Last time on OnTopic, Trauma-Informed Care Coordinator Scott Webb talked to Rick about the Six Principles of Trauma-Informed Care, a new approach to professional engagement that involves peering into a complete picture of any individual’s entire life and the traumas that have shaped their behavior since. But how does an organization start to implement trauma-informed care? What are the best practices? And can any organization simply start on a whim, or is trauma-informed care limited to healthcare and educational workplaces? The answers might just surprise you.
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OT Ep. 8 Transcription.txt
00;00;09;02 – 00;01;12;02
Welcome to OnTopic with Empathia. I’m your host, Rick Hoaglund. Today on this show, we’re following up from the last episode with Scott Webb in which we discuss Trauma-Informed Care. Some are calling it the new workplace. But how can we implement it at our own organization? As the distinction between home life and work life becomes less defined, organizations have found it difficult to provide support to their employees and their customers. In March of 2022, the Harvard Business Review stated that a trauma informed organization is one that operates with the understanding of trauma and its negative effects on the organization’s employees and the communities it serves. And it works to mitigate those effects. In other words, it’s good for employees, it’s good for business, and it’s good for customers. You can find part one of this conversation on our website, Empathia.com. Hi, Scott. Thanks for sitting down with us again!
00;01;12;05 – 00;01;14;24
Well, thank you, Rick. Appreciate being here today.
00;01;14;27 – 00;02;33;03
Trauma is more common than you might think. A 2018 study published by Boston University states that a general Population Survey conducted in 24 countries around the world showed that 70% of respondents experienced a traumatic event. 30% had experienced four or more events. The National Institute of Health reports that 7% of American adults report having a major depressive episode. 19% of Americans say they’ve suffered from anxiety at some point in their lives, and 3.6% of Americans are currently living with post-traumatic stress disorder. An estimated 26% of Americans – aged 18 and older, about one in four adults – suffers from a diagnosable mental disorder. That’s according to Johns Hopkins Medicine. So, Scott, you mentioned in the first part of our discussion, and I know we’re kind of backtracking a little bit, but I think we probably should bring up the six principles of better informed – now, why should we be focusing on that? We’re going to be talking about how businesses implement and it can be implemented in educational settings and other settings as well. But why do we need to think about these six principles? And if you could kind of review what those are, again, that would be great.
00;02;33;05 – 00;06;40;06
Yeah, the six principles come from the Substance Abuse and Mental Health Services Administration, SAMHSA, and there used to be five, but the added six and they’re really key. And I in my training, I talk about them a lot because I think for most organizations they present at this seems to resonate for most of them. But the first one is safety and you think about these six principles. This would be the where people are coming from like trauma survivors. They are coming in and again, people doing good work in every facet of our work world. They may or may not be aware that they have a trauma history. They may have normalized the trauma. They may think, you know, I just had a strict upbringing, no big deal. But when you hear the stories, you’re like, oh, my goodness, that’s horrible. But they’ve normalized it and they’ve minimized it and they don’t think of it’s that big of a deal. But if you were to look at their behavior, you could begin to see some connective tissue between what they’ve been through and what they’re presenting in the workplace. So safety is really important because a lot of trauma survivors do not feel safe in a lot of situations with people or situations. So psychological safety is really important and that’s been a issue that’s been a big conversation in the work world post-pandemic because people are not feeling necessarily very safe. So how do you create this psychological safety where you feel like you can speak up and you can share, you can say I’m struggling and that you’re not going to be reprimanded or thought less of or judged or blamed or ridiculed. Also, physical safety. And what does that look like in your work world? The other one is trustworthiness and transparency. You know, how do you build trustworthiness and how do you appear to be a trustworthy organization to your staff? What do the leadership have to do to create an environment where people feel like there’s some trustworthiness, that they they can actually feel like the company has their best interests in mind? So that’s one piece. Transparency that also is being very clear and consistent in your communication to your staff about what’s going on, not holding anything back, because we all know that in the absence of healthy, good information, gossip is going to flourish and gossip is hearing something you like about somebody you don’t. So it’s not a good thing. We want to make sure we’re not doing that. The other ones, peer support. How do you foster that in an organization where people can come to each other and they can support and help each other if they’re having a rough day? Or how can we be more mindful of our coworkers who may be struggling, reaching out, recommending the EAP, recommending that they get help? Collaboration and mutuality is another one is. But this collaborative nature where we’re kind of flattening the hierarchy and it’s kind of like we’re all in this together and we all have some mutual stake and saying things and we’re collaborating, we’re sharing ideas, and the leaders don’t think that they have all the answers that sometimes the answers lie with their staff. And empowerment, voice and choice is another one because a lot of trauma survivors have learned through their life that they don’t have a voice, so they disappear in meetings or they don’t feel like they feel safe to share anything. And they have some really good ideas, but they feel like they don’t have permission to share that because they don’t feel safe. There’s that other principle again, having a voice, giving people a choice. And then the other one is cultural, historical, gender issues. And again, that’s becoming more and more of an issue, especially in 2023. And I’m doing some trauma informed supervision training where organizations have wanted me to talk more about diversity, equity and inclusion. They want to talk more about implicit biases and what does that mean in a trauma informed environment? What would that look like? So all those six principles are there. You can certainly boil them down into something more basic. I think one of the things I’ve read is you could really boil them down into three big ones, like acknowledgment. I want to be heard. People want to feel like they’re heard. They have a voice. They want to be heard. Support is another one. You could boil it down to support. Can I get the help that I need if I’m struggling? And then the other one is trust. Will I be treated fairly? So you could boil those down into three basic ones as well. But those six principles, that’s always been for me, the ones that I challenge organizations to look at and say, okay, what would that look like, sound like and feel like? How would you put those into action? Some of the training I do around the state really, we spend some time in my training actually getting into work groups and exploring that.
00;06;40;18 – 00;06;53;20
So if I say this is exactly what we need, how do I go about implementing this? I mean, is it just me making policy, just saying this is the way we’re going to do it from now on? Or what does a roadmap sort of look like?
00;06;53;23 – 00;08;17;27
Taking those six principles and actually using them in an implementation process? For instance, instead of you as the leader writing out all the policies and procedures, you would have an implementation team made up of a cross-section of the organization and even if you don’t have customers in my world, I work a lot with behavioral providers. I’ll say some of your clients should be on this team because they have views and ideas and perceptions that you have stopped seeing and hearing from being in this culture so long, so having that outside input. But they the team would be working on looking at their existing policies and procedures and asking really good trauma informed questions like does this align this, this mission of vision, Does this align with any of these values? How good are we at doing make it happen? Is it just a nice little poster on the wall that we look at and point that, but we don’t really live it out? And I challenge organizations that have had me come in after a training and I’m doing some technical assistance. I’ll point to their their mission a vision and say, tell me about that. How are you doing with that? Be honest. What’s going on with that? So that’s always interesting to have those conversations about how to actually do it. But it’s it’s a collaborative process. There’s one of those values against collaboration. It’s about bringing everybody together, all having a voice, sharing, collaborating and coming up with policies that are going to reflect the new reality of being trauma informed, trauma responsive.
00;08;18;07 – 00;08;38;25
So for companies that decide to do this and they go ahead and say, yes, we’re going to do it, we’re going to put the adequate resources we need into this, what are the pitfalls? Like what should they be watching for so that it seems like this is a program that could be very successful, but it also could fail. What are they watching for to make sure that they’re not going down the wrong path?
00;08;39;11 – 00;10;35;10
There’s the people barriers and there’s the non people barriers. So it’s like resources having initiative, fatigue. You’ve got a lot going on right now and we really have time to spend the time to do this. That could be a big barrier because you’re trying to people are tired, they’re exhausted. They’ve gone through a lot of changes already. And now you’ve got one more thing you’ve got to be working on. The people thing to me is the most interesting because I’ve had conversations with organizations who have pulled me in and they’ve said, We’re ready to go. We’re all on board. But we have this one director and she’s not on board. She thinks trauma informed care is a bunch of garbage. So is that going to be a problem? And I say yes, because this person has positional authority and she could be an active saboteur of the efforts. So it’s really important for organizations to know that if they’re going to go down this road, you need to have the right people in place and you want to be bringing in the right people. When you’re hiring. You want your hiring practices to reflect the fact that you’re going to be wanting people coming in that are accepting of this trauma informed culture and that they’re going to embrace it and champion it, and that our people that are sort of. Yeah. Or actively opposed because that’s going to be a problem. So there are pitfalls, there are barriers going too fast. Could be another one or thinking that it’s if we just do this implementation, this one time thing, it’s we’re done. This is a process. This goes on and it’ll always go on. You never really arrive because you’re baking this into your culture. It’s like we’re constantly reevaluating, reexamining, how are we doing? And just having this team come together and just ask really hard questions, How are we doing on this? Are we slacking off in any one area? What do we need to be doing differently? And that’s okay because that’s like continuous quality improvement and most organizations get that. And if you just understand that trauma informed transformation is like that, that might be a little bit easier.
00;10;35;21 – 00;10;54;24
Is this a kind of a process where you can set goals according to a timeline, or can you do goal setting? You know, if you’re looking at a typical project management cycle, you might have, you know, at this particular point, we should be here, we should be here, we should be here. Can you do that when you’re implementing trauma informed care?
00;10;54;27 – 00;11;55;24
Yeah, I’ve seen organizations do that. They’re modest goals, but they’ll set goals for themselves or they’ll put out a timeline where they want to be at certain points, knowing that they may or may not get there. But it’s like it’s always good to have a strategic approach to this. And the one thing that I’ve wrestled with as a trauma informed expert air quotes, there is no one way to go to become trauma informed. There is no recipe I can give you or a formula that will do it. It’s really about how do you take those six principles or whatever ones you want to create on your own, or a variation of what I’ve talked about and actually make those come to life and taking it one step at a time. I usually tell people, if you’re going to start with one goal, it be work on safety. Start with safety. You start creating more psychological safety in your workspace. You’re going to be touching all those other principles in some way. To me, that’s the foundational one. So if you’re going to set a goal, be how do we create more psychological safety and what are the mile markers you want to hit along the way? That’s up to the organization. What works for them?
00;11;56;05 – 00;12;12;09
It seems like there is some low hanging fruit, so even companies that may not want to do this as a traditional program with lots of resources and things, at the very least they can look at their policies and procedures and the standards that they use when they do business right?
00;12;12;11 – 00;13;35;17
Absolutely. Yeah, I’ve I’ve had organizations, they start with a gallon of paint. They just repaint the inside space like they have this institutional green entryway and they want to make it more welcoming. So they try to figure out what would be a really comfortable space to step into given what we have to work with. That’s low hanging fruit. Waupaca County, they had this long hallway. They used to take kids down from their Child and Family Services section, so they had an artist come in and she painted this beautiful jungle mural all the way down the hall. Then they had these little ladybugs hiding, and they would tell the kids who are scared, can you count how many ladybugs are going down the hallway? Now, that wasn’t a huge, huge expenditure, but it was really, really important and it was something that really started to communicate to the rest of the staff and to the clients that we’re really serious about changing the way that we do our work and we want this to be a safe space to come into. For your kids to come in to this is scary stuff that we’re dealing with. So in the policy procedure review, you can certainly do that. I worked with one organization. They were looking at one of their form letters from H.R. that they gave to employees who were on unpaid leave for something that they had done some infraction. And when they looked at that through the trauma informed lens, they kind of went, oh, my goodness, this is horrible. We need to really change the language on here. So that was a big project, but didn’t cost a lot of money except for time to actually go through it, review it and wordsmith it. But the low-hanging fruit pieces can have immediate impact.
00;13;35;22 – 00;13;46;11
And then I would guess the next thing might be some of the cultural adaptation to what you’re doing. So how you supervise people, for instance, how how would that change?
00;13;46;14 – 00;14;54;07
Well, I think that if you’re a supervisor, one of the things you have to do is you have to be willing to do some mirror work. Trauma informed shifting is lens work. You’re looking at the world through a different lens, but there’s also mere work that has to be done where supervisors really need to be looking at themselves, their supervisory style. How are they coming across? Are they open to feedback? Are they taking the time to meet with their staff on a regular basis to check in? How are you doing? A lot of supervisors tell me I don’t have the time to do that. I’m too busy putting out brush fires, which tells me that they’re reacting to things, which is a trauma organized organization, not a trauma informed one. But I think that having that human touch and being compassionate and connecting with people and just seeing how things are going, that can be very instrumental for them because they can learn about things going on in the organization that they may not always hear about, may not get to their level, but it’s also communicated to the employees. I care about what you think. I care about what’s going on with you, and I am invested for you to being the best you can be. So I think that’s important to have that take the time to do that.
00;14;55;00 – 00;15;12;11
So if I’m a supervisor and I want to adopt these principles, whether or not my company believes in the trauma informed care model or not, but I do. So I want to implement these. What are some of the best practices? I mean, you brought up some look at yourself. Is there anything else I should be doing?
00;15;12;14 – 00;16;42;01
I’m going to tell a quick story, if that’s okay. I have a colleague who used to work at a psychiatric hospital and they had the most violent patients in the state working there. And she came in as a nursing supervisor. And one of the things that she did, she saw a lot of violence going on on the unit files between patients and staff is she taught all of them how to communicate in a nonviolent way. She used Marshall Rosenberg’s nonviolent communication, but she was trained, retrained and re-re-retrained her staff on how to do these four steps. It’s O.F.N.R., making observations, not judgments, connecting feelings with the needs of people, and then making a request, not a demand. And she had to teach their staff how to do that. Long story short, in one year she reduced the violence on that unit by 50%, five zero in three years. It was down 90%. And when nurses used to flow through her unit, they didn’t want to leave because it was so chill in there and so safe. And there wasn’t a code being called in a takedown every half hour. So it really brought the emotional temperature down and the patients began to call the staff up. That was a judgment. You judge me instead of, you know. So they were being instrumental in helping everybody stay accountable to this. So that’s one example where a supervisor looked at communication in the words that we use as a means to change the emotional atmosphere in the workspace. And that is also something that’s very worthwhile to look at that because we tend to use jargon we we might not even be aware of how we are unintentionally tearing people down or triggering them rather than building them up and supporting them.
00;16;42;03 – 00;17;03;07
So I can see how that would work in certain positions, especially like health care. It would be huge in health care. How does that work? And I would guess the same principles would also work in an educational setting. I’m a teacher. I teach either you could even say university level or you could say grade school. To be honest, how does that look in an educational setting.
00;17;03;10 – 00;19;19;19
Using the same principles, like you said, it’s having the school administrators, the principals, all the leaders adopting those same principles with the staff. And then what do the staff do to help students who are coming in and they’re disregulated. And the only way that a disregulated child is going to get regulated is if they have regulated adults around them. So we need to be aware that teachers need to be aware of how to ground themselves when they’re in fight, flight, or freeze? How to do that, some of those real basic skills. And then what do you do with the kiddos who are acting out and can we be proactive rather than reactive? A lot of times schools will deal with the child that comes in and they’re not even aware that they’re coming in and fight, flight, or freeze. Something happened before they got to school and so they’re tearing the room apart or they’re just disruptive or violent. The trauma informed school would be very much aware of. These kids may be coming in from places that are not healthy in their family systems. And what can the school do to kind of head that off at the pass? I’ve heard stories of kids. One child, he was having a hard time regulating himself in the school. So the trauma informed school said, what can we do to help this young man stay regulated when he starts to escalate? Well, his dad had passed away and he was very close to his dad. So they put dad’s t shirt in a Ziploc bag. And so when the child began to escalate, that staff would be tuned in to that because they were a trauma aware, they knew where this was coming from. This child’s having a hard time regulating themselves. They give him that shirt and he would smell that. He would actually bring himself back down again to baseline. So those are some real world examples that I’ve heard of where schools are trying to be proactive rather than reactive and helping kiddos stay safe in high schools. It’s like, how do you help de-escalate a high school aged student who is also losing control and what does that look like? You have to have a teaching buddy commanders are there. What kind of system do you have to bring it help de-escalate? Is there restorative justice practices going on in the school? Some schools are looking into doing that more and more. This restorative, that’s also a trauma informed intervention. So the good news is conversations are shifting and schools are becoming aware of and interested in trauma informed transformation within their buildings and having access to mental health services too.
00;19;19;21 – 00;19;44;10
So I could imagine a teacher or some kind of instructor, actually probably anyone in the administrative role as well in a school system may need to use this on themselves because you talked about fight flight or freeze. When things start escalating, I would think their bodies are doing the same thing. They need to be able to regulate themselves as well. Are there any techniques within trauma informed care that they should be using?
00;19;44;12 – 00;20;45;04
You could actually go on the Internet and find volumes of information on grounding techniques, but you could do anything from rubbing your hands briskly and then putting them on your forehead or doing some mindful breathing like four, seven, eight breathing or square breathing. You could do a lot of different things to stay grounded. What’s important in a trauma informed school or any environment is that there is a culture of wellness and self-care that should be communicated and championed at every level and role model by the leadership. I heard of one school where you could walk up to any teacher and say, I’d like to see your power plan. So they’re on their lanyard. They pull out their power plan, which is their own way, that they’re going to stay grounded and they were going to stay in their own wellness plan, if you will. And that’s something that is important to think about in trauma informed practices, having this wellness. And when I do training around trauma informed care and I talk about wellness, I always talk about the usual things we always talk about. But I also mentioned setting healthy boundaries and assertive communication. We often don’t think of well as being that.
00;20;45;06 – 00;21;09;18
So when we’re putting together that we’ve said, okay, we’re going to do this and we’re going to put together a group and this group is going to help us do all of this stuff. I mean, that’s just the beginning. That’s the beginning piece. Who’s on this group like you talked about at one point, a customer being on their group, but from your own organization, who who needs to make up this particular group that’s going to help do the implementation of this program?
00;21;09;20 – 00;22;20;08
I would think it should be a mixture. So there should be somebody from leadership should be on that, maybe not top top level, but a leader should be involved in it. I think you should have somebody who’s really good with numbers, a data person. So in my world, being a psychotherapist, I would not be me. So I’m terrible at math and numbers, but you want to have somebody who’s really good at the data collection and creating instruments and other means to collect data to kind of see how are we doing along some of these goals that we’re trying to implement, how is it working? But having just champions who are going to be committed to it and not being volun-told you have to be on this committee because they’re not going to show up for the meetings. And I’ve seen that firsthand. The groups get too big. You should have no more than maybe six people in an implementation team, but they should meet on a regular basis. I’ve seen some organizations create subcommittees like you’re going to be training in development and you’re going to be policy and procedure and you’re going to be they go away and do their own work and they come back and report out to the larger group what’s happening. I’ve seen different versions of that. But ideally you want an implementation team that is committed for the long haul because this is going to be a 4 to 6 year process just to get it implemented, knowing that you’re never going to arrive, that you’re just it’ll take that much time to get into full implementation.
00;22;20;10 – 00;22;38;10
Well, thank you very much. Is there anything you’d like to add either from our last conversation or this conversation that we haven’t covered? Any advice for those people? Is there any thing that you could put in their toolkit to help them if they decide to use trauma informed care principles going forward?
00;22;38;13 – 00;23;23;11
Well, I could do a humblebrag and just talk about the listserv that I managed through DHS. I just dropped one yesterday. What I do is I curate during the month all the latest information on ACS trauma, trauma Informed Care Resilience, and I put it on to one one spot and I email it off to people who subscribe to the listserv. And I’ve got up close to 20,000 people on that now. And so you could go there and get good information. That’s the most current that I think would appeal to any organization or any audience. All these things can be applied, any organization, but I think that would be a place to go. And I would just say that, you know, if you’re interested in really having good human beings and taking care of human beings in a really compassionate way, this is a really worthwhile model to look at. And I think it’s only going to grow as time goes on.
00;23;23;24 – 00;23;27;01
One quick question. How did they get on that listserv?
00;23;27;04 – 00;23;37;11
Well, you could go to the DHS website and then you just go to the resilient Wisconsin page. I’m on that team and then you’ll find a place to sign up to the gov delivery platform.
00;23;37;13 – 00;23;39;27
Scott, thank you for joining us today!
00;23;40;00 – 00;23;42;29
Thank you, Rick. I really appreciate the opportunity. Take care.
00;23;43;01 – 00;24;06;10
You’ll find more information about overcoming challenges on all of our podcasts. To hear more episodes of OnTopic with Empathia, visit our website, Empathia.com. Follow us on social media @Empahtia, and subscribe to OnTopic with Empathia to hear new episodes as soon as they go live. I’m Rick Hoaglund. Thanks for listening to OnTopic with Empathia!