The Basics of Trauma-Informed Care (TIC)
Let’s get started with some definitions of terms to ensure that we’re on the same page.
First, let’s define trauma. In my decades of experience (including as a trauma survivor, perhaps my chief credential), I’ve learned that, to a trauma survivor, it’s unhelpful (if not re-traumatizing) to distinguish between lower-case ‘t’ and capital-‘T’ trauma. Trauma is trauma (or, more precisely, trauma is Trauma, to the survivor.) I’ve also learned that, to a trauma survivor, it’s unhelpful (it not retraumatizing) to split hairs over whether trauma is the event(s) themselves, the response to event(s), or any other limiting criteria. Trauma is trauma (or, more precisely, trauma is Trauma, to the survivor.) As best practice, I consider it trauma if it (from SAMHSA, the Substance Abuse and Mental Health Services Administration):
- Overwhelming experience.
- Involves a threat to our physical and/or mental well-being.
- Results in vulnerability or a loss of control.
- Leaves people feeling helpless and fearful.
- Interferes with relationships and beliefs.[2]
Again, trauma is Trauma, to the survivor. Any of the above qualifies. That said, as a Clinical Traumatologist who treats trauma, for trauma treatment, it can be helpful to differentiate – but not necessarily name to the survivor – types of trauma. In brief, treatment includes both trauma-focused care (“centers the impact of specific trauma on an individual’s life”[3]) and trauma-specific services (“clinical interventions designed to address trauma-related symptoms and PTSD directly in individuals and groups”[4]). These usually treat Primary Trauma (events and/or effects of events that happened to someone personally). Primary Trauma is sometimes differentiated between Type I (single incident, such as 9/11) and Type II (ongoing, chronic, more complex, more difficult to treat, such as homelessness).
I often describe these terms as stairsteps or a ladder.
The lowest step or rung: receive healing for your Primary Trauma. That impacts everything.
The next step or rung: receive healing for your Compassion Fatigue. As a Compassion Fatigue Specialist and Educator, I reiterate: trauma is Trauma. No matter its source or size, unresolved Primary Trauma provides perfect soil for Compassion Fatigue to bloom and spread; hence the need to heal it first. Again, Compassion Fatigue[5] includes Secondary Trauma and Burnout. Secondary Trauma comes from exposure to someone else’s Primary Trauma. It (or, to throw more terms at you – this field is rife with terms – Secondary Trauma Syndrome, or Secondary Traumatic Stress) “may result from being exposed to another person’s trauma, experiencing stressors of another’s personal history (through the absorption of intense energy and graphic details), and dealing with challenging behaviors. It is the emotional distress that results when an individual hears about the firsthand traumatic experience of another.”[6] An example: a volunteer or case manager, without having received healing for their Primary Trauma, and/or adequate training, working with clients experiencing homelessness, hears explicit details of a traumatic event. Another: what people who are BIPOC (Black, Indigenous, or People of Color), and/or LGBTQ+ (Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, or Nonbinary) experience when learning of another injustice perpetrated against others of the same oppressed or historically marginalized groups. Its symptoms[7] parallel those of PTSD (e.g., hypervigilance, insomnia, somatization or physical ailments). Burnout is E x h a u s t i o n – Physical. Mental. Emotional. Exhaustion – we’re unable to cope with our work environment.
The next step or rung: make your work trauma-informed. “A program, organization, or system that is trauma-informed,” according to SAMHSA, “realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist retraumatization.”[8] An example: do not touch anyone without consent, and make that an explicit policy, procedure, and practice for anyone on staff or volunteering. Another: recognize that your client(s), volunteer(s), and/or staff likely have Primary Trauma, if not also Compassion Fatigue, and provide the necessary support for the healing they need.
The next step or rung: intentionally, comprehensively, and systematically implement a Trauma-Informed Approach (TIA). This optimizes Safety and Stabilization (Phase I of healing from Primary Trauma) for everyone. Here workplaces, organizations, and systems, according to SAMHSA, create, codify, incorporate, deliver, implement, evaluate, and/or refine trauma-informed policies and procedures for “safer environments for their staff and the individuals they serve … services [to achieve] optimal health outcomes … both physical and emotional safety … [and avoid] procedures and practices that retraumatize and remind individuals and communities of past trauma ...”[9] An example: trauma-informed, system-wide homelessness Continuum of Care (CoC) Coordinated Entry (CE) policies and procedures.
The final step or rung: the absolute best practice of all best practices: intentionally, comprehensively, and systematically implement Trauma-Informed Care (TIC) in your workplaces, organizations, and systems. Now we’re getting to the good stuff! Read on.
Trauma-Informed Care (TIC), according to The Institute on Trauma and Trauma-Informed Care, “understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize.”[10] It “calls for a change in organizational culture, where an emphasis is placed on understanding, respecting, and appropriately responding to the effects of trauma at all levels.”[11] It “becomes almost second nature and pervasive in all service responses.”[12]
Countless thousands of pages exist on providing Trauma-Informed Care (TIC). Even within the specific context of homelessness, my particular area of expertise.
Countless thousands of pages exist on providing Trauma-Informed Care (TIC). Even within the specific context of homelessness, my particular area of expertise.
Top 15 recommended Trauma-Informed Care (TIC) policies and procedures within the context of homelessness
- Remember that the externals you see – e.g., addiction, anger, rage, suicidality, self-harm – are useful adaptations to trauma. Trauma responses. Coping skills. Survival strategies. Not merely behavioral problems. Heal the trauma --> heal the behavior.[13]
- Adopt a Housing First approach. It’s been proven complementary to TIC.[14]
- Remember that it’s Housing, First. Offer wraparound services.[15]
- Ensure administrative commitment to integrating a trauma-informed culture.[16]
- Include clients, staff, and leadership in planning and evaluation of services.[17] [18]
- Rest. REST IS RESISTANCE. Rest is how we heal trauma and dream big dreams.[19]
- Provide training and support to all staff; paid, upon hiring, upon request, at regularly scheduled intervals, and as needed in the event of specific traumatic incidents.[20]
- Establish, supervise, pay extra to and/or otherwise incentivize, and heed the advice of an internal trauma team.[21]
- 9. Seek out, find, train, utilize, pay and/or otherwise incentivize, and write great letters of recommendation for peer mentors (aka, present or past clients or recipients of services who can serve as hosts, ambassadors, guides).[22] [23]
- Ensure Cultural Competence. This includes Diversity, Equity, and Inclusion for BIPOC (Black, Indigenous, or People of Color), and/or LGBTQ+ (Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, or Nonbinary) clients, staff, and leadership.[24]
- Rest. Again. REST IS RESISTANCE. Rest is how we heal trauma and dream big dreams.[25]
- Seek out, find, and eliminate any potentially retraumatizing policies and procedures.[26]
- Conduct early and Trauma-Informed trauma screening and assessment for all.[27] [28] [29]
- Implement any changes necessary to course correct from low scores on the above screenings and assessments for all. Repeat as necessary.[30]
- Engage and educate referral sources and partner organizations to scale up Trauma-Informed Care (TIC) to the system level.[31]
FOOTNOTES
[1] My note: Homelessness service providers often use the word “consumers” to describe people who utilize services. Clinical providers – traumatologists, therapists, counselors, and others – often use the word “clients.” Other providers use still other terms. Over the years, I have asked the individuals receiving my services how they want me to refer to them. The answer, overwhelmingly: “clients.” As best practice toward offering Trauma-Informed Care (TIC), I recommend asking the recipients of your services how they want you to refer to them, and codifying that in a handbook of TIC policies and procedures.
[2] Substance Abuse and Mental Health Services Administration. Volk, K., Guarino, K., & Konnath, K. Homelessness and Traumatic Stress Training Package. DHHS. Rockville, MD: Center for Mental Health Services, 2007.
[3] Substance Abuse and Mental Health Services Administration. Practical Guide for Implementing a Trauma-Informed Approach. SAMHSA Publication No. PEP23-06-05-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory, 2023.
[4] Ibid.
[5] My note: Compassion Fatigue also has various terms to describe it. Some better and more precise. But since my credentialling is in Compassion Fatigue, by that name, and this webpage is on Trauma-Informed Care (TIC), already with too many terms to define, I will simplify this by referring to Compassion Fatigue by that name.
[6] Homeless and Housing Resource Center, Building Resiliency: A Guide for Supervisors of Housing and Health Professionals, July 2022.
[7] Johnson, K. Provider and Staff Self-Care: Promoting Staff Wellness and Preventing Vicarious Trauma and Other Work Force Concerns. SAMHSA-HRSA Center for Integrated Health Solutions. Substance Abuse and Mental Health Services Administration. Health Resources and Services Administration, 2020 [PowerPoint slides]
[8] Substance Abuse and Mental Health Services Administration. Practical Guide for Implementing a Trauma-Informed Approach. SAMHSA Publication No. PEP23-06-05-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory, 2023.
[9] Ibid.
[10] The Institute on Trauma and Trauma-Informed Care. What is trauma-informed care? University at Buffalo. Center for Social Research, n.d. (no date).
[11] Bloom, S. L. Creating sanctuary: Toward the evolution of sane societies. New York: Routledge, 1997.
[12] The Institute on Trauma and Trauma-Informed Care. What is trauma-informed care? University at Buffalo. Center for Social Research, n.d. (no date).
[13] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009.
[14] Ward-Lasher, A., Messing, J., and Stein-Seroussi, J. Implementation of Trauma-Informed Care in a Housing First Program for Survivors of Intimate Partner Violence: A Case Study. Advances in Social Work. 18. 202. 10.18060/21313. 2017.
[15] Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. Housing first: Ending homelessness, transforming systems, and changing lives. Oxford University Press, 2016.
My note: I am honored to say that I worked with Deborah Padgett and Ben Henwood when they (we) first began to demonstrate the success of Housing First. I consulted in weekly meetings, advising on outreach, engagement, interview questions, and more. I also met with executive directors of top homelessness organizations in New York City, both to learn from them about their successes and to consult for them on how to do more.
[16] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006.
[17] Ibid. My adaptation. The original language reads “providers and providees,” but I recommend both expanding and reversing that. My recommendation for the absolute best practice is: start with clients, especially those with the longest tenure; expand to staff, especially frontline, client-facing, and those with the longest tenure, in order of seniority; and then get input from leadership, which often has the highest turnover and thus the shortest institutional memory of policies and procedures (including the most Trauma-Informed Approach to particular long-term clients). I first spent time with people experiencing homelessness as an anthropologist and ethnographer; my chief methodology was participant-observation; participate, observe. Often attempts at Trauma-Informed Care (TIC) fail to do just that: participate, observe. Then implement change, based on what you heard, saw, and personally experienced from that participatory-observation. Did you feel unsafe or unsanitary using that bathroom? Did a client tell you how the building used to have a library where they could use a computer and apply for jobs? Did a case manager share how she relies on the free meals to stretch her meager pay? Did leadership win the trust of a client with a particularly complex trauma history by staying out of their office and in the public spaces where clients gather?
[18] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009.
[19] Hersey, T. Rest Is Resistance: A Manifesto. Little Brown Spark, 2022.
[20] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006. My adaptation. The original language reads “introductory,” but I expand that to recommend “paid, upon hiring, at regularly scheduled intervals, and as needed in the event of specific traumatic incidents.” Each of these adds an additional layer of Trauma-Informed Care (TIC). One thing I especially recommend: some form of paid “troubleshooting clinic,” where staff – especially frontline, client-facing – convene, in a circle, with a seasoned, Trauma-Informed expert, who reads a question that an anonymous staffer has posed (e.g., how do you get a client with Complex PTSD, or C-PTSD, ready for housing?), and uses a talking piece or some other egalitarian measure to let everyone, including the expert, ask questions and/or offer input, and then each participant receives some form of incentive for their participation (e.g., donated massages, acupuncture, yoga classes). Some of my offerings in this area include Compassion Fatigue interventions and The Homelessness Haven here in Baltimore.
[21] Ibid. My adaptation. The original language reads only “Establish,” but I recommend expanding that to include “supervise, pay extra to and/or otherwise incentivize, and heed the advice of” this team. One of the constant refrains I hear from staff who are ready, willing, and able to be the Trauma-Informed Care (TIC) team for their organizations or systems is that they are expected to do that heavy lifting without these extra policies and procedures to protect them from (additional) Compassion Fatigue. They’re the first responders. Reward them as such. The TIC often succeeds or fails at the hands of this team.
[22] Key ingredients for trauma-informed care. Center for Health Care Strategies (CHCS), through support from the Robert Wood Johnson Foundation, 2017 [Fact Sheet]. https://www.chcs. org/media/Fact-Sheet-Key-Ingredients-for-TIC.pdf. An example from that Fact Sheet: “When patients first arrive at the UCSF Women’s HIV Program, they are greeted by someone who, like themselves, has been diagnosed with HIV. These peer clinic hosts help make patients feel welcome by reducing the stigma HIV-positive individuals often face in society.” My extra two cents: this also provides Reconnection (Phase III of most Treatment for Primary Trauma). Trauma Treatment is rarely linear. Phase II (Traumatic Memory Reprocessing) is not required for healing. Thus Reconnection (or Phase III) becomes all the more urgent and essential. This form of Reconnection too often eludes people experiencing, transitioning out of, recently out of, or otherwise with lived experience of homelessness, especially when organizations fail to provide this level of Trauma-Informed Care (TIC). On the contrary, with this intentional, comprehensive, systematic approach, they: heal more quickly from their Primary Trauma (including the trauma of homelessness); help de-escalate potentially volatile situations (both at the organization site and wherever they go) (especially when trained in Trauma-Informed Care (TIC) themselves); potentially gain skills and references to re-/enter and remain in the workforce; and often become some of the most competent and loyal members of the organization or system; and countless other benefits.
[23] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009. https://www.air.org/sites/default/files/downloads/report/Trauma-Informed_Organizational_Toolkit_0.pdf
[24] Ibid.
[25] Hersey, T. Rest Is Resistance: A Manifesto. Little Brown Spark, 2022.
[26] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006. My adaptation. The original language reads “Address,” but I recommend a more intentional, comprehensive, systematic approach that starts with “seek out,” moves to “find,” and does not cease until “eliminate.” The aforementioned participatory-observation proves invaluable here. How can a client (or staff member, even on leadership) with a particularly complex trauma history – once viewed through this Trauma-Informed Care (TIC) lens – now be viewed as an expert who can help seek out, find, and eliminate such “potentially retraumatizing policies and procedures”? How can they be rewarded for, and/or redirected toward, this solution-based, Trauma-Informed Care (TIC) practice, rather than penalized or punished for behaviors that stem from their trauma and the lack of ability to receive healing for it?
[27] Ibid. My adaptation. The original language reads “respectful,” but I recommend “Trauma-Informed.” Even at the CoC level, I have had to fiercely advocate for this, and was ultimately hired to consult on the entire Trauma-Informed system; from the creation and ongoing revision of policies and procedures, to the initial outreach, assessments, and training. This should be Trauma-Informed at every step: the assessment instrument(s) or tool(s) (for clients; for staff and leadership – I recommend the ProQOL to assess Compassion Fatigue; and for entire organizations – I recommend the Trauma-Informed Organizational Self-Assessment [footnote 28, or any of the other assessments below [footnote 29]); the assessors themselves (trained, seasoned, assessed for and healed from their own Primary Trauma and Compassion Fatigue); the timeline (allowing a sufficiently slow pace to be Trauma-Informed, both of the assessments themselves, and any required training, reporting, and/or dissemination); and much more than I can detail here.
[28] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. The Trauma-Informed Organizational Self-Assessment. In Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009. https://www.air.org/sites/default/files/downloads/report/Trauma-Informed_Organizational_Toolkit_0.pdf. My note: I especially like this one because it was one of the first to assesses Cultural Competence (aka, Diversity, Equity, and Inclusion), but, do your own due diligence to find the most Trauma-Informed Care (TIC) instrument to assess all (or more) of its recommended measures.
[29] Trauma-Informed Organizational Self-Assessments. Richmond, VA: Greater Richmond Trauma-Informed Community Network, Greater Richmond SCAN (Stop Child Abuse Now), n.d. (no date).
[30] Again, countless thousands of pages exist on providing Trauma-Informed Care (TIC), even within the specific context of homelessness. Utilize all in these footnotes. I can recommend others, or do the screening, assessments, and/or writing/revising of the policies and procedures for you.
[31] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006. My adaptation. The original language reads “Engage referral sources and partner organizations,” but I recommend that you “Engage and educate” (italics mine) “to scale up Trauma-Informed Care (TIC) to the system level.” Another example from that Fact Sheet: “The Greater Newark Healthcare Coalition (GNHHC) is a nonprofit collaborative of stakeholders committed to improving the quality of, and access to, health services in Newark, New Jersey. GNHHC is partnering with Rutgers University Behavioral Healthcare to provide trauma-informed care training to pediatric residents at Newark Beth Israel Medical Center and the staff of BRICK Academy schools. GNHCC is conducting a citywide scan of health care and social service providers to assess organizations’ trauma-informed care knowledge and competency. GNHCC will provide trauma-informed care training to organizations based on the results, with the goal of all city providers becoming trauma-informed.”
If you have any questions, feel free to reach out through the Contact form or send me an email directly.
[2] Substance Abuse and Mental Health Services Administration. Volk, K., Guarino, K., & Konnath, K. Homelessness and Traumatic Stress Training Package. DHHS. Rockville, MD: Center for Mental Health Services, 2007.
[3] Substance Abuse and Mental Health Services Administration. Practical Guide for Implementing a Trauma-Informed Approach. SAMHSA Publication No. PEP23-06-05-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory, 2023.
[4] Ibid.
[5] My note: Compassion Fatigue also has various terms to describe it. Some better and more precise. But since my credentialling is in Compassion Fatigue, by that name, and this webpage is on Trauma-Informed Care (TIC), already with too many terms to define, I will simplify this by referring to Compassion Fatigue by that name.
[6] Homeless and Housing Resource Center, Building Resiliency: A Guide for Supervisors of Housing and Health Professionals, July 2022.
[7] Johnson, K. Provider and Staff Self-Care: Promoting Staff Wellness and Preventing Vicarious Trauma and Other Work Force Concerns. SAMHSA-HRSA Center for Integrated Health Solutions. Substance Abuse and Mental Health Services Administration. Health Resources and Services Administration, 2020 [PowerPoint slides]
[8] Substance Abuse and Mental Health Services Administration. Practical Guide for Implementing a Trauma-Informed Approach. SAMHSA Publication No. PEP23-06-05-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory, 2023.
[9] Ibid.
[10] The Institute on Trauma and Trauma-Informed Care. What is trauma-informed care? University at Buffalo. Center for Social Research, n.d. (no date).
[11] Bloom, S. L. Creating sanctuary: Toward the evolution of sane societies. New York: Routledge, 1997.
[12] The Institute on Trauma and Trauma-Informed Care. What is trauma-informed care? University at Buffalo. Center for Social Research, n.d. (no date).
[13] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009.
[14] Ward-Lasher, A., Messing, J., and Stein-Seroussi, J. Implementation of Trauma-Informed Care in a Housing First Program for Survivors of Intimate Partner Violence: A Case Study. Advances in Social Work. 18. 202. 10.18060/21313. 2017.
[15] Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. Housing first: Ending homelessness, transforming systems, and changing lives. Oxford University Press, 2016.
My note: I am honored to say that I worked with Deborah Padgett and Ben Henwood when they (we) first began to demonstrate the success of Housing First. I consulted in weekly meetings, advising on outreach, engagement, interview questions, and more. I also met with executive directors of top homelessness organizations in New York City, both to learn from them about their successes and to consult for them on how to do more.
[16] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006.
[17] Ibid. My adaptation. The original language reads “providers and providees,” but I recommend both expanding and reversing that. My recommendation for the absolute best practice is: start with clients, especially those with the longest tenure; expand to staff, especially frontline, client-facing, and those with the longest tenure, in order of seniority; and then get input from leadership, which often has the highest turnover and thus the shortest institutional memory of policies and procedures (including the most Trauma-Informed Approach to particular long-term clients). I first spent time with people experiencing homelessness as an anthropologist and ethnographer; my chief methodology was participant-observation; participate, observe. Often attempts at Trauma-Informed Care (TIC) fail to do just that: participate, observe. Then implement change, based on what you heard, saw, and personally experienced from that participatory-observation. Did you feel unsafe or unsanitary using that bathroom? Did a client tell you how the building used to have a library where they could use a computer and apply for jobs? Did a case manager share how she relies on the free meals to stretch her meager pay? Did leadership win the trust of a client with a particularly complex trauma history by staying out of their office and in the public spaces where clients gather?
[18] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009.
[19] Hersey, T. Rest Is Resistance: A Manifesto. Little Brown Spark, 2022.
[20] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006. My adaptation. The original language reads “introductory,” but I expand that to recommend “paid, upon hiring, at regularly scheduled intervals, and as needed in the event of specific traumatic incidents.” Each of these adds an additional layer of Trauma-Informed Care (TIC). One thing I especially recommend: some form of paid “troubleshooting clinic,” where staff – especially frontline, client-facing – convene, in a circle, with a seasoned, Trauma-Informed expert, who reads a question that an anonymous staffer has posed (e.g., how do you get a client with Complex PTSD, or C-PTSD, ready for housing?), and uses a talking piece or some other egalitarian measure to let everyone, including the expert, ask questions and/or offer input, and then each participant receives some form of incentive for their participation (e.g., donated massages, acupuncture, yoga classes). Some of my offerings in this area include Compassion Fatigue interventions and The Homelessness Haven here in Baltimore.
[21] Ibid. My adaptation. The original language reads only “Establish,” but I recommend expanding that to include “supervise, pay extra to and/or otherwise incentivize, and heed the advice of” this team. One of the constant refrains I hear from staff who are ready, willing, and able to be the Trauma-Informed Care (TIC) team for their organizations or systems is that they are expected to do that heavy lifting without these extra policies and procedures to protect them from (additional) Compassion Fatigue. They’re the first responders. Reward them as such. The TIC often succeeds or fails at the hands of this team.
[22] Key ingredients for trauma-informed care. Center for Health Care Strategies (CHCS), through support from the Robert Wood Johnson Foundation, 2017 [Fact Sheet]. https://www.chcs. org/media/Fact-Sheet-Key-Ingredients-for-TIC.pdf. An example from that Fact Sheet: “When patients first arrive at the UCSF Women’s HIV Program, they are greeted by someone who, like themselves, has been diagnosed with HIV. These peer clinic hosts help make patients feel welcome by reducing the stigma HIV-positive individuals often face in society.” My extra two cents: this also provides Reconnection (Phase III of most Treatment for Primary Trauma). Trauma Treatment is rarely linear. Phase II (Traumatic Memory Reprocessing) is not required for healing. Thus Reconnection (or Phase III) becomes all the more urgent and essential. This form of Reconnection too often eludes people experiencing, transitioning out of, recently out of, or otherwise with lived experience of homelessness, especially when organizations fail to provide this level of Trauma-Informed Care (TIC). On the contrary, with this intentional, comprehensive, systematic approach, they: heal more quickly from their Primary Trauma (including the trauma of homelessness); help de-escalate potentially volatile situations (both at the organization site and wherever they go) (especially when trained in Trauma-Informed Care (TIC) themselves); potentially gain skills and references to re-/enter and remain in the workforce; and often become some of the most competent and loyal members of the organization or system; and countless other benefits.
[23] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009. https://www.air.org/sites/default/files/downloads/report/Trauma-Informed_Organizational_Toolkit_0.pdf
[24] Ibid.
[25] Hersey, T. Rest Is Resistance: A Manifesto. Little Brown Spark, 2022.
[26] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006. My adaptation. The original language reads “Address,” but I recommend a more intentional, comprehensive, systematic approach that starts with “seek out,” moves to “find,” and does not cease until “eliminate.” The aforementioned participatory-observation proves invaluable here. How can a client (or staff member, even on leadership) with a particularly complex trauma history – once viewed through this Trauma-Informed Care (TIC) lens – now be viewed as an expert who can help seek out, find, and eliminate such “potentially retraumatizing policies and procedures”? How can they be rewarded for, and/or redirected toward, this solution-based, Trauma-Informed Care (TIC) practice, rather than penalized or punished for behaviors that stem from their trauma and the lack of ability to receive healing for it?
[27] Ibid. My adaptation. The original language reads “respectful,” but I recommend “Trauma-Informed.” Even at the CoC level, I have had to fiercely advocate for this, and was ultimately hired to consult on the entire Trauma-Informed system; from the creation and ongoing revision of policies and procedures, to the initial outreach, assessments, and training. This should be Trauma-Informed at every step: the assessment instrument(s) or tool(s) (for clients; for staff and leadership – I recommend the ProQOL to assess Compassion Fatigue; and for entire organizations – I recommend the Trauma-Informed Organizational Self-Assessment [footnote 28, or any of the other assessments below [footnote 29]); the assessors themselves (trained, seasoned, assessed for and healed from their own Primary Trauma and Compassion Fatigue); the timeline (allowing a sufficiently slow pace to be Trauma-Informed, both of the assessments themselves, and any required training, reporting, and/or dissemination); and much more than I can detail here.
[28] Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. The Trauma-Informed Organizational Self-Assessment. In Trauma-Informed Organizational Toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation, 2009. https://www.air.org/sites/default/files/downloads/report/Trauma-Informed_Organizational_Toolkit_0.pdf. My note: I especially like this one because it was one of the first to assesses Cultural Competence (aka, Diversity, Equity, and Inclusion), but, do your own due diligence to find the most Trauma-Informed Care (TIC) instrument to assess all (or more) of its recommended measures.
[29] Trauma-Informed Organizational Self-Assessments. Richmond, VA: Greater Richmond Trauma-Informed Community Network, Greater Richmond SCAN (Stop Child Abuse Now), n.d. (no date).
[30] Again, countless thousands of pages exist on providing Trauma-Informed Care (TIC), even within the specific context of homelessness. Utilize all in these footnotes. I can recommend others, or do the screening, assessments, and/or writing/revising of the policies and procedures for you.
[31] Fallot, R.D., & Harris, M. Trauma-informed services: A self-assessment and planning protocol, version 1.4. Community Connections: Washington, D.C., 2006. My adaptation. The original language reads “Engage referral sources and partner organizations,” but I recommend that you “Engage and educate” (italics mine) “to scale up Trauma-Informed Care (TIC) to the system level.” Another example from that Fact Sheet: “The Greater Newark Healthcare Coalition (GNHHC) is a nonprofit collaborative of stakeholders committed to improving the quality of, and access to, health services in Newark, New Jersey. GNHHC is partnering with Rutgers University Behavioral Healthcare to provide trauma-informed care training to pediatric residents at Newark Beth Israel Medical Center and the staff of BRICK Academy schools. GNHCC is conducting a citywide scan of health care and social service providers to assess organizations’ trauma-informed care knowledge and competency. GNHCC will provide trauma-informed care training to organizations based on the results, with the goal of all city providers becoming trauma-informed.”
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