1. Avoiding Burnout: Staff Self Care Amy Turk, LCSW Chief Program Officer National Alliance to End Homelessness Annual Conference July 18, 2017
@dwcweb
@AmyFTurk
#IamDWC

2. ABOUT DWC
The Downtown Women’s Center (DWC) provides permanent supportive housing and a safe and healthy community fostering dignity, respect, and personal stability, and advocates ending homelessness for women.
Founded in 1978, DWC is the only resource in Los Angeles that is exclusively dedicated to serving the unique needs of homeless and very low-income women in downtown Los Angeles’ Skid Row community.
Jill and Rose, DWC Co-Founders

3. DWC Programs & Services
DWC is nationally recognized as a prototype for unique and effective programs serving homeless women and ending homelessness. DWC serves over 3000 women every year.
DROP-IN DAY CENTER
Meals, showers, phones & mail
Trauma Recovery Center
CLINICAL HEALTH SERVICES
• Case management, mental
health & medical services
PERSONAL & FINANCIAL OPPORTUNITY
Education, skill development, on-the-job training & transitional jobs
Competitive job placement
Social Enterprise
HOUSING
Onsite Permanent
Supportive Housing
Rapid Rehousing and Housing for Health Scattered Site Housing

4. Trauma-Informed Care Organizations
A program, organization, or system that is trauma-informed
realizes the widespread impact of trauma and understands potential paths for recovery;
recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively
resist re-traumatization.
Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) Rockville, MD: SAMHSA, Available at

5. Trauma-Informed Care: An Evidence-Based Practice
The ACE study (1997) created a new paradigm
Source:

6. Changes the helping paradigm from “What’s wrong with you
Changes the helping paradigm from “What’s wrong with you?” to “What happened to you?” --Sandra Bloom, 2007

7. Downtown Women’s Center’s Approach to Fostering a Trauma-Informed Environment
1. Set the Stage
2. Complete Organizational Self-Assessment
3. Form Trauma-Informed Care Workgroup
4. Develop a Strategic Plan
5. Implement Trauma-Informed Changes
6. Contribute to Trauma-Informed Community Building (Communities of Practice) through collaboration, advocacy, and training
Fuarino, K., Soares, P., Konnath, K. Clervil, R., and Bassuk, E. (2009). Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Available at and

8. Organizational Assessment Tools
Trauma Informed Organizational Toolkit for Homeless Services
Fuarino, K., Soares, P., Konnath, K. Clervil, R., and Bassuk, E. (2009). Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Available at and
American Institutes for Research’s Trauma Informed Care Organizational Capacity Scale
The National Council’s Trauma-Informed Care Organizational Self-Assessment

9. Organizational Self Assessment Domains
1. Supporting Staff Development
Training and Education
Staff supervision, support, and self-care
2. Establishing a Safe and Supportive Environment
Information sharing/open communication
Cultural and gender competency
Confidentiality
Safety and Crisis Prevention Planning
Consistency
3. Assessing and Planning Services
Intake assessment and follow-up
Developing goal plans
Offering Trauma-Specific Interventions
Involving current and former consumers
4. Adapting Policies
Reviewing policies
5. Evaluation and Continuous Quality Improvement

10. Continuum of Staff Experience
Compassion Satisfaction: Positive feelings derived from competent performance, positive relationships with colleagues and conviction that one’s work makes a meaningful contribution
Burnout: Low job satisfaction, feel powerless (unrealistic demands), and overwhelmed; does not alter worldview
Compassion Fatigue: Profound emotional and physical exhaustion, erosion of empathy and hope for our clients and ourselves
Vicarious/Secondary Trauma: Fundamental beliefs change; numbness, sadness, and/or anger toward unfairness of the world; can lead to PTSD

11. Staff Burn Out Risk Factors
Lack of resources for clients and staff
Lack of supervision
Lack of support from colleagues
Lack of acknowledgement
Lack of protocols for safety
Location of services
Staff to client ratio, including number of high acuity clients

12. Staff Burn Out Organizational Protective Factors
Full responsibility of self-care is not just on the staff member—organization is responsible, too
Organizations Leadership communicates a direct message that we are committed to creating a trauma-informed system
Organizational stakeholders (individuals served, volunteers, staff at all levels, Board of Directors) are trained and buy-in to how this model creates a healing environment
Job performance evaluations clearly describe staff expectations and behaviors that are aligned with trauma-informed care principles
The organization helps staff develop personally meaningful and useful stress management strategies

13. Staff Burn Out Organizational Protective Factors
Full responsibility of self-care is not just on the staff member—organization is responsible, too
Adequate compensation
Plans for staff safety (training and protocols)
Invest in the work environment—facility maintenance
Include Trauma-Informed Care principles on hiring practices, onboarding and early orientation training
Sufficient training throughout each year
Balance workload
Shared leadership
Solicit input; demonstrate how staff input makes positive change
Develop a protocol to respond to critical incidents

14. Staff Burn Out Organizational Protective Factors
Trauma-Informed Supervision
Teach people how to debrief (sliming vs low-impact debriefing)
Develop self awareness about how much, where and when to debrief
Teaching people how to deal with negativity at work; preventing toxic environment; Help staff keep things in perspective
Strengths-based
Fail Forward principals
Set a good example
Normalize and address Secondary Trauma; Create structure to discuss self-care
Express concern for general wellbeing of staff
Let staff know the progress of their feedback or fully explain why things can or can’t be implemented—no feedback shaming
Train in EBPs—being clear about agency expectations
Training on importance to track and analyze data
Balance workload

15. Expertise from the Audience
What are you doing to prevent staff burnout?

16. Trauma-Informed Care Organizational Outcomes
Increased better outcomes for individuals served
Less staff turnover related to workplace dissatisfaction
Productivity goals are met/Better outcomes for clients
Stress related workers comp decreases
Reduction of unplanned time off
Staff surveys demonstrate higher satisfaction rates
Client surveys demonstrate higher satisfaction rates/greater ability to reach goals

17. Staff Self Care Resources
Compassion Satisfaction and Compassion Fatigue Tool (ProQOL) Tool assesses for Compassion Satisfaction, Burnout, and Secondary Trauma © B. Hudnall Stamm, 2009–2012. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL).
The Compassion Fatigue Workbook by Francoise Mathieu
Volk, K., Guarino, K., Edson Grandin, M., Clervil R. (2008). What About You? A Workbook For Those That Work With Others. (2008) National Center on Family Homelessness. Available at:
Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) Rockville, MD: SAMHSA, Available at

18. Amy Turk, LCSW
Chief Program Officer
@dwcweb #IamDWC
@AmyFTurk