square bulletThe Four Essential Elements of Implementing Trauma Informed Care: A New Framework

From , LCSW, PhD, Director, Trauma Informed Oregon

Hello to you all,

We will be launching a newsletter in January and will be sharing new offerings for learning and ways to connect during 2022. In the meantime, I wanted to share a new way I am approaching implementing trauma informed care (TIC), my process for getting here, as well as the resources we will be providing to support this work.

Addressing the Issues Surrounding TIC Certification

Over the years we’ve heard suggestions for a certification process for TIC. People have requested TIC certification to 1) help motivate organizations to do the work, 2) be recognized for the work, and 3) ground the work in a model or fidelity process of sorts. We have gathered with folks in the field both nationally and in Oregon to discuss certification, and each time we have decided it is not the way to go – at least not now. Three primary reasons surface in these talks:

  1. Implication that TIC is done once an organization has completed the certification process – think first aid certification;
  2. Concern about who gets to decide what an organization has to “pass” to get certified; and
  3. Perpetuation of othering that can happen because only some are certified.

A few of us explored accreditation vs certification, as a way to attend to the aforementioned concerns. I do think accreditation is more aligned to the values of TIC (e.g., accreditation is an ongoing process and identifies areas for growth while acknowledging strengths). However, I continue to have pause because the process of accreditation can be cumbersome for an organization, especially for those with minimal infrastructure and resources or those that purposely are organizing differently than a traditional non-profit.

While holding these options and limitations in mind, I do very much want organizations to see and be seen for the benefits of their trauma informed efforts. I want organizations to have a way to be accountable to those served and the workforce, so we are always striving for the best and most effective service. And I want the process to uphold the values and principles of TIC: To be transparent, community centered and driven, inclusive, and creative; to evolve, and to be sustainable.

Hence, I am excited to share this new framework – which may serve as a steppingstone toward domains of accreditation – of implementing trauma informed approaches.

Introducing a New Framework for Implementing Trauma Informed Care

As I have worked with organizations and programs in Oregon as well as nationally and internationally, I have come to believe that an organization can feel confident in its trauma informed (TI) work if it can demonstrate that these four essential elements are in place: 1) education and training throughout the job cycle, 2) a policy and procedure review process, 3) feedback processes, and 4) culture and climate habits and behaviors. These four essentials combined can:

  • sustain turnover of staff,
  • adapt and evolve to changes based on new knowledge and experiences,
  • move the work from being held by a person to being a part of the culture,
  • allow for multiple pathways to achieve outcomes, and
  • support modifications, innovation, and imagination.

The Four Essential Elements of Implementing Trauma Informed Care

The 4 essential components of a TI system are as follows:

  1. Education and Training
    I often hear that the “one and done” or “one off” training is not effective. I reframe this to “they are not effective in isolation.” We need to build educational opportunities that promote competence (knowledge) and confidence (skill) to apply to trauma informed approaches (TIA). This learning is done at a reasonable pace, is role specific, and performed throughout the job cycle. This is the “who needs to know what by when” approach. The agency will demonstrate their developmental educational plan with competencies and skills, as well as how the principles and values of trauma informed care are applied in the methodology. To that end, the education and training plan’s goal is staff embodiment of the content shared.
  2. Feedback Processes
    If an organization is successfully practicing TIA, it can demonstrate inclusive and effective feedback practices that solicit how people feel and experience the organization. Both the workforce and those it serves receive this feedback. The organization will demonstrate it has utilized this feedback to impact practice. These processes will demonstrate knowledge about the impacts of trauma in the organization’s methods, language, the feedback that is sought, and how the information used. The findings of the feedback process and the plan for implementation of the feedback is transparent. To that end, the feedback process is routine, multimodal, and centers those most impacted by the work.
  3. Policy and Procedure Review
    This essential component offers a mechanism to sustain TIC work over time and to evolve policies and procedures that allow helpful practices to flourish. A TI organization will be able to demonstrate how it reviews policies and procedures through a TI lens. This process includes how misalignment with TI values is handled, will recognize the limitation of regulatory bodies, will demonstrate changes made in an organization’s locus of control, and will advocate for system change. The process will continuously examine “who is at the table” and whose voice and experience is centered.
  4. Climate and Culture
    This essential component is what we would see, hear, do, and experience in the spaces and places we do this work. An organization that is grounded in TIA will have environments that represent the principles of TIC. One will see and hear practices and habits that demonstrate an understanding of the impact of trauma and toxic stress on the body (both individual and organizational) and power of relationship and belonging. This will show up in language that is used, protocols that are followed, and behaviors witnessed. This is the cohesive narrative, the glue, that holds a TI community together.

The past few years have seen an increase in organizations applying TIA. We have worked alongside many of you in this work and listened to your challenges and successes. In response to identified needs we developed training, standards of practice, a screening tool, a logic model, and ways to think about metrics. The tools continue to be helpful as we do this work, but they are incomplete on their own. They are pieces of the puzzle. This approach will update and better integrate these tools into a sustainable infrastructure. I believe these four essential elements will provide a foundation for TIC to flourish in an organization.

Much of this thinking is not new – it is about culture change and organizational change. What is nuanced to TI is in how we build these essential elements. We do this work with intention and care to the impacts, feelings, and experiences of individuals to advocate for systemic change to end systemic harm and promote wellbeing. We do this work with compassion, joy, and play while honoring the pain and suffering people with trauma have experienced. These essential elements are judged in how they support the work of justice, equity, and inclusion.

This framework is intended to provide a sense of direction while being inclusive of the many ways we care, heal, grow, and hold ourselves accountable. I will be offering more details about applying these elements and the direct connection to trauma over the next months and TIO will be compiling and creating resources for each of these essential elements. We are excited to be partnering with Karen Cellarius with the Center on Measurement and Fidelity to develop a fidelity instrument for organizations to use to demonstrate the work they are doing using these 4 essential components.

We hope some of you will join us in piloting this work. For now, you may want to reflect on the following:

  • How is my organization or team moving forward on each of these elements?
  • Where does the burden lie if any one of these elements is overlooked or under resourced in our agency?
  • How does each of these elements contribute to our team or organization’s vision of where we want to be?