Best Practice Parameters for Clinical and Organizational
ISTSS has formulated Best
Practice Parameters for trauma professionals as teachers,
clinicians, and scholars. The aim is to stimulate discussion and
exchange of information within the traumatic stress community.
Service providers who work with trauma survivors:
- Refrain from dual relationships with clients/consumers, especially
of the sort that would involve exploitation of any sort. In particular,
sexual contacts and intimacies between client and trauma professional
are especially problematic and are expressly forbidden in perpetuity by
many professional organizations. Several forms of trauma specific work
(e.g., disaster work, services during combat or civil unrest) may
preclude the prevention of contact with clients. In these settings,
persons who provide direct client services manage their relationships in
such a way as to preclude developing friendships, romantic or business
- Have the responsibility to practice within the relevant standard of
care. In particular, practitioners are advised to strive to stay current
with advances in relevant research and practice activities; they modify
practice as needed in response to advances in research, policy, and
- Approach all assessments, interventions, techniques, and services
that do not have research or observational substantiation with caution.
If possible, they initiate evaluation efforts in order to assess the
effects of their interventions/services.
- Monitor the progress of interventions or services they provide. If a
client appears to be stalemated, not making progress, deteriorating,
and/or experiencing dangerous or intolerable risks, the practitioner
seeks consultation or supervision to review the intervention/service
plan and determine whether it needs to be modified or ended, whether he
or she is capable of providing the intervention, and whether the client
should be referred to another professional for treatment.
- Conduct interventions with attention to their cultural, political,
demographic, and religious contexts. They strive to provide services
that match the needs and the specific context of the client.
- Are sensitive to issues of trust, power, and boundaries when working
with trauma survivors. Since traumatic life events (especially those
involving interpersonal violence and exploitation) often affect the
capacity to trust others and make choices, practitioners strive to
engage clients in a collaborative process that attends to their
empowerment. To whatever extent possible, clinicians encourage clients
to have a say in their treatment or in the service they receive.
- Respect the confidentiality of clients in accordance with relevant
ethical guidelines and laws. Providers strive to assure that all
electronic and paper records are securely maintained. When a violation
of confidentiality is dictated by law (e.g., in the case of imminent
danger to self or other), the clinician seeks to engage the client's
cooperation and participation in the process.
- Recognize that clinical work with trauma survivors requires
attention to their own emotional health and actively seek to manage the
impact of trauma work on their own lives (vicarious, secondary or
indirect traumatization) through involvement in regular professional and
personal renewal efforts and activities. Practitioners who experience
personal or professional difficulties that interfere with their ability
to function seek support, consultation, supervision, and treatment as
needed. Trauma professionals seek to assist colleagues they perceive as
having difficulty in their ability to function.
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