September 23, 2019

From Ann Kirby, MS, MPA, BSN, Executive Director Care Management – Providence Oregon

It may seem a bit daunting when starting to develop an approach to education about Trauma Informed Care (TIC). The topic is big and so are the numbers of staff who would ideally be educated. In addition, the background of staff and familiarity with TIC concepts may vary widely. Here are some thoughts on how to approach TIC education, but I won’t go so far as to say they are best practices. More like food for thought as you find the approach that is right for your organization. My organization is Providence Health & Services (Providence) which includes hospitals, clinics, home and community care, and an affiliated health plan in the Oregon Region.

Here are some of the steps we are taking which I hope will be helpful to others. Prior to taking any of the steps below, we established a TIC Steering Committee and Core Group of people to help carry out the work.

1. Organizational TIC Understanding and Readiness

Sarah Power, LCSW and Amy Nist, LCSW, who are highly skilled social workers in TIC conducted sensing sessions with leaders and staff (known as caregivers at Providence) in several patient care areas where patient and caregiver vulnerability to trauma is high. Through these sensing sessions we wanted to learn or accomplish the following:

  • Provide an introduction to the TIC Initiative
  • Define TIC and describe the trauma symptoms which present or are activated in healthcare
  • Learn how each patient care area understands and responds to patient care and caregiver needs related to trauma
  • Learn if leaders and caregivers were familiar with TIC and if there were existing TIC or related efforts in place
  • Learn how education/skill-building is delivered and budgeted for in the specific patient care area
  • Determine if the leaders were interested in learning more about TIC or participating in a formal TIC assessment
  • Identify any natural champions in the patient care areas who might be future partners
  • Surface regulatory issues related to TIC

2. Existing TIC-related Education and Gaps in Knowledge/Skill

  • Through the sensing sessions, we learned that there was great variation between our patient care areas in existing TIC knowledge and skills. Many areas were working on TIC, but they were not coordinating or collaborating.  Also, many areas were unfamiliar with TIC.  We began cataloging all of the different TIC initiatives as well as noting where gaps existed
  • The sensing sessions revealed tremendous interest and urgency regarding TIC education and skills. Leaders and caregivers shared feelings of inadequacy in alleviating patient suffering that seemed related to trauma. They also shared feelings of compassion fatigue and expressed opportunities for more individual and organizational resilience related to caring for vulnerable people
  • We began identifying our internal and community experts to provide TIC education with the goal of offering continuing education credits whenever possible
  • We quickly recognized that there was no need to recreate the wheel. As we considered where to identify Providence’s source of TIC truth, we relied heavily on the Substance Abuse and Mental Health Services Administration (SAMHSA) content

3. Identification of Existing Momentum and Enthusiasm for TIC

  • While we wanted as many caregivers and leaders as possible to be exposed to TIC concepts and tools, we were mindful that forcing people, who already felt overwhelmed, to participate in more education may not feel supportive
  • Working with patient care teams who were interested in TIC and sharing their successes helped garner further interest without feeling like a “top-down” initiative
  • Connecting the TIC education to our organization’s mission was key. At Providence, our Mission directs us to be “…steadfast in serving all, especially the poor and vulnerable.” Becoming a trauma informed organization is clearly aligned with our Mission

4. Starting Somewhere

  • As a first step, we developed a series of four foundational TIC Health Stream modules, totaling approximately 75 minutes of education. Health Stream is an online education tool where caregivers can be assigned or self-selected to receive education. The four specific topics include: (1) An Introduction to Trauma, (2) Adverse Childhood Experiences (ACEs), (3) Trauma Informed Care Skills, and (4) Compassion and Resiliency in Healthcare.
  • The education modules are introduced by a short video in which a physician and mission leader help caregivers understand the importance of TIC and encourage them to take care of themselves as they are exposed to the content. We recognize that our caregivers are directly and indirectly impacted by trauma. As a result, we want to be sensitive to the ways the TIC education may be activating to them
  • In order to receive support for the Health Stream education, engagement of leaders at all levels within the organization was critical. Budget concerns regarding paying for the time to participate in education was and continues to be a real consideration
  • After teams of caregivers receive the Health Stream education, their leaders are invited to facilitate follow-up conversations with them. Discussion guides with TIC talking points have been developed to help make the content most meaningful in our day-to-day care of patients and ourselves

We recognize that education is just one of many steps needed to become a trauma informed organization. The work will never be done. To that end, we are developing strategies to address: (1) TIC inclusion in our policies and procedures, (2) Identification of TIC metrics, (3) Real-time support of caregivers who seek to improve delivery of TIC, (4) Ensuring our patients’ voices are informing our TIC practices, and (5) Improving communication to our caregivers regarding existing TIC resources and activities to support compassion, resiliency, and self-care.