Transformational Change Module 7: Trauma-Informed Capacity

MODULE 7: Trauma-Informed Capacity

Overview:

Over the last five years, there has been a recognition that the severity of the needs of those who are being referred has been increasing dramatically. Programs that provide residential interventions are now being asked to work with the results of higher levels of trauma exposure. In large part, this is occurring because those who are making the referrals are specifically targeting those who have experienced trauma (i.e., the Adverse Childhood Experiences (ACEs) scores are high) and are therefore, most in need of specialized support.

Organizations are working with very high levels of anxiety, anger, and fear within the youth and families they serve in almost all the services they are offering. Organizations are not adequately training their staff to deal with these three powerful emotions. Though many organizations have offered some measure of training in trauma-informed care, what they have done in this area has, thus far, seldom been sufficient and often lacks an understanding of historical trauma. Organizations are not simply called on to offer a “check-box” training in trauma-informed care, they are being challenged to fundamentally change the design of their models for staff training and support.

Those who deliver services for our organizations do so by making a constant stream of instant decisions. Many of those decisions are made more by habit than by conscious choice. Without someone offering immediate feedback on those habits that are not trauma-informed, staff may very well continue to rely on those same habits, even when they are not producing positive, trauma-informed results. It is also essential for organizations to gather feedback from youth and families in building their trauma-informed practices.

Organizations will often be called on in their work to help to develop better emotional regulation within many of those they seek to serve. Staff can’t effectively work on emotional regulation with others until they know how to practice emotional regulation within themselves. The same is true for all aspects of trauma-informed care. Organizations can’t expect staff to be patient and understanding of the mistakes that are made by those they serve unless organizations model that same patience and understanding in how they respond to mistakes their staff may make.

Pre-existing Mindsets

Organizations usually feel more comfortable with what they know, what has worked in the past. When they have approaches that have worked in the past, they tend to want to stick with them even after they have stopped working. Many organizations have operated from a “power and control” mindset in the past. TIC calls for organizations to find alternatives to “power and control” approaches. Many are finding that very hard to do. Some organizations have suggested that they may need to expect a transition period where the “old approaches” are still being used while the new approaches are being practiced and learned.

Pre-existing Habits

Even when the philosophy and practice of TIC is accepted as being more effective, many staff find it difficult to break their old habits. Many organizations believe that it helps to provide training for those responsible to supervise and train the staff in TIC practices on gentler ways to address those old habits. The focus, they’re finding, should be on what could be done the next time, not on what was done this time.

Patience

Some organizations see this as part of the pre-existing mindset challenge. Leaders can get caught up in a pattern of needing to “move things along” and can forget that different persons move at different paces. Leaders need to accept that “individualizing” refers to pace as well. Patience always comes from within. Establishing patience as a value and practicing patience while staff develop it helps to model this value.

Caring

A frequently asked question amongst staff who are learning about TIC is: “How do I actually go about showing someone that I care about them?” It is true that some persons are naturally “warmer” than others. Having ongoing discussions about caring and pointing out effective examples of showing an appropriate measure of caring seem to help answer the question. Having discussions about appropriate boundaries also seems to be important in addressing this question.

Kindness

Those receiving services from Youth and Family organizations often report that they know when someone who is serving them is being kind. They also often report that expressions of kindness from those who are serving them are not typical. Organizations should consider establishing kindness as a value. Leaders praising staff who demonstrate kindness whenever they see it is one way to do that. Other ways include discussions with staff about the importance of showing kindness or by asking everyone to report how they feel when someone is kind to them when they are vulnerable.

Calm and Emotional Regulation

Many organizations report that calmness may be the centerpiece of TIC. If staff can remain calm in difficult situations or during difficult conversations, TIC is much easier to install. Until staff can remain calm during difficult situations and conversations, the installation of TIC will remain stalled. Many approaches are being tried – anger management training, breathing exercises, centering and self-awareness discussions and understanding brain science are but a few. When the lack of calm is embedded into the culture of the organization, this needs to be addressed and changed. One of the primary goals of TIC is to avoid emotional escalations and to know how to deescalate emotions when an escalation cannot be averted. Avoiding emotional escalations is important for both the youth and families we serve as well as the staff that serve them. Staff especially need training in how to handle embarrassing situations. Embarrassment can quickly turn to anger during difficult situations and conversations and anger can disrupt feelings of safety.

Trusting Relationships

It’s hard to imagine TIC being successfully implemented within an organization without building upon the capacity among its service providers to form trusting relationships. Those with clinical training usually understand this need. Sometimes it is necessary to provide the background on why this is so important and offer training in the ways and means of forming trusting relationships with those staff who have not received any formal clinical training.

Sense of Time and Responding and Reacting

The work that organizations do and the outcomes they are expected to achieve take time to be realized and some see this directly connected to the need for patience described above. If staff only see their work as extending over the length of a shift or a session, they may be less likely to see the bigger picture of their efforts. TIC is a means to an end and the end is a higher level of safety and stability. When staff can see this and understand the broader goals, it’s easier to install TIC. When staff utilize a TIC approach, they can develop a perspective that allows them to respond and not react to difficult situations and conversations. Some staff may have long-standing habits of reacting to certain issues. Some staff, for example, may react without thought to what they perceive as a show of disrespect or anger or threats. When the ways that they react are themselves disrespectful, angry, or threatening, the safety of the environment is endangered. While it may take time to work this out, but successful installation of TIC requires organizations to help staff to respond and not react.

2. SENSORY MODULATION SUPPORTS:

BBI developed, with the support of the Redlich Horwitz Foundation and the Annie E Casey Foundation, sensory modulation information and materials in response to the COVID crisis organizations and families were experiencing. The sensory modulation tools developed were designed to support self-regulation, comfort, and calming in youth and families. These tools extend beyond the COVID crisis into the sensory work organizations can perform related to trauma regulation. The following links provide information and resources useful to both staff and families.

BBI Sensory Modulation Materials to Support Residential Staff

List of Materials

Download a Letter for a Residential Leader: How to Prepare? What to do?

Download a Document on Recommended Sensory Supplies: How to order and Estimated Costs

Watch a Webinar for Residential Staff: Calming and Coping Strategies for Youth Receiving Residential Interventions: Basics of Sensory Approaches

Review a PDF of PowerPoint Presentation: Calming and Coping Strategies for Youth Receiving Residential Interventions: Basics of Sensory Approaches

BBI Sensory Modulation Materials to Support Families

List of Materials

Download a Letter for a Residential Leader: How to Prepare? What to do?

Download a Document on Recommended Sensory/Comfort Bag Supplies: How to order and Estimated Costs

Download a Letter from BBI to Family Members included within the Sensory/Comfort Bags

Watch a Webinar for Family Members: Calming and Coping Strategies for Family Members of Children Receiving Residential Interventions: Basics of Sensory Approaches

Review a PDF of PowerPoint Presentation: Calming and Coping Strategies for Family Members of Children Receiving Residential Interventions: Basics of Sensory Approaches

“Trauma-informed care calls for us to get better, get stronger and be healthy. In those moments we least expect, we can be challenged and must train ourselves to respond and not react.”

“Sometimes what we learn is easy to adjust to.  Some learning fits with what we’ve always done.  Trauma-informed care is not an easy fir for everyone.  It can be a rough adjustment.  We’ve got to learn how to be comfortable being patient and kind and caring.”