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This developmental phase builds on the awareness that trauma informed care is needed. Once the staff and leadership of an organization understand and can speak about the need for trauma informed care, they move into the trauma sensitive phase where they build knowledge and create readiness for change. The steps for this phase include Foundational Knowledge, Agency Readiness, and Process & Infrastructure.

Foundational Knowledge

In order to create a common language and a shared understanding, it’s important for all staff to have basic information about trauma and trauma informed care. Staff across all levels of the organization should be exposed to trauma related content through trainings, webinars, videos, or online modules.

A few staff have attended foundational training about trauma informed care.

Relates to Standard Ia, Standard IIIa, and Standard IIIc in the Standards of Practice

This action is all about training or the acquisition of knowledge in other ways (e.g., webinars and online learning modules). To create the knowledge needed, the following topics should be included in foundational training: what is trauma, what is trauma informed care, the science of trauma and TIC, an introduction to the application of TIC, and an introduction to workforce wellness.

The acquisition of knowledge (action #3 in Foundational Knowledge) is how you will know if training has been effective. However, for funding and other planning purposes, you might be interested to understand the amount and type of training staff have attended. The following are training areas that might be informative: the amount of face-to-face training staff have had on the topics of trauma and TIC, the amount of exposure through webinars, books, and other sources they have had on the topics of trauma and TIC, and the recency of training (e.g., how long it has been since they last attended a TIC related training).

Most staff have attended foundational training about trauma informed care.

Relates to Standard Ia, Standard IIIa, and Standard IIIc in the Standards of Practice

All levels of the organization should receive foundational TIC education. This includes reception, billing, support staff, volunteers, direct providers, leadership, and management. Frequency and availability of foundational training and education should reflect the needs of the agency—with the following recommendations:

  • New employees should receive education in core principles of TIC as part of the hiring and onboarding process.
  • Foundational training is updated and offered annually to incorporate the rapidly accumulating information on this topic.

The acquisition of knowledge (action #3 in Foundational Knowledge) is how you will know if training has been effective. However, for funding and other planning purposes, you might be interested to understand the amount and type of training staff have attended. The following are training areas that might be informative: the amount of face-to-face training staff have had on the topics of trauma and TIC, the amount of exposure through webinars, books, and other sources they have had on the topics of trauma and TIC, and the recency of training (e.g. how long it has been since they last attended a TIC related training).

In addition to tracking foundational training, it might also be helpful to keep track of the other TIC related trainings attended by staff. For example, non-violent communication, de-escalation, customer service, collaborative problem solving, and motivational interviewing are all trainings that are relevant to TIC. By tracking related trainings, this gives the organization a way to monitor progress and connect dots for staff so that TIC doesn’t feel like a new or different thing. It’s a way for staff to think about how all of this fits together.

Most staff has knowledge about trauma informed care.

Relates to Standard IIIa, Standard IIIe, Standard IIIg, and Standard IIIl in the Standards of Practice

The first two actions in the Foundational Knowledge step reflect training. This step reflects knowledge. In other words, staff have learned and retained facts and information from past trainings and/or experience.

There is still debate about the best way to test TIC-related knowledge. Self-reports of knowledge can be challenging because staff tend to over or underestimate their knowledge. However, factual tests are also challenging given the vast amount of information that could be tested. Researching TIC competence is a priority in the field, so stay tuned for more about this.

Trauma informed care knowledge is exchanged among staff as part of the organizational culture.

As staff become knowledgeable about TIC they will share their expertise more casually with each other. During the stage when staff are forming their opinions and attitudes about TIC, this type of interpersonal communication is especially important.

Exchanging knowledge will be part of the culture and measuring culture can be challenging. However, knowledge exchange can be demonstrated so look for examples in team meetings, with case staffing, etc.

A group in the organization can apply trauma informed care knowledge and skills.

Relates to Standard IId, Standard IIId, and Standard IIIm in the Standards of Practice

With this action, staff are able to apply TIC knowledge and skills in day-to-day work. Ideally, staff are able to reframe behaviors in their own minds as well as for others, they are able to review policies and practice in order to ensure that they reflect TIC principles, and they are able to model TIC in interpersonal interactions. Preferably, some staff will be able to do this most of the time.

It’s worth noting that it’s unlikely someone would be 100% trauma informed all of the time. One of the most important components of TIC is a plan to restore and repair if needed. This is especially true when thinking about interpersonal relationships and modeling.

Instruments for measuring applied knowledge and skills are still to be developed. Stay tuned.

If you develop a method to assess progress in this area, let us know by emailing info@traumainformedoregon.org. It could help the field move forward.

Organization has internal capacity to educate others with foundational knowledge.

Relates to Standard IIIc, and Standard IIIk in the Standards of Practice

Ensuring that TIC education can be shared within the organization will help sustain the TIC effort. This certainly can be an informal process through staff to staff interaction; however, if the organization is looking for a more formal method, online education, onboarding practices, and train the trainer models can be effective.

Measuring progress will be easiest as it relates to formal examples of internal education (e.g., internal trainings held, number of people who attend train the trainer sessions, etc.). Education will also happen informally and this will likely be captured with anecdotal observation or qualitative data.

Agency Readiness

Trauma informed care requires a commitment from agency leaders and staff. Individuals within the organization must believe trauma informed care is needed, appropriate and possible given the service setting and circumstances. Readiness, both in terms of psychological (attitudes, values, and beliefs) and structural factors (skills, knowledge, and infrastructure) is important to consider if trauma informed care is to be embraced and sustained.

Readiness can be created through education and training as well as implementation. Seeing trauma informed care in action can promote the beliefs and commitment needed.

Organization has stable funding and a low level of organizational chaos.

This may seem counterintuitive because we often think TIC is most needed when organizations are struggling. However, if there is too much turmoil in the organization when introducing TIC, it could be viewed as a burden. If staff turnover is high, leadership is new, or there are a lot of new changes or initiatives being introduced in the organization consider whether this is a good time to embark on TIC. That said, leaders with a high level of TIC competence may be able to introduce a TIC effort even given a tumultuous environment.

In addition to tracking staff and leadership turnover, and informally tracking initiative fatigue, organizations can use more formal tools to assess stress level and turbulence (amount of change occurring at one time). Here are two examples that have been used in TIC research:

  • The Organizational Climate Scale to measure stress (subscale of the Organizational Readiness for Change instrument, Lehman, Greener, & Simpson, 2002),
  • Change Turbulence Scale to measure amount of organizational change (Herold, Fedor, & Caldwell, 2007).

Leadership is committed to trauma informed care.

Relates to Standard Ia, and Standard Vf in the Standards of Practice

Leadership commitment is mentioned by most experts in the field as a prerequisite for TIC. Leaders who are committed to TIC will fully understand it, will promote it to others in the organization including boards of directors, and will prioritize it in strategic planning and decision making.

Here are two examples of validated measures that have been used in TIC research. Both instruments can be used with staff and leaders.

  • Affective Commitment to Change (Herscovitch & Meyer, 2002). This type of commitment indicates the desire and willingness to support a change.
  • Principal Support (subscale from the Organizational Change Recipients Belief Scale, Armenakis, Bernerth, Pitts, and Walker, 2007). This instrument is a measure of principal support for an organizational change. These questions are answered by staff to assess the level of support for TIC from both leadership and peers.

A majority of staff are committed to trauma informed care.

Some staff will comply with an organizational change because it is mandated or expected. Commitment that reflects staff enthusiasm, willingness, and desire for TIC is better in the long-run. Not only is it more consistent with a trauma informed approach, it is more sustainable.

Staff who are committed to TIC will talk about it with others and will have positive things to say about the approach. They will believe:

  • TIC is needed in their agency
  • They, individually, have the capability and capacity to practice TIC
  • The agency will support a culture of TIC
  • TIC will benefit everyone involved with the agency

Here are two examples of validated measures that have been used in TIC research. Both instruments can be used with staff and leaders.

  • Affective Commitment to Change (Herscovitch & Meyer, 2002). This type of commitment indicates the desire and willingness to support a change.
  • Principal Support (subscale from the Organizational Change Recipients Belief Scale, Armenakis, Bernerth, Pitts, and Walker, 2007). This instrument is a measure of principal support for an organizational change. These questions are answered by staff to assess the level of support for TIC from both leadership and peers.

Resources are directed to trauma informed care efforts.

Relates to Standard If in the Standards of Practice

TIC, and the resources needed, will look different at each organization. However, the following are likely areas where time and money will be allocated.

  • Training: Funds required to purchase the training and personnel costs for staff who attend.
  • Infrastructure: Staff time could be required if an organization creates internal infrastructure, such as a workgroup, to support TIC.
  • TIC changes: Time and money may be required to make necessary TIC changes within the organization (e.g., new paint in the lobby).

This action will be unique to each organization’s processes and needs. The allocation of resources will be how this is measured.

Trauma informed care is an organizational priority.

Relates to Standard Ib, and Standard If in the Standards of Practice

When TIC is a priority it is visible throughout the organization. TIC principles (safety, transparency, empowerment, voice, choice, collaboration, and cultural responsiveness) are reflected visually (screen savers, posters, flyers, bulletin boards, printed materials, etc.) and in conversations within the organization. The TIC effort is mentioned frequently and staff understand that it’s a priority.

As is the case with action #4, demonstration is the way to measure this. TIC will be reflected in the organization’s mission, vision, program description, and strategic plan. To ensure that TIC is visible, ask someone to walk into your organization and determine if TIC is obvious (and in what ways) and if they can tell what you value.

Organization’s leaders model trauma informed care.

Modeling TIC will vary from leader to leader and organization to organization. However, you can think of modeling as the demonstration of TIC through behaviors and actions; leaders “walk the talk.” The following are examples of ways that leaders might model TIC:

  • They will use the TIC principles in decision making.
  • They will be transparent and keep people informed.
  • During challenging times (e.g., budget cuts) or crises, leaders who model TIC will recognize signs of stress and be able to support staff.
  • They will understand the importance of relationships and will model good interpersonal skills.
  • Leaders who model TIC will be good listeners and will create a space where staff feel heard.

As mentioned, this will look different across leaders. As the field works to better understand which behaviors and skills are most important for TIC leaders to demonstrate, organizations can contribute to this knowledge by learning from their staff. For example, use a brief survey to ask whether staff believe leadership models TIC. Then follow this with an open-ended question that gives staff an opportunity to offer specific examples of how. Again, this is an important area for research. If you develop a method to assess progress in this area, let us know by emailing info@traumainformedoregon.org. It could help the field move forward.

Organization’s leaders embody trauma informed care.

Modeling and embodying TIC have both been identified as important leadership qualities, however it’s unclear exactly what this looks like. Although more work needs to be done to understand these concepts, we offer the following distinction. When a leader models TIC, they demonstrate it. When a leader embodies TIC, staff believe it. They believe that not only will leaders demonstrate it in the present (by modeling), they believe the TIC values will guide the leader’s future behavior and decision making. Embodiment likely creates a sense of trust for unknown circumstances, as staff feel that leadership has their back. A key to the embodiment of TIC is practicing self-evaluation or reflection. Leaders who embody TIC invite feedback and adjust where necessary. They don’t always get everything right, but they genuinely value and embrace the TIC principles

At this point, there isn’t a formal way to measure embodiment of TIC, but we recognize its importance. We invite you to reach out if you think the leadership in your organization embodies TIC. If you develop a method to assess progress in this area, let us know by emailing info@traumainformedoregon.org. We’re eager to learn more about what this looks like. In the meantime, look for examples of leadership openness such as 360 reviews, open door policies, and other means of collecting and utilizing feedback.

Process and Infrastructure

Adopting trauma informed care in an agency takes time and requires commitment and dedication. Driven by a belief in this approach to service delivery, agency leaders and staff must create a process that supports ongoing efforts to integrate a trauma informed care perspective into the agency culture through policies and practice.

A dedicated group (e.g. workgroup) is identified as trauma informed care change agents.

Relates to Standard Va in the Standards of Practice

Implementing and sustaining TIC is most successful when organizations identify an internal group to shepherd the effort. These change agents serve as champions for TIC and work to keep it on the minds of others within the organization. The group can be new or existing. For example, some organizations use their safety committee or quality assurance team—if they have the capacity to take on TIC.

Workgroups are successful when they clarify the process:

  • Who is selected?
  • What are the roles and responsibilities?
  • What is the length of commitment?
  • How are decisions made (e.g., consensus voting)?
  • Who will take notes or facilitate?

Workgroups often focus on the following:

  • Assessing the agency for current TIC efforts and areas of opportunity.
  • Prioritizing and recommending opportunities for TIC.
  • Creating a system for communicating progress to the rest of the agency.
  • Creating opportunities for gathering feedback.

This is measured by the establishment of an identified TIC group.

Change agents include people with lived experience in your service system.

Relates to Standard Ic, Standard IIIf, and Standard Vc in the Standards of Practice

Ensuring the involvement and input of individuals with lived experience of the service system is an overarching priority of TIC. The Standards of Practice specifically suggest these individuals should have decision making roles in the organization and should be part of the agency self-assessment. The workgroup is one area where the perspective of individuals with lived experience is valuable and important.

This is measured by tracking if people with lived experience have roles in the organization and which roles they fill.

A process of communication and information sharing is established.

Relates to Standard Ve, and Standard Vf in the Standards of Practice

Communication throughout the organization about the TIC effort is important for creating buy-in and sustainability. Much of the information will flow from the workgroup. This could look like regular email updates to all staff, new or existing newsletter updates, announcements at staff meetings, or bulletin boards with TIC-related information.

It’s important that staff feel that they are informed about the TIC effort. This can be done by asking staff if they have the information they need about the TIC effort, and other forms of communication that would be helpful.

Change agents are able to infuse trauma informed care knowledge to other staff in the organization.

Relates to Standard IIIk in the Standards of Practice

As noted in action #6 of Foundational Knowledge, ensuring that TIC education can be shared within the organization (staff to staff) will help sustain the TIC effort. The workgroup members are often the individuals with the greatest amount of TIC knowledge, therefore, they are in a good position to educate others in the organization.

This may look like brief educational opportunities at all-staff meetings. It may look like periodic emails or newsletters sent out with case examples or reworked policies/procedures. It may look like posters or flyers hung up around the organization with facts related to TIC. There are many ways that knowledge can be informally infused throughout the organization.

It’s probably unnecessary to measure these informal efforts to infuse knowledge. This could be part of the larger effort to ensure staff have the knowledge and skills they need. See action #3 in Foundational Knowledge for ideas about measurement and concepts to include.

Change agents are empowered to call into question non-trauma informed policy and practice, including power structures.

Relates to Standard Ve, and Standard Vf in the Standards of Practice

Workgroups include individuals with the ability to make change. Balancing the power within the group is important. Individuals may not participate if too much power rests with just a few people. If there is not enough power, it is difficult to make change.

In addition, the workgroup members need to have the skills necessary to confront other power structures within the organization including leadership. This might look like having access to leaders. It also might look like having the words needed to be able to bring up concerns and opportunities for change.

With this action, the best way to measure it is by asking those involved (e.g., workgroup members). It might be effective to use a scenario or role playing as a way to identify gaps in skills or confidence.

Imagine you are needing to explain to the Director that the way they put people on the spot at meetings is not trauma informed. Would you be able to do this? Why or why not? What would help?

Imagine you need to explain to the HR manager ways in which the hiring process could be more trauma informed. Would you be able to do this? Why or why not? What would help?

Phase 3: Trauma Responsive