How a trauma-informed organization leads to intentional care, support for the care team

This paid piece is sponsored by Children’s Home Society.

Kyle, age 5, is jumping up and down in anger. His care provider knows that nighttime often can be a trigger for Kyle and works to calm him down and start his bedtime routine. It provides him with stability and comfort, and makes the transition easier.

Kyle is receiving trauma-informed care. It is designed to understand and consider the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently retraumatize.

Trauma-informed care shifts the focus from “What’s wrong with you?” to “What happened to you?”

“At Children’s Home Society, we offer a continuum of programs,” CEO Michelle Lavallee said. “Each one embraces trauma-informed care practices. Most of the people we serve, whether in residential care, our domestic violence shelter, forensic interviewing or in other programs, have experienced trauma.”

Trauma-informed care seeks to:

• Realize the widespread impact of trauma and understand paths for recovery.
• Recognize the signs and symptoms of trauma in clients, families and staff.
• Integrate knowledge about trauma into policies, procedures and practices.
• Actively avoid retraumatization.

Kyle has been in residential care for only two weeks. He has not yet revealed the reason for his nighttime fears, but his therapist believes he is very close to disclosure. Meanwhile, staff care for him using trauma-informed care principles such as establishing trust and boundaries, supporting autonomy and choice, and promoting resilience and hope.

Trauma-informed workplace

In 2021, Children’s Home Society began a journey of transformation. Leadership saw that to fully achieve the organization’s mission of preventing, treating and healing trauma, it would need to become trauma-informed. An employee-led work group, the Trauma-Informed Organization Committee, came together to help facilitate the journey.

“Research has shown that especially in children, trauma changes the brain,” Lavallee said. “But it’s not just our clients who are affected by trauma — it’s also our staff.”

The TIO Committee was tasked with determining what a trauma-informed organization would look like and how it would be achieved. It eventually identified three themes:

• Employees may have trauma in their own backgrounds and must be self-aware in how those experiences may show up in their work with colleagues or clients.
• Employees can suffer secondary or vicarious trauma through working with clients who have experienced trauma.
• Employees can experience triggers or additional trauma through interactions with other staff or practices in the workplace.

The results of trauma are ever-changing and enormously complex. Distinctions between one’s own and others’ trauma triggers and responses can be difficult to discern.

The committee recognized that being a trauma-informed workplace would mean changing workplace culture and most likely never would be a completed project but instead an ongoing process.

While secondary trauma affects staff who work with clients, all staff would benefit from trauma-informed organizational practices.

The graphic below explains the characteristics of a trauma-informed organization:

The TIO Committee provided training in trauma-informed care and trauma-informed organizations to all staff. They authored articles for the CHS internal newsletter, applied for grants to provide self-care toolkits for all departments and created posters, flyers, window clings and a landing page on the CHS website.

“The entire staff has become more aware of what it means to be trauma-informed both in our work and in our workplace,” Lavallee said. “It benefits everyone.”

Vicarious trauma

Jack, a dedicated care provider, worked closely with individuals who were victims of daily violence, poverty and abuse. Jack did not show symptoms of stress but noticed his threshold for what was shocking or tragic had all but disappeared. His co-workers noticed, too, mentioning that he seemed to be burning out. They encouraged Jack to take a break. After some time away, he realized the impact of the vicarious trauma he experienced.

Secondary or vicarious trauma, also called compassion fatigue, is a natural but disruptive byproduct of working with traumatized people. Hearing firsthand about a client’s traumatic experience has an impact on a care provider. At CHS, vicarious trauma is a common occupational hazard for staff.

Symptoms of secondary trauma can include:

• Emotional: persistent feelings of anxiety, grief, sadness, irritability, anger; easily distracted, feeling unsafe.
• Physiological: increased headaches, heartburn, ulcers.
• Behavioral: increase in substance use/abuse, changes in sleeping and eating habits, risky behaviors, avoiding, decreased participation in activities that were once enjoyable.
• Cognitive: increased cynicism and negativity, inability to concentrate and make decisions, memory issues.
• Spiritual: loss of hope or sense of purpose, feeling disconnected from others, feeling unworthy or undeserving of love.

Preventing secondary traumatic stress in staff

Clinicians and other front-line staff experiencing these symptoms may struggle to provide high-quality care to patients and may experience burnout, leading to staff turnover — which can create a negative feedback loop that intensifies similar feelings in remaining employees.

Preventing secondary traumatic stress can increase staff morale, allow staff to function optimally and reduce the expense of frequently hiring and training new employees.

Strategies to prevent secondary traumatic stress in staff include:

• Providing training sessions that raise awareness of secondary traumatic stress.
• Offering opportunities for staff to explore their own trauma histories.
• Supporting reflective supervision in which a service provider and supervisor meet regularly to address feelings regarding patient interactions.
• Supporting self-care and providing professional support.

Triggers in the workplace

Liz is an employee who reports to Rose. Over the weekend, Liz’s father passed away. Funeral arrangements are beginning, and Liz comes to work  Monday to finish reports before taking funeral leave.  

Near the end of the day, Rose enters Liz’s office to give her a huge assignment; it wouldn’t be due for a month, but it required a complex explanation. Liz feels overwhelmed and snaps at Rose. This triggers Rose, who didn’t sleep well the previous night and has troublesome health issues. She feels attacked and snaps back. 

What might be a trauma-informed approach to this situation?

• Liz could share with Rose that she felt overloaded and ask if they could discuss the project when she returns from funeral leave.
• Rose could notice that Liz was upset and ask if Liz wanted to share her feelings.    
• Rose could discern that it wasn’t a good time to bring a new project to Liz and tell her they could discuss it another time.

Triggers can show up in a variety of ways. It could be that having a talk with a supervisor takes an employee back to school days when you were called to the principal’s office, making you feel now like you’re in trouble even when you’re not. It could be a conflict with a co-worker that reminds an employee of a fight with someone, leaving them feeling unsafe.

These are some common workplace triggers:

• Tone of voice: Those who have experienced trauma or stress in the past may be hyperaware of changes in tone, which can lead them to worry about what someone else is feeling or thinking. Often, instead of just asking, people come up with their own assumptions — typically negative and inaccurate — leading to more stress.
• Touching: For those who have experienced touches that have caused harm or made them feel unsafe, a simple tap on the shoulder may be a trigger.
• Authority roles: Authority can take people back to a time when they were in trouble. Being in a position of authority also comes with its own stressors and triggers.
• Arguments: Conflict at work may trigger the fight, flight or freeze response if one has a history of conflict leading to harm.
• Weak boundaries: This trigger may be self-inflicted; it can happen when someone struggles to say no or worries that they’re not a team player if they’re not available constantly.

It’s important that when the trigger arises, an employee takes time to sit with the feelings and explore what may be causing them. The self-awareness can help them respond in healthier ways when these triggers inevitably arise.

Wellness practices for trauma-informed organizations

For trauma-informed workplace wellness to be effective, the organization needs to create a network of community support that holds teams together while allowing for individuality, authenticity and community-building. The following practices are ways to infuse an organization with trauma-informed protections.

1. Allow vulnerability.

When we allow ourselves and others to show vulnerability, we create a sense of personal safety that allows for stronger workplace teamwork and performance.

2. Engage in honest interactions.

When we engage honestly, we state the facts and work through the details.

3. Interact with integrity.

Integrity requires holding ourselves to a standard of self-honesty, putting judgments aside and working from a place of presence and compassion. This allows others to trust that their interactions with us are sincere and authentic, and minimizes hidden agendas, power games and meanness in general.

4. Practice empathy.

It’s not easy to see from another’s point of view, but in doing so, we open new doors to our heart and mind. Practicing empathy in the workplace requires that we challenge our own fiercely held beliefs and our sense of fragility.

5. Listen attentively.

Put everything else aside when someone from your team is speaking with you. Give them your full attention, and prevent your own personal narrative from getting in the way of hearing what they’re saying. Active listening will help your team understand one another better.

6. Find opportunities for shared professional growth.

Opportunities to grow together as a team in a safe, supportive environment are fantastic ways to increase workplace happiness.

7. Laugh together

If you can laugh with your team, have fun and be a little silly from time to time, you can go miles toward creating an environment where people can blossom.

Resources on trauma-informed organizations are available on CHS’s website at chssd.org/prevention/resources/trauma-informed.