Implementing a Trauma-Informed and Responsive (TIR) approach requires transformation and initiatives at multiple levels of an organization, in alignment with the Guiding Principles. There are five key impact areas in which an organization’s strategically focused TIR actions can make a positive difference.
Leaders at all levels have opportunities to support their organization’s ability to become Trauma-Informed and Responsive. To do this, they must actively demonstrate their commitment on multiple levels:
Be an example by:
- Participating in training on trauma and its effect on children and families.
- Modeling healthy relationship behaviors and interaction skills.
- Clearly communicating roles, responsibilities and expectations to youth, families and staff members.
- Inviting input from staff as well as youth and families to provide meaningful, ongoing input and feedback into organizational decision-making.
- Being visible members of the agency/organization and within the community.
- Tending to their own self-care, to ensure they are able to do all of the above.
Funding:
- Leaders who control organizational budgets should use their decision-making authority to prioritize the needed financial and time investments to implement the TIR actions.
Policies:
- Leaders who make decisions about organizational policies should:
- Articulate the Guiding Principles of a TIR approach in their mission and/or vision statements and help staff understand how these principles apply in their work.
- Incorporate TIR principles into all policies, programs and practices.
- Develop and implement quality assurance procedures to ensure principles are followed.
Staff Hiring, Development and Support:
- Strive to ensure that staff at all levels of the organization – from entry level through senior leadership, as well as organizational materials (curricula, communication materials, etc.) – are representative of the diversity of the community being served.
- Understand the negative and potentially traumatic impact high staff turnover rates can have on youth being served, as well as the overall organization, and advocate for solutions designed to reduce turnover, such as higher pay rates and supports to mitigate the impact of secondary trauma.
- Institute policies and practices that support self-care activities and positive relationship-building among staff.
Organizations can build a Trauma-Informed and Responsive workforce through a sharp focus on training and development, including:
- Determining which skills are necessary to provide TIR care in the context of that organization’s work, and prioritizing these skills in hiring and training practices.
- Encouraging diversity, equity and inclusion in hiring and promotion practices to ensure staff at all levels are representative of the community being served.
- Providing mandatory training on the impact of childhood trauma, secondary traumatic stress and racism/equity to all employees and volunteers during orientation and as a part of ongoing professional development.
- Developing policies and structures to address secondary traumatic stress in staff through training on trauma and offering concrete referrals for support.
Training to support a Trauma-Informed and Responsive approach should include:
- Background on trauma and its impacts, including:
- Explanations of the different types of trauma, as well as the difference between trauma and traumatic stress.
- The biological effects of trauma on brain development and the many ways traumatic stress can manifest—including how it can easily be misinterpreted or misdiagnosed for other issues such as ADHD or behavioral challenges.
- The effect trauma can have on a child, including sense of safety, sense of self, ability to self-regulate, physical health and various developmental areas (e.g. social, emotional, cognitive).
- The impact trauma can have on a child’s behavior, including discussions on internalizing and externalizing behaviors, as well as how these behaviors may vary by age.
- Information about trauma in vulnerable populations of youth (e.g. LGBTQ+ youth, homeless youth, immigrant youth, commercially sexually exploited children and children with disabilities).
- Information on how trauma can manifest in adults/parents/caregivers.
- Key protective factors and strengths/assets that can help individuals who have experienced trauma survive and thrive, as well as strategies for increasing those factors.
- Information about how traumatic responses are adaptations to circumstances an individual has experienced, and reflect survival and coping mechanisms.
- Information on how to respond to trauma and its impacts, tailored to the role a staff member plays, such as:
- Identifying potential triggers/activators for the youth/family and understanding the traumatic response those triggers may cause.
- Teaching de-escalation and other communication techniques.
- Understanding how a staff member’s own experiences and vulnerabilities can impact their response to situations and behaviors as well as create unconscious bias or difficulty responding to a child’s needs objectively.
- Strategies for encouraging healing, including supporting caregivers to ensure the child has nurturing, healthy caregiver/child relationships, building on a child’s strengths, and developing protective factors and strategies.
- Connecting the child and their family with longer-term trauma interventions as appropriate (see “LINK-KID: A Centralized Referral ,” for information on resources to help make these service connections).
- Knowing when to seek additional professional help.
- The types of action that can traumatize or retraumatize a child or family, include:
- Decisions within that staff member’s or their organization’s control, such as restraining a child.
- Actions that may have previously been taken by other organizations (e.g. schools, treatment providers, law enforcement) that were traumatizing, neglectful, or exploitative and may impact that child or family’s interactions with the staff member.
TIR organizations should also strive to create a healthy environment for staff by adopting the following practices:
- Proving staff with information to identify secondary traumatic stress, practices for prevention and strategies for coping.
- Creating a supportive culture that is understanding and responsive to employees who may experience secondary traumatic stress.
- Providing active support (e.g. time, resources, professional guidance, a physical space to go to) after a traumatic event occurs.
- Creating opportunities for staff to receive reflective supervision and/or group supervision and peer support.
- Providing support for all levels of the workforce, including teaching staff strategies for self-care and building personal resiliency.
- Teaching and encouraging the use of mindfulness exercises and other self-directed attention practices/skills.
- Striving for adequate staffing levels and manageable caseloads, including ensuring that duties that require particular expertise (e.g. clinical training) are assigned to staff with that expertise.
- Providing staff with mental health benefits.
TIR organizations must review all policies and procedures through the lens of the Guiding Principles and revise them as necessary. By doing so, they can proactively resist re-traumatization, while helping children and families cope with the impact of those traumatizing decisions when they cannot be avoided.
Trauma-Informed and Responsive policies and procedures:
- Recognize that of the individuals an organization is working with, as well as the staff themselves, many have experienced trauma in their lives.
- Identify agency/organizational decisions and actions that could be re-traumatizing or exacerbate existing traumatic stress for children and families, and take steps to minimize the potential for re-traumatization.
- Are clearly articulated, especially those pertaining to the physical and emotional safety of children, families and staff.
- Identify clear roles and responsibilities for staff members, such as what role they are expected to play in responding to trauma experienced by individuals they work with.
- Seek to maximize predictability and stability for children to the extent possible.
- Detail expected behavior with regard to confidentiality, including any legal requirements staff must follow.
- Provide opportunities for healing practices to be employed by staff and families as part of their interactions.
Decision-making in Trauma-Informed and Responsive organizations:
- Includes children and families in decision-making processes as often as possible, such as:
- In the development of policies and procedures.
- In creating individual treatment goals.
- In developing service plans.
- In designing or re-designing physical spaces.
- As part of formal advisory boards.
- Provides opportunities for staff inclusion in the development of policies and procedures as often as possible.
- Provides explanations for how and why any decisions that impact the child and family are made.
Physical environments should be designed with the needs and abilities of the individuals using the space in mind, and regularly re-evaluated with input from youth, families and staff members.
Aspects of the physical environment to consider include:
- Lighting, color, noise, smell and temperature.
- Seating options (comfort, accessibility for all types of bodies), a dedicated play space for very young children and direct access to exits.
- Language accessibility, as well as the images, amount and tone of language on signage, posters and magazines
- Availability of patient bills of rights and/or privacy, billing and confidentiality policies.
- Availability of private spaces for youth and families to have conversations with staff members and/or regroup after a triggering event.
- A clean, inviting and healthy atmosphere providing respect for the diverse needs (e.g. cultural, linguistic, gender, religious) of clients and staff.
It’s also important to take the time to understand any specific triggers or traumatic reminders for individual children and make changes in the environment to the extent possible and appropriate.
For more information, see: https://www.acesconnection.com/blog/trauma-informed-physical-environments-assessment-tools and https://www.spacesmith.com/blog/trauma-informed-design
TIR organizations should develop written processes for regularly assessing the design and implementation of policies, programs and/or practices to ensure they are having the desired impact and are in alignment with the Guiding Principles.
In doing so, TIR organizations should consider doing the following:
- Identifying specific, desired outcomes and selecting methods for measuring success. These outcomes may include:
- The extent to which the TIR initiatives have been adopted by the organization.
- The impact adoption of the TIR initiatives has had on the quality of services provided.
- The impact on children, youth and families served by the organization (“Are they better off?”).
- Including the voices of youth, families and staff in developing and measuring desired outcomes, identifying challenges and generating ideas for improvement.
- Developing a system to collect and analyze data by race/ethnicity, gender, sexual orientation, gender identity and other demographic information to uncover and address disparities.
- Being ready to adapt policies, programs or practices in ways large and small, based on feedback and data analysis.
- Designating someone in the organization to be responsible for leading the implementation of the organization’s CQI efforts and defining a timetable.
- Training staff involved in these CQI efforts on:
- The importance of collecting accurate data and participating in other CQI efforts.
- How the data and information from CQI processes is ultimately used within the organization.
For more information, see: Traumatic Stress Institute. (2020, February). Measuring Trauma-Informed Care Series. New Britain, CT: Steven Brown. Available via: https://traumaticstressinstitute.org/tic-measurement-series/