Understanding and Incorporating
Trauma Informed Care Practices into
Current Agency Functioning
PRESENTED BY:
JENNIFER BARR, LCSW
FACT TEAM LEADER
APALACHEE CENTER, INC.
TALLAHASSEE, FLORIDA
FADAA/FCCMH ANNUAL CONFERENCE 2013
Adapted from the following original presentation: “How To Make Your Agency Trauma
Informed” by Jennifer Barr, LCSW, Apalachee Center, Inc. & Aimee Griffith, LCSW DISC Village,
Inc. in Tallahassee, Florida.
Overview
 Trauma-informed care (TIC) has received national
attention because of the prevalence of individuals who have
experienced trauma in a variety of settings.
 The implementation of trauma-informed care may present
a challenge to some organizations.
 This presentation will define trauma, Trauma- informed
Care and outline action steps to assist organizations in
identifying the need for trauma-informed care.
 We will also explore the implementation of traumaawareness into current practices.
What is Trauma?
 Trauma is the “direct personal experience“ of an event
involving:
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
1) actual or threatened death,
2) serious injury or
3) other threat to one’s physical integrity.
 Trauma is “witnessing” an event that involves the above 3 factors as
related to another person.
 Trauma is “learning about unexpected or violent” death, injury, or
threat thereof as experienced by a significant other.
 Trauma can be:
 A single event
 A connected series of events
 Chronic lasting stress
Examples of Trauma
 Trauma is an individual experience
•
•
•
•
•
•
•
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•
Military combat
Violent personal assault
Childhood abuse
Being kidnapped/taken hostage
Terrorist attack
Severe automobile accidents
Natural disasters
Being diagnosed with life threatening illness
Loss of a loved one
Impact of Childhood Trauma
“These images illustrate the
negative impact of neglect on the
developing brain. In the CT scan
on the left is an image from a
healthy 3-year-old with an
average head size. The image on
the right is from a 3-year-old
suffering from severe sensorydeprivation neglect. This child’s
brain is significantly smaller than
average and has abnormal
development of cortex.” These
images are from studies
conducted by a team of
researchers from the Child
Trauma Academy
(www.ChildTrauma.org) led by
Bruce D. Perry, M.D., Ph.D.
(Reprinted with permission.)
This material may be freely reproduced and distributed. However, when
doing so, please credit Child Welfare Information Gateway. Available online
at www.childwelfare.gov/pubs/issue_briefs/brain_development/
Trauma Specific Diagnoses
Source: American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition. Washington, DC: American Psychiatric Association.

Acute Stress Disorder
 The person has been exposed to a
traumatic event
 The individual has three (or more)
of the following dissociative
symptoms: numbing, derealization,
depersonalization, dissociative
amnesia
 The traumatic event is persistently
re-experienced (images, thoughts,
dreams, illusions, flashback
episodes)
 Marked avoidance of stimuli
 Marked symptoms of anxiety or
increased arousal
 The disturbance causes clinically
significant distress or impairment in
social, occupational, or other
important areas of functioning.
 The disturbance lasts for a
minimum of 2 days and a maximum
of 4 weeks and occurs within 4
weeks of the traumatic event

Post Traumatic Stress Disorder
 The person has been exposed to a
traumatic event
 The traumatic event is persistently
re-experienced in one (or more) of
the following ways (recollections,
dreams, feeling or re-experiencing
the event, intense psychological
distress)
 Persistent avoidance of stimuli
associated with the trauma
 Persistent symptoms of increased
arousal (trouble falling asleep,
hypervigilence, exaggerated startle
response)
 The disturbance causes clinically
significant distress or impairment in
social, occupational, or other
important areas of functioning.
 Duration of symptoms is more than
1 month
What is Trauma Informed Care?
“When a human service
program takes the step to
become trauma-informed, every
part of its organization,
management, and service
delivery system is assessed and
potentially modified to include a
basic understanding of how
trauma affects the life of an
individual seeking services.
Trauma-informed organizations, programs, and services are based on an
understanding of the vulnerabilities or triggers of trauma survivors that
traditional service delivery approaches may exacerbate, so that these
services and programs can be more supportive and avoid retraumatization.”
-The National Center for Trauma Informed Care
Action Steps
1.
2.
3.
4.
5.
6.
7.
Educate your organization about trauma-informed
care.
Conduct an organizational self-assessment.
Identify training needs and develop training.
Modify policies and procedures.
Implement trauma-informed practices.
Evaluate your organizations’ progress.
Utilize TIC resources and stay current.
Step 1: Educate Your Organization about TIC
 Start with the basics:
 What is Trauma?
 What is Trauma-Informed Care?
 ACE Study (Handout)
 Provide information and resources:
 National Center for Trauma Informed Care

http://www.samhsa.gov/nctic/
Step 1: Educate Your Organization about TIC
 Consider the type, size, and structure of your
organization:


Population served
Organizational leadership
 “Administrative Buy- In” is key!
 Identify leaders to educate
 Explore prior experience incorporating new approaches
Step 1: Educate Your Organization about TIC
 Develop an Action Plan

Sample:
1.
Conduct agency assessment
i.

An Organizational Self-Assessment
Creating Trauma-Informed Care Environments: An Organizational
Self-Assessment
•
ii.
2.
4.
Review policies and procedures to include TIC
Assess staff competence
i.
3.
University of South Florida:
http://www.cfbhn.org/Workgroup%20Information/Circuit%2013/2010
-11%20Org%20self%20assessment%20FILL.pdf
Find or create TIC staff competence assessment
Train all staff in TIC
Train clinical staff in trauma treatment methods
i.
Provide clinical materials (e.g. Seeking Safety, TREM)
Step 1: Educate Your Organization about TIC
 Identify your organization’s TIC liaison(s)
 Create an internal workgroup to facilitate the implementation
of TIC
 Attend the local TIC workgroup meetings
 Create a memorandum signed by chief administrators
displaying commitment to implementing TIC within the
organization
 Incorporating TIC may have benefits and challenges:
 Positive outcome for consumers and staff
 Change embraced by some, fought by others
 Incorporating new approaches takes time
Step 2: Self-Assessment
 Self-Assessment will help your organization
determine practices and policies that are already TIC
and identify areas for growth.
 Creating Trauma-Informed Care Environments: An
Organizational Self-Assessment (Handout)

Components of the assessment:
Organizational Readiness
 Competent Trauma-Informed Organizational , Clinical and Milieu
Practices
 Consumers and Families Engaged in TIC

Step 2: Self-Assessment
 The
assessment should be completed using a
representative sample of your organization.
 Information may be obtained from various sources
(USF, 2010):
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Staff interviews
Consumer/Caregiver Interviews
Review of Policies/Procedures
Client Record Review
Treatment Team or De-briefing
Observation
All of the Above
Step 3: Training
 Identify your organization’s training needs using your
Organizational Self-Assessment .
 TIC is based on the idea that staff start thinking about
trauma at all levels:
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Administrative Staff
Accounting /Human Resources
Receptionist/ Front Desk
Supervisors
Direct Care (Therapists, Case Managers, Correctional Officers,
Teachers, Nurses, etc.)
 Training needs may be position-specific
 Receptionist may need an introduction to trauma-informed care and
tips for interacting with consumers.
 Therapists may need trauma-specific training

For example: Seeking Safety (http://www.seekingsafety.org/)
Step 3: Training
 Identify training developers and trainers:
 TIC liaison(s) may assist with the development of internal
training using research and information gathered from the
local workgroup, TIC trainings, and/or online resources.
 Training staff may be the TIC liaison(s), supervisors or other
experts.
 It may be helpful to identify more than one person who can
assist with development and training.
Step 3: Training
 Develop the training
 The components of the TIC training will vary depending on the
population served by your organization.
 Basic concepts to cover:
Introduction to the concept, history and implications of TIC
 Understanding of trauma and the effects of trauma
 Why TIC is important to your organization, staff and consumers
 Research supporting the effectiveness of TIC
 Information and statistics regarding trauma in the population you
serve
 Practical skills staff can utilize; practice using role plays
 Making your work/service environment welcoming

Step 3: Training
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Techniques and information specific to the population served
 Example: CIT Training for Law Enforcement
You don’t have to reinvent the wheel!
 Statewide TIC presentation (DJJ)

http://www.djj.state.fl.us/partners/our-approach/Trauma
Step 3: Training
 Sample Training Slide (from Apalachee Center training):
TIC: Inpatient Staff Approach
“What makes you feel scared or upset or angry and could cause you to go into crisis?”
Not being listened to
Lack of privacy
Feeling lonely
Darkness
Being teased or picked on
Feeling pressured
People yelling
Arguments
Being isolated
Being touched
Loud noises
Not having control
Being stared at
Room checks
Contact with family
Time of year/time of day
Clients have unique histories with uniquely specific triggers – it’s essential to ask & incorporate triggers in to treatment.
Step 3: Training
 Your organization may choose to create more than
one training curriculum and tailor each curriculum
to staff needs.
 Identify your organization’s training requirements
and frequency training(s) will be offered
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During new employee orientation
Set a date to train existing staff
Updates every 6 months, 1 year, etc.
Step 4:Policies and Procedures
 Update Policies & Procedure to reflect Trauma-
Informed Care Practices
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Staff orientation/training requirements
Screening & Assessment address consumer’s experience of
trauma
Safety Planning to address reactions to trauma/PTSD
Treatment/Case Planning to include trauma and other
individualized needs of consumers
Step 5: TIC Practices
 Engage supervisors in ensuring that your organization is using TIC
practices.
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Identify situations within your organization that require trauma-informed
responses.
Identify staff behaviors that support TIC principles and encourage them.
 Provide follow-up training and/or discussion to ensure continued use
of TIC principles.
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Internal trainings, outside training/webinars, staff meetings, etc.
Step 5: TIC Practices
 Instill hope in your consumers
 Shift from “What’s wrong with you?” to “What has happened
to you?”
 Understand how trauma impacts your consumers’
interactions and responses to you
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Always treat consumers with respect and approach them with
equality.
 Encourage staff to care for themselves so that they
can care for others
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EAP program
Healthy lifestyle choices
Step 5: TIC Practices
 Screening & Assessment
 You may incorporate some questions about trauma into your
current practices/tools
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
ACE Questionnaire
Use a standardized or recommended screening tool

ATTC Resource List includes (TIS Part 2):
 Trauma-Screening Questionnaire (TSQ)
 Impact of Events Scale (IES-R)
 Life Stressor Checklist (LSC-R)
 Post-traumatic Stress Diagnostic Checklist (PDS)
Step 5: TIC Practices
 Trauma-Specific Treatment
 Educate staff about local resources and make referrals… OR
 If you are a local provider, incorporate trauma-treatment into
your behavioral health practice!

Research trauma treatment models:
• SAMHSA’s National Registry of Evidence-based Programs and
Practices (NREPP) http://www.nrepp.samhsa.gov/
• 29 models for keyword “trauma”
Use evidence-based practices and individualize services to meet
consumer needs.
 Ask your staff about their knowledge of and training in traumatreatment models.

Step 6: Organizational Evaluation
 How do you measure whether the incorporation of
TIC is effective or beneficial?
 Employee Evaluation
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Incorporate knowledge and utilization of TIC into standard
employee performance evaluations
Ask staff about the effectiveness of TIC trainings and practices
 Consumer Satisfaction
 Collect information regarding staff’s sensitivity to trauma in
consumer satisfaction surveys.

Yes/No Questions: “Staff asked about my experiences with
trauma;” “I was treated with respect;” and “I felt comfortable and
safe in the [office/clinic/institution].”
Step 7: TIC Resources

General Information & Resources
 The National Child Traumatic Stress
Network www.NCTSN.org
 National Center for Trauma-Informed
Care
http://mentalhealth.samhsa.gov/nctic/
 Trauma Resource Institute
http://traumaresourceinstitute.com/
 American Psychological Association
Trauma Division
http://www.apatraumadivision.org/resou
rces.php
 International Society for Traumatic Stress
Studies
http://www.istss.org/WhatIsISTSS/2465
.htm
 Trauma-Informed Toolkit (CA)
http://www.trauma-informed.ca/
 Trauma-Informed Webliography
http://www.sdcadre.org/traumainformed-webliography.aspx

Population-Specific
 Healthcare Toolbox (Children)
http://www.healthcaretoolbox.org/
 Homeless Programs Trauma Informed
Toolkit
http://www.familyhomelessness.org/med
ia/90.pdf
 Child Welfare Treatment & TraumaInformed Care
https://www.childwelfare.gov/respondin
g/trauma.cfm
 TIC for Women Veterans Experiencing
Homelessness
http://www.dol.gov/wb/trauma/
 Crosscurrents: Journal of Addiction and
Mental Health (Trauma Issue)
http://www.camhcrosscurrents.net/archi
ves/spring2009/crosscurrents_spring20
09.pdf
Step 7: TIC Resources
 Treatment
 ACE Study practical applications
http://www.aceresponse.org/
 US Dept. Veterans Affairs: National Center for PTSD
http://www.ptsd.va.gov/
 Trauma-Informed and Trauma-Specific Models
http://www.theannainstitute.org/Models%20for%20Dev
eloping%20Traums-Report%201-0909%20_FINAL_.pdf
 Video: Healing Neen: “Where there’s breath there’s
hope”

http://healingneen.com/
Questions?
 Please feel free to contact me with any questions:
 Jennifer Barr, Apalachee Center, Inc.

jenniferb@apalacheecenter.org
 Thank you for helping to make Florida trauma-
informed!