Putting Trauma Informed Care into Practice – Part 2

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:

  • Reactive
  • Organizational Hyperarousal
  • Reliving/retelling
  • Us vs. Them
  • Interpersonal Conflict
  • Avoiding
  • Authoritarian leadership
  • Dissociation/Amnesia

Characteristics of a TRAUMA INFORMED system:

  • Shared language
  • Understanding of trauma and healing
  • Understanding racial disparities and insidious trauma

Characteristics of a HEALING system:

  • Reflective
  • Collaborative
  • 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:

Additional resources to create trauma informed clinics:

Examples of trauma-informed and non-trauma-informed office waiting rooms

Creating Safe, Trauma-Informed Agencies (North Carolina Division of Social Services)

Developing a Trauma Informed Agency (Alameda County CA)

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