions and homework review to reflect on the learning experience and reinforce key takeaways.
• Conclude each session by summarizing key points, opening the floor to questions and discussion, and providing guidance on next steps for further learning or practice.
• Consider the following modes of delivery:
  • Synchronous Delivery – The curriculum is structured for synchronous delivery over three sessions. Each session consists of approximately 30 minutes of education followed by brief vignettes and discussions. Homework assignments are given to teams to complete between sessions. There are three synchronous delivery modes:
    • In-person: All team members are physically present.
    • Hybrid: A mix of in-person and virtual participants.
    • Virtual: All participants join remotely.
  • Asynchronous Delivery – If delivered asynchronously, the course could include recorded sessions provided by the facilitator (or recordings of live sessions) that can be shared with staff who are unable to attend the synchronous sessions. Staff would view the recordings independently, followed by later team-based discussion and reflection. 

Training Materials

PATTeR for Clinic Staff Training Slide Deck  

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Format: Synchronous Didactic Lectures 

Estimated Duration: 30 mins didactics + 30 mins discussion per session  

Description: The training slides include speaking notes to guide facilitators in delivering the content effectively. These speaking notes include discussion questions aimed at encouraging learner interaction and fostering discussion. The course is designed as a multi-session series that can be delivered in one sitting or over several sessions. The training slide deck is divided into three sections for ease of access. If delivered in one sitting, repeated slides at the start of each session can be "hidden." Sessions 1 & 2 end with a suggested homework assignment that can reviewed at the start of the subsequent session. If delivered in one sitting, the facilitator can consider integrating the homework assignments as teamwork activities between sessions. 

Session 1: Foundations of Trauma-Informed Care 

• Learning Objectives:
  • Define trauma and trauma-informed care. 
  • Describe the intersection of one’s upbringing and trauma.
  • Describe ACEs (adverse childhood experiences).   
  • Describe toxic stress and how it becomes biologically embedded and affects the brain and body. 
  • Describe how to buffer the toxic stress response.   
  • Define resilience and how an individual becomes resilient.    
• Content:
  • What do we mean by trauma? 
  • What is trauma-informed care? 
  • What is the intersection of one’s upbringing and trauma? 
  • What are ACEs (Adverse Childhood Experiences)?
  • What is toxic stress and how does it become biologically embedded and affect the brain and body?
  • What buffers toxic stress?
  • What is resilience and how does someone become resilient?
  • Homework: Discovery Shopping   

Session 2: Promoting Resilience and Relational Health Skills in Practice 

• Learning Objectives:
  • Describe how to apply TIC skills with patients and families.
  • Describe the provider’s role in addressing trauma. 
  • Describe staff’s role in supporting trauma screening. 
• Content:
  • Homework discussion 
  • How do we apply TIC skills with families and patients? 
  • What’s going on in the exam room?
  • What can staff do to support trauma screening?
  • Homework: Resilience in Action  

Session 3: Navigating Healthcare Stressors and Building Trauma-Informed Teams

• Learning Objectives:
  • Describe the types of stressors or threats at work. 
  • Define burnout, moral injury, and secondary traumatic stress. 
  • Describe how to use the affiliate response in the face of stressors/threats at work.   
  • Describe the importance of trauma-informed clinical teams. 
• Content:
  • Homework discussion 
  • Last session recap 
  • What are the types of stressors or threats at work? 
  • How can we use the affiliate response at work? 
  • How do we navigate healthcare stressors?   
  • What are team-building strategies for trauma-informed teams?   
• Closing  

PATTeR Infographics for Pediatric Providers and Clinic Staff

Description: The infographics offer a visualization of practical strategies pediatric care providers and clinic teams can implement during clinic visits to foster a trauma-informed environment. 

Course of a Pediatric Trauma-Informed Care Visit WITH Families (For Pediatricians & pediatric healthcare clinicians)  

• Content: This infographic is designed to help pediatric providers visualize the flow of a trauma-informed care visit with patients/families. This infographic utilizes the mnemonic "WITH" (Wonder, Investigate, Treat, Hope) that maps onto the mnemonic "SOAP" (Subjective, Objective, Assessment, Plan), familiar to physicians in clinical practice. The role of the pediatrician is to serve as a reliable resource of care for patients/families, to identify and reduce family stressors, to nurture the caregiver-child relationship and build caregiver and child skills -- the WITH framework provides the structure for this work. 
• Suggested Use: This infographic can be introduced alongside session 2 when discussing how trauma can be addressed during a clinic visit. It provides a shared conceptual framework for a trauma-informed pediatric visit with respect to the role providers play in TIC.   

Overview of a Trauma-Informed Pediatric Visit (Staff Version)  

• Content: This infographic provides a visual overview of a trauma-informed care clinic visit. A trauma-informed care clinic visit starts at entry to the clinic and checking-in as a patient, and continues to the waiting area, interactions with nurses and physicians, and exiting the clinic. At each step, there are practical strategies pediatric healthcare workers can use to foster a trauma and resilience informed approach to care.   
• Suggested Use: This infographic can be introduced alongside session 2 when discussing how trauma can be addressed during a clinic visit. It provides a shared conceptual framework for a trauma-informed pediatric visit with respect to the role clinic staff plays in TIC.  

Trauma-Informed Care Resource Infographics for Clinic Staff   

• Content: The additional resources are intended to help healthcare teams to visualize the steps to implement trauma-informed care across different clinical scenarios including routine visits, phone visits, and challenging interactions. Handouts also cover trauma-informed care principles, de-escalation strategies, safety protocols, and non-verbal communication strategies. 
• Suggested Use: These infographics can used as supplemental training materials during and after the session to reinforce key trauma-informed care principles. They can be provided to clinic staff as take-home resources for ongoing use in their daily clinical practice.

PATTeR for Clinic Staff Short Videos

These short videos serve as essential companions to the training sessions by providing concise and focused content that enhances understanding and retention of key concepts.

What is Trauma-Informed Care (TIC)? (Duration: 1 min 25 sec)

This video introduces trauma and trauma-informed care, explaining the three E’s of trauma, the impact of trauma on families, and the core principles and importance of recognizing and responding to the effects of trauma in healthcare settings.  

Suggested Use: This video can be used as a supplemental resource during session 1 to establish a shared foundational understanding of trauma and trauma-informed care before introducing clinical applications. 

Why is TIC important?  (Duration: 2 min 3 sec)

This video emphasizes the importance of trauma-informed care, highlighting the effects of childhood trauma, building trusting relationships, and promoting resilience and healing.  

Suggested Use: This video can be used as a supplemental resource during session 1 to reinforce the relevance of trauma-informed care to pediatric practice, setting the stage for clinical application.  

Safety (Duration: 1 min 17 sec)

This video defines the concept of safety within trauma-informed care, focusing on the benefits of safe healthcare environments, the impact on staff and providers, and creation of a secure and supportive environment for both patients and staff.  

Suggested Use: This video can be used as a supplemental resource during session 2 when the trauma-informed principle of safety is presented to prompt discussion about psychological and physical safety for patients, families, and staff. 

Engagement (Duration: 1 min 37s)

This video explores the role of engagement in trauma-informed care, detailing how the affiliate response is crucial for care. It highlights relational care and empathy, building trust and safety, and supporting emotional well-being.  

Suggested Use: This video can be used as a supplemental resource during session 2  to highlight engagement.  

Instructions for Each Training Session

Session 1: Foundations of Trauma-Informed (Relational) Care

• Introductory slides: Begin with an introduction to the faculty who developed the training, acknowledgments of funding sources, and important considerations about the training content, including the sensitive nature of trauma-related topics. Explain why this training is important and what participants can focus on.
• Session 1 Title: Foundations of Trauma-Informed (Relational) Care
• Overview: Provide an overview of the session’s topics and learning objectives.
• Case Study: Cleo and her parent, Jordan {Please feel free to share a case tailored to your clinical setting} 
  • Cleo Johnson, a 4-year-old girl with a history of asthma, presents with her parent (Jordan) for a well child visit. The family is 15 minutes late. As soon as the medical assistant tries to measure Cleo’s height and weight, Cleo starts crying and clings to Jordan, refusing to cooperate. When asked to step on the scale, she begins kicking and yelling. Jordan appears embarrassed and apologizes repeatedly, saying, “She’s always difficult when we go to the doctor.” The front desk staff notes that, although historically on time for visits, this family has started to miss or reschedule appointments, resulting in inconsistent care. At check-in, Jordan provided updated address information. During vitals, Jordan shares in passing with the nurse that they are now living with Cleo's grandmother. After meeting with Cleo and Jordan, the pediatrician has discovered that Cleo has unexpectedly lost her other parent in a motor vehicle accident 6 months ago. Jordan, a newly single parent, has struggled to maintain consistency for Cleo. 
  • Discussion Questions:
    • What might be driving the patient’s response? (e.g., fear, past trauma, etc.?)
    • How might the parent be feeling? 
    • How might we adjust the visit flow to reduce stress for the patient and the parent?
    • What support might the parent need in this moment?
  • Concepts to Reinforce:
    • Recognizing behavioral cues as potential stress responses
    • Avoiding labels and cultivating curiosity over judgment
    • Small relational strategies to promote safety and cooperation
• Key concepts: 
  • Trauma, Trauma-informed care 
  • Relational Care 
  • Personal experiences and Trauma
  • Adverse childhood experiences 
  • Stress response systems, toxic stress physiology 
  • Affiliate response 
  • Resiliency factors as THREADS 
  • Trauma systems as threads becoming FRAYED 
  • Promoting Resilience: The Ordinary Magic
• Homework Assignment: Discovery Shopping (See Appendix 1 if planning for separate session to conduct activity).
  • Encourage participants to think about how the homework relates to the training. 
  • Instructions: The objective of this activity is to critically assess your clinical setting through a trauma-informed lens. This exercise aims to identify elements within the clinic that contribute to or detract from a sense of safety and belonging for patients and their families. Practices ideally will, as a team, “walk” a real or pretend patient/family through the clinic visit from entry to exit, trying to “see” the clinic setting and staff through the patient/families’ eyes. Some participants may opt to “walk” through the clinic literally on their own for experience. As a team, discuss your observations and findings. Reflect on how these insights can be used to improve the clinic environment. Prepare to report your findings and discuss them in the next training session.
  • Wrap Up and Next Steps: Conclude with a slide summarizing the topics covered and introducing the topics for the next session.  

Session 2: Promoting Resilience and Relational Health Skills in Practice 

• Introductory slides to training: Begin with an introduction to the faculty who developed the training, acknowledgments of funding sources, and important considerations about the training content, including the sensitive nature of trauma-related topics. Explain why this training is important and what participants can focus on.
• Recap Session 1’s homework assignment (See Appendix 1). What did participants or teams find while “discovery shopping”? Highlight specific elements that contribute to a sense of safety and welcome, as well as those that detract from it. Identify practical changes that can be made to enhance the patient experience.
• Session 2 Title: Promoting Resilience and Relational Health Skills in Practice
• Overview: Provide an overview of the session’s topics and learning objectives. 
• Case Study: Joseph and his parent, Alex. {Please feel free to share a case tailored to your clinical setting}
• Joseph Brown, a 2-year-old boy, is brought in by his parent, Alex, for a follow-up visit about developmental concerns. They arrive 30 minutes late and are initially told the appointment will need to be rescheduled. Frustrated, Alex explains they took the day off work to be there and insist that Joseph be seen. Recognizing the tension, the front desk and nursing staff work together to adjust the schedule and accommodate the visit. During check-in, staff notice that Alex sometimes pauses before answering questions, asks for clarification, and appears tense and fatigued. In the exam room, Alex remains quiet and withdrawn, offering brief responses while Joseph plays nearby. When Joseph becomes fidgety and restless during vitals, the nurse gently checks in, and Alex shares that Joseph’s mother recently entered inpatient rehab after a relapse. He has been managing work and Joseph’s care on his own, and the day has been overwhelming.
• Keep in mind: As we go through today's presentation and talk about the "how" of trauma-informed care and apply TIC skills to the case study, remember that your own perspectives will shape your approach. Reflecting on how your experiences, assumptions, and personal contexts come through for you as we discuss the skills of trauma-informed care is important in building empathy and perspective taking, overcoming frustrations, and breaking down barriers when they arise.
• Key concepts: 
  • Trauma-informed care
  • Move from being trauma-informed to practicing trauma-informed care
  • THREADS of Resilience
  • How to apply TIC skills with families and patients 
• Homework Assignment: Resilience in Action (See Appendix 2)
  • Encourage participants to think about how the homework relates to the training. 
  • Instructions: The objective of this activity is to promote resilience during clinical visits through small, meaningful actions that enhance the patient and family experience. It is an opportunity to practice one of the resilience-promoting skills from this training and put it into action.  

Session 3: Navigating Healthcare Stressors and Building Trauma-Informed Teams  

• Introductory slides to training: Begin with an introduction to the faculty who developed the training, acknowledgments of funding sources, and important considerations about the training content, including the sensitive nature of trauma-related topics. Explain why this training is important and what participants can focus on.
• Recap from Session 2: homework assignment (See Appendix 2). 
  • What did participants or teams notice while practicing “resilience in action”? What worked well and what didn't? Any unexpected outcomes or insights? 
  • Why are protective relationships and the affiliate response important? 
  • Why is the affiliate response crucial for us (as health care workers)? 
• Session 3 Title: Navigating Healthcare Stressors and Building Trauma-Informed Teams
• Overview: Provide an overview of the session’s topics and learning objectives. 
• Case Study: Jane the front desk receptionist {Please feel free to share a case tailored to your clinical setting}
  • Jane is a front desk receptionist at a busy community pediatric clinic. Over the past month, there has been significant staff turnover, leaving Jane feeling increasingly overwhelmed at work as she has taken on additional tasks that are not in her job description. Additionally, families have been showing up to appointments late or upset. Jane recently had an upsetting interaction with a caregiver who yelled at her for rescheduling an appointment. In the past week, Jane has had trouble sleeping, and she struggles to wake up and get ready for work. She finds herself having trouble connecting with the patients who come through the clinic and feels annoyed when her team asks her for things. At home, Jane has been irritable with her partner and two young children. Recently, a co-worker who is close with Jane invited her to a yoga class and out for dinner after work. During dinner, Jane expressed gratitude, sharing that recently it has felt challenging to prioritize her own needs over the needs of others.
• Key concepts: 
  • Stressors and threats at work
  • Navigate healthcare stressors 
  • Team-building strategies for trauma-informed teams
• Wrap Up and Next Steps: Conclude with a slide summarizing the topics covered and considerations for next steps after this training. 
• Team Reflections: Guide participants to reflect on the training and develop an action plan to integrate lessons learned after the training. (See Appendix 3) 
• Conclusion / Final “Homework”: Facilitators can end with a final assignment (this is in the spirit of the homework ending the other sessions, recognizing that there is no next session to return this homework). Encourage participants to consider: How can you continue to leverage the affiliate response in working to improve patient and family experience and to build a more collegial work environment? 
• Team Building Activity (See Appendix 4): Since this is the last session of the training, there is no actual homework assignment as learners will not be returning. However, facilitators can consider the following activity if they are reconvening the team after this training.
• Additional resources and handouts about trauma-informed care systems (Appendix 5), patient and provider resources (Appendix 6) and references (Appendix 7) can be shared from the Appendix section of this facilitator guide.  

Training Evaluation

Reflections from Learners: To assess the effectiveness of the PATTeR Training for Clinic Staff and to gather valuable feedback, consider inviting participants to reflect on the following areas. Encourage participants to provide honest feedback, as this information is vital for refining and improving the training program. Collecting feedback can be done through surveys, discussion groups, or one-on-one interviews, depending on what resources are available to you.  

• What aspects of the training were most helpful? 
• What aspects of the training were not helpful? 
• What would you change about the training?
• In what ways was the training relevant to your work? 
• What change(s) will you make as a result of this learning, if any? 
• What do you wish you had learned or learned more about? 
• If you could ask the experts in trauma-informed care additional questions, what would you like to ask them?  

PATTeR Training for the Clinic Team– Post-Training Evaluation Survey for Learners 

Ask learners to complete this evaluation after the training. 

PATTeR Training for Clinic Staff- Feedback Survey for Facilitators 

For training facilitators to provide feedback about using the training toolkit. 

Evaluation Tools for Consideration

The following tools are provided as examples of validated measures used to assess trauma‑informed care across organizations and systems. Detailed information regarding each tool’s development, validity, scoring, and guidance for use is available through the respective websites and publications linked below. 

• TICOMETER/TIC Scale 
  • Use:
    • 35-item survey tool 
    • Measures the extent to which organizations provide trauma-informed care. 
    • Use this tool to assess current capacity to provide trauma informed care, identify areas for improvement, and monitor for changes in practice over time.  

• The Attitudes Related to Trauma-Informed Care (ARTIC) Scale
  • Use:
    • 3 survey versions: 45-item, 35-item, 10-item short form 
    • Measures staff attitudes toward trauma-informed care. 
    • Use this tool to gauge readiness, evaluate the impact of staff training, and assess the sustainability of trauma-informed change efforts.  

• Trauma-Informed Practice (TIP) Scales  
  • Use:
    • 33-item survey tool 
    • Measures the degree to which programs are using trauma-informed practices from the patient’s perspective. 

• Trauma Informed System Change Instrument  
  • Use:
    • 19-item survey tool 
    • Measures the extent to which staff understand trauma-informed practices, use safety plans, and perceive their organization as having formal TIC policies.  

• Knowledge, Attitudes, and Practices of Trauma-Informed Practice
  • Use:
    • 36-item survey tool
    • Measures the knowledge, attitude, and practice of trauma-informed care among interdisciplinary pediatric healthcare staff.