Research on the powerful effect of trauma on health and child development continues to build, collectively describing a foundational element of pediatric science: traumatic childhood experiences – even in infancy – have a profound effect on the developing architecture of the brain, and on a child’s long-term health. Research tells us that experiencing trauma during childhood is pervasive: more than two-thirds of children under the age of sixteen have experienced a traumatic event, and young children (birth to age five) are disproportionately exposed to traumatic events. And, research tells us that there are proven strategies and therapies – collectively grouped as “trauma-informed care” (TIC) - that can help children cope and heal from these traumatic experiences, particularly when delivered soon after the traumatic event.
As a health care community, we have been aware of the impact, prevalence and healing of childhood trauma for some time. So, why does it feel so difficult to translate the principles and practice of trauma-informed care into daily behaviors and organizational norms?
One clue lies in how we speak. I have often heard health care leaders say that their clinic or system is “implementing” trauma-informed care. Though a true statement, this language implies a singular training or campaign. In reality, the most important component of instilling a trauma-informed approach to care is the ongoing reinforcement of what is learned during training. Comprehensive trauma-informed care trainings will challenge health care providers to re-evaluate their past thinking and behaviors when interacting with patients, sometimes establishing new practices that will replace years of professional training and practice. It is through consistent reinforcement and practice that the health professional is able to deepen their understanding and competency of trauma-informed care.
Another clue may be in who is invited to participate in trainings and reinforcement activities. Many systems prioritize training for clinicians in key leadership roles over specific departments (e.g. primary care, psychology/psychiatry, emergency services) with the rationale that training these individuals will enable them to cascade the principles to critical service delivery sites, and ultimately maximize the allocation of scarce resources. In practice, this strategy may fall short because it is based on the perspective of the healthcare insider rather than the child and family experience. Consider the number of direct and indirect interactions that a child will experience when receiving care, particularly emergent or acute care. Whether a child’s first encounter is with an EMT in an ambulance, a triage nurse in the emergency department or a scheduler/administrative staff in a clinic, both the staff and the child are processing their interactions and environment based on their life experiences. A child who has experienced trauma may feel threatened or vulnerable by an interaction that is routine from the staff’s perspective. A child may transition between multiple settings with multiple staff before seeing a clinician who has been introduced to the ideas of trauma-informed care.
These two insights combine to yield a final clue: how is accountability for adopting a trauma-informed approach shared across an organization? A campaign to establish trauma-informed care will have the most significant and sustainable results when accountability is shared by clinical, administrative and operational teams. Each individual and every team has a role to play. Re-evaluating how systems are designed for patient triage, flow, safety, communication, and the like will often yield insights in how to adapt trauma-informed approaches to these functions. Looking at the built environment with a new, trauma-informed perspective could uncover opportunities to improve patient experience, privacy or choice in care and lessen chances of re-traumatization. Assessing system policies for staff expectations and patient care standards may lead to revising policies to support the health and healing of staff who struggle with secondary traumatic stress, or amending administrative policies on how to respond to no-shows to the clinic or security response to a tense situation.
Each organization has its own unique blend of cultural norms, community needs and organizational assets. There are numerous ways for leaders to introduce trauma-informed care to their teams and support their learning and practice of these principles. Those organizations that invest in the process of managing change alongside substantive trainings on trauma-informed care are more likely to be successful at achieving transformative change for their employees, providers and patients.
Key Points:
Training on trauma-informed care is just the beginning. Real change and outcomes are the result of ongoing reinforcement. Consider whether your organization has a strategy for how, when, and what you will do to reinforce TIC principles and practices.
Ideally, systems should approach training on TIC as a universal competency for their employees. When resource limitations require phased investment or trainings, consider how to incorporate roles and environments that will be a first point of contact for patients, or have the greatest number of interactions with patients.
The most impactful strategy to practice TIC is to embed its principles in individual patient interactions, system and built environment design, and in system policies. In this, every department has a role to play to ensure they are contributing to TIC.
Finally, consider whether your organization is prepared to manage the change of introducing, adopting and reinforcing TIC. Despite conclusive research and validated training models, many organizations struggle to achieve the traction and results they seek because they do not adequately plan for how they will guide their people and systems through this change.
Genesis Health Consulting has significant experience coaching organizations on how to successfully facilitate change within their business, and to work across sectors to manage change within their industry or community. We welcome the opportunity to learn about your particular challenge, and to share more about our experiences. Please contact us at: info@genesishealthconsulting.com.