DPI Rapid Review

Best practices, frameworks and tools for measuring trauma-informed practice (TIP)

Full Report

From Training to Transformation:

Why Measuring Trauma-Informed Practice Matters

Can you prove that your trauma-informed approach is making clients feel safer, more empowered, and genuinely heard? Despite widespread adoption of trauma-informed principles, research reveals a critical gap between implementation efforts and evidence of real-world impact on service users and organizational culture.

September 2025

Trauma-informed practice (TIP) has become the gold standard across public and social services—from child welfare to healthcare, education to justice systems. Organizations are investing heavily in training, policy revisions, and cultural shifts. But here's the uncomfortable truth: despite widespread adoption, we're often flying blind when it comes to knowing whether these efforts actually work.

DPI conducted a rapid review that reveals a troubling gap between our aspirations and the evidence base. While TIP training consistently improves staff knowledge and attitudes, we have limited proof that these changes translate into better outcomes for the people we serve.

 

The Training Trap

Most organizations start their TIP journey with staff training—and that's where many stop. The research shows training works: staff feel more confident, understand trauma better, and report improved attitudes. But training is the foundation, not the destination.

The critical question isn't whether your staff can define the four R's of trauma-informed care. It's whether a formerly homeless client feels genuinely safe in your shelter, whether a child in care experiences real choice in their treatment planning, or whether your policies actually prevent re-traumatization rather than just a committed intent.

What Actually Needs Measuring

Effective TIP measurement requires looking beyond individual knowledge to capture three interconnected levels:

Individual Impact: Are clients reporting feelings of safety, trust, and empowerment? Are staff experiencing reduced burnout and secondary trauma? These are examples of measurable indicators of whether your TIP efforts are working.

Organizational Transformation: Have you embedded TIP principles into your policies, not just your mission statement? Is your physical environment welcoming rather than institutional? Does your leadership allocate meaningful resources to TIP implementation?

System-Wide Change: Are you collaborating effectively with other agencies? Do your community's various service systems speak a common language around trauma? Are you addressing structural inequities that perpetuate trauma?

Explore the framework below to learn more.

Multi-Level TIP Measurement Framework

Click on each level to explore indicators, outcomes, and measurement approaches for comprehensive trauma-informed practice evaluation

Individual Level

Service Users & Staff Outcomes

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Client Perceptions
Self-reported feelings of safety, trust, empowerment, and choice in services; perceived cultural responsiveness
Client Well-being
Improvements in emotional regulation, behavioral management, mental health symptoms, and service engagement
Staff Knowledge
Understanding of trauma and TIP principles; improved attitudes towards trauma-informed care
Staff Well-being
Reduced secondary traumatic stress, burnout rates, and improved job satisfaction and confidence
Data Sources & Collection Methods
Client Surveys (TIP Scales, TIC Grade) Staff Assessments (ARTIC Scale) Focus Groups Clinical Interviews Administrative Records

Organizational Level

Policies, Culture & Environment

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Leadership & Governance
Senior leadership commitment, resource allocation, and championing of TIP cultural change
Policies & Procedures
Integration of TIP principles into organizational policies, procedures, and mission statements
Physical Environment
Welcoming spaces, safety features, and trauma-sensitive environmental design
Workforce Development
Training completion, ongoing supervision, coaching, and staff support systems
Data Sources & Collection Methods
TICOMETER Assessment CCTIC Self-Assessment Policy Document Review Environmental Audits Leadership Interviews Staff Culture Surveys

System Level

Cross-Sector Collaboration & Policy

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Cross-Sector Collaboration
Inter-agency partnerships, shared TIP understanding, and coordinated service delivery
System-Level Policies
Integration of TIP principles into broader system policies across sectors
Financing & Sustainability
Dedicated funding streams, resource allocation, and long-term sustainability planning
Population Outcomes
Reduced re-traumatization, improved population health, and decreased health disparities
Data Sources & Collection Methods
Inter-agency MOUs Policy Analysis Funding Reports Administrative Data Linkage System Leader Interviews Community Outcome Metrics

The Cultural Responsiveness Challenge

One size doesn't fit all when it comes to TIP. Many existing measurement tools were developed with predominantly white, college-educated populations, creating a significant blind spot in how we assess effectiveness across diverse communities. For instance, the widely-used ARTIC (Attitudes Related to Trauma-Informed Care) scale showed poor performance when evaluated with racially and culturally diverse staff in specialized settings, potentially leading to inaccurate assessments due to cultural differences in how trauma and healing are understood.

What feels "trauma-informed" varies significantly across cultures, communities, and contexts. Indigenous communities healing from intergenerational trauma from residential schools require fundamentally different approaches than recent immigrants fleeing war zones or urban communities facing systemic racism and poverty. A practice that feels empowering to one group may feel intrusive or irrelevant to another.

The research reveals that many evaluation frameworks fail to capture structural factors like systemic oppression, racism, and historical trauma—precisely the issues that disproportionately affect marginalized communities. This creates a measurement system that may inadvertently perpetuate the very inequities that trauma-informed practice aims to address.

Effective measurement must be co-designed with the communities you serve, not imposed upon them. This means involving people with lived experience not just as respondents to surveys, but as partners in deciding what questions to ask, how to ask them, and what outcomes truly matter. It requires acknowledging that communities are the experts on their own healing and that authentic measurement honors diverse ways of understanding safety, trust, and empowerment.

Eight Evidence-Informed Recommendations

Based on the review and synthesis of the research evidence, several actionable recommendations emerge:

  1. Adopt comprehensive, multi-level measurement strategies that go beyond training metrics to systematically assess individual client and staff outcomes, organizational culture changes, and system-wide impacts. This means tracking everything from client perceptions of safety to policy integration to cross-agency collaboration effectiveness.
  2. Use mixed methods combining surveys, interviews, and administrative data to capture both the breadth and depth of TIP impact. Quantitative data can track trends in incident rates or client retention, while qualitative interviews reveal the nuanced experiences that numbers alone can't capture.
  3. Prioritize service user and staff voices in designing evaluation approaches, moving beyond extractive research to genuine co-design. This includes establishing client advisory boards for evaluation design and recognizing that those with lived experience are essential partners, not just data sources.
  4. Invest in ongoing workforce development with trauma-informed supervision and support that extends far beyond initial training. Research shows that sustainable TIP requires continuous coaching, debriefing, and professional development to prevent staff burnout and maintain practice fidelity over time.
  5. Secure strong leadership commitment with dedicated resources and policy alignment that demonstrates TIP as an organizational priority, not just a program add-on. This means allocating real budgets, revising policies to be trauma-informed, and ensuring senior leaders champion the cultural transformation required.
  6. Emphasize cultural responsivity in both implementation and measurement, recognizing that trauma-informed approaches must be adapted to diverse communities and contexts. Standard measurement tools may not capture what healing looks like across different cultural frameworks and historical experiences.
  7. Plan for long-term assessment using longitudinal designs to track sustained change beyond the immediate post-training glow. Many evaluations stop at measuring increased staff knowledge, but the real question is whether these changes persist and translate into lasting improvements in client outcomes and organizational culture.
  8. Promote cross-sectoral collaboration with common language and shared standards, recognizing that many clients move between multiple service systems. When child welfare, healthcare, education, and justice systems all speak different languages about trauma, clients experience fragmented and potentially re-traumatizing care.

TIP Measurement Planning Process

A step-by-step guide to developing comprehensive trauma-informed practice measurement strategies

1

Articulate Your Vision

Define organizational TIP approach and alignment with core principles

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Organizational Vision
Clearly articulate how TIP will enhance services and client outcomes within your specific context
Example: "We envision TIP creating safer, more empowering experiences for trauma survivors accessing our housing services"
Core Principles Alignment
Map how your approach integrates safety, trustworthiness, peer support, collaboration, empowerment, and cultural responsiveness
Consider: How will you ensure physical/emotional safety? What does collaboration look like in your setting?
Target Population
Identify specific client groups, staff, and stakeholders who will be impacted by TIP implementation
Be specific: Which client demographics? All staff or targeted roles? Community partners?
2

Design Measurement Strategy

Select indicators, data sources, and collection methods across all levels

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Multi-Level Indicators
Define specific, measurable indicators for individual, organizational, and system levels
Individual: Client safety perceptions; Organizational: Policy integration; System: Cross-agency collaboration
Data Sources Selection
Identify appropriate data sources for each indicator including surveys, interviews, administrative data, and observations
Match tools to outcomes: ARTIC scale for staff attitudes, TIP Scales for client perceptions, document review for policies
Collection Methods
Plan specific approaches for data collection including timing, frequency, and responsible parties
Pre/post training surveys, quarterly focus groups, annual environmental audits, ongoing administrative tracking
Ethical Review Checkpoint
Ensure measurement approach prioritizes client safety, cultural responsiveness, and meaningful participation
3

Implement & Evaluate

Execute measurement plan with ongoing assessment and adaptation

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Resource Allocation
Secure human and financial resources needed for comprehensive measurement implementation
Dedicated evaluation staff, training budget, data analysis tools, external consultation if needed
Stakeholder Engagement
Involve clients, staff, and community partners throughout the measurement process as co-designers and participants
Client advisory boards, staff feedback sessions, community partner input on system-level indicators
Continuous Improvement
Establish processes for regular review, analysis, and adaptation of both TIP practices and measurement approaches
Quarterly data review meetings, annual measurement plan updates, responsive adjustments based on findings
Outcomes Assessment
Are measurement results demonstrating meaningful progress toward trauma-informed transformation? If not, revisit and refine approach.

The Bottom Line


TIP represents a fundamental shift from asking "What's wrong with you?" to "What happened to you?" However, without rigorous measurement, we risk this paradigm shift becoming merely rhetorical rather than transformational.

Organizations serious about TIP must be equally serious about trauma-informed evaluation. The stakes are too high for us to assume our good intentions automatically translate into good outcomes.

DPI's full report includes a practical measurement framework, assessment tools, and a planning guide to help organizations move beyond aspirational TIP toward demonstrable impact. Because in the end, TIP isn't about what we intend to do—it's about what we actually accomplish for the people whose lives have been shaped by trauma.

This article summarizes key insights from a DPI rapid review on measurement approaches for trauma-informed practice and care. To read the detailed evidence synthesis, you can access the full report below.

Download Full Report