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In this final developmental phase, the organization will be implementing trauma informed care. Policies and practice will support the principles of TIC and should create a culture and environment that feels safe, empowering, trustworthy, and welcoming. This is an ongoing process of continuous improvement and monitoring. The steps for this phase include Implement & Monitor, and Adopt Policy & Practice.

Implement & Monitor

Because trauma informed care (TIC) is unique to each setting, individual, and agency there is no standardized curriculum or implementation manual. However, it is important that organizations do something. After an organization has gathered information and prioritized needs, the next step is to implement the work plan and monitor the impact.

Any change(s) to policy, practice, and environment have been initiated.

See Standard IV in the Standards of Practice for examples

This action is moving from recognizing how current policies are hindering or promoting TIC to implementing the recommended changes. Policy changes often require involvement from a Board of Directors, Human Resource, or Quality Assurance departments.

The best way to measure this is to keep track of the date, recommendations, and status of the policy change. This helps the organization track their progress. For example, organizations would be able to state that 20% of the policies have been reviewed and eight have been recommended for modification.

Changes are reviewed and monitored—“did it work”?

Relates to Standard Ie, and Standard Vh in the Standards of Practice

As we are learning about the best practices for implementing TIC it is important to ask if a change is working. It is common in our busy work schedules to implement a change but not have time to notice if it was helpful or if it causes more burden than benefit. It is often the case that a practice in one department might not work the same in all departments.

This could be a formal evaluation process or tracking certain data elements to determine if the desired impact is happening. For example if you develop a space for staff to practice self-care you would monitor if it is being used and if staff find it helpful.

Changes are modified as needed.

Relates to Standard Vh in the Standards of Practice

It is important to use feedback to actually make modifications. For example, an agency may find that staff want to use a self-care room but need to have coverage for their work while they use the room. It is rare that a policy or practice will not need to be modified. It’s also important to know when to forgo a modification. Courage is needed in both your commitment to try things out and your commitment to stop doing what isn’t working. Continuing ineffective or costly change efforts erodes staff trust and commitment, defeating the purpose of TIC. When a change has been abandoned, be transparent and explain the “why” to staff and others.

Organizations may already have a way to track policy changes and modifications (often noted at the bottom of a policy). If there is no process in place, noting the change and the date of the change can help you link changes to possible outcomes.

Most changes to policy, practice, have been initiated.

Within the organization, it feels like most policies have been reviewed and modified. The focus at this point is for ongoing monitoring and modifications as needed.

The organization can say that all polices have been reviewed and a percentage of the modifications have been initiated.

Adopt Policy & Practice

As agencies identify, prioritize, and pilot trauma informed changes to policy and practice, it is important to adopt the changes that make a difference. Whether these are micro level changes that involve individual practice or meso and macro level changes that target policy and practice of an organization or community, it’s important to build support so that TIC changes are institutionalized and sustained.

Any change(s) to policy, practice, or environment have been adopted.

Adopting a policy means completing the formal process within an organization to have changes officially recognized by the organization. Often this leads to developing procedures and ways to measure implementation. Informally, think about ways to promote policy and practice changes for staff. For instance, the organization could introduce small changes in all-staff meetings or newsletters, but have a kick off for big changes.

Agencies can report out how many policies were developed or changed as a result of the organizations TIC work.

Any change(s) to policy, practice, or environment have been institutionalized.

Institutionalizing a policy means that all impacted parties are informed of the policy change and have the knowledge and skills to implement as intended. It is often the case that an organization has a policy “on the books” but no one knows about it or is confused. It’s important to be transparent about who is involved in the change, how they will be affected, and what is the expected timeline. Keeping staff in the loop will promote buy in and trust.

Measuring the institutionalization of a policy means monitoring the implementation and desired impact of the policy. To return to the example of the staff self-care room, you would see that this service was developed, policies regarding usage were developed, and that everyone knows and uses the space as intended.

Most changes to policy, practice, or environment have been institutionalized.

Institutionalizing policy or practice means that all impacted parties are informed of the change and have the knowledge and skills to implement as intended. This action builds on #2 and suggests that from the list of identified opportunities for TIC, most of the changes have been made and institutionalized.

The organization can say that all polices have been reviewed and a percentage are being implemented as intended.

Assess