APPLYING TRAUMA INFORMEDPRINCIPLES ACROSSSYSTEM OF CARE SERVICESMIRIAM SILMAN MSWSYSTEM OF CARE ACADEMY

JUNE 9, 2020

understand and appreciate the relevance of the six principles of trauma informed systems

learn strategies and approaches to promote these principles across SOC services

assess the current level of support for each principle in your services

create a plan to integrate practical strategies to support each principle in SOC services

Objectives

Self-Awareness Reminder

• Pay attention to your own needs & responses

• Take care of yourself however you need to during our discussion

• Effects can linger, or surface later

• Use coping skills that help you metabolize your responses to trauma

• Find a safe space in which you can process your experiences – this may mean using coping strategies including talking to colleagues, friends, family, or a professional provider

3

A System Of Care is:A spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life.

(Stroul & Friedman, 2011)

Core Values: SOC is…1. Family driven and youth guided, with the strengths and needs of the

child and family determining the types and mix of services and supports provided.

2. Community based, with the locus of services as well as system management resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level.

3. Culturally and linguistically competent, with agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports.

(Stroul & Friedman, 2011)

Guiding Principles:SOC are designed to…

1. Ensure availability of and access to a broad, flexible array of effective, evidence-informed, community-based services and supports for children and their families that addresses their physical, emotional, social, and educational needs, including traditional and nontraditional services as well as informal and natural supports.

2. Provide individualized services in accordance with the unique potential, strengths, and needs of each child and family, guided by an individualized, “wraparound” service planning process and an individualized service plan developed in true partnership with the child and family.

3. Deliver services and supports within the least restrictive, most normative environments that are clinically appropriate.

(Stroul & Friedman, 2011)

Guiding Principles:SOC are designed to…

4. Ensure that families, other caregivers, and youth are full partners in all aspects of the planning and delivery of their own services and in the policies and procedures that govern care for all children and youth in their community, state, territory, tribe, and nation.

5. Ensure cross-system collaboration, with linkages among child-serving systems and mechanisms for system-level management, coordination, and integrated management of service delivery and costs.

6. Provide care management or similar mechanisms to ensure that multiple services are delivered in a coordinated and therapeutic manner and that children and their families can move through the system of services in accordance with their changing needs.

(Stroul & Friedman, 2011)

Guiding Principles:SOC are designed to…

7. Provide developmentally appropriate mental health services and supports that promote optimal social-emotional outcomes for young children and their families in their homes and community settings.

8. Provide developmentally appropriate services and supports to facilitate the transition of youth to adulthood and to the adult service system as needed.

9. Incorporate or link with mental health promotion, prevention, and early identification and intervention to improve long-term outcomes, including mechanisms to identify problems at an earlier stage and mental health promotion and prevention activities directed at all children and adolescents.

(Stroul & Friedman, 2011)

Guiding Principles:SOC are designed to…

10. Incorporate continuous accountability mechanisms to track, monitor, and manage the achievement of system of care goals; fidelity to the system of care philosophy; and quality, effectiveness, and outcomes at the system level, practice level, and child and family level.

11. Protect the rights of children and families and promote effective advocacy efforts.

12. Provide services and supports without regard to race, religion, national origin, gender, gender expression, sexual orientation, physical disability, socio-economic status, geography, language, immigration status, or other characteristics, and services should be sensitive and responsive to these differences.

(Stroul & Friedman, 2011)

Elements of the System of CarePhilosophy

Infrastructure

Services & Supports

Six Principles of Trauma-Informed Systems

(Fallot & Harris, 2009)

Safety Trust Choice

Empowerment CollaborationCultural

Competency & Equity

Trauma-Informed Systems

Safety

Trust

Choice

Empowerment

Cultural Competency

& Equity

Collaboration

TIC Elements are Always Present

Outreach Referral Triage Intake & Assessment

Service Planning

Service Delivery

Post-Service Planning

Service Completion

Safe

tyPsychological safety refers to the ability to be safe with oneself, to rely on one's own ability to self-protect against any destructive impulses coming from within oneself or deriving from other people and to keep oneself out of harm's way.

(Sanctuary Model)

Safe

ty• Where? When? Who?

• Physical safety? How is security handled? Exits clear?

• Welcoming? Respectful? Neat & clean?

• Restrooms clearly marked?

• Privacy/ confidentiality respected for all?

• Clear road map at start; clear next steps at end?

• Consistent providers?

• Grievance policy?

• Recognition of potential safety threats for those you serve?

Safe

ty• Consistency, predictability

• Active listening, attentiveness

• Freedom to express feelings and thoughts• Freedom to take risks, ask questions, try new

things, make mistakes

• No fear of judgment, stigma, othering

• Psychological safety evolves over time; but can disappear in an instant

• To have clients feel safe, we have to ensure all workers feel safe: will they tell you what they need?

SafetySafety Now Safety Next Steps

Trus

t • Say what we do, do what we say• Explain when we can’t; apologize as

appropriate; accept responsibility• Transparency & honesty• Follow-up on everything; no loose ends • Active listening, attentiveness• Authenticity & authentic caring

• Predicated on communication: verbal & non-verbal

• How can you establish trust if you don’t really like the client?

Trus

t • Boundaries: role, agency, limits of what we

can and cannot do

• Clear expectations of people, services, agencies, meetings, medications, advocacy, support, etc.

• Role clarity: e.g. how do we make sure others always know we are mandated reporters?

• Informed consent & assent: people must understand and appreciate the situation applies to them

Trus

t In the workplace:• Reflective supervision is routine; distinct from

administrative supervision

• Active listening; meaningful input

• Follow through on what you promise

• Support for resilience-building activities

• Acceptance of Compassion Fatigue & Secondary Traumatic Stress as part of the work; no stigma, no retribution

TrustTrust Now Trust Next Steps

Choi

ce

• Choices start with 2 options

• No choices is too small

• Type of services; clear informed consent & understanding of consequences if refuse

• Responsibilities & rights for youth & caregivers

• When to meet, where to meet; where to sit, what pronouns, what to be called, etc.

• Choice of provider

• Eligibility for additional services clear

• Choice counters the sense of powerlessness trauma can create

Choi

ce In the Workplace:

• Provide guidance, prize autonomy

• Choices in how to meet requirements

• Meaningful voice & input

• Choices re caseload, flex time, leave, training opportunities, philosophical approach, office décor, etc.?

Choice Choice Now Choice Next Steps

Empo

wer

-m

ent

• Significant & meaningful voice; actually incorporate ideas, acknowledge & respond

• Validation & affirmation of youth & families

• Strengths-focused approach; build on strengths & skills

• Realistic optimism that services will benefit

• Promote skill enhancement & positive achievement

• At every level, for everyone in every part of the system

Empo

wer

-m

ent

In the Workplace:• Recognition, validation & affirmation of staff

at all levels; celebrate success

• Strengths-focused approach; build on strengths & skills

• Realistic optimism that staff are competent; constructive criticism

• Provide professional development & training opportunities as part of work day

• Annual trauma-informed training for all staff

• Become STS-informed

EmpowermentEmpowerment Now Empowerment Next Steps

Colla

bora

-tio

n

• Work “with” not “to” or “for” consumers

• Consumer as expert; significant voice in all aspects of service planning

• Consumer role in agency planning & evaluation; consumer preferences substantially weighed

• Trauma survivors have a voice & a place

• Lived experience is valued & always present

• At every level for consumer: within youth, within family, within community

• This is hard work – takes time and intentional nurturing of relationships

Colla

bora

-tio

nIn the Workplace:• Horizontal & vertical collaboration internally

• Formal & informal internal collaborations are supported; external as well

• Across professional systems; your agency should be leading collaboration in your community

• Also requires time, attention and intention to be meaningful

CollaborationCollaboration Now Collaboration Next Steps

Cultu

ral

Com

pete

ncy

& E

quity

Trauma -informed systems acknowledge the compounding impact of structural inequity and are responsive to the unique needs of

diverse communities. (NCTSN)

• Attend to race, ethnicity, gender, age, gender identity, sexual orientation, ability, past diagnosis, language, geography, etc.

• Don’t assume: We don’t know what has been a trauma

• See professionals who look like them

• We address the issue openly & frankly

Cultu

ral

Com

pete

ncy

& E

quity

• Always use professionals translators, not the child or another family member

• Recognize the impact of culture, ethnicity, gender, etc. on coping, expression of emotion, psychological safety, etc.

• Assume heterogeneity among people of other cultures, not just your own

• What are your implicit biases around geography?

Cultu

ral

Com

pete

ncy

& E

quity

• Cultural awareness/ competency is where we start – but not sufficient

• Cultural humility

• Awareness of implicit bias

• Recognize micro-aggressions

• Recognize macro-aggressions & race-based trauma

• Anti-racism

Cultu

ral

Com

pete

ncy

& E

quity

In the workplace:• ADA is the starting point

• Name the elephant in the room

• Learn about humility, implicit bias, micro-aggressions, etc.

• Grant grace & be generous; recognize added stress

• Check-in!

Cultural Competency & EquityCultural Competency/ Equity Now

Cultural Competency/ Equity Next Steps

Reflection: Taking it Back to Work

1. One thing you plan to use tomorrow

2. One thing you want to learn more about

3. One thing that worries you about becoming more trauma-informed

Miriam Silman, MSWProject AWARE/Trauma Informed Care Program Administrator Department for Behavioral Health, Developmental and Intellectual DisabilitiesCabinet for Health and Family Services275 East Main Street 4W-FFrankfort, Kentucky 40621miriam.silman@ky.gov502-782-3662