Trauma Informed Care and Compassion Fatigue: Top Questions asked by Professionals

Last week we conducted our third and final webinar in the Trauma-Informed Care (TIC) series. I have to admit, I’m sad to say goodbye to getting together monthly with you all in the field of human services and our amazing presenter Karen Johnson. This webinar was like the others; hundreds of attendees and great content on TIC best practices.  One of the best parts of this webinar series were all the insightful, practical and focused questions asked.  You all really dug into this topic, wanted to learn more and most importantly, apply it to your work.

We have created this post to answer all the questions that came in and provide additional information.  We appreciate how many of you were asking about how to apply what you learned to yourself; how to take better care of yourselves, apply the principles of TIC to your own self-care and improve how you feel about work and how you perform. Taking care of yourself is just as important as taking care of those you serve; you can’t have one without the other.

The questions were answered by:

  • Karen Johnson, Director of Trauma-Informed Services, NCBH
  • Linda Henderson-Smith, Consultant for Trauma-Informed Services, NCBH

The questions are organized into themes for ease of use, starting with the fundamentals:

What is trauma?

Answer: Great question! Making sure you know the fundamentals and we’re all on the same page with definitions is important in this work. This was covered in webinar #1 in this current series on Trauma-Informed Care titled “Becoming Trauma-Informed: What Does this Mean for Non-Clinical Staff?”. The definition is multi-faceted:

  • Trauma refers to intense and overwhelming experiences that involve serious loss, threat or harm to a person’s physical and/or emotional well-being.
  • Trauma experiences often overwhelm the person’s coping resources
  • This often leads the person to find a way of coping that may work in the short run but may cause serious harm in the long run
  • Trauma is always defined by the individual

Working with Leadership on TIC, Self-Care and Burnout

How can you get management to seek help when everybody around them knows they are burnt out?

Answer: It might be helpful to present information on trauma-informed care and secondary traumatic stress to management.  You may want to frame the conversation around the concept that self-care is non-negotiable in a trauma-informed organization, and leadership needs to “walk the talk” in order for staff to embrace self-care.   Having honest conversations with management, providing resources, i.e. books like Trauma Stewardship by Laura van Dernoot Lipsky, or encouraging the use of a staff wellness screening tool for all staff, such as the ProQol, are other considerations.

I am interested in ideas how to prevent “burnout”. Particularly when it comes to organizational change and accepting changes in our practices.

Answer: Creating a trauma-informed environment is an overriding approach to preventing burnout.  When staff feel that they are heard, understood, valued, and appreciated by co-workers and management alike, it allows for burnout to be minimized.

Here are some ideas for preventing burnout:

  • Train all staff in vicarious trauma in new hire orientation
  • Offer other trainings regarding self-care
  • Offer trauma-informed, reflective supervision
  • Encourage supervisors to check in on their supervisees and explore how the person is doing, outside of the responsibilities they have
  • Offer EAP benefits that provide free short term counseling for staff
  • Offer discounts for health clubs
  • Teach mindfulness to staff
  • Create a safe environment where staff can talk about their fears and worries without fear of repercussion

Note from Relias: We have some information and resources on our website not only about managing change but other business challenges facing health and human services organizations.  Karen spoke about the impact of burnout on an organization, specifically how it impacts turnover, which is a big challenge in the human services industry.  Burnout and turnover impact quality of client care, costs an organization money and has been shown to be contagious (a few staff experience it and it spreads to others). Check out the information and resources, we hope it helps.

What is the best way to work with an employer or HR department that is not geared toward preventing burnout? My current employer has no prevention activities in place. I work in a Crisis Call Center for a major MCO.

Answer: Great question.  Again, the answer rests in helping administration and staff to increase their understanding of trauma and trauma-informed care.  Sharing resources and information about trauma-informed care, including the Relias webinars in this series, may have an impact on people’s thinking.  Your direct supervisor may be able to advocate with HR and upper management for having these conversations.

Can you talk about building a bridge between administration and direct care staff? The various demands of the job are often not heard or taken seriously. I feel like I am in the middle as a supervisor and it is exhausting.

Answer: If you are in a position to educate the C-suite about TIC, that’s a great place to start.  It is important to communicate that this is not about entitlement and that staff are willing to do their part in managing their own self-care.  Again, it is critical to emphasize that staff wellness is at the core of becoming a trauma-informed organization.  It can be helpful to explain that there is a huge cost associated with not taking care of staff (high turnover is extremely expensive, for example) and TIC and burnout are directly connected to staff productivity and getting the job done. You can conduct focus groups, listening sessions, and encourage staff to do it in a way that is productive and helpful to leaders.

Our agency took the initiative a couple of years ago to become TIC.  We all underwent a training and now every new employee is required to take this training.  I am currently the trainer for it.  Not sure admin still is interested.  How do we keep leadership committed to and supportive of Trauma-Informed Care?

Answer: One way to keep leadership interested is to provide ongoing data about the benefit TIC is having in the organization (both human benefit and fiscal benefit if possible).  Also, continuing to connect Administration with the needs of staff is important.  A staff survey that specifically asks questions about staff wellness and needs can be helpful.  Also, this type of initiative usually requires the focused work of an implementation team that focuses on communicating for buy-in, creating a sense of urgency, visioning for the future and other implementation steps, as we know that becoming trauma-informed goes beyond an initial training.  Perhaps your leadership can explore why they focused on this work a few years ago.  Did the initiative accomplish what they hoped for?  Also, exploring concerns that can be addressed via a TIC initiative, such as staff turnover, decrease in critical incidents, increase in positive client outcomes, decrease in missed appointments, etc., can be helpful in creating a renewed sense of urgency around the work.

ProQOL and Other Resources and Tools:

I have heard about the ProQOL several times now – my concern with having staff administer the ProQOL is in regard to follow up. What should we have in place for follow up for staff after administering the ProQOL?

Answer: You may want to consider holding focus groups that can help to identify the immediate needs of staff that come out of the ProQOL survey.  Follow up activities would be geared towards the identified needs and likely would include processes such as trauma-informed supervision, EAP, staff wellness activities, and most importantly, staff voice and choice – the ability for staff to make recommendations on how to assist them with compassion fatigue and burnout.

Any other recommendations other than the ProQOL?- we have used for 2 years and the scoring does not accurately reflect for our staff who are experiencing burnout

Answer:   One tool you may want to consider is Maslach’s Burnout Inventory.

Are there resources for trauma informed care from a policy/macro/business perspective?

Answer: The following resources are helpful related to addressing trauma-informed care from a broader perspective, or for advancing trauma-informed care practices across an organization, system or community:

  • Organizational Trauma and Healing by Vivian and Hormann
  • Restoring Sanctuary: A New Operating System for Trauma-informed Systems of Care by Sandra Bloom and Brian J. Farragher
  • Trauma-Informed Care in Behavioral Health Services, Substance Abuse and Mental Health Services Administration.
  • Using Trauma Theory to Design Service Systems, by Maxine Harris and Roger Fallot

The National Council for Behavioral Health specializes in helping organizations to advance trauma-informed approaches via our training, consultation and learning communities.  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.  For more information about the National Council’s Trauma-Informed Services, please contact Karen Johnson at [email protected].

Additional Resources From this Webinar

Mary Wolfe’s piece from the Milwaukee Journal Sentinel? Article about burnout in child welfare workers, including the quotes from Mary about how it felt to be a direct care staff and feel burned out.

Brene Brown’s TEDtalks: The Power of Vulnerability and Listening to Shame. Two TEDtalks that are very powerful and relate to TIC (which is why she was referenced and quoted!)

Watch this webinar:

  • Go Relias Academy to purchase as a course (check out continuing education credit opportunities there as well!)
  • Relias Learning Management system site – if you are a current Relias customer with a behavioral health library, these courses will be/were added to your site as courses, free of charge. Check the certificate information on the course for CEU details.
  • Not a customer? check out becoming a Relias customer and these webinar courses as well as many others will be yours to access anytime, anywhere on your organizations learning management system website.

Thanks again to all of you who attended the webinar series on Trauma-Informed Care.  We posted the Q&A from the other two webinars here and here and have more recorded webinars on this topic here, if you want to learn more.


Strategic Marketing Manager BH/CYF and CH, Relias

Kristi has more than 20 years of experience in the health and human service industry, the majority of that time working as a direct practitioner with children, adolescents and adults in both outpatient and residential/inpatient settings. She has worked with Relias for over 10 years, initially working with customers on getting the most out of Relias products, then managing the content products for HHS, and now as the Strategic Marketing Manager for Health and Human Services.

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