MergedFile - ATTACh · 9/6/2018 · 8/13/2018 10 Challenging issues in trauma-informed supervision •Support vs. accountability •Multiple roles - clinical supervisor, boss, evaluator

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Creating an Innovative Organization that Develops and Sustains Resilient Foster Care Programs

Patricia Wilcox, LICSW

Traumatic Stress Institute

Klingberg Family Centers

2018

Sources of Job Stress

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The Many Faces of Workplace Stress

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Burnout

Moral Distress

Primary trauma

Secondary Trauma Compassion

Fatigue

Vicarious trauma

Traumatic Grief and Loss

Systems Failure

Adapted from The Compassion Fatigue Workbook by Françoise Mathieu (Routledge 2012)

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The Effect of the Work on the Treater

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Contributing Factors:

• Nature of work: control over schedule, healthy work place, support, supervision, caseloads, physical conditions, sense of caring, ethic and fairness, relationships with colleagues

• Nature of clients: See improvement, match worker/client, training, balance/variety, enjoyment, chronicity, type of symptoms

• Nature of helper: previous trauma, current support system, healthy practices, hobbies and interests, self-awareness

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What’s an Agency to Do?

• Administration

• Supervision

• Team work

• Social Connections

• Voice and Choice

• Attention to Vicarious Trauma

• Sustain through Celebration

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Administration/ Agency

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Administrative buy in • Provide resources

• Target praise

• Possibilities for undoing

• Value and provide opportunity for supervision

Policy

• Recreation and activities

• Philosophy of treatment

• Intake explanation

• Handouts for foster and bio parents

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Hiring and promotion • Hire and promote people who “get it”

• Questions for hiring

Administration Develops and Shares a Clear Vision of What a Trauma-Informed Resilient Agency Is

• Inspirational

• Connects to agency mission and values

• Modelled by administration actions

• Constantly mentioned

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A Resilient, Trauma-Informed Agency Vision

• We act on our belief that everyone is doing the best they can. Every client. Every foster parent. Every bio parent. Every staff.

• We base our interventions on our knowledge that people act better when they are safer, more connected, and happier.

• We inform our decisions with our knowledge that fear does not produce lasting growth. Kindness produces lasting growth.

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• We believe that change happens within relationships.

• We know how neglect, trauma and attachment disruptions change the body, and use that knowledge to design our interventions.



All behavior is communication and is adaptive. It is an attempt to solve a problem in the best way a person knows. Therefore, we attempt to understand behavior before we attempt to change it.


• With our clients we are collaborative and respectful. We are also that way with each other.

• We individualize our approach because each person is different.

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A Resilient, Trauma-Informed Agency Vision • We are patient and flexible, trying to help the

person reach their goals in less destructive ways. We avoid shaming.

• We teach skills and help each person discover and use their voice.

A Resilient, Trauma-Informed Agency Vision • Our most important job is to demonstrate that

some people are trustworthy, kind and genuinely caring.

• We do this work with our hearts and it effects us as people. We pay attention to vicarious transformation and take good care of ourselves and each other. We offer forums, fun, and recognition.

A Multi-Layered Approach

Child

Foster and Bio

Families

Line Worker

Supervisor

Treatment Program

Agency

Social Service System and Community

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Exercise

• My Administration-

• To what extent does your administration follow the principles we just discussed? What are the barriers? Use handout How Administrators can Sustain Trauma Informed Care

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Supervision

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The role of supervision in a great team

• Regular supervision helps with counter transference and vicarious trauma

• The supervisors reactions to inter-personal splits is essential in magnifying or solving them

• Ideally all team members have the same supervisor

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Why focus on supervision? • Primary method to embed trauma thinking into every day

life

• Opportunity to step back and think

• Chance to vent

• Teach clinical thinking- looking beneath

• Create culture of self awareness

• Fight erosion of TIC thinking

• Awareness of and attention to VT

• Handling staff performance issues

• Helping staff to grow transforms the pain

What trauma principles are important in supervision? • Relationships matter

• We are all doing the best we can at the moment

• Symptoms are adaptations- yes, even for adults

• Current relationships are influenced by the past

• Self awareness is essential

• Relationships are the vehicle of growth

• Parallel process

• Collaboration, empowerment, caring, respect- it matters

In other words, ALL of them.

Trauma principles at work in supervision

• Make time

• Be on time and pay attention

• Connect

• Set frame and boundaries

• Remember details

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• Validate

• Safe relationship to explore personal reactions

• Use symptoms as adaptation lens

• Self awareness essential


• Acknowledge validity of concerns

• Explore connections between reactions and past

• Encouraging and deepening self awareness


• Validation and push for change

• Need to handle difficult issues kindly

• Clear expectations

• Collaborative and empowering

• Mutual problem solving not blaming

• Can’t have relationship with the clients if you are feeling blamed, scapegoated and angry

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Challenging issues in trauma-informed supervision • Support vs. accountability

• Multiple roles - clinical supervisor, boss, evaluator of job performance,

• When to listen, when to problem-solve

• Working with resistance and defensiveness

• Supervising former peers, people older than you, etc

• Boundary between supervision and therapy

Teams that Sustain Treaters

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How does our team functioning

matter?

• Clients notice everything we do

• Can’t treat clients any better than we treat each other

• Our happiness in our jobs largely influenced by our social surroundings

• Our connection is our strongest defense against VT

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Attached Teams

• Staff form strong relationships with clients while maintaining clear boundaries, and discuss boundary dilemmas with their teams

• Staff have time to connect with supervisor and team and discuss their cases

• Combats isolation

• Attention to successes

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• Boundaries are clear and open; boundary

questions are discussed with the team

• Most aspects of the client’s treatment are

shared with the team.

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• We share with each other how the work is

affecting us and how we are feeling towards

individual clients.

• We value our relationships with each other

and we create activities to enhance them.

• We share humor.

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• We have time and mechanisms to share the ways that the work is affecting us over time (vicarious traumatization).

• When there is a problem in the program or

a decision to be made all get together to

discuss it and decide.

• We can admit when we are lost and we ask

each other for help.

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• We do fun activities together.

• We celebrate milestones and excellent work

• Administration is supportive and

appreciative.

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What makes this so difficult?

• In small groups, discuss barriers to this type of team functioning.

• What have you done to improve/enhance team functioning?

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Other Determinates of Job Satisfaction

• Social Connections

• Voice and Choice

• Increasing Stamina

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Social Connections that Support the Work

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Our relationships

• Our attachments are what enable us to form attachments with the clients

• We handle conflict directly and respectfully.

• We talk with each other when we have strong feelings about a client.

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Choice and Voice

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In what areas can employees have choice?

• Work hours

• Decorating space

• Use of treatment methods

• Including own interests (music, meditation, etc.)

• New responsibilities (training, supervise interns)

• Community involvement

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In what areas can employees have voice?

• Agency policies and operations

• Treatment decisions

• Strategic planning

• Moral and ethical decisions

• What else…..

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Embedding Attention to VT

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Vicarious Traumatization

VT refers to the negative changes in the helper as a result of empathically engaging with and feeling,

or being, responsible for traumatized clients.

How this work will change you

Laurie Pearlman, PhD

Kay Saakvitne, Ph.D.

Vicarious Traumatization (2) The single most important factor in the success

or failure of trauma work is the attention paid to the experience and needs of the helper.

Addressing VT is an ethical imperative. This is

as true with teams as with individuals, maybe more so.

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Attention to vicarious traumatization and transformation

Training

Supervision

Staff meetings

Special meetings after upsetting events

Rituals

Recognition

Fun

Staff development and growth

Vicarious Traumatization

Imbed attention to VT

Use of art

Nourish mission and spirituality

Notice success

Replenish hope

Ceremonies

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Organizational Responses to VT

Foster culture where there’s permission to discuss VT.

Embed attention to VT in the workings of organization like regular retreats or forums.

Provide adequate supervision.

Offer health benefits that include mental health coverage.

Use staffing patterns that allow back-up and sharing of responsibility and coverage.

Set reasonable caseload expectations.

Work with staff to identify and address signs of VT.

p. 184

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Promoting Growth and Transformation

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Transforming the Pain of VT

The pain of VT can lead us to search for hope and meaning in our work and our lives.

Working with people who have experienced great pain teaches us about:

Courage and human resilience

The possibility of transformation

Gratitude in our own lives

The power of hope

Remembering the meaning of our work helps us to transform VT. How does being a foster parent help you grow as a person?

What Gives Us Hope?

• Have a theory

• Notice small successes

• Love your work

• Reclaim your relationship to your body

• Recognize moments of connection

• Growing as a person

• Make a difference

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Building Resilience Against VT

Resilience is successful adaptation in the face of biological challenges and stressful life events. (adapted from Werner, 1992)

– Ability to bounce back from a challenge

– Ability to endure during challenges

– Ability to learn and make meaning out of a challenge (post-traumatic growth)

(Devereux Center for Resilient Children, Devereux Foundation)

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Sustaining Through Celebration

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Measures

Measures help to see progress and add to sustaining

Examples:

– Decrease in restraints, seclusions, negative discharges, staff and client injuries, turnover

– Increase in positive discharges, job satisfaction, client satisfaction

ARTIC Attitudes Related to Trauma-Informed Care

How to publicize success?

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The ARTIC (Attitudes Related to Trauma-Informed Care)

The Attitudes Related to Trauma-Informed Care (ARTIC) is the first psychometrically valid measure of trauma-informed care (TIC) published in the peer reviewed literature. It is a measure of professional and para-professional attitudes favorable or unfavorable toward TIC. It was developed by the Traumatic Stress Institute of Klingberg Family Centers and Dr. Courtney Baker of Tulane University.

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Publicize and celebrate

• Choose measures-

– Reduce restraints

– Reduce turnover

– Positive discharges

– Follow up

• Track

• Celebrate and publicize success

• Staff appreciations

For more information contact: Patricia D. Wilcox, LCSW

Vice President, Klingberg Family Centers

370 Linwood St.

New Britain, CT. 06052

[email protected]

860-832-5507

www.traumaticstressinstitute.org

www.partnerforhealing.org

www.trauma-informed-care.org

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mailto:[email protected]

http://www.traumaticstressinstitute.org/

http://www.partnerforhealing.org/

http://www.trauma-informed-care.org/





The Resilient Agency

A Trauma-Informed Approach to Creating an Innovative Organization that Develops and Sustains Resilient Treaters

Patricia Wilcox, LCSW Traumatic Stress Institute Klingberg Family Centers 2018

The Resilient Agency

Table of Contents

The Many Faces of Workplace Stress 1 How Administrators Can Sustain Trauma-Informed Care 2 What Do We Really Mean By Provide Trauma-Informed Care? 4 Scenarios for Hiring Interviews 5 Best Practice Guidelines for Reflective Supervision 7 Trauma Informed Team Characteristics- Milieu 10 Trauma Informed Team Characteristics- Community 11 Checklist for Team Collaboration in Tough Times 12 Teams as Social Support 13 Embedded Agency Interventions for VT 17 Evaluating Agency Attention to Vicarious Trauma 19 Strategies to Combat Workplace Stress 20 37 Ways to Manage Vicarious Traumatization 22 Ideas to Promote Vicarious Transformation 24 Staff Development Plan 27 Therapist Development Plan 28 10 Characteristics of a Resilient Treater 29 How to Communicate and Celebrate Your Success 30 Signs that Trauma-Informed Care is Eroding and What to Do 31

The Many Faces of Workplace Stress


Types:

Burnout- physical and emotional exhaustion caused by low job satisfaction, feeling powerless and overwhelmed. “The chronicity, acuity and complexity that is beyond the capacity of the service provideder. (Beth Stamm) Also influenced by physical conditions of job, workload and amount of hours worked Moral Distress: When policies or routines conflict with beliefs aboit patient care. When we are told to do things that we fundamentally disagree with or to which we are morally opposed. Primary trauma: direct trauma personal and at work Secondary Trauma: exposure to trauma of others Compassion Fatigue: profound emotional and physical erosion that takes place when we are unable to refuel and regenerate Vicarious trauma: transformation of our world view due to exposure to trauma Traumatic Grief and Loss: the losses we suffer within our work Systems Failure- discouragement about inadequacy and injustice of caring system; also dismay about own workplace in areas such as fairness, ethics, excellence of work

Contributing Factors:

Nature of work: control over schedule, healthy work place, support, supervision, caseloads,

physical conditions, sense of caring, ethic and fairness, relationships with colleagues

Nature of clients: See improvement, match worker/client, training, balance/variety, enjoyment, chronicity, type of symptoms Nature of helper: previous trauma, current support system, healthy practices, hobbies and interests, self-awarenes

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How Administrators can Sustain Trauma Informed Care

The following are specific steps that Senior Administrators can take to create and sustain trauma informed care in their agencies.

Develop a mechanism to learn of moments of success, such as patience and understanding helping a child or family, and praise the staff member personally

Establish communication forums such as Lunch with the CEO and listen.

Take clients to lunch. Ask them how you could improve your agency.

Call families who have been involved with the program a few weeks or a month. Ask them how it is going and how you could improve.

When you are asked to consult on a case, ask how the staff understands the behavior.

Develop and sustain employee recognition events and employee and client fun events.

Establish client councils

Have a client on your Board.

When you observe or must respond to a problem situation, praise any one who did anything caring and collaborative with the client.

When things go wrong, seek systems solutions. When possible, do not blame individuals. Make sure to maintain a "we are in this together" stance.

Occasionally join in program fun events.

Convey hope

Establish contact with every staff member who is hurt.

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Traumatic Stress Institute of Klingberg Family Centers ©2013

Speak warmly and hopefully of the youth.

Remind staff about their reason for doing this work, the mission, the importance to the youth.

Make resources available for change effort.

Articulate overall program expectations, such as what is meant by imminent danger and when restraint can and cannot be used, or when to call the police.

Congratulate team members on their stamina in sticking with a certain child, reminding them that it is the most important thing they can do.

Be clear and specific in your intent to establish trauma informed care.

When you make a mistake, admit it. Make amends.

Include descriptions of your success with trauma informed care in all your external communications.

Learn which staff are good at this and support them. And promote them.

When making key hires and promotions, consider the person's familiarity with and commitment to trauma informed care.

Create policy to support this way of working, such as guide to behavior management and treatment philosophy.

Strongly support training.

Consider the agency structure and change if necessary to (as much as possible) unified teams with clinical leadership.

The stories and experiences of these clients, and the pain of the staff, and the complexities of this difficult work we do, will affect you too. Make sure you have someone to talk to about vicarious traumatization, and be alert for its effects on you. Take care of yourself and each other.

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What Do We Really Mean When We Say We Provide Trauma-

Informed Care?

Patricia D. Wilcox, LCSW

We act on our belief that everyone is doing the best they can. Every client. Every staff. Every family.

We base our interventions on our knowledge that people act better when they are safer, more

connected, and happier.

We inform our decisions with our knowledge that fear does not produce lasting growth. Kindness

produces lasting growth.

We believe that change happens within relationships.

We know how neglect, trauma and attachment disruptions change the body, and use that knowledge to

design our treatment.

All behavior is communication and is adaptive. It is an attempt to solve a problem in the best way a

person knows. Therefore, we attempt to understand behavior before we attorney to change it.

With our clients we are collaborative and respectful. We are also that way with each other.

We individualize our approach because each person is different.

We are patient and flexible, trying to help the person reach their goals in less destructive ways. We

avoid shaming.

We teach skills and help each person discover and use their voice.

Our most important job is to demonstrate that some people are trustworthy, kind and genuinely caring.

We do this work with our hearts and it effects us as people. We pay attention to vicarious

transformation and take good care of ourselves and each other. We offer forums, fun, and recognition.

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Scenario 1:

A client returns from school, bursts into the house and swears loudly, throwing their backpack across the living room at the wall. There are other clients in the area but the backpack does not hit anyone directly. What are your initial thoughts, feelings and actions?

Scenario 2:

You are working second or third shift and the clients are in bed. As part of your nightly duties, you are completing room checks at the specified intervals. You walk into a double bedroom with two teenage same-sex clients and find they are engaging in sexual relations. What are your initial thoughts, feelings and actions? Scenario 3: You are working with another coworker who you think has shown poor boundaries with the clients. He or she is often tickling one client in particular and often goes into this client’s room alone and shuts the door. You feel uncomfortable with their interactions when you observe them together. What are your initial thoughts, feelings and actions?

Scenario Four:

You are on the unit and Susie comes back from school, throws her book bag on the floor, goes to her room and slams the door. What would you do? What is the first thing you say to her?

Scenario Five:

You have just come on shift and a client is crying. She has a red mark on her face. You ask what’s wrong and she states that another staff member hit her prior to you walking through the door. What would you do?

Scenario Six:

A client approaches you and asks to speak with you privately. You find a quiet space to talk with them and sit down. The client says, “I have something really important to tell you, but I need you to promise that you won’t tell anyone.” How do you react? Do you promise to keep a secret for the client?

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Scenario Seven:

A client asks to speak with you and states that she is thinking about killing herself. She reports that she has a knife hidden in her bedroom and has no desire to go on living. What do you do?

Questions

What would you do if a youth friended you on Facebook or asked for your personal cell phone number?

What information do you think would be ok to share with our clients about yourself? What is never ok to share with clients?

What do you feel is too much to share about yourself with a client?

What does the phrase “it's not about me” mean to you?

What do all children need from adults?

What would your reaction to a child be if they asked you to adopt them?

What do appropriate physical or emotional boundaries look like to you?

What do you think might be the most difficult time of day for clients?

What can staff do to make clients feel safer or more comfortable around bedtime and/or shower?

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Best Practice Guidelines for Reflective Supervision

• Agree on a regular time and place to meet • Arrive on time and remain open, curious and emotionally available • Protect against interruptions, e.g. turn off phone, close door • Set the agenda together with the supervisee(s) before you begin • Respect each supervisee’s pace/readiness to learn • Ally with supervisee’s strengths, offering reassurance and praise, as appropriate • Observe and listen carefully • Strengthen supervisee’s observation and listening skills • Suspend harsh or critical judgment • Invite the sharing of details about a particular situation, client, parent, their competencies,

behaviors, interactions, strengths, concerns • Listen for the emotional experiences that the supervisee is describing when discussing the case

or response to the work, e.g. anger, impatience, sorrow, confusion, etc

Respond with appropriate empathy • Invite supervisee to have and talk about feelings awakened in the presence of a client or family. • Wonder about, name and respond to those feelings with appropriate empathy • Encourage exploration of thoughts and feelings that the supervisee has about the work with

children and families as well as about one’s response(s) to the work, as the supervisee appears ready or able

• Encourage exploration of thoughts and feelings that the supervisee has about the experience of supervision as well as how that experience might influence his/her work with children and their families or his/her choices in developing relationships.

• Maintain a shared balance of attention on child, parent/ caregiver, and supervisee • Reflect on supervision/consultation session in preparation for the next meeting • Remain available throughout the week if there is a crisis or concern that needs immediate

attention

Adapted from: “Best Practices for Reflective Supervision/Consultation”. Michigan Association for Infant Mental Health, 13101 Allen Road Suite 200 · Southgate, Michigan 48195 · p 734.785.7700 · f 734.287.1680 · http://www.mi-aimh.org

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Supervisee: __________________________ Date: __________________

Mutually Identified Items (i.e. Vacation requests; Mileage Reimbursement; Receipts)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

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ISSUES RAISED BY SUPERVISEE

Program Concerns (Rules; Staff; Milieu Schedule; Teammate):

_____________________________________________________________________________________

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Clinical Concerns (Clients; Treatment Plans/Reviews; Counter-transference; Vicarious Traumatization):

_____________________________________________________________________________________

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Documentation Issues (T&A; Harmony; Paperwork; Trainings; PNMI; TCI):

_____________________________________________________________________________________

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FOLLOW UP FROM SUPERVISOR

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Trauma Informed Teaching Point:

_____________________________________________________________________________________

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Feedback to supervisee (positive/negative):

_____________________________________________________________________________________

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Next Supervision (Date/Time):

_____________________________________________________________________________________

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Tasks/Follow Up:

_____________________________________________________________________________________

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Supervisee Signature & Date

___________________________________

Supervisor Signature & Date

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Trauma Informed Team Characteristics

Please rate your current practice- how much do you think your team has these characteristic

son a scale of 1-5, 1 being very little to 5 being this is a solid part of our treatment. Put N/A if

this does not apply to your program. Have individuals rate separately then discuss as a team.

We discuss why a client is doing a harmful behavior, what problem is it

solving for them, before we decide how to respond to it.

Staff are encouraged to form strong relationships with the clients.

Staff have time and permission to spend time with individual clients or with

clients in small groups.

We value our relationships with each other and we create activities to enhance them. We share humor. When there is a problem in the program or a decision to be made staff of all

disciplines get together to discuss it and decide.

We can ask each other for help. We tag each other out when someone gets caught in a power struggle. We handle conflict directly and respectfully.

We share with each other how the work is affecting us and how we are feeling

towards individual clients.

The clinicians are on the unit interacting with staff and clients, and do not rely mainly

on scheduled office appointments for their therapeutic interactions.

The clinicians participate in fun activities and celebrations on the unit. Every staff member has some time to reflect, talk, learn and plan away from

direct care while working.

Most aspects of the client’s treatment are shared with the team.

All full-time direct care staff know each client’s history, treatment goals, and

discharge goal.

Every staff member is clear who his/her supervisor is. Every staff member receives regular supervision. Administration is supportive and appreciative.

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Trauma Informed Team Characteristics Outpatient and Community Services

Please rate your current practice- how much do you think your team has these characteristic son a scale of 1-5, 1 being very little to 5 being this is a solid part of our treatment. Put N/A if this does not apply to your program. Have individuals rate separately then discuss as a team.

We discuss why a client is doing a harmful behavior, what problem is it solving for them, before we decide how to respond to it.

Staff are encouraged to form strong relationships with the clients.

Boundaries are clear, and any boundary dilemmas are discussed with the team.

We value our relationships with each other and we create activities to enhance them.

We share humor.

When there is a problem in the program or a decision to be made staff of all disciplines get together to discuss it and decide.

We can ask each other for help.

We discuss when someone is having difficulty being compassionate towards a client.

We handle conflict directly and respectfully.

We share with each other how the work is affecting us and how we are feeling towards individual clients.

We have a mechanism for sharing information about our clients so that if someone has to respond to a client that is not their own they can do so thoughtfully.

Every staff member has time to reflect, talk, learn and plan with others while working.

All full-time staff know each client’s history, treatment goals, and discharge goal.

Every staff member is clear who his/her supervisor is.

Every staff member receives regular supervision.

Administration is supportive and appreciative.

(Where applicable) We have safety procedures so that our team knows where we are at all times.

We have time and mechanisms to share information and resources with each other.

We have a way to share successes and praise with each other.

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Check List for Team Collaboration in Tough Times

Have team discussions of what is going on and how it is affecting us as people Are we connecting with anyone who has been hurt and expressing our concern? Team discussion of possible reasons for chaos Reinstatement of positive activities that do not have to be earned, such a board games, art

projects, music nights, walks, special food events (pizza competition Make sure therapists are spending individual time with clients Divide and conquer- do things with clients in small groups Do we need training on a specific issue or problem? Should we bring in a consultant, maybe from another part of the agency or from outside the

agency? Can we repair any damage that has been done, and what resources do we need to make the

living quarters look nice? Can we reinstitute routines and rituals such as meals together, bedtime stories (no matter how

old the clients are) or hellos and goodbyes? Are the therapists spending time hanging out on the units? Are the staff staying out of the office and engaging the clients in games, discussions, jokes, fun? Does the program leadership need any additional support or training? Is supervision happening? Do we have enough structure with regular activities and little down time and not too much

reliance on electronic distraction? Are we flexible enough to respond to individual needs? Is our environment too noisy? Can we add music? Can we make the space more pleasant, add decorations? Have we talked openly with the clients about recent losses, such as a staff leaving? Have we looked for secrets the clients may be keeping- such as bullying or sexual activity that

may be going on? Have we had group and individual discussions with the clients about what they think is going on,

and what they think would help? Do we have mechanisms in place to recognize staff for special effort? Are we planning staff fun activities like pot luck lunches? Has administration expressed gratitude for the efforts of the staff, and sadness for their pain

and injuries? Are we continuing to talk about what is going on, with compassion and respect, recognizing that

everyone is doing the best they can?

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Teams as Social Support

List three formal ways that your team gathers together (meetings, etc.)

Ways these meetings provide support

How could they be more supportive?

List three informal ways that your team gathers together (social, lunch, after work, etc)

Ways these meetings provide support

How could they be more supportive?

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List two things someone did to help you recently

List two things you did to help someone else recently

Ideas for how we could help each other more

Think back to a recent crisis. How did team members support those who were involved?

What more could have been done?

Does your team speak optimistically of the work and the clients, or cynically and hopelessly?

Suggestions to include more hope in conversation, including ways you currently use

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How does your team currently recognize the good work of its members?

Ideas for more recognition

How does your team react to negative things that happen?

What else could you do?

In what ways does the team allow and encourage creativity, control over work, the ability of members to influence how things are done?

How could this be increased?

What does your team really value?

How are these values conveyed

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to new members?

Any ideas for improvement here?

This form is adapted from Building Resilient Teams by Patricia Fisher, PhD. Fisher and Associate, Inc. 2012

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Embedded Agency Interventions to Address Vicarious Traumatization

The following are some suggestions for how organizations can embed attention to vicarious

traumatization into the daily workings of their programs.

Mandated Staff Training. Staff are introduced to the concept of VT in staff orientation, and discussion of

VT is a part of all mandated staff training. For new employees this matter-of-fact inclusion in training

serves as an inoculation against the inevitable VT they will experience. They can begin to plan for self-

care strategies that will sustain them in this work and learn of agency supports that will assist them in

managing the stress.

Supervision. All staff who work with clients, including direct-care staff, receive regular supervision. That

supervision is focused on exploring clinically-related issues. Supervisors can model talking about VT:

“With everything that’s been happening, I’m finding that I can’t stop thinking of work at home.” They

can ask direct questions about VT: “How are you noticing work seeping into your outside life?” “How

were you feeling during that restraint?” “I notice when I’m stressed, I dream about work, does that ever

happen to you?” In addition, talking about specific cases using a trauma focus will help the staff

understand the client’s actions, not take them so personally, and develop a road map to guide future

interventions.

Regularly Scheduled VT Groups. Rather than gathering people only after a crisis, a regularly scheduled

group sends the message that this is an ongoing aspect of our work that we need to address. Using an

outside facilitator can help staff feel safe to talk about any and all contributors to their VT including ones

within the agency. In their book Trauma and the Therapist Pearlman, and Saakvitne provide many

exercises and ideas for exploring VT with staff. (Pearlman, and Saakvitne, 1995)

End-of-Shift Debriefings. While sometimes difficult logistically, even a short check-in among staff about

how the shift went can provide an outlet for venting feelings, and send the message that it is okay to

17


talk about these feelings. This exchange can also be an opportunity for staff to search for positive

meaning in their day.

Rituals Addressing VT. Building in ritual helps keep staff conscious of VT and the continual need for self-

care. Rituals can demark the separation between one’s life inside and outside of work. A team can begin

or end meetings with a quick go-round about what feels challenging and gratifying about your work; at

the end of a shift, have staff literally do the motion of brushing off what they want to leave at work and

depositing it in a container of some sort; have staff quickly write down what they want to leave at work,

and what they are looking forward to about being off work, and leave it in a ritual container.

Retreats. Annual or semi-annual retreats are opportunities for staff to be with each other outside of

work, eat together, learn together, and have fun together. Integrate a VT exercise into every retreat.

Celebration and Recognition of Success. These celebrations can include: monthly commendations for

staff who demonstrate excellence or go above and beyond; invitation to lunch with CEO for recognized

staff; annual staff appreciation event; holiday parties; client/staff day; unexpected thank you or

recognition emails.

Formal Program Structures. One example of a formal program structure comes from the Devereux

treatment program in Massachusetts, which created Comprehensive Assistance in Response to

Employees (CARE) as the result of ideas generated in a Risking Connection training. Based on the Critical

Incident Stress Debriefing literature, CARE offers a voluntary forum for staff to talk with a trained peer

about a difficult incident that occurred. Referrals can come to the CARE Team via the staff him/herself, a

colleague, or a supervisor. While not meant as psychotherapy or an investigation, the purpose of a CARE

meeting is to listen supportively, validate feelings, teach about VT and self-care, and provide hope and

exploration of meaning.

Over time, embedded interventions like these convince staff that agency attention to VT and self-care is

not just lip service, but rather a deeply held agency value. Gradually, staff will internalize these

messages and, as a community, share the weight of this incredibly demanding and challenging work.

What previously felt like overwhelming feelings endured alone, can feel more manageable and worth

the struggle when weighed against the great benefits of this honorable endeavor.

18

http://r20.rs6.net/tn.jsp?llr=hvjdxkdab&et=1103568274438&s=0&e=001BWHs7fxTGQnDcxz_vigqw1OClWOJJpDHkCoiVtyoKJfxjH31oohQTdEiYdSZitOjBoYEVHJSQSvUO1uth0_nvSWiRUVbT9UOWK2Q662vIxA=

Evaluating Agency Attention to Vicarious Trauma

Rate how much you currently do these things.

___________________________________________________________________________

1 2 3 4 5

We very rarely do this This is a regular practice in our program

Agency Practices to Combat VT Current Practice

1. All staff are trained in the concept of VT, that it is an inevitable part of the work, and the importance of self-care.

2. All staff receive regular supervision.

3. Supervision includes checking in on how the work is affecting the person and self-care steps.

4. After major incidents and injuries the staff has an opportunity to debrief.

5. There are regularly scheduled opportunities for staff to talk about how the work is affecting them, such as groups.

6. Teams do exercises to address VT, such as those in Trauma and the Therapist

(Pearlman, and Saakvitne, 1995)

7. Staff have the opportunity to debrief at the end of each shift, and commenting on how the day affected you is considered a strength.

8. We have rituals, jokes and practices that help us manage our stress as a team.

9. We have regular team retreats and they always include a VT exercise.

10. We have immediate ways of recognizing extra effort by staff.

11. We have fun activities together such as pot luck lunches, celebrations of birthdays, etc.

12. We make our work space appealing.

13. We use art, music and other sensory input to make our work place enjoyable.

14. We have a formal structure for reaching out to employees who have experienced a difficult event or been injured.

15. We have reasonable caseloads and avoid over using our employees.

19

Strategies to Combat Workplace Stress

Workplace

Identify and resist embitterment

Promote breaks and meal times

Manage work loads

Promote social support

Offer varied schedules, and mixtures of types of activities

Allow workers control of their work when possible

Encourage workers to incorporate their own interests and joys into the work where appropriate

Promote mission and importance of work

Cultivate hope and optimism

Discuss and support personal growth of workers

Provide many types of employee recognition

Deliberately orient new employees to the cultural of the agency

Provide supervision

Create comfortable workspaces

Promote peer support groups

Offer ways to grow and develop

Notice and celebrate successes

Cultivate humor

Bring nature into the work

Offer meditation, yoga, etc.

Work to improve the system and give employees the chance to participate

Work to improve the agency and give employees the chance to participate

20


Personal

Work (or do direct work) part time

Pay attention to bodily distress signals

Self-awareness of how past influences your work

Social supports

Intention to maintain non-anxious presence

Self-care that is guilt-free, a means of remaining healthy

Work to home transition ritual

Meditation

Physical activity

Tracking and limiting your trauma inputs

What’s On Your Plate exercise

Actively manage work/life balance

Consider ideal schedule, including scheduling physical activity, down time, and fun activity

Self-reflection, journaling

Try something new and not work related

Spend time in nature


21

37 Ways to Manage Vicarious Traumatization

1. Have team discussions of what is going on and how it is affecting us as people

2. Connect with anyone who has been hurt and express your concern

3. Make sure that supervision is happening

4. Is our environment too noisy?

5. Can we add music?

6. Can we make the space more pleasant, add decorations?

7. Recognize staff for special effort

8. Plan fun staff activities like pot luck lunches

9. Continue to talk about anything that is going on, with compassion and respect, recognizing that everyone is doing the best they can

10. Remind yourself of your role with your clients, that you do not have infinite power, and that you are only a part of their healing journey.

11. Listen responsively to your client’s stories without making them your own or visualizing them too vividly.

12. Remind yourself of your specific role as a treater, and do not expect yourself to solve all the clients’ problems.

13. Remind yourself of the power of the therapeutic relationship and do not expect yourself to also take on other roles in the client’s life.

14. Have some time in your life in which work does not intrude.

15. Have support around the limits of your responsibility and your ability to change your clients.

16. Utilize mindfulness practices

17. Use journaling and other creative expressions to increase self-awareness.

18. Participate in therapy for yourself.

19. Seek out on-going training.

20. Notice when you become cynical and hopeless about your work and challenge your negative beliefs.

21. Have and use support at work. 22. Create a balance in your day through scheduling of cases and including breaks for connection and

renewal.

23. Take time off and vacations.

24. Stay home if you are sick.

25. Receive regular supervision that includes discussion of your reactions to your work.

22


26. Use techniques such as breathing, connecting to items around me, and remembering your resources

to manage painful client interactions. 27. Include in your space some items such as pictures and objects that remind you of people

that you love and good things that you have experienced. 28. Stay in the present while listening to painful stories, and remember that your client has

survived and now has your support.

29. Use your breathing and physical sensations to stay in the present.

30. Remember that you are only one part of the client’s journey, and you do this work in a community of other healing people.

31. See your clients as resilient and as having the resources to heal.

32. Notice your client’s strengths and resiliencies.

33. Process painful work-related experiences creatively through movement, writing, sculpture making music or art or designing a garden.

34. Connect to a community.

35. Have a spiritual connection with something larger than yourself, whether that be: the best of all that is human, nature, history, or a spiritual entity such as God, Yahweh, Allah, the Goddess or any other practice such as prayer or meditation.

36. Regularly take time to think or talk about the rewards of your work.

37. Take time to talk about or think about the painful feelings you have at work and the lessons or wisdom you receive from them.

23

Ideas to Promote Vicarious Transformation

Vicarious transformation refers to the process of integrating a larger understanding of the human

condition and humanity as a result of facing the truth and impact of traumatic events.

Individual

I remind myself of my role with my clients, that I do not have infinite power, and that I am only a part of their

healing journey.

I can usually find a way to listen responsively to my client’s stories without making them my own or visualizing

them too vividly.

I remind myself of my specific role of treater, and do not expect myself to solve all the clients problems.

I remind myself of the power of the therapeutic relationship and do not expect myself to also take on other

roles in the client’s life.

I maintain time limits of session, I am straightforward about the financial arrangement with my clients, and I

clearly state (and maintain) the limits of my availability outside of session.

I have some time in my life in which work does not intrude.

I have support around the limits of my responsibility and my ability to change my clients.

I utilize mindfulness practices

I use journaling and other creative expressions to increase self-awareness.

I have participated in therapy for myself.

I seek out on-going training.

I keep up with the current literature.

I notice when I become cynical and hopeless about my work and challenge my negative beliefs.

I have and use support at work.

24


I create a balance in my day through scheduling of cases and including breaks for connection and renewal.

I take time off and vacations.

I stay home if I am sick.

I receive regular supervision that includes discussion of my reactions to my work.

I use techniques such as breathing, connecting to items around me, and remembering my resources to manage

painful client interactions.

I include in my space some items such as pictures and objects that remind me of people I love and good things

that I have experienced.

I can stay in the present while listening to painful stories, and I can remember that my client has survived and

now has my support.

I can use my breathing and physical sensations to stay in the present.

I can remember that I am only one part of the client’s journey, and I do this work in a community of other

healing people.

I feel that I am part of a social movement to help trauma survivors, and that energizes my work.

I see my clients as resilient and as having the resources to heal.

I notice my client’s strengths and resiliencies.

I process painful work-related experiences creatively through movement, writing, sculpture making music or art,

or designing a garden.

I feel connected to a community.

I have a spiritual connection with something larger than myself, whether be that the best of all that is human,

nature, history, or a spiritual entity such as God, Yahweh, Allah, the Goddess or any other, or practice

such as prayer or meditation.

I regularly take time to think or talk about the rewards of my work.

I take time to talk about or think about the painful feelings I have at work and the lessons or wisdom I receive

from them.

Agency

Our staff feels and psychologically physically safe.

25


Staff has a voice in decisions that affect them.

Benefits include an EAP and coverage for mental health treatment.

Caseloads are reasonable.

We limit after-hours availability.

We offer generous amounts of professional training.

Staff have access to a safe, comfortable space in which to talk with clients.

We provide regular supervision and consultation.

We have relationships to many other services such as medication and physical health consultation; self-help groups,

newsletters, books, films, and web-based resources for survivors; and access to specialized inpatient, partial

hospital, and outpatient treatment services (including therapy groups, expressive therapies, and bodywork) so we

are not doing our work alone.

Staff have choice in every area possible.

When interviewing for hiring, we describe the risks related to doing trauma work.

We have procedures to respond to emergencies that help keep our staff safe.

When something goes wrong our investigations are respectful and collaborative.

We offer opportunities individually and in groups in which to discuss the strong feelings that are a normal part of

work.

Administrators and colleagues recognize that discussions of VT responses do not reflect inability to work, lack of

professionalism, psychopathology, or any other inherent limitation of the treater.

All clinical and administrative supervisors have training in vicarious traumatization, compassion fatigue, or

secondary traumatic stress.

We encourage occasional outings, both social (sharing lunch or a birthday celebration) and professional

(attending a workshop or participating in a staff retreat together, attending a conference together).

We structure staff to work in teams and provide feedback to staff about individual and agency successes.

We offer regular and frequent clinical consultation or supervision with an experienced trauma therapy consultant

to enhance therapist self-care, as well as to maintain our ethical commitment to our clients.

26

Staff Development Plan

Current strengths

1. Current Challenges

2. Personal interests/ Hobbies I could bring into my work

3. New skills, techniques, theory, practice I would like to learn:

4. Training I would like to attend:

5. Personal areas of development:

6. Vicarious trauma/ self-care areas of growth

Plan for emphasis in upcoming year:

Name: Date: Signature: Supervisor’s signature

27

Therapist Self-Development Plan

1. Current strengths

2. Current Challenges

3. Personal interests/ Hobbies I could bring into my work

4. New skills, techniques, theory, practice I would like to learn:

5. Training I would like to attend:

6. Personal areas of development:

7. Vicarious trauma/ self-care areas of growth

Plan for emphasis in upcoming year:

Name: Date: Signature: Supervisor’s signature

28

Worksheet: 10 Characteristics of a Resilient Treater

Directions: Rate how true the statement is for you. Then pick the 2 highest scores and answer the question how you acquired this ability. For the 2 lowest scores, answer how you could build this capacity.

___________________________________________________________________________ 1 2 3 4 5 Not So Much Yet So-So Very True for Me

Characteristic Rating For 2 highest scores, how did you acquire this ability?

For 2 lowest scores, what could you do to build this ability?

1. I have a strong social support system.

2. I look at the positive side of challenging situations.

3. I have faith in myself to get through challenges.

4. I am curious about situations and focus on new possibilities.

5. I feel connected to my values and see meaning and purpose in what I do.

6. I focus on the important things and don’t fight things I cannot control.

7. I take responsibility for my physical self care.

8. I seek solutions for problems that arise and can live with uncertainty until a solution is found.

9. I consider adversity a challenge, not a threat.

10. I have a sense of humor about challenges.

Adapted from: The Resilience Alliance: Promoting Resilience and Reducing Secondary Trauma in Child Welfare Staff; ACS-NYU Children’s Trauma Institute, September 2001. Characteristics adapted from: http://ezinearticles.com/?10-Characteristics-of-Resilient-People&id=5648714

29

http://ezinearticles.com/?10-Characteristics-of-Resilient-People&id=5648714

http://ezinearticles.com/?10-Characteristics-of-Resilient-People&id=5648714

Measure the things you want to change. Publicize widely when these metrics change for the better.

Start every staff meeting with a review of incidents that went well due to new approach.

Start a weekly newsletter- Relationships are Building at … Agency! Share examples of this approach in action.

Share quotes from families, youth and outside professionals who remark on the changes.

Share news of a client who returns as an adult and is doing reasonably well.

Have ceremonies to mark significant changes like the elimination of point cards or a reduction in restraints.

Report on your efforts and results to your Board of Directors.

Present your changes at local and national conferences.

Involve staff in presenting and in teaching. You learn something more deeply and believe in it more when you teach it to others.

Publish an article.

Tell nearby agencies and trade groups what you are doing. Offer to have them come to your place and talk to your staff.

Develop some staff that you trust to be spokespeople for the new approach.

Talk to your youth and families and consider whether any of them could be spokes people for the effort and how it helped them change.

Educate legislators and funders about what you are doing.

Make this change a reason to be proud to work for your agency.

Deliberately clarify how this new approach matches your agency mission and values.

Point out changes you see.

Compliment staff on any moments of patience and compassion that you observe.

Publicize metrics (such as restraints, injuries, etc.) by program. Congratulate those that are doing well. For those that are struggling, be compassionate and find out what they need.

Share your results in the community of members of this class!

30

Signs That Trauma Informed Care is Eroding- and What to Do About It

This list describes indicators that a trauma informed approach to treatment may be eroding in a team, factors that may be contributing to that erosion, and actions to take to restore compassionate and effective treatment. Signs that trauma informed care is eroding:

Grounding are more frequent and longer

Restorative tasks begin to look like punishments

People start talking about clients “getting away with” things

Behaviors are described as deliberate and attempts to get at staff

Team members are not trying to understand behavior or figure out how it is adaptive

for the client. Instead they focus on how to change it.

Divisions start between team members, there is more blaming of each other

Team members start asking for more rules to govern their interactions

Staff stay in offices and interact less with clients

The words “consistency” and “structure” are used more than usual

Activities begin to have to be earned, and clients are not allowed to attend fun events or

arts or recreation activities due to recent problem behaviors

Clients are described in pejorative terms such as “manipulative” and “borderline”

People say things like "she wants to be that way"

People make hopeless and cynical statements

Less laughter and fun

People are talking about returning to points and levels or adding more severe

consequences

What to look for as contributing factors:

Staff injuries

31


Client turnover

Staff vacancies and over work of remaining staff

A new, more severe type of client

Administration being less available

Any particular staff having severe problems

Personal issues and losses

New reporting or oversight demands

Difficult incidents and/or bad discharges

What to do:

Talk about it

Acknowledge changes and stressors

Make a plan to solve particular issues ( I.e. Hiring) with deadlines and responsible

people and stick to it

Discuss vicarious traumatization (VT), do VT exercises, acknowledge difficulty of work

Provide opportunities to reflect on successes

Arrange team building retreats and fun events

Increase staff recognition

Emphasize the mission and the importance of the work

Increase administrative presence

Remember past successful clients, and how they started

Do not get sucked into making more rules for clients or staff- look beneath to the

meaning

32

WHAT IS TRAUMA-INFORMED CARE (TIC)? A model for offering services that is responsive to the needs of people who have endured adverse childhood events (ACEs) and trauma. It maximizes healing and reduces the chance of re-traumatization.

WHY BECOME A TRAUMA-INFORMED ORGANIZATION?

Two-thirds of the general population has suffered ACEs such as abuse, witnessing violence, or living with an

alcoholic parent. The percentage is higher for at-risk populations. TIC is best practice for organizations serving people with this history. TIC enhances client outcomes, reduces costly staff turnover, and elevates an

organization’s reputation in the eyes of funders.

HOW DO WE BECOME A TRAUMA-INFORMED ORGANIZATION?

Becoming a trauma-informed organization requires a system-wide change in culture. Time-limited trainings,

training clinicians in an evidence-based practice, or restraint reduction will NOT, by themselves, make an organization trauma-informed. Becoming trauma-informed usually requires a multi-year initiative involving broad administrative buy-in, mandated staff training, policy changes, and persistent reinforcement by TIC

champions in the organization.

HOW DOES THE TRAUMATIC STRESS INSTITUTE HELP CLIENTS BECOME

TRAUMA-INFORMED ORGANIZATIONS?

WHOLE-SYSTEM CHANGE MODEL. TSI works for 12-18 months with organizations to transform their

organizational culture and practices. It begins with leadership education and involves coaching throughout.

PROVEN, TESTED TRAUMA TRAINING MODELS. TSI is national provider of the Risking Connection (RC) Trauma Training Model and the Restorative Approach (RA), a model for implementing TIC in congregate care settings. TSI helps you embed these models in your organization through a train-the-trainer dissemination model.

INFORMED BY EVIDENCE AND THEORY. TSI has been conducting empirical research on our model for implementing TIC for 10 years. RC and RA are listed on the California Evidence-Based Clearinghouse for Child

Welfare.

SUSTAINABLE. TSI training and consultation is not “flavor of the month.” Embedding trauma training, awareness, and practice enables organizations to sustain TIC and prevent backslide.

DATA AND OUTCOME-DRIVEN USING STATE-OF-THE-ART TOOLS. TSI is a leader in development of TIC

measurement tools such as the ARTIC Scale. We move beyond vague TIC principles to tangible outcomes.

370 Linwood Street, New Britain, CT 06052 | Telephone: 860.832.5562 Websites: www.traumaticstressinstitute.org | www.klingberg.com For more information contact Steve Brown, Psy.D. at [email protected]

WHAT IS TRAUMA-INFORMED CARE (TIC)? A model for offering services that is responsive to the needs of people who have endured adverse childhood events (ACEs) and trauma. It maximizes healing and reduces the chance of re-traumatization.

WHY BECOME A TRAUMA-INFORMED ORGANIZATION?

Two-thirds of the general population has suffered ACEs such as abuse, witnessing violence, or living with an

alcoholic parent. The percentage is higher for at-risk populations. TIC is best practice for organizations serving people with this history. TIC enhances client outcomes, reduces costly staff turnover, and elevates an

organization’s reputation in the eyes of funders.

HOW DO WE BECOME A TRAUMA-INFORMED ORGANIZATION?

Becoming a trauma-informed organization requires a system-wide change in culture. Time-limited trainings,

training clinicians in an evidence-based practice, or restraint reduction will NOT, by themselves, make an organization trauma-informed. Becoming trauma-informed usually requires a multi-year initiative involving broad administrative buy-in, mandated staff training, policy changes, and persistent reinforcement by TIC

champions in the organization.

HOW DOES THE TRAUMATIC STRESS INSTITUTE HELP CLIENTS BECOME

TRAUMA-INFORMED ORGANIZATIONS?

WHOLE-SYSTEM CHANGE MODEL. TSI works for 12-18 months with organizations to transform their

organizational culture and practices. It begins with leadership education and involves coaching throughout.

PROVEN, TESTED TRAUMA TRAINING MODELS. TSI is national provider of the Risking Connection (RC) Trauma Training Model and the Restorative Approach (RA), a model for implementing TIC in congregate care settings. TSI helps you embed these models in your organization through a train-the-trainer dissemination model.

INFORMED BY EVIDENCE AND THEORY. TSI has been conducting empirical research on our model for implementing TIC for 10 years. RC and RA are listed on the California Evidence-Based Clearinghouse for Child

Welfare.

SUSTAINABLE. TSI training and consultation is not “flavor of the month.” Embedding trauma training, awareness, and practice enables organizations to sustain TIC and prevent backslide.

DATA AND OUTCOME-DRIVEN USING STATE-OF-THE-ART TOOLS. TSI is a leader in development of TIC

measurement tools such as the ARTIC Scale. We move beyond vague TIC principles to tangible outcomes.


370 Linwood Street, New Britain, CT 06052 | Telephone: 860.832.5562 Websites: www.traumaticstressinstitute.org | www.klingberg.com

For more information contact Steve Brown, Psy.D., [email protected]

The Traumatic Stress Institute (TSI) of Klingberg Family Centers is an internationally-recognized leader in the rapidly growing field of trauma-informed care (TIC). TSI envisions a world where

organizations and service systems fully embrace and embed TIC so that all trauma survivors who enter their doors heal and thrive.

Whole-System Change Model Produces Measurable Outcomes Through our Whole-System Change Model, TSI supports organizations that serve people with histories of trauma and other adverse childhood experiences (ACEs) to transform their

organizational culture and services to TIC. Over 12-18 months, TSI works intensively with client organizations to deliver:

Leadership consultation

Foundational trauma training

Train-the-Trainer to credential internal trainers

Coaching for a TIC Task Force around implementation

Program evaluation using an online dashboard tailored to the organization

Ongoing professional enrichment via webinars and in-person training events

TSI helps organizations develop a stable and well-trained workforce and increase clinical expertise. It has assisted organizations worldwide reduce restraints and seclusions, decrease staff

turnover, sustain referrals within a competitive marketplace, and achieve lasting results with

even the most difficult clients and families.

Evidence-Based Staff Trauma Training Models The workforce development pillars of the Whole-System Change Model are: Risking Connection®,

an industry-leading foundational trauma training model; Risking Connection for Foster Parents; and Restorative Approach®, a trauma-informed alternative to “point and level” systems for group

care settings. TSI uses a Train-the-Trainer model of dissemination so that organizations can embed and sustain the training indefinitely in their system. Both Risking Connection® and the Restorative Approach® are listed on the California Evidence-Based Clearinghouse for Child

Welfare (CEBC).

TIC Research TSI staff are thought leaders in TIC research as well. With Tulane University, we created the

Attitudes Related to Trauma Informed Care (ARTIC) Scale, one of the first psychometrically valid

measures of TIC to exist in the field that is being used worldwide. Client organizations of TSI benefit from the use of this and other state-of-the-art measurement tools.

Overview of Services

MISSION:

To foster the

transformation of

organizations and

service systems to

trauma-informed care

through the delivery

of whole-system

consultation,

professional training,

coaching, and

research.

Trauma- Informed

Care

Initial Staff Training • Risking Connection Trauma 101 Training

• Restorative Approach Training (for group care settings)

Engagement and Planning • Meeting with Executive Leadership and Board of Directors • Formation of TIC Task Force

Whole-System Change Process

0 - 2

Months

2 Months

4 Months

4 - 18 Months

Post-Consult

For information: www.traumaticstressinstitute.org [email protected] 860.832.5562

Training Trainers & Champions

• Risking Connection Train-the-Trainer (TTT)

• Restorative Approach TTT

• Risking Connection Foster Care TTT

Follow-Up Coaching

• TIC Implementation Plan

• 6-8 Coaching Calls on Implementation with TIC Task Force

Trainer Certification and Professional Development

• 4 In-Person Trainer Consult Groups Annually

• 4 Trainer Webinars Annually

• Trainer Recertification




For more information contact Steve Brown, Psy.D. at [email protected]

When a child depends on a caretaker for nurturance and love, they should not be taking a risk. If hurt and betrayed in those relationships, making future connections as a teenager or adult require risking disappointment at minimum, if not shame, loss, and further trauma. Many people in the human service system have been hurt and betrayed many times — by parents, by other caretakers, by the system itself.

To heal, a traumatized person must risk connecting with caring helpers who are different from those of their past. Yet, there are many reasons why people would not take that chance. Over time, however, through the experience of RICH® relationships — those that demonstrate Respect, Information, Connection, and Hope — people can learn to put their trust in helpers and move beyond the wounds of the past.

Risking Connection® (RC) is an evidence-informed foundational trauma training model rooted in relational and attachment theory. Listed in the California Clearinghouse of Evidence-Based Clearinghouse for Child Welfare (CEBC), it provides a framework for understanding and healing the wide array of symptoms and behaviors that land traumatized people in a wide range of human service settings.

The Risking Connection Training Model is unique in that:

· It is a staff training model that organizations can adopt as a critical step toward TIC system change.

· It uses a Train-the-Trainer model so organizations can sustain RC staff training indefinitely by having internal RC Trainers and Champions.

· RC Trainers and Champions benefit from certification and professional enrichment through annual consult groups and webinars.

· Our clients join an international community of organizations using RC to implement TIC.

Risking Connection training is unique in that:

· It is a philosophy for providing services rather than a treatment technique.

· It is aimed at organizational staff from all disciplines, roles, and levels of training.

· It creates a common language among staff.

· It asserts that relationships are the primary agent of change.

· It stresses that treating traumatized people also poses risks to helpers – the risk of vicarious trauma. Therefore, respect for and care of both consumer and treater are viewed as vital.

Risking Connection® Trauma Training Model

MISSION:

To foster the

transformation of

organizations and

service systems to



of whole-system

consultation,


coaching, and

research.


For more information contact Steve Brown, Psy.D., [email protected]

The Traumatic Stress Institute (TSI) of Klingberg Family Centers is an internationally-recognized leader in the rapidly growing field of trauma-informed care (TIC). TSI envisions a world where

organizations and service systems fully embrace and embed TIC so that all trauma survivors who enter their doors heal and thrive.

Whole-System Change Model Produces Measurable Outcomes Through our Whole-System Change Model, TSI supports organizations that serve people with histories of trauma and other adverse childhood experiences (ACEs) to transform their

organizational culture and services to TIC. Over 12-18 months, TSI works intensively with client organizations to deliver:

Leadership consultation

Foundational trauma training

Train-the-Trainer to credential internal trainers

Coaching for a TIC Task Force around implementation

Program evaluation using an online dashboard tailored to the organization

Ongoing professional enrichment via webinars and in-person training events

TSI helps organizations develop a stable and well-trained workforce and increase clinical expertise. It has assisted organizations worldwide reduce restraints and seclusions, decrease staff

turnover, sustain referrals within a competitive marketplace, and achieve lasting results with

even the most difficult clients and families.

Evidence-Based Staff Trauma Training Models The workforce development pillars of the Whole-System Change Model are: Risking Connection®,

an industry-leading foundational trauma training model; Risking Connection for Foster Parents; and Restorative Approach®, a trauma-informed alternative to “point and level” systems for group

care settings. TSI uses a Train-the-Trainer model of dissemination so that organizations can embed and sustain the training indefinitely in their system. Both Risking Connection® and the Restorative Approach® are listed on the California Evidence-Based Clearinghouse for Child

Welfare (CEBC).

TIC Research TSI staff are thought leaders in TIC research as well. With Tulane University, we created the

Attitudes Related to Trauma Informed Care (ARTIC) Scale, one of the first psychometrically valid

measures of TIC to exist in the field that is being used worldwide. Client organizations of TSI benefit from the use of this and other state-of-the-art measurement tools.

Overview of Services

MISSION:

To foster the

transformation of

organizations and

service systems to



of whole-system

consultation,


coaching, and

research.

Trauma- Informed

Care

Initial Staff Training • Risking Connection Trauma 101 Training

• Restorative Approach Training (for group care settings)

Engagement and Planning • Meeting with Executive Leadership and Board of Directors • Formation of TIC Task Force

Whole-System Change Process

0 - 2

Months

2 Months

4 Months

4 - 18 Months

Post-Consult

For information: www.traumaticstressinstitute.org [email protected] 860.832.5562

Training Trainers & Champions

• Risking Connection Train-the-Trainer (TTT)

• Restorative Approach TTT

• Risking Connection Foster Care TTT

Follow-Up Coaching

• TIC Implementation Plan

• 6-8 Coaching Calls on Implementation with TIC Task Force

Trainer Certification and Professional Development

• 4 In-Person Trainer Consult Groups Annually

• 4 Trainer Webinars Annually

• Trainer Recertification




For more information contact Steve Brown, Psy.D. at [email protected]

When a child depends on a caretaker for nurturance and love, they should not be taking a risk. If hurt and betrayed in those relationships, making future connections as a teenager or adult require risking disappointment at minimum, if not shame, loss, and further trauma. Many people in the human service system have been hurt and betrayed many times — by parents, by other caretakers, by the system itself.

To heal, a traumatized person must risk connecting with caring helpers who are different from those of their past. Yet, there are many reasons why people would not take that chance. Over time, however, through the experience of RICH® relationships — those that demonstrate Respect, Information, Connection, and Hope — people can learn to put their trust in helpers and move beyond the wounds of the past.

Risking Connection® (RC) is an evidence-informed foundational trauma training model rooted in relational and attachment theory. Listed in the California Clearinghouse of Evidence-Based Clearinghouse for Child Welfare (CEBC), it provides a framework for understanding and healing the wide array of symptoms and behaviors that land traumatized people in a wide range of human service settings.

The Risking Connection Training Model is unique in that:

· It is a staff training model that organizations can adopt as a critical step toward TIC system change.

· It uses a Train-the-Trainer model so organizations can sustain RC staff training indefinitely by having internal RC Trainers and Champions.

· RC Trainers and Champions benefit from certification and professional enrichment through annual consult groups and webinars.

· Our clients join an international community of organizations using RC to implement TIC.

Risking Connection training is unique in that:

· It is a philosophy for providing services rather than a treatment technique.

· It is aimed at organizational staff from all disciplines, roles, and levels of training.

· It creates a common language among staff.

· It asserts that relationships are the primary agent of change.

· It stresses that treating traumatized people also poses risks to helpers – the risk of vicarious trauma. Therefore, respect for and care of both consumer and treater are viewed as vital.

Risking Connection® Trauma Training Model

MISSION:

To foster the

transformation of

organizations and

service systems to



of whole-system

consultation,


coaching, and

research.


The Restorative Approach® is a trauma-informed alternative to traditional “point and level” systems for child congregate care settings. Based on attachment theory and the principles of restorative justice, it answers the question: “Now that I understand how trauma affects children, what should I actually do on Monday?” The Restorative Approach® translates what we know about trauma, the brain, and how children heal into specific strategies for all treatment providers within the organization. When children display behaviors that hurt others and the community, rather than “doing time” or dropping levels, staff assign learning and restorative tasks to help children learn skills and make amends. Therefore, after children lose control, they learn that all is not lost; they can handle emotions differently and take effective action to mend relationships. The model also includes a focus on taking care of the staff who do this difficult work.

The Restorative Approach® includes practical strategies for:

· Responding to behaviors with concrete learning and restorative tasks.

· Interacting with youth in an attuned manner.

· Understanding the adaptive role of behavior and using that understanding to create change.

· Defining the role of the clinician within the team. This includes helping the clinician develop formulations, use them to guide daily life, and lead the team to consider the function of behavior.

· Designing unit structure and programming to promote healing relationships.

· Teaching children that effective action is possible and that problems within relationships can be solved.

· Individualizing treatment and examining the role of consistency.

· Structuring and strengthening self-aware teams consisting of staff who care for themselves and each other.

The Restorative Approach®

MISSION:

To foster the

transformation of

organizations and

service systems to

trauma-informed

care through the

delivery of whole-

system

consultation,

professional

training, coaching,

and research.

“The Restorative Approach® has given us a concrete method to respond to the behaviors of our girls. Staff now have the tools they need to provide trauma- informed

care.” -Jean Alberghini

Director of Residential Services, Noank Group Homes and Support Services, Inc.,

Noank, CT

Why was the ARTIC developed?The ARTIC was developed because there was no objective way to determine the extent to which an individual or system is trauma-informed. The TIC field is primed to move from conceptual thinking to data-driven decision making but is blocked by the absence of valid instruments. The ARTIC is a low-cost, practical, and immediate way to measure TIC within organizations and schools.

Why measure staff attitudes related to trauma-informed care?Staff attitudes are an im portant driver of staff behavior and the moment-to-moment behavior of staff is generally regarded as a critical factor in successful im plementation of TIC.

What Is the evidence supporting the ARTIC?Items for the ARTIC were generated by content experts via a community-based participatory research approach and tested on a sample of 760 service providers in human services and education. Item analysis resulted in 45 items and seven subscales (ARTIC-45), a 35 item version (ARTIC-35), and a 10-item short form (ARTIC-10). Confirmatory factor analysis revealed that the seven-factor model fit the data well. Internal consistency was excellent for the ARTIC-45 (α = .93) and ARTIC-35 (α = .91), and very good for the ARTIC-10 (α = .82). Subscale alphas ranged from respectable to very good. Test-retest reliabilities were also strong on all three.

In what settings can the ARTIC be used?Participants in the original study worked in human service and education settings. However, the ARTIC was also developed with the goal of being applicable to other settings where TIC is being implemented such as primary care, corrections, whole communities, youth development, or law enforcement.

For what purpose can the ARTIC be used?Organizations and schools can use the ARTIC to assess readiness for TIC implementation. They can use it to measure change as a result of intervention. Use of the ARTIC can help to prevent the backsliding of TIC that commonly occurs or determine which staff need additional training and supervision related to TIC.

How do I obtain the ARTIC?For more details, and to obtain the ARTIC:

www.traumaticstressinstitute.org/artic-scale

What Is the ARTIC?The Attitudes Related to Trauma-Informed Care (ARTIC) is one of the first psychometrically valid measures of trauma-informed care (TIC) published in the peer reviewed literature. It is a measure of professional and para-professional attitudes favorable or unfavorable toward TIC. It was developed by the Traumatic Stress Institute of Klingberg Family Centers and Dr. Courtney Baker of Tulane University.

Measuring Trauma-Informed Care Using the ARTIC Scale

TRAUMATIC STRESS I N S T I T U T E

370 Linwood Street, New Britain, Connecticut 06052 | (860) 832-5562 | [email protected] | www.traumaticstressinstitute.org

The full citation for the study is: Baker, C.N., Brown, S.M, Wilcox, P.W., Overstreet, S. & Arora, P. (2015). Development and psychometric evaluation of the attitudes related to trauma-informed care (ARTIC) scale. School Mental Health. DOI:10.1007/s12310-015-9161-0.

Endorsements

370 Linwood Street, New Britain, CT 06052 | Telephone: 860.832.5562 Websites: www.traumaticstressinstitute.org | www.klingberg.com For more information contact Patricia D. Wilcox, LCSW at [email protected]

Author Patricia Wilcox has written the essential guide to trauma-informed care with at-risk youth. Wilcox provides a foundational understanding of trauma’s impact on the developing brain and then details its implications for treatment, the promotion of pro-social behaviors, and improving the culture among clients and staff. Incorporating the key

concepts of compassionate understanding, validation, skill-teaching, and the primacy of

trustworthy relationships for healing trauma and rebuilding connections in the child’s brain, Wilcox tackles some of the most difficult challenges in treatment settings with

practical approaches grounded in theory and research. This book is the foundation of the

Restorative Approach training offered by the Trauma, and is also an invaluable resource

for parents, social workers, childcare staff, therapists, agency administrators, and anyone who cares about how kids are treated when they need skillful, trauma-informed care. It is the companion to the Traumatic Stress Institute’s Restorative Approach training.

Trauma-Informed Treatment: The Restorative Approach

A must-read for trainees and workers new to this field and a wonderful resource for administrators, families,

policy makers, and staff at all levels of experience. Anyone who works with this population or who is treating or

raising kids can benefit from reading this fine volume.”

-Laurie Anne Pearlman, Ph.D. Co-author, Risking Connection: A Training Curriculum for Working with Survivors

of Childhood Abuse

“Pat Wilcox has written a book full of compassion and common sense. She integrates the restorative approach

with a trauma-informed one, enriching both in the process. Her vast experience with children, youth, and their

families is fully apparent here, as is her creative way of thinking about and working with them. Pat tells

important stories about young people and their traumas, about their responses to being traumatized, and about

how a particular kind of setting with a particular set of staff behaviors might be most helpful. Her bulleted lists of

ideas are priceless and the volume’s valuable appendices are an additional highlight. Pat’s deep caring for

children and youth, their families, and the staff who serve them is evident throughout this important, new work.”

-Roger D. Fallot, Ph.D. Director of Research and Evaluation; Community Connections; Washington, DC

Patricia D. Wilcox, LCSW NEARI Press 2011

Documents

MergedFile - ATTACh · 9/6/2018 · 8/13/2018 10 Challenging issues in trauma-informed supervision •Support vs. accountability •Multiple roles - clinical supervisor, boss, evaluator