Developing a Trauma Informed Agency

iStock_000000419303_SmallSustaining organizational change to becoming a trauma-informed system requires programs to be both thoughtful and creative about how to thoroughly integrate trauma-informed principles and practices into the culture of the organization.

First, an agency should perform a trauma informed self-assessment.  Self-assessment is a critical tool for organizations to examine their current practices and take specific steps toward becoming trauma informed.  Trauma informed self-assessments attempt to provide clear and consistent guidelines for agencies or programs interested in facilitating trauma informed modifications in their service systems. They are tools for administrators, providers, and survivor-consumers meant to identify areas of strength, pinpoint areas for improving trauma informed service, and to use in the development, implementation, evaluation, and ongoing monitoring of trauma informed programs.

Implementing trauma specific interventions without assessing the agency’s trauma informed care culture, is likely to reduce the efficacy of the intervention considerably.

The following are examples of trauma informed agency self-assessment questions based on the six guiding principles of trauma informed care (i.e. trauma understanding, safety & stability, cultural humility & responsiveness, compassion & dependability, collaboration & empowerment, resilience & recovery):

Trauma Understanding –when we understand trauma and stress we can act compassionately and take well-informed steps towards wellness.

  • Have all staff been trained on the Principles of Trauma Informed Care and Systems.
  • Are consumer “symptoms” understood as attempts to survive (i.e. what appears as symptoms may also be a person’s current, best and only solution to cope)?
  • Do public sites and staff behavior cultivate a “healing” environment?
  • Are Trauma informed evidence-based or emerging best practices utilized?
  • Are hiring practices, policies and procedures, contracts, etc. trauma informed?

Safety & Stability -ensuring Physical and Emotional Safety

  • Are facility environments welcoming (e.g. a greeter is present, clean comfortable seating, appropriate unobtrusive security)?
  • Do all staff understand that “trust” must be earned, not assumed?
  • Are relationships with consumers strengths-based and collaborative (i.e. the consumer is not a passive recipient, staff is an ally not caretaker)?
  • Are there positive working relationships that can provide support and calming in times of stress?
  • Does the program provide clear information about what will be done, by whom, when, why, under what circumstances, at what cost, with what goals?

Cultural Humility & Responsiveness – When we are open to understanding cultural differences and respond to them sensitively, we make each other feel understood and wellness is enhanced.

  • Does the décor in facility environments reflect the colors, textiles, and images of cultural/ethnic populations served by the program?
  • Does staff not assume that everyone from the same culture will react the same or hold the same cultural belief or value system?
  • Are educational and resource materials available in the county’s threshold languages?
  • Is the program’s telephone greeting available in languages in addition to English?
  • Are the diversity of cultural/healing rituals honored?
  • Do program policies support cultural humility & responsiveness?

Compassion & Dependability – when we experience compassionate and dependable relationships, we reestablish trusting connections with others that fosters mutual wellness.

  • Does all staff seek to develop secure and dependable relationships characterized by mutual respect and attunement?
  • Does staff communicate in ways that are clear, inclusive, and useful to others?
  • Are routines, rituals, and consistent practices embedded into staff meetings, calendars, and the organization?
  • Does staff communicate in ways that promote dependability and foster trust?
  • Is the staff role, scope, and availability clearly communicated to consumers?

 Collaboration & Empowerment – when we are prepared for and given real opportunities to make choices for ourselves and our care, we feel empowered and can promote our own wellness.

  • Are relationships with consumers strengths-based and collaborative (i.e. the consumer is not a passive recipient, staff is an ally not caretaker)?
  • How much choice does each consumer have over what services she or he receives?
  • How much choice does each consumer have over when, where, and by whom the service is provided (e.g., time of day or week, office vs. home vs. other locale, gender of provider)?
  • Does the consumer choose how contact is made (e.g., by phone, mail, to home or other address)?
  • Do consumers have a significant role in planning and evaluating the agency’s services?
  • Is there a Consumer Advisory Board (do consumer-survivor advocates have significant advisory voice in the planning and evaluation of services)?
  • In routine service provision, how are each consumer’s strengths and skills recognized?

Resilience & Recovery – when we focus on our strengths and clear steps we can take toward wellness, we are more likely to be resilient and recover.

  • Does the program communicate a sense of realistic optimism about the capacity of consumers to reach their goals?
  • How does staff support and demonstrate their commitment to wellness?
  • Does staff recognize the value of instilling hope by seeking to develop a clear path towards wellness that addresses stress and trauma?
  • What types of practices are utilized that promote a strength-based environment?
  • What policies are focused on building a strengths-based work environment?
  • Do services proactively identify and apply strengths to promote wellness and growth, rather than focusing singularly on symptom reduction?

 Agency Self-Assessment Resources

Below are resources of agency self-assessments and web resources that explain how to utilize such assessment tools:

Once a self-assessment is complete, an agency can better gauge and tailor the next steps to become more trauma informed.  There are a number of actions an agency can take to translate the principles of trauma informed care into concrete practices.  A brief sampling of these actions include:

  • Staff Training and Education:  Staff should understand the short and long-term impacts of trauma and neglect, and should be trained to respond with empathy, sensitivity, and respect.  Additionally, all staff should understand the impact of secondary and vicarious trauma and agencies should find ways to support staff needs in this area.
  • Creating a Safe Environment: Creating an environment of staff support and creating a safe, supportive, welcoming and respectful environment in general, is also crucial to providing quality care to trauma survivors.
  • Incorporation of Consumers’ Voices into Agency Practices: Recovery and success for trauma survivors is largely based on their ability to regain control of their lives. Trauma informed organizations should be designed as collaborative and supportive environments.  Organizations should facilitate empowerment by giving consumers a voice in what happens on a daily basis in the program.

Implementing trauma informed care principles, practices, and change in culture takes time.  This is a process that does have its challenges, but there is a lot of support and are resources to assist you in this.   Additionally, below are a few of the beneficial outcomes that organizations have found because of implementing trauma informed care (Reference: Shelter from the Storm: Trauma-Informed Care in Homelessness …):

  • Trauma-informed service settings, with trauma- specific services available, have better outcomes than ‘treatment as usual’ for many symptoms
  • Trauma-informed, integrated services are cost- effective.
  • Qualitative results indicate that consumers respond well to TIC..
  • TIC for children lead to better outcomes, such as better self-esteem, improved relationships, and increased safety.

Resources:

For more information on steps to take to develop or continue on the process of creating trauma informed agencies and systems of care: