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You Asked, We Answered; 12 Questions About Trauma-Informed-Care

Our community of health and human services organization is brilliant, dedicated and just plain awesome.  How do I know this?  Well…earlier this week we at Relias joined with our partner National Council for Behavior Health and conducted a great webinar on Trauma-Informed Care (TIC).

The number of people who signed up was unlike most webinars; over 10,000 registrants. We were pleased to see so many people taking this important topic seriously, wanting to learn more and making an effort to change how they work every day.

In addition to the high interest of this topic, the number of thoughtful and insightful questions during the webinar was also in the upper echelon.  That’s why we think the people in the Relias community are the cream of the crop in the world of human services. We appreciate you all; the work you do, the sacrifices you make and for always trying to learn, grow and improve.  The people you serve, their families and the communities they/we live in thank you. Even if they don’t always articulate it.

What Does Becoming Trauma-Informed Mean for Non-Clinical Staff

Below are the questions and the answers from the webinar; “What Does Becoming Trauma-Informed Mean for Non-Clinical Staff?”

1) What can supervisors and managers do to support employees that may have experienced ACE and bring TIC into supervision while maintaining safety and boundaries for both?

Answer: We think this question/issue is so important, we conducted a webinar solely on this topic last year and have included it in our course offerings through Relias Learning.  The webinar/course is titled “Trauma-Informed Supervision: What they Didn’t Teach us in Graduate School”. If you want or need continuing education credit for the course, you’ll need to take it on Relias Academy or in your Relias Learning organizational website (if you are a customer).

2) Is there data showing how often/percentages of people experience those adverse outcomes as a result of ACE? (related to slide with the list of outcomes related to ACE)

Answer: There is a tremendous amount of information available about ACEs. Researchers have been exploring the question of the impact related to frequency and numbers of a single category of ACEs. ACEsConnection is a valuable resource for recent information about this work.

3) Are there any trainings that you would recommend for an agency looking to become trauma-informed?

Answer:  The National Council for Behavioral Health provides training, consultation and technical assistance focused on operationalizing a plan for advancing trauma-informed approaches within an organization, system or community.  Since 2011 the National Council has partnered with over 350 organizations through a Learning Community model, or via consultation with individual organizations.  Organizations have made significant progress within each of the Seven Domains of Trauma-Informed Care using the National Council’s Organizational Self-Assessment© (OSA).  Participants have created safer environments, addressed staff self-care, provided more trauma-sensitive services, avoided re-traumatization of those receiving services and transformed organizational culture through critical policy and practice changes.  The National Council’s model empowers organizations to implement trauma-informed approaches and to sustain the work for years into the future. In addition Relias Learning has courses in their library on advancing trauma-informed approaches within an organization.

For more information about the National Council’s Trauma-Informed Services, please contact Karen Johnson at [email protected].

4) How long can trauma lie dormant?

Answer: Due to the ACEs study, we are learning that a traumatic event, especially when unacknowledged or untreated, can have lifelong impact.  The very good news is trauma is treatable and people do experience post-traumatic growth.  Unresolved trauma, however, can impact an individual throughout their whole life and is correlated to the long list of physical and mental illness outlined in the ACEs research.   The vicious loop talked about on the webinar can be the result of unresolved trauma.

5) Can trauma began in the womb?

Answer: Yes, certainly there is trauma in the womb and definitely physical trauma can greatly impact the overall health and wellness of the child post-birth. There are some studies and research that indicate experiences in utero can impact the child post-delivery. Here is a great article about this topic.

6) Besides the American Indian, as an example of Historical Trauma & Generational, what other examples exist?

Answer: In addition to Native American populations, examples of historical trauma include African-American Slavery, the Holocaust and the internment of Japanese populations during World War II.  Here is an excellent resource to learn more about Historical Trauma:

7) There’s resistance in our system (case management for persons with HIV) to offer trauma screening – as a means to identify opportunity for referral AND start the educational process. Do you have any data on the acceptability of screening in this setting?

Answer: We understand that there is a high prevalence of trauma, both past and ongoing, among persons who live with HIV.  It is important to screen for trauma with this population, assuming it is done in a respectful and culturally sensitive way that allows for shared decision making.  The Trauma-informed Care approach is relevant and needed for this population.  Here are two articles on this area of focus that may be helpful.

Khanna, Naina, and Suraj Madoori. “Untangling the Intersection of HIV and Trauma: Why It Matters and What We Can Do.” TheBody.com. Gay Men’s Health Crisis, Sept. 2013

8) Are there resources to provide basic knowledge of TIC to summer camp staff available in non-clinical, accessible language?

Answer:  National Child Traumatic Stress Network is a good resource for information about working with children.  Also, here is an article regarding trauma-informed care and summer camp.

9) Is it possible to get TIC as part of the library of webinar classes for Relias customers to use in the future?

Answer: Yes! We already have courses on trauma informed care including this webinar (recorded, edited, knowledge check questions and an exam added) in our libraries and on Relias Academy. We frequently conduct webinars such as these, record them and turn them into courses (two more webinars on TIC will become courses in summer 2016)

10) How does Trauma Informed Care link to a group that has not interaction with clients? Say an IT Department?

Answer: An organization who is working within a trauma-informed framework involves all aspects of business, all employees and works on transforming the whole organization.  It’s more than about specific interventions with clients and isn’t simply about the face to face interaction.  It’s in our attitudes, beliefs, documentation, physical environment and how we treat each other.  As it relates to IT, individuals in this department need to understand the basics of trauma, such as the paradigm shift, prevalence and impact of trauma, universal precautions, etc. for several reasons.  First the mission of a trauma-informed organization is grounded in trauma-informed care principles and practices.  Trauma-informed care is the organization’s way of doing business, and thus everyone in the organization needs to understand and embrace it.  Also, an IT staff member interacts frequently with staff, and needs to understand that staff have their own trauma histories and are impacted by the work.

11) We are developing our plan on how to roll this out, especially to non-direct care. Since they don’t interact with the people we serve they do not feel as connected, how can we help see the value?

Answer: Please see the answer above.  This work is as much about how we interact with each other as it is about how we partner with the people we serve.  We cannot be trauma-informed with those we directly serve if our entire organization is not committed to the approach.

Also, implementation science teaches us about the steps that need to be taken in order to effectively make this kind of organizational change.  These steps include creating a sense of urgency, creating consensus and communicating for buy-in with individuals throughout the organization, including non-direct care staff.  Using the stories of persons with lived experience can help non direct staff to see the value.  The National Council’s trauma-informed care work with organizations focuses on these important implementation steps to creating organizational change.  John Kotter’s two books, The Heart of Change and A Sense of Urgency provide valuable information about this question.

12 ) Can you give me an example of how an agency’s policies and procedures can be more trauma informed?  Is this where being attentive to language comes in?

Answer: Attention to language is important when considering policies and procedures, as well as honoring the basic paradigm shift and principles of trauma-informed care.  Behavior management policies, such as level systems, are one example of an area that is often reworked when an agency strives to become trauma-informed.  These policies often focus on consequences and rewards that are not effective with people who have experienced trauma.  Codes of conduct for people served by the organization is another example of a policy that is often changed as the result of a trauma-informed initiative.  In addition, staff policies are often rewritten to reflect an increased understanding of the impact of trauma on the work force.


Question: Good basic treatment of being trauma informed both at organizational and individual level.  I particularly appreciated the focus on compassion fatigue.

Answer: We agree, taking care of yourself is key for caregivers, counselors and other staff at your organization.  We are conducting a webinar on June 14th focused on that topic and have courses in our libraries specifically on that topic as well as those related to keeping yourself healthy and balanced in all areas of wellness.

Comment: In Ohio we have TIC Collaborative. There are trained people to provide the information. To find your local group, go to http://mha.ohio.gov/Default.aspx?tabid=772

Answer: Great information, thanks for sharing.  There are other learning collaborative and resources all over the country.  National Council provides many services and tools to assist organizations, click here to learn more.

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