From Principles to Practice: Understanding How Trauma- and Violence-Informed Care are Conceptualized, Operationalized, Expressed, and Evaluated in Integrated Community-Based Youth Services in Ontario

Trauma & Violence both are pervasive. Health and human service sectors increasingly recognize the widespread prevalence of trauma and violence and its profound effect on well-being, particularly among youth. Many young people seeking services carry these experiences, even if they never disclose them, especially those from specific populations, who are disproportionately affected by systemic inequalities. Given this, trauma- and violence-informed care (TVIC) has become an essential approach in service settings. TVIC is a framework that recognizes the widespread impact of trauma and violence (interpersonal and structural) on health and well-being. It aims to create safe environments, foster choice, collaboration, and connection, and promote a strength-based approach to service users. In recent years, TVIC has been increasingly endorsed in health policy, health services, and organizational mandates across Canada and internationally. Public health, mental health, and social service agencies are promoting TVIC as a best-practice framework. Notably, the Public Health Agency of Canada endorsed TVIC in 2018 to promote safety and equity for both service users and providers, and to support organizations in becoming trauma- and violence-informed. Grounded in principles of safety, trustworthiness, collaboration, peer support, empowerment, culture and gender responsiveness, TVIC offers a framework that acknowledges the pervasive effects of trauma on mental well-being while explicitly acknowledging the structural and systemic factors that perpetuate harm, violence and inequality during service delivery. In the context of Integrated Community-Based Youth Services, understanding of how TVIC looks in real-world context which is designed specially for youth is crucial. These service models are designed to provide coordinated, youth-friendly, and youth-centred services across multiple domains, such as mental health, substance use, addiction, primary care, housing, education and employment, typically co-located in one, youth-friendly service setting. Such setings engage with youth with diverse needs, recognizing the range of intersecting experiences and identities they may carry that may not be immediately visible or disclosed. Given the complexity and often hidden nature of youth’s intersecting experiences and identities, TVIC plays an essential role in ensuring that services are delivered safely and responsively, tailored to youth’s needs and preferences, and delivered without re-traumatization. Despite widespread advocacy for TVIC, there remains limited clarity on how TVIC principles are conceptualized (how it is understood by providers or organizations), operationalized (how TVIC is supported), and expressed (observable practices), as well as how they are monitored and evaluated in real-world settings, particularly within Integrated Community-Based Youth Services settings. The existing literature highlights gaps in understanding how organizations translate these principles into actionable strategies and how these efforts impact staff and service users. Limited conceptual clarity may pose challenges in translating TVIC principles into meaningful practices. This gap also points to important empirical questions that guide the present study: Do providers and organizations share an understanding of and importance of TVIC within Integrated service delivery models, and how is this understanding shared across settings? How are TVIC principles currently reflected within Integrated community-based youth services, and what factors influence the manifestation of TVIC in service delivery, and what TVIC-related outcomes can be observed at the service providers’, service users’ and at the organizational levels?