MARRCH - Minnesota.ppt (Read-Only)5 Contact: [email protected] 202.684.7457 “We always recognized the importance of physical safety. Our refusal to tolerate violence

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Contact: [email protected]

202.684.7457

w w w. T h e N a t i o n a l C o u n c i l . o r g

Trauma-Informed Care, Trauma Aware Communities: TIC TAC for Organizations

Cheryl S. Sharp, MSW, ALWF

MARRCH Spring Conference April 25, 2014

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Overview

About the National Council

Safety and Sanctuary

Seven Domains: Begin the Change

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About Trauma and Trauma Informed Care


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We begin to ask, “What happened to You rather than what is wrong with you?” We have to ask, “What’s strong, rather than what’s wrong?”

Paradigm Shi+

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Agenda: Becoming a Trauma-‐Informed OrganizaFon

§  What is a Trauma-‐Informed Environment §  Why is Trauma-‐Informed Care Important to our OrganizaFon? §  How Can Our OrganizaFon Create and Sustain Change? §  Where Do We Begin? §  How Will We Know We Are Making Progress? §  What Are Our Next Steps?


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What Does Trauma Do?

•  Trauma shapes a person’s basic beliefs about idenFty, relaFonships, world view, and spirituality

•  Everyone reacts differently to a traumaFc event: some people are naturally resilient and will bounce back; many will need to learn to be resilient

•  Not everyone who has experienced a traumaFc event ends up in the MH/SA system; however the majority of those served in the MH/SA system have had a history of trauma

•  Using a trauma framework, the effects of trauma can be addressed and a person can go on to lead a producFve life

•  Symptoms are ADAPTATIONS


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•  “If we could somehow end child abuse and neglect, the eight hundred pages of DSM (and the need for the easier explanaFons such as DSM-‐IV Made Easy: The Clinician's Guide to Diagnosis) would be shrunk to a pamphlet in two generaFons.” John Briere

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Therefore……

We need to presume the clients we serve have a history of traumaFc stress and exercise “universal precauFons” by creaFng systems of care that are trauma-‐informed. (Hodas, 2005)


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Why Is Trauma-Informed Care Important To Our Organization?


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What Is Trauma-‐Informed Care?

>  An appreciaFon for the high prevalence of traumaFc experiences in persons who receive mental health (physical health and substance abuse) services

>  A thorough understanding of the profound

neurological, biological, psychological and social effects of trauma and violence on the individual

(Jennings, 2004)

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What Is A Trauma-‐informed Approach?

•  A definiFon of trauma-‐informed approach incorporates four key elements: (1) realizing the prevalence of trauma; (2) recognizing how trauma affects all individuals involved with the program, organizaFon, or system, including its own workforce; and (3) resisBng re-‐traumaBzaBon (4) responding by pudng this knowledge into pracFce. (SAMHSA, 2012)


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What Does a Trauma-‐Informed OrganizaFon Include?

•  Safe, calm, and secure environment with supporFve care

•  System wide understanding of trauma prevalence, impact and trauma-‐informed care

•  Cultural Competence •  Consumer voice, choice and advocacy •  Recovery, consumer-‐driven and trauma specific

services •  Healing, hopeful, honest and trusFng relaFonships


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CreaFng Sanctuary

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“We always recognized the importance of physical safety. Our refusal to tolerate violence of any sort constituted our best defense against any breach in physical safety. But a physically safe environment, although necessary, was not sufficient. So there had to be other kinds of safety, which I have termed psychological safety, social safety, and moral safety.”

(Sandra L. Bloom, Creating Sanctuary, 2013)

“But What Exactly Does Safety Mean?”


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Psychological Safety

If you have never felt safe or remembered safety, how will you know it when it is present?

“Refers to the ability to be safe within oneself, to rely on one’s ability to self-protect and keep oneself out of harm’s way.”

(Bloom, 2013)


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“The sense of feeling safe with other people…There are so many traumatized people that there will never be enough individual therapists to treat them. We must begin to create naturally occurring, healing environments that provide some of the corrective experiences that are vital for recovery.”

(Bloom, 2013)

Social Safety

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Moral Safety

The never-ending quest for understanding how organizations function in the healing process. •  An attempt to reduce the hypocrisy that is

present, both explicitly and implicitly •  A morally safe environment struggles with

the issues of honesty and integrity (Bloom, 2013)


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Principles of a Trauma-Informed Approach

•  Safety •  Trustworthiness and

Transparency •  Collaboration and mutuality •  Empowerment •  Voice and choice

(Fallot 2008, SAMHSA, 2012)

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Intrinsic to be Included

•  Compassion FaFgue •  Gender and Trauma •  EpigeneFcs •  Historical Trauma •  Trans-‐generaFonal Trauma •  Culture in the Context of Trauma •  Trauma in the Community •  Trauma-‐Informed Supervision

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Why is Trauma-‐Informed Care Important?

•  We might unintenFonally cause harm by pracFces, policies and acFviFes that are insensiFve to the needs of our clients

Re-‐trauma2zing someone uninten2onally is a real possibility

•  Understanding trauma also means recognizing that our personal traumaFc experiences or the stress associated with working in human services may impact our emoFonal and physical well being as well as our work success and saFsfacFon


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Why is Trauma-‐Informed Care Important?

•  Understanding that a person’s life situaFon contributes to their current problems allows for more effecFve treatment

•  Current problems are ogen related to traumaFc life experiences

•  Trauma survivors are ogen sensiFve to situaFons that remind them of the people, places, or things associated with the traumaFc event

•  Reminders or triggers could cause a person to relive the trauma and view our organizaFon as a source of distress rather than a healing and welcoming environment


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What are the Benefits of AdopFng Trauma-‐Informed Approaches? ü Increases safety for all

ü Improves the social environment ü Cares for the caregivers ü Improves the quality of services ü Reduces negaFve encounters and events ü Creates a community of hope, healing and recovery

ü Increases success and saFsfacFon at work ü Promotes organizaFonal wellness ü Improves the boiom line

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WHAT HURTS? •  Interactions that are

humiliating, harsh, impersonal, disrespectful, critical demanding, or judgmental

WHAT HELPS? •  Interactions that express

kindness, patience, reassurance, calm and acceptance and listening

•  Frequent use of words

like PLEASE and THANK YOU

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The Importance of Relationships


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WHAT HURTS? •  Congested areas that are

noisy •  Poor signage that is

confusing •  Uncomfortable furniture •  Cold non-inviting colors

and paintings/posters on the wall

•  Physical barriers that create distance

•  Stigmatizing language and signage in public areas

WHAT HELPS? •  Treatment and waiting

rooms that are comfortable, calming and offers privacy

•  Furniture is clean and comfortable

•  No wrong door philosophy: we are all here to help

•  Wall coverings, posters/pictures are pleasant and coveys a hopeful positive message

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The Importance of Physical Environment


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WHAT HURTS? • Rules that always seem to be broken (time to take a second look at these rules) • Policies and procedures that focus on organizational needs rather than on client needs • Documentation with minimal involvement of clients • Many hoops to go through before a client’s needs are met • Language barriers

WHAT HELPS? • Sensible and fair rules that are clearly explained (focus more on what you CAN DO rather than what you CAN’T DO) • Transparency in documentation and service planning • Materials and communication in the person’s language • Continually seeking feedback from clients about their experience in the program

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The Importance of Policies and Procedures

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WHAT HURTS? • Asking questions that convey the idea that “there is something wrong with the person” • Regarding a person’s difficulties only as symptoms of a mental health, substance use or medical problem

WHAT HELPS? • Asking questions for the purpose of understanding what harmful events may contribute to current problems • Recognizing that mental health, substance use and physical health symptoms may be a person’s way of coping or adapting to trauma that has occurred

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The Importance of Attitudes and Beliefs


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How Can Our Organization Create and Sustain Change?

Providence


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Organizational Readiness Ask Yourself:

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1) Is my organization committed to increasing our awareness and understanding of the principles and practices of trauma informed care? 2) Does my organization want to insure that we address the needs of those we serve affected by trauma as an integral part of our strategic plan? 3) Does my organization wants to insure that we screen and assess for trauma for all we serve in a way that is sensitive and respectful?

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5) Does my organization want to offer our customers a range of evidence-informed interventions and services that address trauma related adaptations and difficulties provided by knowledgeable; skillful and culturally respectful staff? 6) Does my organization want to insure that our policy and procedural decisions are informed by the experience and perspective of those we serve (peers as employees/volunteers/advocates in a variety of influential roles)?

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7) Does my organization want to insure that our entire workforce is educated about trauma-informed approaches and how every person (employee/customer/student/volunteer) contributes to accomplishing this goal? 8) Does my organization want to raise the awareness of trauma informed approaches to other organizations, programs and service systems that interact with those we serve? 29


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How Can Our OrganizaFon Create and Sustain Change?

•  The Seven Domains of Trauma-‐Informed Care (TIC)

•  The role of leadership and the Core ImplementaFon Team

•  Eight steps to successfully implement change (Koier)

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The Seven Domains of TIC

Domain 1. Early Screening and Comprehensive Assessment of Trauma •  Developing a respec>ul screening and assessment process that is rou2ne, competently done and culturally relevant and sensi2ve


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Domain 2. Consumer Driven Care and Services •  Involving and engaging people who are or have been recipients of our services to play numerous roles (e.g., paid employee, volunteer, members of decision making commiFees, peer specialists) and meaningfully par2cipate in planning, implemen2ng and evalua2ng our improvement efforts


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Domain 3. Trauma-‐Informed, Educated and Responsive Workforce •  Increasing the awareness, knowledge and skills of the en2re workforce to deliver services that are effec2ve, efficient, 2mely, respec>ul and person centered

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Domain 4. Provision of Trauma-‐Informed, Evidence Based and Emerging Best PracFces •  Increase the awareness, knowledge and skills of the clinical workforce in delivering research informed treatment services designed to address the cogni2ve, emo2onal, behavioral, substance use and physical problems associated with trauma


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Domain 5. Create a Safe and Secure Environment •  Increase the awareness, knowledge and skills of the workforce to create a safe, trus2ng and healing environment as well as examining and changing policies, procedures and prac2ces that may uninten2onally cause distress and may re-‐trauma2ze (cause harm) those we serve.

Heal the Heroes


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Domain 6. Engage in Community Outreach and Partnership Building •  Recognize that the people we serve may be part of and affected by a larger service system including housing, correc2ons, courts, primary health, emergency care, social services, educa2on and treatment environments such as substance use programs.

• We can engage and increase the awareness of other service providers to the principles and prac2ces of trauma-‐informed care.

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Domain 7: Ongoing Performance Improvement and EvaluaFon •  A system is in place to measure performance in each domain. Data is tracked, analyzed and reviewed to address challenges and/or reinforce progress.

•  A standing work group of key stakeholders is empowered to sustain a con2nuous organiza2onal focus on trauma-‐informed care. The team u2lizes the data and develops ac2on plans that contribute to posi2ve outcomes.


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It Takes Everyone to Make the Difference!

•  Every contact with a person receiving services and with each other will affect us in one of two ways:

1. Contribute to a safe, trusBng, and healing environment

OR 2. Detract from a safe, trusBng, and healing environment

•  All of us play a role when it comes to creaFng a safe, trusFng and healing environment


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Role of Leadership and Core ImplementaFon Team

•  Leaders and leadership teams who employ research informed approaches are more likely to acFvate the organizaFon to support a change iniFaFve

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John Koier’s Eight Stages of Change

The Heart of Change

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Step 1: Increase Urgency

•  Leadership CommunicaFon ü Communicate to everyone ü Organiza2on “owns” the change ü Content of the message

● The change is important ● The change is not easy ● Everyone is part of making change successful ● Pros of success and the cons of failure

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CommunicaFng Urgency Strategies

•  Message stresses criFcal importance of becoming trauma-‐informed organizaFon

•  Thriving in a changing healthcare system: Why is TIC important?

● Poor assessment, inappropriate services, access barriers and the overuse, underuse and misuse of services leads to poor quality ● Lack of awareness may actually cause harm ● Consistent with core mission of behavioral health, primary care, social and safety net services

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Ask Yourself

•  Who is responsible for conveying urgency?

•  Why do we consider TIC to be urgent?

•  What is our message (3 key points)?

•  Who do we need to convey this message to?

•  When and how can we do this?


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Step 2: Build Guiding Teams

Who to include: •  Leadership with responsibility and authority to guide the change process

•  Those affected by the change (clients and staff) •  Those expected to carry out the change day to day •  Those with experience or knowledge related to trauma-‐informed care

•  Those with quality improvement and data related exper2se •  Those who can provide needed resources •  Those whose values, interests, beliefs, and orienta2on aligns with the improvement effort (trauma champions)

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Build the Right Core ImplementaFon Team (CIT)

• Leadership/Program Director • Clinical Director • Consumer/Family Leaders (2) • Quality Improvement Staff

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Build The Right Core ImplementaFon Team (CIT)

•  Members communicate regularly to share their experiences and to learn from each other

•  Ask yourself… ü Do we have the right compliment of people on our CIT?

ü Should we develop workgroups to assist with implemen2ng domain specific goals


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Step 3: Get the Vision Right

•  To accomplish significant organizational change, the guiding implementation team produces a clear sense of direction through a shared vision

•  A trauma informed care vision helps stakeholders “see” the direction where all the organizational plans and strategies will take you

•  Visioning requires the creativity to see possible futures

•  The goal is to articulate a vision that is so clear that it fits on one page and takes less than a minute to share

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Get the Vision Right

•  Developing a shared understanding of what it means to be a trauma-‐informed organizaFon – Communicate vision with clarity and consistency – Bridge current prac2ces with future prac2ces – Focus on the posi2ve goal rather than the problem

•  Vision guides the organizaFon in deciding what to……. – Keep Doing – Do Differently – Start Doing

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Ask Yourself

•  What is our vision statement? •  Who needs to know this? •  What opportuniFes do we have to communicate this?


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Step 4: CommunicaFon for Buy In

What is it? • Influencing adtudes, beliefs, expectaFons, percepFons and worries in a direcFon that supports the adopFon of trauma informed care principles and pracFces

• Increasing posiFve feelings about the change in a way that overcomes the “negaFve” feelings ogen associated with change:

> Control > Meaning > Status

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Why is this important?

ü Successful and sustainable change is inextricably linked to the moFvaFon and behavior of leadership and the workforce

ü Human service work is ogen conducted in private sedngs-‐commitment on the part of the workforce in the absence of direct supervision is criFcal

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Communication for Buy In

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CommunicaFon for Buy In

•  Emphasizes pros of adopFng trauma-‐informed care throughout organizaFon for all stakeholders

•  Explores cons of not becoming more trauma-‐informed

•  Involves and engages staff to share ideas to successfully meet the goals of the trauma-‐informed care iniFaFve •  Assists staff to regain control, status and personal meaning in the new direc2on

•  Emphasizes the supports, resources and tools available to promote adopFon of pracFces and policies that facilitate the goals of the trauma-‐informed care iniFaFve


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CommunicaFon for Buy In

•  CriFcal Challenges facing leadership and CIT: ü Communica2ng for buy-‐in (what is the message? Who delivers the message? How do we know if the workforce understands and values the message? What prac2cal ac2ons can the workforce take that promotes engagement of consumers?

ü How does an organiza2on insure that the workforce supports the aims of the TIC ini2a2ve?

ü How does the organiza2on insure key stakeholders understand, value, and act in ways that are likely to support change?


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Step 5: Enable AcFon

The Core ImplementaFon Team has…. • Direct and Fmely access to organizaFonal leadership • Time and resources to take on serious tasks associated with adopFng and sustaining TIC goals • ExecuFve leadership communicates to enFre organizaFon that it stands behind core implementaFon team • Leadership expects everyone to support the work of the team (Minimizes “hoops to jump through to get a green light”)

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Enable AcFon

The Core ImplementaFon Team has…. • Direct access to organizaFonal leadership in a Fmely fashion • Time and resources to take on serious tasks associated with adopFng and sustaining goals • Core ImplementaFon Team has full support of execuFve leadership. Leadership expects everyone to support the work of the team (Minimize “hoops to jump through to get a green light”)


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Ask Yourself

•  Have you goien the buy in, support, approval from leadership?

•  Do you have a mechanism in place for keeping leadership informed of progress, needs, plans?

•  Will you consider draging messages for leadership (i.e. Vision Statement)?


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Step 6: Create Short Term Wins

•  Short term acFon steps are observable and meaningful

•  The organizaFon has a system in place to communicate across the organizaFon… ü Progress towards the aims of the iniFaFve ü Short term wins ü Data as well as human stories behind the data

•  Reinforce posiFve changes and acknowledge how everyone contributes to posiFve outcomes

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6. Create Short Term Wins

•  The CIT is tracking and analyzing data to idenFfy short term progress/achievements ü  Short term ac2on steps are observable and

meaningful •  System is in place for communicaFng across the organizaFon… ü Progress towards the aims of the ini2a2ve ü Data as well as human stories behind the data ü Contribu2on of all to posi2ve outcomes


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Step 7: Don’t Let Up

•  Change takes passion, commitment and persistence ü Ask yourself: What has your organiza2on recently done that demonstrates its ability to s2ck with a change process?

ü What were the things that happened that made it possible to change?


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7. Don’t Let Up

•  Expect process to be non-‐linear -‐ bumps are inevitable and signs you’re making real change

•  There will be inevitable forces at work to resist the change and return to the more comfortable habituated state

•  Keep an eye on the process at all Fmes •  Have a system in place to insure that iniFaFve is a high priority goal of the organizaFon

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Ask Yourself

•  Is our CIT conFnuing to meet as planned? •  Are we conFnually monitoring and using data?

•  Are we coordinaFng and sharing findings and recommendaFons with execuFve leadership, workgroups, extended CIT, all others?


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Step 8: Make It SFck

•  OrganizaFons historically have adopted new strategies, intervenFons and policies and procedures that as soon as aienFon is turned elsewhere lose all momentum and lapse back into old ways of doing business ü Ask yourself: ● What are ways we can maintain our momentum and con2nue moving forward? ● What do we need to be aware of? ● How can we begin to think about sustainability


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Seven Domains of Trauma-‐informed Care

ImplementaFon Process

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Gaining Commitment from Leadership

•  Buy in to create culture change • Willingness to lead change process •  Input and approval of vision statement

•  Par2cipa2on and support for all TIC efforts


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Developing Our Core ImplementaFon Team (CIT)/Oversight Team

•  Review of team membership •  Role of CIT iden2fied, repor2ng system established

• Workgroups established to address specific domains/topics

• Mee2ng schedule and agenda established that includes data review (using Implementa2on Planning Guide, PMT


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Building Consensus

•  CIT gains consensus on what TIC means to each member, for the organiza2on, language around TIC

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CreaFng a Shared Vision

•  Establish why TIC is important to the mission (may use TIC Domains)

•  Determine what organiza2on should look like/how it will be different

•  Create a vision statement and get leadership approval

•  Decide who needs to know about the vision and how, where and when to get the word out


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CommunicaFng for Buy in

•  Decide who needs to know about TIC efforts (can use the Communica2ng for Buy in Tool)

•  Determine what they need to know and gather the resources to heighten awareness (DVD’s and PP slides available through the faculty)

•  Decide where and when to provide this informa2on •  Iden2fy who will deliver this informa2on and what data needs to be collected


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Assessing Our OrganizaFon

•  Familiarize yourselves with the Organiza2onal Self-‐Assessment (OSA)

•  Decide which programs you wish to assess-‐star2ng with one or two or the en2re organiza2on/system

•  Decide who should complete OSA, how to disseminate the OSA and how to collect completed OSA data

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Developing a Plan

•  Analyze results of OSA •  Iden2fy strengths and areas for improvement •  Decide where to begin improvement efforts (one or two programs or en2re organiza2on/system)

•  Decide which domain or domains to begin focus of efforts •  Can use or add to the PMT to establish measureable goals •  Consider establishing workgroups for each domain or to focus on topic areas such as policies and procedures

•  Use the Implementa2on Planning Guide to drive the process and to document goals


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CreaFng a Monitoring System

•  Establish a system to collect data related to each goal using the Performance Monitoring Tool (PMT)

•  Determine who will be responsible for collec2ng this data

•  Ensure that mee2ng agenda includes review of data

• Use the data to iden2fy and address challenges and revise or establish new goals


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Taking AcFon

•  Ensure that CIT (responsible party for implemen2ng goals) is clear about their mission and that they have the approval of leadership

•  Establish repor2ng system so all involved par2es are kept informed of data, progress, challenges, revised goals, recommenda2ons

•  Iden2fy a system for communica2ng progress to all (leadership, board, staff, consumers) and their role in achieving these outcomes

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Taking AcFon

• Meet regularly to make changes s2ck • U2lize your supports, resources and tools available through the Learning Community website, list serve, faculty, webinars, calls

• Maintain your momentum


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Contact InformaFon

Cheryl S. Sharp, MSW, ALWF Senior Advisor for Trauma-‐informed Services

NaFonal Council for Behavioral Health [email protected]

202/684-‐7457, ext. 254 252/670-‐0178

Documents

MARRCH - Minnesota.ppt (Read-Only)5 Contact: [email protected] 202.684.7457 “We always recognized the importance of physical safety. Our refusal to tolerate violence