Trauma-Informed Counties — Newsletter Content

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma-informed care is an approach that “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 re-traumatization.” NCACC and organizations participating in the TICP project are committed to being trauma-informed, and this series will dive deeper into what it looks like to become more trauma-informed, both for our community members and for staff. If you want to start diving deeper now, SAMHSA and traumapolicy.org are great places to begin.

Activities/reflection questions:

• What do you know about trauma-informed care already? What do you wonder about it?
• What do you currently do in your role that you think may align with trauma-informed care, even if you didn’t call it that before?
• How might shifting from “What’s wrong with you?” to “What happened to you?” change the way you interact with clients or colleagues?

In the context of mental health, trauma can be defined as:

• An actual or perceived threat to an individual or their loved one’s life or their psychic or bodily integrity, during which…
• The individual’s coping capacity and/or ability to integrate their emotional experience is overwhelmed
• Which results in an injury that changes the way the brain functions, causing psychological, cognitive, and neurophysiological impairment.

Traumatic experiences involve profound feelings of danger and lack of control or agency over one’s own life or circumstances. Some people who have had traumatic experiences struggle with longer-term traumatic stress, which affects areas of the brain tied to regulating emotions, storing memory, and telling the difference between danger and safety. This means they may have strong reactions to everyday situations or struggle with focus and trust. If you want to learn more, here are some great resources: Trauma and the Brain; What is Trauma? with Bessel van der Kolk; What is Trauma? from the Trauma-Informed Care Implementation Resource Center.

Activities/reflection questions:

• Watch Trauma and the Brain together. How might knowing more about the brain’s response to trauma help you stay compassionate and effective during stressful interactions?
• Watch What is Trauma? together. In pairs, share one insight that surprised or resonated with you.
• How might your own understanding of trauma be shaped by your cultural background, training, or life experiences?
• Review this handout. How might the impacts of trauma affect your work with clients and/or colleagues?

Trauma can affect people’s emotions, cognitions, and behaviors and sometimes makes the ways they respond to everyday situations or interactions seem confusing or challenging. People who struggle with post-traumatic stress are often very sensitive to perceived danger, threats, or lack of control over their circumstances. Service seekers who have experienced trauma may perceive our organization or services as dangerous, threatening, or overwhelming. They may appear angry, unmotivated, overly compliant (disempowered), or shut down, even when we are trying our best to help. They may struggle with memory, decision-making, or trusting others. When these behaviors come from trauma responses, they generally aren’t conscious decisions people are making, but rather adaptations that helped keep them safe during past threatening situations. Learn more about how trauma shows up in adults generally, in young children, and in both individuals and communities.

When we understand that some behaviors we label as challenging may be related to trauma histories, we can respond with greater empathy and effectiveness. A trauma-informed approach helps us ask, “might this person be feeling unsafe or overwhelmed?” rather than assuming bad intent or lack of engagement. This mindset shift, along with proactively promoting safety and empowerment for community members, can de-escalate tense situations, build trust over time, and help participants make the most of the services available.

Activities/reflection questions:

• What kinds of client behaviors are hardest for you to respond to with empathy? Why?
• What internal reactions do you have when someone shuts down, escalates, or avoids services? 
• How do you stay grounded when a client’s response feels personal or frustrating?
• In pairs or groups, brainstorm three challenging client behaviors and reframe why a client might exhibit each behavior using a trauma-informed lens.
• Analyze a common client-facing form or process and identify where trauma responses might be triggered.
• Write about or discuss a time you changed how you responded to a client after learning more about trauma and what difference it made.

Supporting people through trauma can take a toll on those providing care. Secondary trauma, also known as vicarious trauma, is when someone experiences the symptoms of traumatic stress from witnessing or learning about other people’s trauma, and it is common among social service providers. You may find yourself feeling emotionally drained, irritable, numb, overwhelmed, or burnt out. These are not signs of weakness. They’re signs that you are empathetic and connected to the people you interact with. Learn more about what secondary trauma is, how it can affect you, and some ideas for how to respond to it.

Burnout can happen when the emotional demands of work exceed the resources we have to cope, especially when we’re working in high-stress environments with limited support. NCACC and organizations participating in the TICP project recognize this risk and values promoting a culture of care for staff, not just for community members.

To address both secondary trauma and burnout, we are actively working to leverage the strengths and address the needs that staff identified during the Trauma-Informed Counties in Practice assessment process. Managers may also be interested in this resource about trauma-informed support and supervision. 

Taking care of ourselves and our staff is not selfish; it’s essential for doing this work well and sustainably.

Activities/reflection questions:

• Have each person create a personal stress warning signs list and a plan for 2-3 “self-care in the moment” strategies they think would be helpful for them. Supporting questions:
  • What are some signs that you’re starting to feel overwhelmed, burned out, or emotionally depleted?
  • What supports, personal or organizational, help you manage stress in this work?
• What is one belief you hold about “toughing it out” that might be getting in the way of your own wellness?
• In pairs or small groups, have each person share one wellness support strategy that works for them.
• In pairs or groups, identify 1-3 ways your organization prevents burnout and/or supports staff self-care well, and 1-3 ways your organization could do better.

So far in this series on trauma-informed care, we’ve gotten a basic definition of trauma and trauma-informed care and learned about how trauma can show up for participants and staff. Now, let’s shift to how to become more trauma-informed. SAMHSA defines six principles of trauma-informed care:

• Safety – physical, emotional, and psychological dimensions.
• Trustworthiness and transparency – following through, protecting confidentiality where appropriate, and proactively sharing information about what is or is not possible and why
• Peer support – opportunities to connect and work with people who have had similar experiences
• Collaboration and mutuality – including sharing power and decision-making
• Empowerment, voice, and choice – supporting participants and staff to make their own choices and inform how programs look
• Cultural, historical, and gender lens – recognizing that these identities and dynamics shape how people experience the world, our organization, and our services

These principles can inform the way we make decisions in our work and in our organization and are just as important for decisions that affect staff as they are for the way we provide services to participants. In the upcoming installments of this series, we’ll dive deeper into each of the six principles. For more detail on the principles, see page 11 of SAMHSA’s “Concept of Trauma and Guidance for a Trauma-Informed Approach” document.

Activities/reflection questions:

• In small groups, choose one principle that is currently affecting in your role and give an example of how.
• Which of the six principles feel like they naturally fit or show up in our work already? Which one(s) are most challenging?
• In this case study, brainstorm one way that each of the six principles could have been applied to improve the situation.
• The principles of trauma-informed care can be applied to many dimensions of our work: human resource policies, relationships, case management, administrative processes, physical spaces, partnerships, program or service development, public policy advocacy, community engagement, etc. Pick one principle and brainstorm ways it can show up in 3-5 dimensions of our work.

Trauma is an actual or perceived serious threat to an individual or their loved one’s life or psychic or bodily integrity. It involves a profound sense of danger, and people who struggle with post-traumatic stress are hypervigilant about potential threats. In a sense, safety is the opposite of trauma. To be trauma-informed, we have to work to make our services and our organizations be and feel as safe as possible – physically, emotionally, and psychologically. 

Safety is the foundation of trauma-informed care. People can’t engage, learn, or heal if they don’t feel safe. This includes physical safety (e.g., secure spaces, clear exits) and emotional safety (e.g., respect, predictability, confidentiality, noncoercion, nonjudgment, etc.). Inconsistent or chaotic environments can be triggering for both clients and staff. Creating a sense of safety requires not only policies and procedures, but also daily practices that foster trust and calm. Learn more about ways to make physical spaces feel safer through trauma-informed design.

Activities/reflection questions:

• What aspects of our physical or digital spaces could feel unsafe or unwelcoming to clients?
• How do I personally help create emotional safety for clients or coworkers?
• In pairs, discuss a time when you felt particularly safe (physically or emotionally) in a professional setting and why.
• Walk through your common space, client-facing spaces, or your personal work space and identify one thing that supports or detracts from physical, emotional, or psychological safety.

Many traumatic experiences, such as violence, abuse, or neglect, occur in the context of interpersonal relationships. Sometimes, people experience trauma at the hands of a person they should have been able to trust. Thus, people who struggle with post-traumatic stress often are cautious about who they trust. Trauma-informed approaches aim to prioritize building trust over time through consistency, follow-through, and transparency. Transparency means explaining what’s happening and what options are available and why. Transparency is important regardless of whether we can offer someone exactly what they want. For clients with histories of broken trust, this clarity is vital. The same applies to staff: transparent leadership and communication help build confidence, reduce anxiety, and create a culture where people feel informed and valued. Learn more about transparent communication and building a culture of trust.

Activities/reflection questions:

• Identify one area where clients or staff often feel unclear or left out of the loop.How could communication around this area be improved through better consistency, follow-through, or transparency?
• With a colleague, name one work process you think could be made more transparent.
• When do you typically find yourself explaining to your colleagues or clients apolicy that creates a barrier or a “no” to their requests? Is there an opportunity to explain it earlier on so that colleagues or clients are better prepared and know what to expect in advance?
• Think about a restrictive policy or “no” that you sometimes need to communicate to others in your role. In pairs, practice explaining it in a way that is honest, kind, and grounded in our organizational values.

Strong, supportive relationships are critical to coping with potentially traumatic events and to healing after trauma. Shared experiences can be a powerful source of connection in relationships. Peer support involves creating opportunities for people with similar lived experience to connect with and support each other. For people who have experienced trauma, connecting with others with similar experiences offers validation and reduces shame. In trauma-informed workplaces, organizations create an environment in which staff are encouraged to lean on one another, celebrate successes, and talk openly about challenges. Learn more about trauma-informed approaches to peer support.

Activities/reflection questions:

• Share one example of a time a coworker’s support made a difference in your day.
• In pairs, do a 3-minute “mutual check-in”: one challenge and one celebration this week.
• How do we support people to feel comfortable telling their stories without pressuring them toward disclosures that aren’t necessary for our work or that they may not want to share?
• What kinds of shared lived experiences might be relevant for our clients? What opportunities already exist for them to connect with and support each other around these experiences? How might we be able to facilitate more peer support among clients in these areas?

Trauma-informed care shifts power dynamics to level power differences between staff and participants, as well as among staff in different roles. Being trauma-informed involves engaging in genuine partnership with others, rather than “fixing” or deciding what is best for them. Collaboration requires honoring everyone’s knowledge and role, whether it’s a participant, a coworker, or someone in a different department. Mutual respect and shared decision-making create environments that foster supportive relationships where people feel valued and invested, which leads to better outcomes and stronger teams. Learn more about tools for collaborative goal-setting with participants, involving community in program design, and inclusive organizational decision making, including frameworks like RAPID decision making.

Activities/reflection questions:

• In what situations do you tend to make decisions without collaboration? What is it about these situations that makes you less likely to collaborate?
• How can you help clients or coworkers feel more like partners, rather than recipients?
• What power dynamics are present in our team or service relationships, and how do we address them?
• Name one recent decision where you invited input and one where you could have.
• Watch the RAPID decision making video. In your work team, think about one kind of decision your team often makes. Map how you all have made decisions previously, using the RAPID framework. Are there any adjustments that could be made to make the decision-making process more effective?

Trauma often involves a loss of control over one’s safety, circumstances, and decision-making ability. For example, car crashes often involve losing control of a vehicle or being hit by another vehicle, and intimate partner violence is a pattern of one partner exerting power and control over their partner.

Thus, for many people who have experienced trauma, one key to healing is restoring theirsense of agency over their decisions, circumstances, and ultimately, their own safety. In service provision, that means offering meaningful choices, such as how to receive support, when to meet, or how to be addressed, and letting participants choose their own goals and paths, even if we don’t agree with them. Empowerment also means building on people’s strengths and capacities, not just focusing on what’s “wrong.” This kind of empowerment can happen through everything from providing options for small choices like where to sit, to identifying and leveraging participants’ strengths, to allowing participants to choose for themselves whether, when, and how to engage in services. 

Supporting empowerment, voice, and choice for staff members is also crucial for creating a trauma-informed workplace. Organizations and leadership can empower staff through providing professional development opportunities, seeking and integrating staff input into decisions that will affect their work (for example, using the RAPID framework), creating room for staff autonomy while still meeting organizational expectations, and creating a culture of regular, multi-directional feedback.

Activities/reflection questions:

• List 5-10 ways you can regularly provide clients or your supervisees with choice and agency. These can be small ways, like offering multiple options for where to sit, or more significant ways, like how to adapt programs.
• What gets in the way of providing real choice for clients or supervisees? Are there ways of getting around or removing these obstacles (while still complying with regulations, upholding organizational values, and meeting other requirements)?
• Think about a time you’ve felt empowered as a staff member or as part of a team at work. What decisions did you have room to make, and what decisions or parameters were made by others? What were the expectations of your work, and how did they affect your feelings of empowerment?
  • How might you be able to apply these insights to your interactions with clients or coworkers?
• Think of a client or coworker behavior or characteristic that’s been challenging for you. How might that behavior or characteristic have served people in the past? Can you reframe it as a possible strength (e.g., “stubborn” might also be “persistent,” “distrustful” might also be “discerning”)? How could this strength be useful in your service provision or professional collaboration?

Trauma doesn’t impact everyone equally, and different people heal in different ways. Experiences of racism, sexism, colonization, ableism, and other systemic harms compound trauma and shape how people interact with services. Trauma-informed care requires both cultural responsiveness and cultural humility, or a commitment to listening, self-reflection, and challenging our own assumptions. 

According to SAMHSA, a trauma-informed organization “actively moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, religion, gender identity, geography, etc.); offers access to gender responsive services; leverages the healing value of traditional cultural connections; incorporates policies, protocols, and processes that are responsive to the racial, ethnic and cultural needs of individuals served; and recognizes and addresses historical trauma.”

Staff should have a working understanding of the various communities they serve, including historical traumas that have affected each community and what those histories mean to community members. Building collaborative and mutually beneficial partnerships with culturally specific organizations in the community can be very helpful. These organizations can help providers learn more about common values, strengths, and needs within each group, while recognizing that each person is an individual and brings their own experiences and preferences. These partnerships can also help inform the way we design our services and help us learn about existing culturally specific resources that we can refer our participants to.

Workplaces can also be responsive to cultural, historical, and gender issues among staff members by having and enforcing anti-discrimination policies, addressing issues faced by marginalized staff members, and supporting staff through balancing life demands that are typically gendered, such as through paid parental leave and family medical leave.

Activities/reflection questions:

• Reflect on one identity or lived experience that shapes how you do your work.
• The facilitator should choose 1-3 flyers, forms, or policies from the organization. Assign one each to small groups for them to reflect on: Does this documentassume anything about the users’ culture, gender, or ability?
• Read page 11 of “CHANGING MINDS: Preventing and Healing Childhood TraumaState Policy Guide.” Although this document was originally written for state governments, the information can be applied to many other kinds of organizations. How has your organization engaged in activities similar to those listed on page 11? How might engaging in these kinds of activities in the future help your organization serve the community more effectively?
• What culturally specific organizations exist in our community that serve our clients? How do we collaborate with them already? How could we establish or strengthen partnerships with them?
• How does our workplace currently support staff around cultural, historical, or gender issues? What are 1-3 ways we could do better?

Trauma-informed care isn’t just something individual staff do; it’s a collective, organization-wide approach. The goal is a workplace where both staff and clients can heal, grow, and thrive. Your organization has participated in Trauma-Informed Counties in Practice, an in-depth assessment to see how we can become more responsive to trauma. The program involves a long-term, intentional organizational and cultural shift that changes how we work because of what we know about trauma. This process requires integrating knowledge about trauma into every aspect of how we operate: policies, practices, environments, and relationships, both internally and with participants. 

Shifts toward a more trauma-informed approach can happen across all levels, and NCACC and organizations participating in the TICP project are committed to getting your input on what works and what will be sustainable, as well as supporting you in implementing any shifts that are planned. 

Becoming trauma-informed doesn’t mean doing everything at once. It means starting where we are, listening to our community, and making thoughtful, sustainable changes that reflect our values. It’s about creating a culture where both participants and staff feel respected, supported, and able to thrive.

Activities/reflection questions:

• Group discussion: If our organization continually works to be trauma-informed, how might clients’ lives be improved? How might staff experience be improved? 
• Select one policy or procedure to review as a group and identify ways it could be strengthened, using the six trauma-informed principles as a guide. Staff can work in small groups first and then share their ideas.
• How can our organization best support internal capacity to continually become more trauma-informed? 
• How can we work with our organizational or community partners to sustain community-wide trauma-informed approaches?