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Trauma-Informed Care Approach: How Practice Can Influence Work Culture
Trauma-Informed Care Approach: How Practice Can Influence Work Culture
From Todd Beran, Manager, Screenwise
I manage Oregon’s state breast and cervical cancer screening program, called ScreenWise. Our mission is to support the early detection of breast and cervical cancer among individuals with low income and who are uninsured and underinsured. In our work, we center marginalized communities and serve people who live with generational and historical trauma and encounter disfranchisement from structures of power from and within the healthcare and public health systems. To help address and mitigate some of the barriers these individuals face when accessing cancer screening services, we have committed to adopting a trauma-informed care (TIC) approach across all areas of operation. The goal is to do better for the individuals we serve, and along the way we have found this approach to be equally valuable in grounding our team and nurturing our work culture.
Developing a Plan
We contracted with Trauma Informed Oregon (TIO) to implement a TIC approach within our program. With guidance from TIO staff, our team completed a TIC Fidelity Assessment. We reviewed the assessment report with TIO’s input, and developed an implementation plan. The plan included orienting all staff to a TIC approach, reviewing program policies for the inclusion of TIC principles, developing feedback loops to help assess programmatic impact on our clinical and community partners and the patients the program serves, and ongoing training and education for staff.
Putting TIC Into Practice
Embedding TIC principles into programmatic practices has not been easy. Given the fact that our program sits with the state Public Health Division, we have had to balance several competing factors these past 18 months that have stretched resources and my team’s capacity. A little more than two years into the process, we have yet to complete a single program policy review, and we still haven’t developed workflows and systems to collect partner and patient feedback. That said, the team’s orientation to TIC principles and ongoing training and education have centered a TIC approach, albeit unstructured. Staff have begun to instinctively apply a TIC lens to our work. When convenient, they gather feedback during encounters with clinical and community partners and patients, and they regularly note in meetings where our policies and practices are not trauma informed. We know we cannot rely on this approach. Though we’re making small, steady steps toward systemized feedback loops and policy reviews, we understand that TIC principles need to be embedded into programmatic operations. They cannot simply live amidst the good intentions of individuals, or they will go by the wayside.
To that end, one simple TIC tool we have embedded into the structure of our program is quarterly Lunch and Learns. These are staff-led sessions where a topic is chosen, and staff review a short, TIC-related video or reading prior to the session. During the sessions, small groups of typically 2-4 staff discuss the topic and material, with a full group-share at the end of the session. What came out of the Lunch and Learns brings a smile to my face.
What Came into Being
Each of my team members, including myself, is an introvert. Prior to the Lunch and Learns, group discussions were practically nonexistent. Staff were used to a siloed work environment and shied away from addressing disagreements or conflict head on. Fast-forward a couple of years, and I have witnessed a remarkable shift in the culture of the team including in how we communicate with each other. Through the Lunch and Learn discussions, staff have begun to express to one another what work activities and interactions trigger trauma in them; and as a team, we have developed some shared group agreements to help reduce and mitigate those triggers. I have also witnessed deeper and more frequent conversations where understanding and an appreciation of one another are expressed. Microaggressions have lessened, and staff are exhibiting more resiliency when triggered. Perhaps the clearest indicator of change is that the team asked to extend the Lunch and Learns from one hour to 90 minutes. They said they were just beginning to dig into the topics and wanted more time to share and discuss.
The work is not done. It will never be done. But I’d like to think we have made some headway, which is a very good start.