What Is Trauma-Informed Care?
In 1985, American internist Dr. Vincent Felitti noticed a recurring pattern among his weight-loss clinic patients: many who had successfully lost weight would regain it over time. Through further inquiry and treatment, he discovered that some of these patients had also experienced significant early life adversity. This observation led him to explore the connection between adverse childhood experiences and health outcomes in adulthood.
The Adverse Childhood Experiences (ACEs) Study, formally published in 1998, revealed striking findings. Among the participants—most of whom were middle-class, predominantly White, and highly educated—about 60 percent reported at least one adverse childhood experience, and nearly one in eight reported four or more. The study highlighted how common trauma in childhood truly is.
The U.S. Centers for Disease Control and Prevention (CDC) further emphasized that whether positive or negative, childhood experiences have profound effects on future exposure to violence, potential criminal behavior, overall health, and life opportunities. This is a significant public health issue.
Research has shown that individuals with higher ACEs scores are more likely than those with a score of zero or one to develop chronic illnesses such as heart disease, liver disease, cancer, and depression. They are also at greater risk of obesity, alcohol misuse, substance dependence, social and emotional difficulties, suicidal tendencies, sexually transmitted infections, and cardiovascular conditions.
However, a high ACEs score does not mean that a person is destined to develop physical or mental health problems. Rather, it points to a heightened vulnerability, underscoring the importance of providing supportive resources that foster resilience, healthy development, and social integration for those who have experienced childhood adversity.
Healing from Trauma Requires Collective Care
Drawing on the Adverse Childhood Experiences (ACEs) study, CWLF conducted a national survey of 12th-grade students in Taiwan[1]. The findings revealed that more than one in three (32.4%) reported at least one adverse childhood experience: 14.3% had experienced one trauma, 7.2% reported two, 5% reported three, and 5.9% had four or more. The study shows that even a single traumatic experience can affect a young person's physical and emotional well-being, underscoring the need for timely understanding and support.
Traumatic experiences not only affect children’s emotions; their impact on physical development should not be underestimated. Among students with an ACEs score of four or more, the rates of hyperactivity and developmental delays were significantly higher than among those with lower scores. Even though we recognize that adverse childhood experiences can affect an individual’s physical and mental health—and may negatively impact families, communities, and society—it does not mean that people with high ACEs scores will necessarily develop serious physical or mental health issues. Many individuals with high ACEs scores still maintain good physical and mental well-being.
This research reminds us of two important truths: first, adverse childhood experiences are common; and second, their impact on health and well-being is profound.
Note [1]: The survey was originally scheduled from April 22 to May 31, 2021, with a random sample of 12th-grade students nationwide. A total of 3,049 questionnaires were distributed. However, after classes were suspended on May 18 due to the escalation of the COVID-19 pandemic, only 1,505 responses were collected, resulting in a 49.4% response rate. In Taipei City and New Taipei City, where schools closed earlier amid heightened concerns, the response rates were even lower—26.2% and 33.7%, respectively.
The trauma-informed care approach emphasizes the importance of understanding trauma in supporting survivors. Since the founding of the U.S. National Center for Trauma-Informed Care in 2005, this model has been promoted widely. It is built around four core principles—known as the 4Rs (SAMHSA, 2014): Realizing the impact of trauma, Recognizing its signs, Responding with trauma-informed practices, and Resisting re-traumatization.
The Impact of Trauma on Body and Mind
Recent studies show that the human brain develops much like the construction of a building. It begins with the brainstem, which regulates essential functions such as blood pressure, heart rate, and body temperature. Development then moves to the diencephalon, which governs alertness, appetite, and sleep; followed by the limbic system, which manages emotional attachment, emotional responses, and motor regulation; and finally the cortex, which enables abstract thought and logical reasoning.
Each stage of brain development requires consistent and appropriate stimulation. Without it, the nervous and stress response systems may become either overly sensitive or underactive. As a result, a child may overreact to everyday situations or dissociate. When children experience trauma, their developing brain and stress response system can become overwhelmed, leading to fight, flight, or freeze reactions. Conversely, insufficient stimulation due to neglect or other factors can slow brain development. In both cases, the growth of the cortex may be impaired, leaving a child's overall abilities below their actual age (Perry & Szalavitz, 2018).
Approaches
When facing trauma, people process their experiences through cognition, which then shapes emotions, behaviors, and coping strategies. Research has shown that how individuals think about and interpret traumatic experiences significantly influences the severity of post-traumatic stress disorder (PTSD). Survivors often struggle with negative beliefs such as: “I am powerless, I am worthless, the world is dangerous, nowhere is safe…” These thoughts can intensify anxiety, prevent healing from past pain, and make it difficult to engage with present life.
Some scholars believe that trauma responses are closely tied to early attachment experiences. Infants feel secure when caregivers are nearby, and over time they develop an internal secure base that helps them manage emotions even when the caregiver is absent. In contrast, when infants often feel unsafe or stressed by their caregivers, these experiences leave lasting imprints in the right brain's long-term memory. This can shape a child's self-perception, leading them to feel unworthy or unloved.
Attachment in early childhood has profound effects throughout life. Positive or negative interactions during development influence how secure one feels in relationships. In recent years, Attachment-Based Treatment (ABT) has been developed to strengthen caregiver responsiveness and foster stable parent–child bonds. ABT is not only for infants and caregivers but can also be applied to adolescents and adults.
The Neurosequential Model of Therapeutics (NMT)
Developed by child psychiatrist and trauma expert Dr. Bruce Perry, the Neurosequential Model of Therapeutics (NMT) is a framework grounded in brain development and the effects of trauma.
NMT is not a specific therapy, but an integrative way of assessment and planning. It helps professionals—such as teachers, social workers, and psychologists—tailor support based on a child's developmental stage and life experiences, creating a therapeutic web of care and support.
NMT emphasizes the importance of developmental sequence: the capacities that should emerge at each stage, and how early stress or trauma may disrupt later functioning.
Through NMT, we can view children's behaviors with greater empathy—not simply as problems to be punished or corrected, but as signals of unmet needs. By providing the right support and care, we can help children build healthy relationships and strengthen their ability to cope with stress.