December 13, 2018

From Stephanie Sundborg, PhD, Research and Evaluation Coordinator, Trauma Informed Oregon

Over the past several years our understanding about trauma informed care (TIC) implementation has grown and deepened. Before introducing Trauma Informed Oregon’s (TIO) new TIC Screening Tool, it might help to have a brief review of where we’ve been, especially because it feels like we are starting to come full circle.

Where We Started

The Standards of Practice was the first tool created by TIO to help organizations think about TIC implementation. This comprehensive document describes TIC strategies across various organizational domains, such as service delivery or environment and safety. The Standards is a culmination of many hours and many voices, including youth, families, and adults with lived experience of the service system; and it is intended to provide a basis of what is needed for organizations to be trauma informed. As TIO learned more about organizational efforts to implement TIC, it became clear that there were factors related to a change process that needed to be considered as well, such as agency readiness. To address these issues, TIO introduced the Road Map to Trauma Informed Care. This tool illustrates a series of sequential steps on the journey to TIC, including those that reflect organizational change.  After learning about the work of the Missouri State Trauma Roundtable, and their phased approach to TIC implementation (see The Missouri Model: A Developmental Framework for Trauma Informed Care for information about the Missouri Model) we introduced the Road Map to Trauma Informed Care 2.0. This version illustrates the order and sequence of the original but adds developmental phase language (e.g., trauma aware, trauma sensitive, trauma responsive, and trauma informed)—language that has resonated with people. It also adds a step for assess as it is essential when implementing TIC to learn what changes as a result of a TIC effort and for whom. Organizations have liked the Road Map to TIC as it conveys a sense of priority and order, but it is vague in terms of what to actually do—enter the TIC Screening Tool.

New Tool

The Trauma Informed Care Screening Tool was created as a way to not only provide detail about what each step on the road map might entail, but also provide a developmental way to think about these steps. Each step includes a number of actions that are, for the most part, sequential. For example a few staff have attended training before most staff have attended training. Not all actions will be meaningful or important to all organizations. Some of the steps, such as agency readiness, has a number of actions that don’t necessarily build on each other but rather describe all of the factors involved in creating readiness. This step, in particular, might be less sequential than others. Use this tool in whatever ways are most meaningful to your organization. The following are additional considerations.

  • Agencies or programs may use this tool as a way to highlight progress.
  • Agencies or programs may find this tool most useful in understanding why they are encountering resistance. In other words, rather than a prescription for moving forward, they use the tool retrospectively to identify potential obstacles for progress.
  • There is no expectation that an agency or program will accomplish every action listed. Furthermore, an agency may be doing other things to create TIC that we have not captured here.
  • Some actions will be more important for some agencies than for others. Feel free to adapt however is needed.
  • There is no correct way to implement TIC. Some agencies may find that they are accomplishing the first few actions of each step across several of the phases, while others may find that they are delving more deeply into one phase at a time.

Tools That Work Together

The Road Map to TIC and the TIC Screening Tool are meant to work together. If you hover over the phases on the road map home page (e.g., phase 2) you will be offered additional information about the actions included in each step. These are the same actions as those outlined on the TIC Screening Tool. By clicking to learn more, you will be taken to additional information about what each action looks like, and how you might think about measuring progress. Additionally, because the Screening Tool describes actions toward implementation, it is also related to the Standards of Practice (hence the reference to coming full circle).  We have identified which Standards correspond to each action, and provide that information along with the additional information of each phase. While we’ve provided initial information for each of these actions, we know that it will need to be updated as you learn more about this in the field. We hope that you will play with the Screening Tool and let us know what you think and what you learn.

See the August 2018 blog Destination TIC: Using the TIO Road Map and Standards of Practice to Guide Implementation, for additional information.