square bulletImplementing Trauma Informed Care in Your Agencies

February 9, 2015

From: Diane Yatchmenoff, Director of Trauma Informed Oregon

Updates from our Partners

Recently, I asked some of our early partners to provide me with examples of how they have implemented some of the principles of trauma informed care. I couldn’t improve on their answers if I tried, so I’m posting what I learned directly from them.

At Impact Northwest, a multi-service anti-poverty agency in Portland, Oregon, Suzanne Washington, former Deputy Director, and Renata Wilson, Director of Housing, stepped up to undertake a comprehensive agency-wide self-assessment. Here’s what Renata had to say about some of the results:

Based on our agency assessments, the first two years were primarily focused on improving the agency’s practices on ensuring physical and psychological safety for staff and clients. This included efforts with training, facilities, human resources, program development, service delivery, program evaluation, and how all agency, program policies and procedures reflect and support the Trauma Informed Care model. The guiding themes that arose were physical safety, confidentiality, transparency, and client choice.

All sites, including centers and schools, were assessed for safety, welcoming environment, and confidentiality. Significant changes were made to all sites to improve safety and client confidentiality, such as rearranging for more private interview spaces, rearranging to ensure staff regularly observe communal areas, improved lighting and gender neutral bathroom signage. We have changed the lens for administrators when negotiating future contracts and MOU’s for services provided at non-Impact NW sites. In programs where confidential work space is limited, staff and supervisors’ brainstorm ways to meet with the client that better support confidentiality, including communicating space limitations to client, increased home visits, and using semi-private spaces in public. The agency’s diversity committee attempted to engage all staff in developing signage for all sites to help create a more inclusive environment.

Staff received intensive training directly in Trauma informed Care and receive continued guidance on ways to implement, such as intimate partner violence, abuse, de-escalating  aggressive behaviors, how to handle various incidents, and total transparency in service provision and documentation. Staff must ensure the client clearly understands their rights and program expectations in the simplest language possible. During the first two years of implementation, trainings that supported this model were prioritized and required to influence a greater cultural shift across the agency. Training is still required for new staff and offered annually for any staff who are interested. Supervisors receive additional training on how to support staff with systemic issues, personnel conflicts, and critical incidents. Additional support is provided to staff around grief and loss.

Program policies and procedures agency wide were assessed and changed to reflect Trauma Informed Care, including a project where program management and lead staff reviewed the agency’s overall Program SOP Manual and changed all language to support this model. Leadership worked within programs to develop improved safety protocols specific to site and service type. Administrative staff who have influence on program operations are required to assess systems and practices to reduce retraumatization to clients and direct service staff. This is evident in trainings provided, program evaluation processes, and general operations. The annual consumer satisfaction survey was completely rewritten to get at how the client perceives the agency’s provision of Trauma Informed Care. The agency’s Service Delivery Model, created prior to the Trauma Informed Care Assessment also identified Trauma Informed Care as one of it’s the practice models that should guide all agency services.

We continue to work internally to develop ways to measure client progress in ways that honor client choice. Some of these efforts include working with funders to advocate when established “outcome” targets do not align with client identified needs as well as creating our own system that can show progress in a more honest and holistic way. Regardless of funder driven targets, staff are trained to help clients form their own realistic and attainable goals as well as help them identify what success would look like to them.

Theresa Willett, director of the Women’s Residential Treatment program at Volunteers of America, took on trauma informed care on her own and established a Resident Council to allow program participants more power and choice. Here’s the process they developed:

Each week, participants raise issues regarding policy and procedure at the Women’s Residential Treatment program (WRC). Participants are considered to be equal partners with staff regarding making changes that affect treatment protocols, house rules, and house issues. Many of the policies and procedures that are currently in place at the WRC were either amended or created by clients. Some examples of this include our Ladder of Achievement procedure, our Smoke Captain policy, laundry room rules, house rules around narcotic medications, Spirit week, and pass rules.

A small workgroup at Human Solutions, which provides family housing and many other support services, went to the Board of Directors with information and ideas and received permission to develop and deliver training to every department. Here are some of the progress notes they sent:

We incorporated Trauma Informed Care onboarding for all new staff and another one specific for supervisors. We are constantly evaluating our forms and procedures in social services to be more Trauma Informed. We changed the annual skills survey (employee review done with their supervisor) to include Trauma Informed Care goals for the coming year, and a reflection on ways Trauma Informed Care was incorporated in the previous year. The process for the search for a new Executive Director will include a session with the Trauma Informed Care committee to get our input. We have also changed many of our hiring processes to be more trauma informed.

Many of the perks to working here are part of self-care and sustainability for employees, which is part of Trauma Informed Care. We’ve started offering 3 yoga classes every week, had two transparency/appreciation meetings with our Executive Director and management. We are offering optional All Staff meetings 4-5 times a year that are focused on self-care from a variety of different angles.

We continue to work on it, it’s a slow process because we all have such busy jobs – but even after 4 years we’re still committed and it’s nice now that Trauma Informed Care gets brought up by people at different levels and areas of the agency. It’s definitely starting to infuse more into the daily part of our jobs, but it’s always a work in process (which I think is how it should always be considered…).