Implementing Trauma-Informed Care: Recommendations on the Process
DOI:
https://doi.org/10.18060/21311Keywords:
Trauma informed care, implementation, health and human servicesAbstract
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.References
ACE Interface. (2014). Laura Porter. Retrieved from http://www.aceinterface.com/Laura_Porter.html
Armenakis, A. A., & Harris, S. G. (2009). Reflections: Our journey in organizational change and research. Journal of Change Management, 9, 127-142. doi: https://doi.org/10.1080/14697010902879079
Baker, C. N., Brown, S. M., Wilcox, P. D., Overstreet, S., & Arora, P. (2015). Development and psychometric evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) scale. School Mental Health, 8(1), 61-76. doi: https://doi.org/10.1007/s12310-015-9161-0
Berger, W., Coutinho, E. S. F., Figueira, I., Marques-Portella, C., Luz, M. P., Neylan, T. C., . . .Mendlowicz, M. V. (2012). Rescuers at risk: A systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology, 47(6), 1001-1011. doi: https://doi.org/10.1007/s00127-011-0408-2
Bloom, S. L. (2010). Organizational stress as a barrier to trauma-informed service delivery. In M. A. Becker & B. L. Levin (Eds.), A public health perspective of women’s mental health (pp. 295-311). Retrieved from http://www.sanctuaryweb.com/Publications/ListofPublications.aspx doi: https://doi.org/10.1007/978-1-4419-1526-9_15
Bloom, S. L. (2012). Trauma-organized systems. In C. R. Figley (Ed.), Encyclopedia of trauma (pp. 741-745). Retrieved from http://www.sanctuaryweb.com/Publications/ListofPublications.aspx doi: https://doi.org/10.4135/9781452218595.n255
Bloom, S. L., & Farragher, B. (2011). Destroying sanctuary: The crisis in human service delivery systems. New York: Oxford University Press.
Burnes, B. (2011). Introduction: Why does change fail, and what can we do about it? Journal of Change Management, 11(4), 445-450. doi: https://doi.org/10.1080/14697017.2011.630507
Choi, M. (2011). Employees' attitudes toward organizational change: A literature review. Human Resource Management, 50(4), 479-500. doi: https://doi.org/10.1002/hrm.20434
Clandinin, D. J., & Huber, J. (2010). Narrative inquiry. In B. McGaw, E. Baker, & P. P. Peterson (Eds.), International encyclopedia of education (3rd ed., pp. 436-441). New York, NY: Elsevier. doi: https://doi.org/10.1016/B978-0-08-044894-7.01387-7
Dube, S. R., Anda, R. F., Whitfield, C. L., Brown, D. W., Felitti, V. J., Dong, M., & Giles, W. H. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28(5), 430-438. doi: https://doi.org/10.1016/j.amepre.2005.01.015
Elliott, D. E., Bjelajac, P., Fallot, R. D. Markoff, L. S., & Reed, B. G. (2005). Trauma- informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461-477. doi: https://doi.org/10.1002/jcop.20063
Fallot, R. D., & Harris, M. (2006). Trauma-informed services: A self-assessment and planning protocol (Version 1.4). Washington, D.C: Community Connections. Retrieved from https://www.theannainstitute.org/TISA+PPROTOCOL.pdf
Fallot, R. D. & Harris, M. (2009). Creating cultures of trauma-informed care (CCTIC): A self-assessment and planning protocol. Washington, DC: Community Connections. Retrieved from https://www.healthcare.uiowa.edu/icmh/documents/CCTICSelf-AssessmentandPlanningProtocol0709.pdf
Family Resources [famresmarketing]. (2013, June 12). Laura Porter - dealing with resistance to trauma informed care [Video file]. Retrieved from https://www.youtube.com/watch?v=hupRddaE0tw
Fowler, F. J., Jr. (2013). Survey research methods. Los Angeles, CA: Sage Publications.
Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67(2), 113-123. doi: https://doi.org/10.1001/archgenpsychiatry.2009.186
Guarino, K., Soares, P., Konnath, K., Clervil, R., & Bassuk, E. (2009). Trauma-informed organizational toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation. Retrieved from http://www.air.org/resource/trauma-informed-organizational-toolkit
Hall, D. J., (2016, May). What role did trauma-informed care play in alleged juvenile prison abuse? WisconsinWatch.org. Retrieved from http://wisconsinwatch.org/2016/05/what-role-did-trauma-informed-care-play-in-alleged-juvenile-prison-abuse/
Harris, M., & Fallot, R. D. (Eds). (2001). Using trauma theory to design service systems. San Francisco, CA: Jossey-Bass.
Hendricks, A., Conradi, L., & Wilson, C. (2011). Creating trauma-informed child welfare systems using a community assessment process. Child Welfare, 90(6), 187. Retrieved from http://www.chadwickcenter.org/CTISP/images/TICWPracticeToolkit.pdf
Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28(7), 679-692. doi: https://doi.org/10.1007/s10896-013-9531-z
Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(2), 80-100. doi: https://doi.org/10.2174/1874924001003020080
Huang, M. C., Schwandt, M. L., Ramchandani, V. A., George, D. T., & Heilig, M. (2012). Impact of multiple types of childhood trauma exposure on risk of psychiatric comorbidity among alcoholic inpatients. Alcoholism, Clinical and Experimental Research, 36(6), 1099-1107. doi: https://doi.org/10.1111/j.1530-0277.2011.01695.x
Hummer, V., & Dollard, N. (2010). Creating trauma-informed care environments: An organizational self-assessment (in Creating trauma-informed care environments curriculum). Tampa, FL: University of South Florida, The Department of Child & Family Studies within the College of Behavioral and Community Sciences. Retreived from http://www.cfbhn.org/assets/TIC/youthresidentialself%20assess%20Fillable%20FORM%20%282%29.pdf
Institute for Health and Recovery. (2012). Developing trauma-informed organizations: A tool kit. Retrieved from http://healthrecovery.org/images/products/30_inside.pdf
Institute for Healthcare Improvement. (2003). The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. Retrieved from http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx
Jennings, A. (2004). Models for developing trauma-informed behavioral health systems and trauma-specific services. Alexandria, VA: National Association of State Mental Health Program Directors, National Technical Assistance Center for State Mental Health Planning. Retrieved from http://www.theannainstitute.org/MDT.pdf
Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., . . . & Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396-404. doi: https://doi.org/10.1037/0735-7028.39.4.396
McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication II: Associations with persistence of DSM-IV disorders. Archives of General Psychiatry, 67(2), 124-132. doi: https://doi.org/10.1001/archgenpsychiatry.2009.187
Miller, N. A., & Najavits, L. M. (2012). Creating trauma-informed correctional care: A balance of goals and environment. European Journal of Psychotraumatology, 3, 1-8. doi: https://doi.org/10.3402/ejpt.v3i0.17246
Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. M. (2014). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56, 1213-1222. doi: https://doi.org/10.1176/appi.ps.56.10.1213
National Council for Behavioral Health. (2013). Trauma-informed care-top ten: A checklist for behavioral health organizations. Retrieved from https://www.integration.samhsa.gov/clinical-practice/TIC_Flyer_web_2013_new.pdf
Oreg, S., Vakola, M., & Armenakis, A. (2011). Change recipients’ reactions to organizational change: A 60-year review of quantitative studies. The Journal of Applied Behavioral Science, 47(4), 461-524. doi: https://doi.org/10.1177/0021886310396550
Oregon Health Authority, Addictions and Mental Health Division. (2014). Trauma Informed Services (AMH-060-1607). Retrieved from http://www.oregon.gov/oha/HSD/AMH/Trauma%20Policy/Trauma%20Policy.pdf
Patwardhan, A., & Spencer, C. H. (2012). Are patient surveys valuable as a service-improvement tool in health services? An overview. Journal Healthcare Leadership, 4, 33-46. doi: https://doi.org/10.2147/JHL.S23150
Salazar, A. M., Keller, T. E., Gowen, L. K., & Courtney, M. E. (2013). Trauma exposure and PTSD among older adolescents in foster care. Social Psychiatry and Psychiatric Epidemiology, 48(4), 545-551. doi: https://doi.org/10.1007/s00127-012-0563-0
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014a). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf
SAMHSA. (2014b). Trauma-informed care in behavioral health services. Treatment improvement protocol (TIP) series 57 (HHS Publication No. SMA 13-4801). Rockville, MD: Author. Retrieved from https://store.samhsa.gov/shin/content/SMA14-4816/SMA14-4816.pdf
Trauma Informed Oregon. (2015). Standards of practice for trauma informed care. Retrieved from http://traumainformedoregon.org/standards-practice-trauma-informed-care/
Trauma Informed Oregon. (2016a). Roadmap to Trauma Informed Care. Retrieved from https://traumainformedoregon.org/roadmap-trauma-informed-care/
Trauma Informed Oregon. (2016b) Trauma Informed Care Workgroup Meeting Guidelines. Retrieved from https://traumainformedoregon.org/wp-content/uploads/2016/01/Trauma-Informed-Care-Workgroup-Meeting-Guidelines.pdf
U.S. Department of Health and Human Services, Office of Adolescent Health. (2015). A checklist for integrating a trauma-informed approach into teen pregnancy prevention programs. Retrieved from https://www.hhs.gov/ash/oah/sites/default/files/traumainformed-checklist.pdf
Vivian, P., & Hormann, S. (2013). Organizational trauma and healing. North Charleston, SC: Create Space.
