Part II: Implementing Trauma-Informed Care into Organizational Culture and Practice (Ken Epstein PhD LCSW, SF Department of Public Health and Rahil Briggs, PsyD, Montefiore Medical Group)
Link to audio of entire webinar session: https://www.youtube.com/watch?v=XrKL9ov4ddw#action=share
Chronic Stressors and Collective Trauma In an Organization Are Caused by:
- Not enough time for collaboration or supervision
- Staff and budget cuts
- Client needs vs. services offered
- Technology and paperwork demands
- Task-driven vs. relational reforms
- Feeling unsafe with co-workers
- Staff turnover
- Traumatic events in the workplace
Characteristics of a TRAUMA ORGANIZED system:
- Organizational Hyperarousal
- Us vs. Them
- Interpersonal Conflict
- Authoritarian leadership
Characteristics of a TRAUMA INFORMED system:
- Shared language
- Understanding of trauma and healing
- Understanding racial disparities and insidious trauma
Characteristics of a HEALING system:
- Culture of learning/curiosity
- Making meaning of the past
- Growth and prevention oriented (conflict OK)
- Relational leadership
Understanding the traumatic beliefs or TRIGGERS for those who have experienced trauma:
- Event: Door to examining room is closed even when patient asks for it to be open.
- Traumatic belief: I am not safe.
- Event: Patient told she must undergo a certain procedure regardless of her anxiety.
- Traumatic belief: People want to hurt me.
- Event: Patient is told she cannot be seen because she arrived late for appointment.
- Traumatic Belief: If I am in trouble, no one will help
- Event: Waiting room is filled to overflowing with patients allowed to be disruptive.
- Traumatic Belief: The world is dangerous
Negative roles providers/staff can take with patients who have had traumatic experiences:
- The Avoider (moving away): Withdrawing, dis-enrolling or referring patient elsewhere, silence with patients/colleagues, using inappropriate humor
- The Superhero (moving toward): Exaggerated sense of responsibility, excessive advocacy, over-sharing
- The Critic (moving against): Anger and irritability, heated arguments, sarcastic remarks
Trauma-informed reactions to the traumatized patient (PEARLS)
- Partnership: Let’s work together
- Empathy: That sounds frustrating (when patient complains)
- Apology: I am sorry that happened (when untoward event occurs with patient)
- Respect: You have gone through a lot
- Legitimization: I understand why you are so upset
- Support: Let’s see what we can do
Secondary trauma or compassion fatigue:
- A gradual erosion of all the things that keep us connected to others in our caregiver role.
- You didn’t experience the trauma but hear about it second-hand from a patient or a colleague
- Symptoms are similar to those of patients who have trauma experiences including PTSD
Online MINDFULNESS/RELAXATION RESOURCES for patients or staff dealing with past or current trauma:
- PHC at-home resources in English, in Spanish, in Russian, in Tagalog.
- Non-PHC resource for mindfulness/relaxation resources from webinar presenter in English, Spanish, and Arabic
Additional resources to create trauma informed clinics: