What Does it Mean to be Trauma-Informed?

Last week, I introduced the idea that all organizations and leaders would benefit from a trauma-informed leadership approach. I’m guessing that if you’re reading this, you have interest in trauma informed care and you might agree with me. But maybe you’re asking yourself the question – what does it really mean to be trauma-informed?

Defining Trauma-Informed Care

Chloe was an experienced supervisor with a small team within her university setting when the COVID-19 pandemic hit.? Immediately, members of her team started calling out sick more often, requesting to work remotely for their safety (although her university had not yet shifted to remote work), and rumors began circulating among her team members about her organization’s response.? Initially, she felt like this was going to be a short-term issue, but as the pandemic drew on, she realized that this was going to go on for a long time. While she prided herself on her leadership skills with her team, her patience for call outs and gossip was growing thin.

Chloe, like many leaders during the COVID-19 pandemic, was struggling to support, engage, and retain her team while trying to balance the needs of her organization.? Chloe understood that her team members were experiencing extreme stress, and at times, personal loss due to the pandemic.? This new frame changed how they understood their world and engaged in their work.? Suddenly, the language of trauma, specifically, “global trauma’ due to the pandemic, was emerging in the forefront.?

The concept of trauma-informed care was originally coined by Harris and Fallot (2001) who describe a trauma informed service system as a “one whose mission is altered by knowledge of trauma and the impact it has on the lives of the consumers. This means looking at all aspects of programming through a trauma lens, constantly keeping in mind how traumatic experiences impact consumers.”

Their work arose from years of working in the field of substance abuse and mental health treatment.? It was originally designed to support teams in service systems who may not provide trauma-focused therapy services, but who still serve an essential role in providing care and comfort.? For example, when a client comes in for their initial weekly appointment and they are highly anxious and easily agitated, how are they treated by the team member sitting at the front desk? Is the team member curt and frustrated that the client didn’t complete their pre-appointment paperwork? Or does the team member understand that the experience of coming in for an initial appointment can be scary, especially to someone who has experienced trauma, and kindly offer to help them complete their paperwork with clear and specific directions? This approach is essential in agencies who serve children, adults, and families who have experienced one or more traumatic events and are actively scouring their environment to determine if it’s safe or not. Unfortunately, in today’s day and age, this is everyone.

While the approach began with a focus on client interactions, it quickly integrated elements of supporting the workforce and the organization more broadly.? The Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the Department of Health and Human Services, identified four “R’s” of a trauma-informed approach within a program, organization, or system.? According to SAMHSA, a trauma-informed approach:

1.?????? Realizes the widespread impact of trauma and understands potential paths for recovery.

2.?????? Recognizes the signs and symptoms of trauma in clients, families, team, and others involved with the system.

3.?????? Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and,

4.?????? Seeks to actively Resist re-traumatization.

For several years, “trauma-informed” was specifically used within agencies and organizations who served a population with the high likelihood of trauma exposure, including child welfare and juvenile justice systems, mental health programs, adult residential treatment facilities, and prisons, among others. ?However, with the recent increased focus on trauma more broadly, the language and practice of trauma-informed care has received increased media attention creating a slew of self-proclaimed trauma informed organizations, from “Trauma informed yoga” to (I kid you not) “Trauma informed tattoo parlors”!? While the desire to be labeled as trauma-informed grows, the need to understand the actual principles of trauma-informed care is more important than ever.

In addition to the four R’s of a trauma-informed approach, SAMHSA identified six principles to integrate at an agency level that serve as a broad framework to integrate trauma-informed practices.? These principles are flexible, rather than a rigid set of practices and procedures.? They are identified as follows:

1.?????? Safety – Throughout the organization, team members and the individuals they serve feel physically and psychologically safe and all interpersonal interactions promote a sense of safety.

2.?????? Trustworthiness and Transparency – Organizational operations and decisions are conducted with transparency and with the goal of building and maintaining trust among team, clients, and family members of those receiving services.?

3.?????? Peer Support –Peer support includes a process in which individuals support one another through the utilization of stories and lived experience to promote recovery and healing.

4.?????? Collaboration and Mutuality - There is true partnering and leveling of power differences between team and the children and youth served, as well as among organizational team, from direct care team to administrators.

5.?????? Empowerment, Voice, and Choice - Throughout the organization and among the clients served, individuals' strengths are recognized, built on, and validated and new skills developed as necessary.

6.?????? Cultural, Historical, and Gender Issues – The organization actively moves past cultural stereotypes and biases and demonstrates knowledge of how specific social and cultural groups may experience, react to, and recover from trauma differently while being proactive in respectfully seeking information and learning about differences between social and cultural groups.

While these concepts provide a helpful frame for all types of organizations, they are not immediately actionable and require individuals with real expertise to convert them from principles to practices. There is confusion about the difference between just “being kind” and being trauma informed. While there is certainly some overlap (being kind is certainly a facet of being trauma informed), there is also a clear distinction that warrants further exploration.

Even as someone with more than 20 years of experience working in organizations designed to serve individuals who are experiencing trauma, I found it difficult to be truly “trauma informed” in the wake of the COVID-19 pandemic. As team members began to call out repeatedly, or became frustrated at organizational decisions, I found that there were specific types of clients and team members that I found particularly challenging. I began to ask myself questions such as, “Why is THIS situation difficult? Why do I find THIS person challenging?” As I explored the answers to those questions, I realized that there was something about myself, and my own life experiences, that were impacting my ability to be the leader that I wanted to be. As a result, I developed the “Four Pillars of Trauma-Informed Leadership” which take these principles and distill them into specific and actionable practices that leaders can take to be trauma-informed. These will be discussed in a future blog post, so stay tuned!

Key Points to Remember

·?????? The concept of trauma-informed care has existed within serving systems for over twenty years.

·?????? SAMHSA has identified the four Rs of trauma-informed care: Realize, Recognize, Respond, and Resist Re-Traumatization.

·?????? There are six trauma-informed care principles to integrate at an agency level: (1) Safety, (2) Trustworthiness and Transparency, (3) Peer Support, (4) Collaboration and Mutuality, (5) Empowerment, Voice, and Choice, and (6) Cultural, Historical, and Gender Issues. ?

·?????? While trauma-informed care is a helpful framework, they are not immediately actionable and require individuals with real expertise to convert them from principles to practices.

Suggested Reading:

·?????? New Directions for Mental Health Services: Using Trauma Theory to Design Service Systems

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Bio: Lisa Conradi is a licensed clinical psychologist, trauma expert and former Executive Director of a large non-profit that provides trauma-focused treatment and training and technical assistance to organizations across the US on becoming trauma-informed. She is an author, speaker, trainer and leadership consultant with more than 20 years in the field of child trauma and trauma-informed care.? She does not currently provide any clinical or treatment services to clients.

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