Skip to site content

Transmittal Notice 22-19


The purpose of this Transmittal Notice (TN) is to transmit a copy of the revised Part 3, Chapter 37, “Trauma-Informed Care,” Indian Health Manual (IHM). The purpose of this revised chapter is to update the training requirements and remove the early assessment guidance as it was not sustainable. The purpose of this chapter is to provide guidance to Indian Health Service (IHS) hospitals, health centers, clinics, and health stations (hereafter referred to as facilities) in delivering Trauma-Informed Care services. This chapter will also prepare our workforce to be trauma-informed and promote self-care to prevent and treat secondary traumatic stress, also known as vicarious trauma, which can lead to compassion fatigue and staff burnout.

/Elizabeth A. Fowler/
Elizabeth A. Fowler
Acting Director
Indian Health Service


The revised Part 3, Chapter 37, “Trauma-Informed Care,” IHM.


Part 3, Chapter 37, “Trauma-Informed Care,” IHM, dated May 7, 2020.


Part 3, Chapter 37, “Trauma-Informed Care,” IHM in its place. Log and file this TN in sequential order.

Distribution:  IHS-wide
Date:  09/02/2022