Trauma-Informed Systems Change Introduce the module   Discuss purpose. Tell participants that you will: define and explore core elements of trauma-informed systems change, explore questions/tools for assessing the current status of trauma informed systems change in an organizational context and Discuss possible strategies to for making environments and processes in agencies more trauma-informed

Transforming Systems/ Paradigm Shifts Transforming systems of care into trauma-informed systems requires a paradigm shift. Trauma-informed transformation involves a shift in: the way clients/participants are viewed the way trauma is viewed the way staff responds the way services are delivered Discuss the need for systems to have a “paradigm shift” in order to address transforming practices and systems   What does it mean to have a paradigm shift? Paradigm shifts need to happen in many different areas:  The way clients/ participants are viewed  The way trauma is viewed  The way staff responds  The way services are delivered Ask Participants: Can you think of other areas where systems need to have a paradigm shift?

Questions for Transforming Trauma-Informed Service System What would we do differently if we truly believed that trauma is an expectation and not an exception, and if we believed that trauma is a centralizing concept in our clients’ lives ? Allow participants a chance to respond to this question and discuss as a group.   What would we do differently if we truly believed that trauma is an expectation and not an exception, and if we believed that trauma is the centralizing concept of our clients’ lives? Points to Consider:  Ensure we emphasize prevention as well as treatment (e.g., community education about trauma).  Recognize the prevalence of trauma, and think “trauma first”.  Using the word “trauma” rather than other terms is a very important choice. Emphasis on healing rather than pathology is critical. Key point to emphasize – Just as we use assessment tools to inform the work we use in direct practice; it is valuable to assess our organizations and systems to concurrently ensure that we are not, unintentionally, re-traumatizing clients and that we are contributing to the healing process.

Core Assessment Domains for a Trauma-Informed System of Care Program activities & settings (consistent with principles of trauma informed practice). Program policies Screening, assessment, service planning and trauma-specific services Administrative support Staff training and education Human resources Fallot & Harris (2009) Creating cultures of trauma-informed care (Harris & Fallot, 2001) Discuss each core principle of a trauma-informed system    Safety: Ensuring physical and emotional safety  Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries  Choice: Prioritizing client choice and control  Collaboration: Maximizing collaboration and sharing of power with clients and other providers  Empowerment: Prioritizing client empowerment and skill-building Refer participants to Handout on Guidelines for Trauma-Informed Assessment: These guidelines were designed so that agencies and systems could walk through their agency or system in order to identify triggers, points at which we may be re-traumatizing clients. In addition, once the triggers were identified, to identify possible solutions, and develop an Action Plan. This instrument has been utilized by the Family Wellness Court network in Santa Clara County, California.

1. Program alignment with principles of trauma-informed care Safety Trustworthiness & transparency Choice Collaboration and mutuality Empowerment SOURCE:Fallot & Harris (2009) Creating cultures of trauma-informed care One of the most important assessment domains involves examining the degree to which the program activities, practices, and environment are congruent with these core principles. (NOTE: there are some variables of principles that have been defined by different systems, but they generally include some version of these principles defined by Fallot and Harris. These core principles may be generalizable across different settings, although the terminology used in different disciplines and the specific practices adopted may vary.   Safety: Ensuring physical and emotional safety Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries   Choice: Prioritizing client choice and control   Collaboration: Maximizing collaboration and sharing of power between staff and clients, and with other providers   Empowerment: Prioritizing client empowerment and skill-building

2. Formal services policies Development of policies and procedures that reflect an understand of trauma survivors needs, strengths & challenges. Policies that address staff needs. Organizations have policies and procedures in place that are congruent with trauma-informed care. Examples may include: Policies about confidentiality and protection of privacy for both clients and staff. Clear communication about client and staff rights and responsibilities. Formal adoption of models and practices that minimize re-traumitization and maximince client/consumer choice. Organizational structures are in place to support staff in addressing secondary trauma

3. Screening, Assessment, Planning & Trauma-Specific Services Integrate trauma screening and assessment with other screening and assessment to minimize burden Trauma-related issues identified in screening are included in treatment plan and addressed through the trauma-specific intervention   Points to Consider The program has a consistent way to identify individuals who have been exposed to trauma. (Screening avoids over-complication, unnecessary detail, and redundancy to minimize stress for clients).    Trauma-related issues identified in the screening are included in treatment plan and addressed through trauma-specific interventions. The program offers or makes referrals to accessible, affordable and effective trauma-specific services.

4. Administrative Support for Program-Wide Trauma-Informed Services Support for the integration of knowledge about trauma/violence into all aspects of agency/system functioning Possible indicators: Rethinking formal policy or mission statements Developing a “trauma initiative” Making resources available despite funding challenges Active administrator participation in systems change (and cross-systems change) efforts Release staff for training Discuss the need to administrative support in developing trauma-informed services.   Examples are provided above. One example, that shows up in research as helpful, may involve developing a “trauma initiative” - - designating a “trauma champion,” someone in the system who is accountable for keeping the system knowledgeable about trauma, new research, new trainings, and new practices.

5. Staff Training & Education Integrate information into existing channels/venues, e.g. employee orientation, new staff trainings Initial system-wide trainings to disseminate trauma-informed principles and why Multi-leveled trainings for direct service providers and supervisors related to different components of the system Provide supervisors with emerging literature on trauma and encourage them to incorporate into supervision Points to Consider   Basic trauma training is for everyone in the system, so they understand how to answer or respond to survivors. Ideally, staff across systems who frequently work with the same families should be receive inter-professional training related to trauma. Multi-level training for counselors, clinicians, and supervisors. Program staff need to recognize the impact of historical and intergenerational trauma for a number of cultures (e.g., African Americans, American Indian, etc.)

6. Human Resources (HR) Issues Hiring and fostering staff who are: Able to recognize their own judgments/ biases Collaborative and view the client as a partner Understand the role of trauma in client’s lives Respectful of client choices Willing to develop new skills Providing supportive and reflective supervision Supervision/support for addressing personal and professional stress This domain focused on the extent to which trauma-related concerns are part of the hiring and performance review process. One important step is to emphasize important characteristics of employees that will contribute to building trauma-informed systems. Supervision with employees should help to foster similar characteristics and practices. Addressing secondary trauma is critical to

Cross-systems collaboration and change is also important! Developing collaboration at multiple levels is crucial to successful change Collaboration between systems helps to foster cooperation, collaboration, trust, respect, and collective achievement Discuss the need for collaborations at every level. Key points:   SYSTEMS Collaboration between systems is important for families who have multiple needs, and who are often involved in multiple systems. Openly and respectfully discuss differences (and similarities) from the outset Develop a common vision statement Use of tools to actively examine values, practices, and opportunities for improvement in different systems – and in different components of a service delivery system. TEAMS Builds connections at multiple levels with information flowing between them Brings together diverse constituencies Openly and respectfully discuss differences from the outset Creates a collaborative and mutually empowering environment in which all members have an impact on the group’s outcome Emphasize that patterns of collaborative teamwork hopefully will also lead to more cooperative and collaborative relationships with clients.

Specific Ideas Related to Theme What works in collaborative systems change? Overarching Themes Specific Ideas Related to Theme Developing a shared vision and strengthening a commitment to better address trauma within and across systems. Dialogue and discussions have helped to create a shared vision for broad systems change Key leaders across systems have a shared commitment to improving systems to better serve families Commitment to avoid re-traumatizing families. Enthusiasm in working together Common language regarding trauma. Training and discussion to create a common “trauma” language Opportunity for dialogue from various agencies Building on existing relationships with each other and across systems. Trauma work is grounded in relationships and trust from working together on previous county wide projects Meetings create access to each other, builds momentum, and helps create opportunities to leverage resources Helping break down system “silos” and increase collaboration. Working collaboratively is critical; each system perspectives, resources, and services are important to addressing trauma. Create opportunities for communication; leveraging existing resources Leadership driven and buy-in is necessary in all levels of the system. Buy-in from the leadership across systems is critical In many systems, staff were characterized as ready, interested, or “hungry” for concrete opportunities to become more trauma-informed (healing/recovery oriented). Review highlights of works in collaborative systems change. Emphasize the importance of developing common values and shared commitment to improving systems. SEQUE – to discussion of specific tools to assess current status of systems. Findings from a study in Santa Clara County, Cross-Agency Systems Team

Organizational Components of Trauma-Informed Transformation Adoption of principles/philosophy for trauma-informed care. Administrative commitment and support Screening Training Hiring and other HR issues Policies and Procedures Review each organizational component of trauma-informed transformation (examples follow on next slides).