Performance Monitoring Tool: Adoption of Wellness-Oriented Trauma-Informed Care Practice

PERFORMANCE MONITORING TOOL: ADOPTION OF WELLNESS-ORIENTED TRAUMA-INFORMED CARE PRACTICE (WOTIC-PMT)

Tracking progress is an important part of systems change. Successful organizations have a clear understanding of where they are starting, where they want to go, and tools to measure their progress along the way. This allows team members and others interested in the work to remain enthusiastic and to determine what is working and what is not. It creates the opportunity for the team to regroup, refocus and monitor momentum. This simple tool is one way to stay on track.

Your team will submit the Performance Monitoring Tool (PMT) to your National Council faculty lead three times during the duration of the Learning Community. In partnership with your faculty lead, you can use this tool to review your progress, help you think through your next steps and address any challenges your team might be facing.

Contact Information

Name of Organization______

Your Name______

Your E-Mail______

Date of Submission______

For the domains you have chosen to focus on, please use the following five-point scale below to indicate the quality to which your organization has implemented the evidence of wellness-oriented trauma-informed care.

1= Very Poor/Have not started 2 = Poor 3 = Fair 4 = Good 5= Excellent N/A = This does not apply to our organization

Implementation Process Overview: Please select the option that best describes your organization’s status of the following implementation steps: Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 1 Very Poor Poor Fair Good Excellent Gain commitment from leadership regarding TIC Implementation 1 2 3 4 5 N/A Develop Core Implementation Team 1 2 3 4 5 N/A Build Consensus 1 2 3 4 5 N/A Create a Shared TIC Vision 1 2 3 4 5 N/A Communicate about TIC for Buy-In 1 2 3 4 5 N/A Assess your organization’s needs around TIC 1 2 3 4 5 N/A Develop a TIC implementation plan 1 2 3 4 5 N/A Create a TIC monitoring system 1 2 3 4 5 N/A Take TIC Reform Action at your organization 1 2 3 4 5 N/A If you have completed Create a Shared Vision, please share it here: ______Please list any questions you have regarding the implementation process ______Please list any accomplishments you have made in the implementation process ______Please list any key challenges you have in regards to the implementation process ______Please list any future plans you have regarding the implementation process ______Based on OSA results, please check the domains your CIT has developed goals around for this learning community: □ Domain 1 - Early Screening and Comprehensive Assessment □ Domain 2 – Consumer-Driven Care and Services □ Domain 3 - Wellness and Trauma-Informed, Educated and Responsive Workforce □ Domain 4 - Provision of Wellness-Oriented Trauma-Informed, Evidence-Based and Emerging Best Practices □ Domain 5 - Create Safe and Secure Environments □ Domain 6 – Engage in Community Outreach and Partnership Building □ Domain 7 – Ongoing Performance Improvement and Evaluation

DOMAIN 1: Early Screening and Comprehensive Assessment Very Poor Poor Fair Good A screening and assessment tool that includes questions regarding past and current adverse 1 2 3 4 N/A experiences A screening and assessment tool that includes questions regarding physical health, social 1 2 3 4 N/A determinants and behavioral health as it relates to trauma A policy/procedure that spells out how the screening and assessment process should be 1 2 3 4 N/A

Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 2 implemented sensitively and respectfully, including performing it in a physically safe space and respecting the voice and choice of the people seeking service. A policy/procedure that indicates how trauma is assessed in regular intervals 1 2 3 4 N/A

Please enter and rate your goals for Domain 1 here 1 2 3 4 5 N/A 1 2 3 4 5 N/A 1 2 3 4 5 N/A

Please list any questions you have regarding this domain. ______Please list any accomplishments you have made in this domain. ______Please list any key challenges you have in regards to this domain. ______Please list any future plans you have for this domain. ______

DOMAIN 2: Consumer-Driven Care and Services Very Poor Poor Fair Good N/A Consumer feedback survey 1 2 3 4 N/A Consumer advisory group 1 2 3 4 N/A Consumer focus groups 1 2 3 4 N/A A policy/procedure about the inclusion of people with lived experience on the Board, advisory 1 2 3 4 N/A council, and/or other decision-making groups A policy/procedure about informed consent that includes provision of information regarding 1 2 3 4 N/A clients’ rights, service opportunities, wellness activities, and care coordination.

Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 3 A policy/procedure about voice, choice and empowerment of the people seeking/receiving 1 2 3 4 N/A services which includes their right to refrain from staff’s recommended programmatic services without punitive action. Employing people with lived experience in trauma in direct service positions 1 2 3 4 N/A Employing people with lived experience in trauma in indirect service positions 1 2 3 4 N/A

Please enter and rate your Domain 2 goals here: 1 2 3 4 N/A 1 2 3 4 N/A 1 2 3 4 N/A

How many staff positions at your organization require lived experience in trauma? ______How many volunteer positions at your organization require lived experience in trauma? ______Please list any questions you have regarding this domain. ______Please list any accomplishments you have made in this domain. ______Please list any key challenges you have in regards to this domain. ______Please list any future plans you have for this domain. ______

DOMAIN 3: Wellness and Trauma-Informed, Educated and Responsive Workforce Very Poor Poor Fair Good A clear message internally that the organization is committed to trauma-informed care (e.g. 1 2 3 4 N/A employee handbook, memos, emails, newsletters, etc.) A clear message externally that the organization is committed to trauma-informed care (e.g. 1 2 3 4 N/A bylaws, website, social media, mission statement, etc.) A training plan that includes initial training on trauma-informed care (upon hire) AND ongoing 1 2 3 4 N/A for ALL STAFF All job advertisements that include a preference for experience with or knowledge of trauma- 1 2 3 4 N/A informed care

Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 4 All job descriptions have language regarding knowledge of trauma-informed care 1 2 3 4 N/A All staff performance appraisals include metrics related to trauma-informed care 1 2 3 4 N/A All management/supervisory staff receive training in trauma-informed supervision 1 2 3 4 N/A A policy/procedure regarding prevention, identification and appropriate response to staff 1 2 3 4 N/A burnout, secondary traumatic stress, compassion fatigue, etc.

Please enter and rate your goals for Domain 3 here 1 2 3 4 N/A 1 2 3 4 N/A 1 2 3 4 N/A

DOMAIN 4: Provision of Wellness-Oriented Trauma-Informed, Evidence-Based and Emerging Best Practices Very Poor Poor Fair Good Excellent A policy/procedure regarding the inclusion of people’s support network in the treatment 1 2 3 4 5 N/A planning process which includes providing psychoeducation to them regarding the person’s wellness-oriented trauma-related challenges A policy/procedure regarding services received utilizing the strengths perspective, 1 2 3 4 5 N/A specifically indicating using what happened vs what’s wrong A documentation policy that clearly indicates the need to utilize the strengths perspective 1 2 3 4 5 N/A versus the deficit-based documentation model, Provision of evidence-based wellness-oriented trauma-specific services, i.e. Seeking 1 2 3 4 5 N/A Safety, TREM, G-TREM, M-TREM, EMDR, TF-CBT, WRAP, DBT. Provision of evidence-based wellness-specific services, i.e. Care Coordination, Population 1 2 3 4 5 N/A Health Management, Motivational Interviewing, WHAM, Mindfulness, etc. A policy/procedure regarding release of information that includes language regarding the 1 2 3 4 5 N/A clients’ choice regarding sharing their trauma-related information

Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 5 Please enter and rate your goals for Domain 4 here 1 2 3 4 5 N/A 1 2 3 4 5 N/A 1 2 3 4 5 N/A

Please list the evidence-based or emerging best practices currently utilized by your staff (examples include Motivational Interviewing, Trauma-Focused Cognitive Behavioral Therapy, WRAP, Trauma Recovery and Empowerment, Seeking Safety, etc.): ______Please list any questions you have regarding this domain ______Please list any accomplishments you have made in this domain ______Please list any key challenges you have in regards to this domain ______Please list any future plans you have for this domain ______

DOMAIN 5: Create Safe and Secure Environments Very Poor Poor Fair Good Excellent An active team including representatives from leadership, practitioners, support staff 1 2 3 4 5 N/A AND consumers that is responsible for assuring a safe and secure physical environment A policy/procedure for conflict resolution between employees that embodies the 1 2 3 4 5 N/A trauma-informed care values/principles A policy/procedure for conflict resolution between employees and clients that 1 2 3 4 5 N/A embodies the trauma-informed care values and principles A formal/grievance policy/procedure that embodies the trauma-informed care 1 2 3 4 5 N/A values/principles A policy/procedure for staff to communicate when the physical work environment is 1 2 3 4 5 N/A unsafe without retaliation A policy/procedure for clients to communicate when the physical work environment is 1 2 3 4 5 N/A unsafe without retaliation A policy/procedure for staff to communicate when interpersonal interactions are unsafe without retaliation A policy/procedure for clients to communicate when interpersonal interactions are 1 2 3 4 5 N/A unsafe without retaliation A Code of Conduct that expresses the responsibility of all staff to participate in creating 1 2 3 4 5 N/A safe and secure environments A policy/procedure on addressing adverse incidents that includes debriefing, support 1 2 3 4 5 N/A

Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 6 for those affected by the incidents (staff and clients), limiting physical and chemical seclusion and restraint and a review of the incidents by the safety team as part of the CQI process Please enter and rate your goals for Domain 5 here 1 2 3 4 5 N/A 1 2 3 4 5 N/A

DOMAIN 6: Engage in Community Outreach and Partnership Building Very Poor Poor Fair Good Excellent N/A Trauma-specific awareness and education activities for colleagues in other agencies 1 2 3 4 5 N/A Trauma-specific awareness and education activities for consumers and families 1 2 3 4 5 N/A Trauma-specific awareness and education activities for the general public 1 2 3 4 5 N/A Participation in a community partnership or workgroup focused on building resilience 1 2 3 4 5 N/A Please enter and rate your goals for Domain 6 here 1 2 3 4 5 N/A 1 2 3 4 5 N/A 1 2 3 4 5 N/A

Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 7 DOMAIN 7: Ongoing Performance Improvement and Evaluation Very Poor Poor Fair Good Excellent N/A Collection of trauma-informed care metrics 1 2 3 4 5 N/A Use of trauma-informed care metrics for organizational level decision making 1 2 3 4 5 N/A Clear and easy to understand data reports disseminated 1 2 3 4 5 N/A Data presented to an array of audiences (leadership, board, staff, consumers, community 1 2 3 4 5 N/A partners) Please enter and rate your goals for Domain 7 here: 1 2 3 4 5 N/A 1 2 3 4 5 N/A 1 2 3 4 5 N/A

Please provide any baseline data and follow up data that you are using to evaluate this journey: ______Please list any questions you have regarding this domain. ______Please list any accomplishments you have made in this domain. ______Please list any key challenges you have in regards to this domain. ______Please list any future plans you have for this domain. ______

Copyright: National Council for Behavioral Health May not be reproduced in whole or part without express permission. Contact [email protected] or 202.684.7457 8