Trauma Informed Organizations

Too often, human service systems are focused on dealing with the symptoms (or adaptations) of trauma rather than addressing trauma directly. Often times, people affected by trauma – especially complex or developmental trauma – will carry a variety of labels or diagnosis including: borderline personality, schizophrenia, depression and other affective disorders such as anxiety disorders, eating disorders, dissociative disorder, addictions,  and labels such as being resistant, difficult, manipulative, or uncooperative.        

This can result in systems creating “revolving doors” in which trauma affected people frequently become stuck in. The lack of a trauma informed approach then contributes to higher service usage for which the trauma affected person gets blamed for.

For individuals impacted by trauma, the common stressors inherent in the primary care setting may result in avoidance or overuse of health services and poor management of health conditions.

TheNationalCouncil.org

In some cases, trauma affected people can encounter services that mirror the power and control they experienced in the abusive relationships from which the trauma originated. In many trauma “un-informed” systems, the client is viewed as a passive recipient and the service provider or care system as possessing superior knowledge and resources. Unfortunately, this relationship with a powerful authority figure whose opinions and wishes take precedence is tragically reminiscent of the abuse dynamic in which the trauma affected person was forced to accept an unequal relationship in order to avoid worse treatment. Organizational policies and procedures can often place the needs of the organization over the needs, and comfort of those they are serving.

It is a safe and necessary assumption for every service provider to make that the person they are trying to help has likely been effected by trauma. This is adopting universal precautions and the first step in becoming trauma informed.

Questions for Supporting Change and a Trauma Informed Approach^[1]

There are a number of both Self-Assessment and Organizational Assessments to determine what extent an individual and/or organization is trauma informed. The following is an overview of questions common in most assessments:

• To what extent do the program’s activities and settings ensure the physical and emotional safety of clients and staff? How can services be modified to ensure this safety is more effective?
• To what extent are program activities and settings consistent with the principles of: Safety, Trust, Choice, Collaboration, Compassion, and Empowerment?
• To what extent do the program’s activities and settings maximize trustworthiness by making tasks involved in service delivery clear, by ensuring consistency in practice, open, honest, and respectful communication, and by maintaining boundaries that are appropriate?
• To what extent do the program’s activities and settings maximize collaboration and sharing of power between Staff and Clients?
• To what extent do the program’s activities and setting maximize client experiences of choice and control?
• To what extent do the program’s activities and settings prioritize consumer empowerment and skills building?
• To what extent does the program have a consistent way identifying individuals who have been exposed to trauma and include trauma-related information in planning services with clients?
• To what extent do program or agency administrators support the integration of knowledge about violence, abuse, and trauma into all program practices?
• To what extent have all staff and volunteers received appropriate training in trauma informed care?
• To what extent do the formal policies of the program reflect an understanding of trauma survivors’ needs, strengths, challenges, and vulnerability?
• To what extent are trauma-related concerns a part of the hiring and performance review process?

A Process for Becoming a Trauma-Informed Organization

Often we do not know where to start in terms of organizational changes needed to become more Trauma-informed. The following is a suggestion with links to further tools to help assist individuals as well as organizations in this pursuit.

Steps:

1. Program leaders bring all the staff together to begin talking about the goal of being trauma-informed.
2. Staff are asked to complete a trauma informed service provider self-assessment.
3. Leaders provide all staff with training on trauma and trauma-informed care.
4. The program leaders evaluate the organization’s interest in and readiness for change prior to beginning the organizational assessment process. This occurs once all staff has participated in the initial discussions about the need for change and have received a more formal training in trauma and trauma-informed care.
5. Program leaders introduce the Trauma-Informed Organizational Self-Assessment as a guiding tool to help the organization become trauma informed.
6. The results of the assessment process are shared with all staff.
7. Based on the staff discussions begun in Step 2 and both assessments (Self and Organizational), program leaders identify specific goals for becoming more Trauma informed.
8. A strategic plan for the program is developed.

Challenges to becoming trauma-informed

• Going through process steps too quickly without meaningful evaluation at each step.
• Making assumptions that both Management and Staff within organizations are starting from the same knowledge base, self-awareness, willingness to adapt, and commitment level.
• Lack of awareness of the Principles of Change Management
• A lack of ongoing training, consultations, and problem-solving in order to empower Staffs’ voice, choice, collaboration, and control.
• Implementing TIC principles will create a restructuring of systems including service delivery, policy and procedure development. Subsequently, time and flexibility is required to implement and adopt this new model.
• Funding structures may create barriers to integrating services (E.g., Time for collaboration with other systems that may not be acknowledged in a funding agreement or job description such as in the case of advocacy for clients).
• Lack of ongoing evaluation and follow up quarterly, annually, etc.
• Discovering potential fragmentation, duplication, and/or gaps in service delivery within the organization leading to the need for more time and commitment for Interprofessional Collaboration.
• Commitment towards Psychological health in the workplace. Some examples include Staff satisfaction surveys, resources to help assess and address the psychological health and safety of workplaces, and Employee Assistance Programs.
• Workplace burnout and vicarious trauma.

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[1] Adapted from Harris and Fallot (2009)