Organizational Trauma-Informed Care Whitney Walsh M.S.

What is trauma? Derived from Greek word for wound Types: Emotional/Physical response when resources are not enough to cope with external threat Types: Physical/sexual abuse Neglect Witnessing violence Bullying Community-based violence War/terrorism Natural Disaster

Where is this population? Treatment centers Mental health Substance abuse Hospitals Medical Psychiatric Foster care systems Soup kitchens Homeless shelters Therapeutic practices Faith-based groups Community

Importance of language Changing language as key component of the trauma-informed care movement Victim Negative connotation, evokes pity Survivor Empowering, more positive connotation SAMHSA and The National Council on Behavioral Health Survivor and individual with lived experience

Examples of non-Trauma-informed care Long list of invasive initial questions Staff who are intended to gather information rather than provide services “The unit”, conditions, close proximities Seclusions and restraints in psychiatric hospitals Office settings in which door is closed behind patient and he/she cannot see who is entering the room Male staff member completing overnight rounds on wing with female sexual abuse survivor Human trafficking prosecution of children

Need for trauma-informed care Patient: Loss of trust Higher self-harm Less engagement in treatment More distressed, for longer Staff: Higher injury from assault Stress, secondary trauma Staff turnover and low morale Little attention on supervision Treatment models are less effective

What is trauma-informed care? Substance Abuse and Mental Health Services Administration SAMHSA Realizes widespread impact of trauma Understand paths for recovery Recognizes signs and symptoms Responds by integrating knowledge into policies, practices, etc. Actively resists retraumatization in staff and survivors

Principles of ti organizations Safety Feeling physically and psychologically safe Trustworthiness and Transparency Goal of building and maintaining trust Peer support and Mutual Self-help Collaboration and Mutuality Reducing power differences, meaningful sharing, everyone has role Empowerment, voice, and choice Individual’s strengths recognized, emphasis on choice Cultural, historical, and gender issues Moves past cultural bias, offers gender responsive services, addresses historical trauma

Samhsa’s strategies 1. Establishing organizational commitment to trauma-informed care 2. Develop a strategic plan using trauma-informed principles 3. Update the mission, vision, and value statements of the organization 4. Assign a trauma-aware senior staff member to oversee the process 5. Establish an oversight committee that will provide feedback throughout the course of the change process 6. Complete a self-assessment 7. Creating an implementation plan with which to move forward

Cont’d 8. Initial review of policies and procedures to assess potential for retraumatization 9. Make a disaster plan, less reactive 10. Create and implement a universal screening process 11. Establish culturally competent practices regarding the implementation 12. Utilization of Evidence Based Practices 13. Creating an environment that highlights peer support 14. Strive for continuous feedback and evaluation 15. Carefully assess environmental safety 16. Establish connections with other trauma-informed organizations in the community

4 models Sanctuary Risking Connection THRIVE Developing Trauma Informed Organizations: A Toolkit (Second Edition)

sanctuary Gold standard- full certification Creating and maintaining nonviolent lives and nonviolent systems of recovery Changes organizational structure 30 months-3 years Three phases Training, Consultation, Independent practice and certification Re-certification every 3 years Cost: $165,000 across the 3 years For more information: http://sanctuaryweb.com/TheSanctuaryModel.aspx

Risking Connection RICH relationships, characterized by respect, information sharing, connection, and hope Survivors of childhood abuse Manualized 20-hour program with 5 modules Module 1: Understanding Trauma is the First Step Module 2: Using Connections to Develop Treatment Goals with Survivor Clients Module 3: Keeping a Trauma Framework When Responding to Crises and Life Threatening Behaviors Module 4: Working with Dissociation and Staying Grounded: Self-Awareness and a Tool for Clients and Helpers Module 5: Vicarious Traumatization and Integration: Putting it All Together

RC cont’d Cost: $8,500 plus trainer travel and training manuals Intended for smaller organizations up to 70 people Additional consultation can be purchased Abbreviated 6-hour version of training available for leadership teams Those who would benefit from exposure but don’t need mastery 20-40 people costs $3,750 plus travel and manuals For more information: http://www.riskingconnection.com

thrive Individual’s response to and recovery from trauma is rooted in the community response (resiliency) “family driven, youth guided, and culturally and linguistically competent.” Strength-based Highly customizable program Utilizes web-based Hornby-Zeller Associates, Inc. for assessment support For more information: http://thriveinitiative.org

Thrive cont’d Option 1: Agency Preparation for Trauma-Informed Change (90 days) Review policies, motivate organization Cost: $6,600 plus travel, up to 50 people Option 2: Trauma-Informed Agency Assessment (TIAA) (30 set up available for a year) Self-assessment through Hornby-Zeller Cost: $4,500 for standard assessment, can be customized Option 3: Continuous Quality Improvement (CQI) Planning for Organizational Change Discussion of the self-assessment Cost: $3,000 plus travel, $900 for additional consultation Option 4: Sustainability of Community Training and Trauma-Informed Change.

Toolkit (2nd edition) Trauma-informed care begins at foundational level Designed for policy makers and organization leaders Women with co-occurring mental health and substance use Principles for an integrated, trauma-informed service system Template for Developing a trauma-informed strategic plan Sample trauma policies Trauma-Informed Self-Assessments Staff practice survey Trauma-Informed Supervision For more information: http://www.healthrecovery.org/publications/detail.php?p=30

Questions?