Abstract
The importance of trauma-informed care (TIC) is now recognized across most health and human service systems. Providers are calling for concrete examples of what TIC means in practice and how to create more trauma-informed organizations. However, much of the current understanding about implementation rests on principles and values rather than specific recommendations for action. This paper addresses this gap based on observations during the provision of technical assistance over the past decade in fields like mental health and addictions, juvenile justice, child welfare, healthcare, housing, and education. Focusing on the infrastructure for making change (the TIC workgroup), assessment and planning, and the early stages of implementation, the authors discuss barriers and challenges that are commonly encountered, strategies that have proven effective in addressing barriers, and specific action steps that can help sustain momentum for the longer term.
Highlights
The importance of trauma-informed care (TIC) is recognized across most health and human service systems
Rates of past and current trauma are known to be high among service recipients involved in many health and human service systems (Hopper, Bassuk, & Olivet, 2010; Ko et al, 2008; Salazar, Keller, Gowen, & Courtney, 2013), in the social service workforce (Berger et al, 2012; Elliott, Bjelajac, Fallot, Markoff, & Reed, 2005), and in the general population (Dube et al, 2005; Green et al, 2010; Huang, Schwandt, Ramchandani, George, & Heilig, 2012; McLaughlin et al, 2010)
Service providers recognize that are our public systems populated with trauma survivors but that many service settings, programs, and processes can be re-traumatizing (Bloom & Farragher, 2011; Substance Abuse Mental Health Services Administration [SAMHSA], 2014a)
Summary
Workgroups can be challenging to manage and sustain. Some of the difficulties are preventable by considering the following as the initial team comes together. One technician in a residential setting gently pointed this out when his expert outside consultant was confused by the awkward silences in the room It helps to know ahead of time that the work of the first few months may progress slowly until relationships form. The workgroup is the place where some of these divisions can begin to be breached; sustaining factions only contributes to the problem and undercuts the effort It is helpful if workgroups include individuals with lived experience of trauma and of the organization or service system. It has been helpful to form the workgroup with a limited duration (six–eight months works well), at which point the group can revisit the structure, membership, and process. Many workgroups find it helpful to have support, at least initially, from outside the organization. This role can rotate, but we have found it works best when the point person is a committed champion for traumainformed care, is relatively well-versed in the concepts, has the ear of leadership, and is respected by colleagues
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