Strengthening Supports to Lessen the Impact of and Prevent Future Traumatic Experiences

June 30, 2026

Although society works to ensure that individuals are surrounded by and have access to supportive environments, systems, programs, and services, gaps in support remain. This causes some people to still encounter significant risks and adverse experiences. When this occurs, it is critical that effective interventions are in place to address those traumatic experiences, lessen their impact, and reduce the likelihood of ongoing emotional instability. This goes for these individuals and their children who may experience intergenerational trauma.

There are many ways to provide supportive environments that facilitate healing and healthy development for children and families. Together, the following strategies can form a coordinated approach that promotes safety, stability, and well‑being in families and across generations:

  • Integrating behavioral health into primary care ensures that individuals receive support for mental and emotional challenges before they escalate.
  • Expanding access to behavioral health treatment and services offers people at risk the tools and guidance they need to navigate stress, trauma, and conflict in healthier ways.
  • Strengthening civil protections to support those at risk of emotional adversity or violence helps stabilize individuals and families during vulnerable periods.
  • Enhancing responses to traumatic events further supports healing and reduces long-term health impacts.

The approaches detailed in this action guide are key to creating supportive conditions for children and families while reducing the impact or likelihood of ongoing traumatic experiences, with an abundance of research demonstrating they are at the intersection of preventing adverse childhood experiences, suicides, overdoses, and mental health concerns. Effective implementation of each takes:

  • Convening and partnering with organizations that can support education efforts.
  • Collecting and disseminating data on opportunities for and benefits of these interventions. 
  • Raising awareness in communities and reducing barriers for families and those providing these critical services.
  • Identifying care deserts where primary care and/or behavioral health care may not be available or so overwhelmed that new referrals cannot be seen in a timely manner to guide opportunities for expanding access.
  • Assessing the evidence of both benefit and increased risk for these interventions. If a particular intervention is assessed as risky, this may lead to an opportunity for increased training and/or policy change.

On This Page


Supporting Behavioral Health Integration into Primary Care

Enhance Screening and Referrals for Individuals at Risk of Instability, Loss, or Violence

Primary care providers are trained to identify and address risk factors that lead to adverse health outcomes among children and adults. Intentional efforts to integrate behavioral health into primary care include screening for risk factors that might increase instability or violence, such as:

  • Child abuse or neglect.
  • Substance use or misuse.
  • Access to lethal means (i.e., firearms).
  • Dating or intimate partner violence.
  • Mental health concerns (e.g., depression, anxiety, or suicidal ideation).

When identified in the primary care setting, providers can offer families educational resources and provide referrals to support and behavioral health care. Primary care settings also allow for ongoing follow-up with children and adults to ensure they are receiving the support they need to address risk factors for instability or violence.

HRSA, SAMHSA, and CMS have provided funding for behavioral health integration into primary care. Foundations, states, and health care organizations have also funded these efforts to identify individuals at risk and lessen the short/long-term challenges that these risk factors can cause.

How to Implement This Approach

Partnership

Key partners that can help educate the public and decision-makers about the need to integrate behavioral health into primary care include state agencies involved in public health, health care finance and regulation, behavioral health authorities, social services, and child welfare. These groups can also collaborate with private insurance organizations or payers, health systems with primary care services, and coordinating bodies for those providing primary care clinics or behavioral health services.

Education

Key Data

Focus on sharing information about how integrating behavioral health into primary care can enhance opportunities to identify and support children or adults at risk of instability or violence. If available locally, showcase data showing increases in screening and subsequent referrals provided to those who demonstrated risk for child abuse or neglect, depression, self-injury, intimate partner violence, or substance use or misuse.

Local Stories

Source stories directly from families who have been positively impacted by screening and referrals from primary care providers, and how they connected them to subsequent support or behavioral health services. If families’ stories are too confidential, providers can also provide examples of success stories they have experienced by integrating behavioral care into their practice.

State Assessment

Determine whether the state has funding (federal, state, or local) to support efforts that can be used to integrate behavioral health into primary care, and if these resources are adequately reaching children and adults with risk factors for instability or violence. Determine whether additional state- or local-level programming could be implemented to further enhance efforts to integrate behavioral health into primary care, such as:

  • Enhancing training opportunities for providers to recognize risk factors, build communication skills with patients on sensitive topics (including asking about firearm access and storage), and use trauma-informed approaches.
  • Enhancing health information technology efforts to integrate screening forms into electronic health records.
  • Connecting primary care and behavioral health providers, and ensuring there is a clear referral pathway and feedback loop for primary care to conduct consistent follow-up.
  • Enhancing efforts to integrate universal screening of risk factors related to self-injury or violence into primary care, which ensures that those who are not willing to disclose any concerns or experiences still have access to information and resources.

Raising Awareness and Reducing Barriers

  • Support state or local agencies in accessing federal, state, or local funding for integrating behavioral health into primary care.
  • Support workforce development programs for primary care providers to access training that enhances their recognition and ability to screen risk factors for instability or violence.
  • Establish statewide behavioral health screening guidelines (e.g., depression, anxiety, substance abuse, and intimate partner violence).
  • Develop or support communities of practice that allow organizations to share best practices in screening tools, electronic health record integration, educational resources, and building referral networks.
  • Create incentives for primary care organizations working to create supportive and safe environments for people to disclose adverse experiences or concerns, by improving their physical space, appointment options (e.g., longer appointments), or training offerings.
  • Communicate the importance of implementing evidence-based strategies, such as Safe Environment for Every Kid, Bright Futures, or Screening, Brief Intervention & Referral to Treatment, which can be implemented in adult or pediatric primary care settings.
  • Inform state and local decision-makers about how they can enhance laws and administrative regulations that enhance children’s access to behavioral and mental health care.

Behavioral Health Integration Resources

 

Enhancing Access to Behavioral Health Treatment and Services

Support Efforts to Provide Care to Individuals and Families at Risk

Many individuals benefit from working with a trained mental health professional, particularly if they have experienced a traumatic event or situation, substance use or misuse, are at risk for perpetuating violence against others, or are depressed, anxious, or stressed. Behavioral health treatment — which can involve multiple types of effective treatment, often matched to the individual’s risk factors and preferences — can help reduce behaviors or symptoms, and prevent any ongoing emotional instability. This care can also impact families of individuals at risk, as parental or caregiver hardships often perpetuate trauma among their children.

The federal and state governments have worked to expand access to behavioral health care through multiple mechanisms:

  • Medicaid and the Children’s Health Insurance Program are the largest payers for behavioral health services due to expanding coverage of behavioral health services (e.g., telehealth, school-based care, community behavioral health clinics, mobile crisis services, and short-term stays in treatment facilities).
  • CMS and CDC have supported efforts to build the workforce capacity in behavioral health care, so that providers can provide effective treatment for those who want to access care.
  • SAMHSA can help individuals identify appropriate treatment, with a registry of providers and a hotline to call for support. It also provides a directory of technical assistance and training providers who can support those working on expanding access to behavioral health care.

How to Implement This Approach

Partnership

Key partners that can help educate the public and decision-makers about the need to expand access to behavioral health care include state agencies involved in public health, health care finance and regulation, behavioral health authorities, social services, and child welfare. These groups can also collaborate with private insurance organizations, payers, health care systems, or directly with behavioral health care providers.

Education

Key Data

Focus on sharing information about how receiving behavioral health care for problematic behaviors or traumatic experiences can alleviate future emotional instability. If available locally, highlight data showing increases in behavioral health care for those who were referred to care versus accessing on their own.

Local Stories

Source stories directly from individuals who have been positively impacted by accessing behavioral health care, and how it helped reduce their own problematic behaviors, symptoms, or helped make them a more supportive parent or caregiver. If individuals’ stories are too confidential, behavioral health care providers can also share success stories about providing care to these at-risk individuals, with their consent.

State Assessment

Determine whether the state has funding (federal, state, or local) to support efforts that can enhance behavioral health care access, and if these resources adequately reach those with behaviors or risk factors for instability or violence. Determine whether additional state- or local-level programming could be implemented to further enhance access to behavioral health care, such as:

  • Helping to reduce costs for accessing behavioral health care for those who do not have insurance or other resources to access care (e.g., Colorado’s I Matter Program).
  • Expanding access to behavioral health care in non-clinical settings, such as in schools, community centers, or nursing homes.
  • Building workforce capacity for providers who offer behavioral health care.
  • Supporting outreach to individuals or communities who have experienced trauma or engage in problematic behaviors to understand how they can access behavioral health care tailored to their unique needs.

Raising Awareness and Reducing Barriers

  • Establish statewide mental health frameworks to guide prevention, early intervention, and treatment.
  • Support state or local agencies in accessing federal, state, or local funding to expand access to behavioral health care.
  • Support workforce development programs for behavioral health care providers to access training on effective treatments and trauma-informed care
  • Communicate the importance of implementing effective treatments that are tailored to each client’s risk factors. Evidence-based treatment protocols may include cognitive behavioral therapy, cognitive processing therapy, cognitive trauma therapy, dialectical behavior therapy, prolonged exposure therapy, multisystemic therapy, multidimensional family therapy, and marriage and family therapy.
  • Provide financial support to behavioral health providers to provide secure platforms for telehealth services, and to expand their reach to individuals at risk.
  • Support informational campaigns about how access to behavioral health care can be a lifesaving strategy that reduces risks or traumatic symptoms. Ask policymakers to allocate resources to improve outreach about the importance of behavioral health care.
  • Inform state decision-makers about how they can enhance laws to increase access to behavioral health care.

Improving Behavioral Health Access Resources

Improving Civil Protections to Prevent Traumatic Experiences

Promote Awareness of Protection Orders

Domestic violence protection orders (DVPOs) and Extreme Risk Protection Orders (ERPOs) are two types of civil protection designed to protect people from violence, without charging someone with a crime (although DVPOs can include both non-criminal and criminal cases). Both use a court order from a judge to stop someone from injuring another (ERPOs can also protect against self-injury), and can prohibit the the subject of the order from possessing or purchasing firearms, with the goal of giving time and space away from firearms (due to their lethality) while they access support and behavioral health care.

  • DVPOs are more broadly focused on protecting individuals from domestic or intimate partner abuse/violence by prohibiting access to or communication with the victim. The judge issuing a DVPO can create an additional requirement that the perpetrator does not possess or purchase firearms while the order is in effect. DVPOs exist in all U.S. states and jurisdictions; however, the protection specifics (including prohibition of firearm access), order length, and how orders are enforced vary widely.
  • ERPOs are designed to be used when someone poses a significant and immediate risk of self-injury or violence against others, and that risk is intensified by their ability to access firearms. ERPOs exist in less than half of U.S. states and jurisdictions, and differ in their implementation, the standard used to decide if an order should be issued, the order length, and how orders are enforced. The National ERPO Resource Center provides training and technical assistance to states and localities with the implementation of their ERPO programs.

How to Implement This Approach

Partnership

Key partners that can help educate the public and decision-makers about the need to promote awareness of protection orders as a tool for keeping people safe from immediate risk include state and local government agencies, health care and mental health providers, courts and attorneys, and community organizations supporting survivors of domestic violence or individuals experiencing suicidal ideation.

Education

Key Data

Focus on sharing information about how protection orders have helped individuals at risk of violence from others or self-injury. Showcase local trends in awareness and use of protection orders, and how they have prevented escalation of violence (e.g., University of Colorado’s State of the Policy: Extreme Risk Protection Orders).

Local Stories

Source stories directly from families who have been positively impacted by using a DVPO or ERPO for protection. If families’ stories are too confidential, law enforcement, health care, behavioral health providers, or organizations supporting victims can offer success stories they have experienced.

State Assessment

Determine whether DVPOs and ERPOs exist in your state and how they are implemented and enforced. Identify gaps and whether improvements can be made to implementation and enforcement in your state. This might include:

  • Who can petition for an order.
  • Who is protected by the order.
  • What standard the courts apply to determine whether to issue the order.
  • What protections are included in the order.
  • How long the order is in effect. How the order is enforced.
  • How the order prevents possession and purchase of firearms.

Raising Awareness and Reducing Barriers

  • Support informational campaigns promoting awareness of protection orders as a tool to keep people safe from immediate risk of self-injury or violence. Ask policymakers to allocate resources to improve outreach to individuals or families who might benefit from knowledge regarding the existence of these orders.
  • Ensure groups already reaching and supporting individuals at risk of self-injury or violence (e.g., law enforcement, behavioral health providers, health care providers, educators) are aware of and know how to petition directly (in the case where allowed by state ERPOs). Or that they are able to provide resources about the ability to petition for a DVPO to ERPO to clients.
  • Make it easier to file DVPOs or ERPOs, such as by offering support through a hotline, providing online or phone filing (rather than just filing at a courthouse), extending hours to file if in person, removing fees to file, or providing multilingual forms.
  • Strengthen enforcement of protection orders (e.g., requiring timely service of orders by law enforcement, creating statewide systems to track active orders, and ensuring firearm surrender is carried out and verified).
  • Strengthen legal protections for survivors of violence, such as increasing penalties for violating protection orders, allowing long-term orders in severe cases, and ensuring they do not face retaliation from the perpetrators related to child custody.

Enhance Access to Supervised Visitation and Exchange Programs

In supervised visitation and exchange programs, parents spend time with children while a trained, neutral third party is present, who is focused on monitoring the child’s physical and emotional safety. Courts can order these when they believe parents cannot safely interact with each other or the non-custodial parent cannot safely interact with a child. Families can also voluntarily participate in these efforts. These programs are designed to protect children and parents or caregivers during family interactions when domestic violence has occurred, and separation is in place. Because they are ordered by courts, they are considered an additional civil tool to keep people safe from potential violence.

The U.S. Department of Justice and HHS have provided funding to states to support supervised visitation and exchange programs, due to federal legislation like the Violence Against Women Act, Family Violence Prevention and Services Act, and the Victims of Crime Act. While the availability of supervised visitation and exchange programs depends heavily on this federal funding, some state and local governments and community-based organizations have supplemented federal funds to enhance access to these services.

How to Implement This Approach

Partnership

Key partners can help educate the public and decision-makers about the need for supervised visitation and exchange programs in families who have experienced domestic violence. This includes state and local agencies involved in public health, social services, child welfare, courts and attorneys, and community organizations providing direct services to individuals or families at risk of injury and violence.

Education

Key Data

Focus on sharing information about how supervised visitation and exchange programs have ensured that children and survivors of domestic violence can interact with family members in a safe, structured environment. If available locally, showcase data demonstrating the use of these programs and any success in supporting these families.

Local Stories

Source stories directly from individuals who have been positively impacted by supervised visitation and exchange programs. If families’ stories are too confidential, individuals or groups that have supported these services can offer examples of success stories they have experienced.

State Assessment

Determine whether the state has supervised visitation and exchange programs, how they are funded (federal, state, or local), and if programs are adequately reaching individuals and families at the highest need for the service. Determine whether additional state- or local-level programming could enhance access to these services, such as:

  • Ensuring groups providing supervised visitation and exchange programs are adequately funded and able to provide sufficient services to those in need.
  • Expanding the reach of these programs to rural or tribal areas, given that they are more commonly implemented in urban areas.
  • Enhancing training opportunities to build workforce capacity for those providing programs.
  • Standardizing court practices on how to determine if a supervised visitation or exchange is needed.

Raising Awareness and Reducing Barriers

Support state or local agencies in accessing federal, state, or local funding for supervised visitation and exchange programs, particularly in tribal or rural areas. Also, support workforce development programs for those who provide services to families on culturally responsive and trauma-informed care.

Ensure courts are aware of programs and have sufficient knowledge of how to determine risk and subsequent decisions in requiring the use of the program. This includes ensuring coordination about cases with child welfare and domestic violence organizations. Finally, reduce logistical barriers that families face (e.g., addressing transportation availability or costs, providing services for free, or expanding hours of visitation for on-site programs into evenings and weekends).

Improving Civil Protections Resources

Enhancing Responses After Traumatic Events

Strengthen Crisis Response Services to Address Immediate Needs

To protect people at their most vulnerable, it is important that crisis response services address immediate needs and prevent further violence. When someone is in immediate danger — whether experiencing suicidal thoughts, domestic violence, or sexual assault — they need fast, skilled support to keep them safe and connect them to behavioral health/wraparound services.

Hotlines offer immediate, confidential support by assessing urgent needs and linking people to local resources for support (i.e., 988 Suicide and Crisis Lifeline and the National Domestic Violence Hotline). Domestic violence shelters and rape crisis centers provide safe, healing environments where survivors can access resources and victim advocacy. Having an advocate is critical because it provides survivors with support and a voice at a time when they may feel overwhelmed or powerless and helps them navigate ongoing care and services. When first responders or law enforcement are called to respond to domestic violence incidents, they can use a lethality screen to assess how likely a person is to be killed by the other. This assessment can connect individuals to other crisis response services that prevent intimate partner homicide.

The U.S. Department of Justice and the HHS have provided funding to states to support these crisis response services, due to federal legislation like the Violence Against Women Act, Family Violence Prevention and Services Act, and the Victims of Crime Act. State and local governments and community-based organizations often supplement federal funding to address local needs.

How to Implement This Approach

Partnership

Key partners can help educate the public and decision-makers about the need to enhance crisis response services for those at immediate risk of suicide or domestic/sexual violence. This includes state and local agencies involved in public health, health care finance and regulation, behavioral health authorities, public safety, social services, and child welfare. These groups can also collaborate with groups or agencies providing direct services to individuals or families at risk.

Education

Key Data

Focus on sharing information about how expanding crisis response services can enhance support for those who are at risk of violence and help stabilize a person and their family. If available locally, showcase data on the use of these services and any data demonstrating stabilization of individuals or families (through access to care and wraparound services).

Local Stories

Source stories directly from individuals who have been positively impacted by using hotlines, accessing shelters or centers for domestic or sexual violence, or using victim advocate services. If individuals’ stories are too confidential, advocates or those who provided care can offer success stories they have experienced.

State Assessment

Determine whether the state has funding (federal, state, or local) to support efforts related to crisis response services, and if these resources are adequately reaching individuals and families at the highest risk. Determine whether additional state- or local-level programming could further enhance crisis response services, such as:

  • Ensuring groups providing crisis response services are adequately funded and able to provide sufficient services to those in need.
  • Enhancing training opportunities to build workforce capacity for those providing care and support to those at immediate risk or survivors of violence.
  • Ensuring a coordinated system of crisis care by connecting those who may respond to immediate crisis (such as 911, hotline providers, or health care systems) to those who can provide ongoing care and support (such as domestic violence shelters, rape crisis centers, or groups providing behavioral health services).

Raising Awareness and Reducing Barriers

Support state or local agencies in accessing federal, state, or local funding for crisis response services. Also, assess areas for improvement and implement recommendations from the national framework for improving crisis care systems. Support workforce development programs for those who provide services or care to survivors or those experiencing suicidal ideation on risk assessment (including the danger assessment for law enforcement officers), safety planning, and trauma-informed care.

In addition, inform state and local decision-makers about how they can enhance laws that improve crisis response services. Finally, connect those at immediate risk with behavioral health treatment and/or victim advocate services.

Provide Post-Trauma Support to Individuals and Communities

If traumatic injuries or deaths occur (i.e., from suicide, interpersonal violence, mass violence, or natural disasters), there are important steps communities can take to prevent escalation into more serious long-term challenges. Postvention efforts focus on helping those who have lost someone and reducing the likelihood that traumatic events lead to lasting emotional or behavioral difficulties, including preventing the risk of others in the community copying violent behaviors. These efforts include:

  • Offering proactive behavioral health support like counseling or peer support groups.
  • Hospital-based violence intervention programs (HVIPs) also play a key role by having trusted community-based partners provide trauma-informed care and wrap-around services to people who have been violently injured, helping prevent re-injury and potential retaliation.
  • Safe reporting practices in the news media further reduce the risk of additional crises in response to the event by emphasizing that such events are preventable and promoting resources to access for support.

The U.S. Department of Justice and HHS have provided funding to states to support these services through the Crime Victims Fund. State and local governments and community-based organizations often supplement federal funding to address local needs.

How to Implement This Approach

Partnership

Key partners can help educate the public and decision-makers about the need for a comprehensive plan to respond immediately and safely to traumatic events. This includes state and local agencies involved in public health, behavioral health, public safety, emergency management, and social services. These groups can also collaborate with other agencies or organizations to ensure they have access to resources provided as part of the response to traumatic events.

Education

Key Data

Focus on sharing information about the need to have a comprehensive plan in place, focused on supports for those affected and safe messaging with appropriate resources to communities. This ensures efforts focus on preventing future emotional instability among those affected.

State Assessment

Understand whether the state has a comprehensive plan in place to proactively support loss survivors, those violently injured, individuals exposed to traumatic events, and communities broadly who feel the psychological impact of the events. Determine whether additional state- or local-level adjustments could be made to create a more robust plan, such as:

  • Ensuring groups providing postvention or HVIP services are adequately funded and appropriately trained in trauma-informed care.
  • Ensuring agencies and organizations have access to guidelines or resources to respond safely and effectively to traumatic events, such as law enforcement, health care, mental health, workplaces, or schools.
  • Sharing safe reporting guidelines with news media.

Raising Awareness and Reducing Barriers

  • Provide guidelines for different agencies or organizations on how to immediately and safely respond to traumatic events.
  • Connect loss survivors or those exposed to a traumatic event to behavioral health care.
  • Ensure HVIP outreach workers are appropriately trained to provide care to those violently injured.
  • Provide training to professionals who provide care to loss survivors or those violently injured on effective treatments and trauma-informed care. 
  • Support state or local agencies in accessing federal, state, or local funding to initiate or expand HVIP efforts.
  • Provide training or resources to news media on safe reporting practices, both prior to traumatic events occurring as well as immediately following one.

Responding to Trauma Resources

This resource reflects the collective efforts of many contributors, including ASTHO staff Alison Maffey, MSW, Vice President, Social and Behavioral Health; Caitlin Langhorne-Griffith, Director, Injury, Suicide, & Violence Prevention; Rachel Scheckman, Senior Analyst, Intersection of ACEs, Suicide & Overdose Prevention; and Erin Wright-Kelly, DrPH, MA, of Community Impact Partners, LLC.

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