Hi Laneita, I am not sure exactly what you are looking for but let me share my experience. First I would tell you the protocols and policy are the easy part, organizational and leadership support are essential challenges that are requisite for successful implementation. To that question I am attaching a recently released Brief by RWJF - Key Ingredients for Successful Trauma-Informed Care Implementation which is a good document for anyone interested in your questions. For developing specific protocols, I will provide the guidelines we used in the facility where I worked. I worked in both acute care hospital and outpatient setting for 17 years and for 6 years was head of a Women's Health Department (5 Ambulatory Care Clinics, and all hospital programs). When we began to address trauma in the hx of our patients it essentially began with the same 'protocol' and policy in each setting. Adversity and toxic stress cannot be addressed if it is not identified. Thus the very basic protocol, similar to other medical condition was; Step 1 to briefly educate the patient about new knowledge and understanding of how stress impacts health, use framing questions to begin the screening process "because adversity in childhood, or because violence in the home... or because we now understand how events in childhood impact adult health......followed by the specific screening questions....we are now asking all of our patients if they have experienced any of the following: you can use the ACE screen, a screen for Intimate partner violence, or other available tools depending on your focus and setting. There are lots of examples out there including Kaisers intake screen which includes the ACE questions. Step 2 is to address immediate medical concerns or conditions and if possible and indicated discuss potential impact that a hx of trauma or current adversity may have on their current health status. Further, an additional check for safety is required as many patients with a high ACE score this may be an immediate concern - either the violence of others i.e. intimate partners, or toward self. Step 3 is discussing what if any help, assistance or needs they may have beyond the scope of the care being immediately provided and would they like to discuss this with someone who has expertise in this area whether inside our hospital system or in the community; It is not the role or responsibility of a provider or nurse in an acute care setting to "fix" ACEs or other adversities. It is our responsibility to take a comprehensive history including all traumatic antecedents so that we can provide appropriate care. Step 4 is outlining in protocol and policy the actual mechanisms for referral or MOU and assuring the patient is empowered to make that choice (and ensure the referral is a functional referral not just a card or phone number i.e. a warm hand-off). Step 5 is including in protocols parameters for documentation. This was the broad framework we used to develop specific protocols and policy for all settings including acute care, ED, outpatient, long term care etc. I have done numerous training's over the years for providers, nurses, social workers, and allied health professionals and i am always curious about, and begin my training with trying to understand what are the "actual barriers" to developing and or integrating such protocols are. Most of the individuals have developed protocols on many topics/conditions for their facilities but have both personal and professional barriers to broaching these topics which are sentinel to health. I encourage you to try to actively identify what are perceived as the specific barriers as it is most often deeper and more complex than lack of protocols. The RWJF brief addresses this well.