Taking S.T.E.P.S. at ICL

Written by Brian Mundy, LCSW, Clinical and Implementation Specialist – Institute for Community Living, Inc. Laura Bercuson, MSW, Project Manager/Analyst – Institute for Community Living, Inc.

Trauma-informed care (TIC) incorporates the recognition of and appreciation for the high prevalence of trauma experienced by individuals in health and behavioral health settings. TIC recognizes the complex neurological, biological, psychological and social effects of trauma and violence on individuals, families, and communities. The key to trauma-informed care is creating services, supports, and an organizational culture and environment that are designed to be sensitive to the impact of trauma for every single person, including consumers and staff. At its core, trauma-informed care is the new frontier of good clinical care, and rests upon the shared understanding that experiencing trauma can irreparably shape a person’s worldview and heighten their sensitivity to situations that remind them of their trauma. This sensitivity can translate into high vulnerability to re-traumatization. Effective provision of services is based upon the creation of a healing and welcoming environment whereby this worldview is understood. Trauma-informed services are guided by sensitivity to the triggers of trauma-impacted individuals that traditional service delivery approaches may ignore or exacerbate.

TIC does not only include clinical interventions, but should be incorporated into every aspect of an agency’s culture. When implementing TIC, small details matter and can have a significant impact on individuals with histories of trauma. Simple things like decreasing the amount of clutter in an office or choosing softer paint colors and lighting can reduce the likelihood of triggering a trauma response, help ease an individual’s anxiety, and foster a greater sense of safety. Providing individuals with information and psychoeducation can normalize the feelings associated with trauma, create genuine collaboration between staff and consumers, and empower individuals to experience themselves in a new light. Everyone has a unique experience and specific triggers, so taking a trauma-informed approach means that it is essential to provide individualized care and explore possible triggers and solutions with each client.

For example, the intake process, by necessity, can include questions about past experiences that could be triggering to individuals. TIC does not necessitate casting these questions aside, rather contextualizing them in terms of client safety, provision of individuated services, and checking in during the intake process to see how the client is doing. TIC is largely predicated on the Adverse Childhood Experiences (ACE) Study. This study is one of the largest investigations ever conducted to investigate the link between childhood maltreatment, family dysfunction and trauma, and later-life health status/health-related behaviors. It was found that a higher number of ACEs increases the likelihood for negative health outcomes such as heart disease and pulmonary disease and health-related behaviors such as smoking, drug and alcohol use, unsafe sexual behavior, and self-harm, among others. Additionally, other factors associated with increased ACE scores included mental health conditions such as depression and proneness to suicide. The ACE Study highlights the profound consequences of trauma on overall quality of life and the need to incorporate TIC into the core values and policies of behavioral health agencies. The National Council for Behavioral Health, a national not for profit member behavioral health association and the unifying voice of America’s community mental health and addictions treatment organizations, has recognized the relevance of TIC, and has created the Trauma-Informed Practices Learning Community. ICL was proud to participate in this learning community along with other organizations nationwide, through which we examined and modified such important practices as Trauma Screening and Assessment, Safe and Secure Environments, Evidence-based Practices related to trauma, and Consumer Involvement practices. In early 2012, ICL’s Borden Avenue Veteran’s Transitional Residence, providing short-term transitional housing for homeless veterans in Long Island City, Queens and the ICL Tillary Women’s Residence, a shelter for homeless women in downtown Brooklyn, began earnestly engaging in efforts to examine their policies and practices with a TIC lens. Leadership began meeting to evaluate current practices and develop systemic, cultural, and consumer-driven change over time. Making small changes, such as helping staff recognize the difference between asking residents “What happened to you?” versus “What is wrong with you?” began having a growing impact on program environment and culture. Intake processes were revised, trauma discussions were included at all levels of staff and community meetings, and information about trauma as well as resident’s artwork was placed on the walls. The sites collaborated with ICL management and support to create STEPS, which represents the trauma-informed principles we value at ICL: S for Safety, T for Trauma-Informed, E for Empowerment, P for Personal Responsibility, and S for Strengths-Based:  Safety is primary to all who live and work here.  Trauma impacts our lives.  We Empower each other to choose healthy lifestyles  We all have Personal responsibility for our choices.  We reach for the Strengths in each other STEPS represents a paradigm shift that is changing the way that we at ICL view the individuals we serve and ourselves; where we view behavior in the context of past experiences. Both transitional living sites are especially committed to developing increased peer involvement through the creation of the peer leadership program at ICL Borden and the peer advocate program at ICL Tillary. These programs have resulted in increased collaboration between staff and individuals served, as well as an increased sense of mutual ownership of program culture. Efforts at both sites are ongoing and represent a significant step in ICL’s commitment to trauma-informed work. ICL has recently broadened efforts to implement TIC agency-wide via the newly created Agency Practice Expertise Network (APEX), a learning structure created to harness the expertise of program directors and department leaders in disseminating the principles of trauma-informed care across all programs. APEX Cohorts meet monthly to discuss a TIC topic, and generate ideas and action steps to adapt their respective program’s approach to TIC. APEX fosters continuous learning and promotes organizational practice innovation to support staff in a systematic and cohesive way. APEX cohort meeting discussions include everything from philosophically reflecting on how stigma creates barriers in worker/client relationships, to the color of program common areas, to the specific wording in intake packets. Each month, APEX Cohort Members assign themselves experiential tasks that will help improve their awareness of services and how programs can help or hinder the healing process from the perspective individuals served. Participants have expressed appreciation for the collaborative nature of APEX meetings which provides a forum for discussing the interrelatedness of such topics as supervision, facilities, budgeting, clinical care, and physical wellness. Ultimately, APEX encourages all involved with ICL – leadership, staff, and individuals served, to engage in dialog among programs to promote person-centered and recovery-oriented care across the agency. APEX seeks to actively involve consumers to co-develop APEX’s monthly curricula in a way that meaningfully acknowledges and addresses trauma from a consumer perspective. ICL recognizes that incorporating a multitude of consumer voices empowers both consumers and staff and can lead to significant changes in the services and supports we offer. Developing a shared understanding of what it means to be a trauma-informed organization will ensure that staff and consumers will experience a safe and trusting physical and social environment which provides individualized, trauma-specific services that are accessible, strengths-based, culturally respectful, and consistent with the recovery-oriented principles of collaboration and self-direction. If you currently receive services from ICL and want to be a part of this initiative or to learn more about bring STEPS to your organization, please send an email to [email protected].