Trauma-Informed Care Assessment Template
Client Information
Name:
Date:
Assessor:
Safety
Describe client's sense of emotional and physical safety:
Environmental considerations:
Trust & Transparency
How is trust established and maintained?
Information shared with client:
Peer Support & Mutual Self-help
Does the client have access to peer support?
Observed peer interactions:
Collaboration & Mutuality
Describe collaboration with the client in care planning:
Empowerment & Choice
How is the client empowered in service delivery?
Decisions client is encouraged to make:
Cultural, Historical, and Gender Issues
Cultural considerations:
Historical/gendered trauma recognized:
Notes & Recommendations
Summary and recommendations: