Bomi Kim
8/20/2013
Fostering Futures: Trauma informed Care Survey Results
I. Survey Information
To better understand the type of Trauma-Informed Care (TIC) activities going on across
Wisconsin, Fostering Futures conducted a statewide survey to gather information on TIC
experiences. Survey questions were developed through several Fostering Futures meetings and
with help from TIC advisory members. The final questionnaire included 13 main questions with
six follow-up identifying questions and others asking participants’ information. The main
questions asked about TIC definition, efforts and barriers in implementing TIC, initiation of TIC
changes, and other relevant TIC experiences and perspectives of the respondents.
The survey was done via an online survey through Survey Monkey
(http://www.surveymonkey.com/s/Z5XHQ97) from July 29th to August 12th (15 days). Members
of Wisconsin TIC listserv were requested to participate in the survey.
127 individuals participated in the survey from 26 Wisconsin counties and five other states. The
top three counties where most participants were from were Milwaukee (n=26), Dane (n=11), and
Brown (n=6). The average question response rate was 94%.
II. Survey Results
A. Participants Information
1. Type of entities
First, participants were asked to identify the entity that best categorizes the context of traumainformed care that they will be referencing in the survey. 48% identified their entities as
organizations, 39% did as systems. Communities and institutions were 8% and 5%, respectively.
In the follow-up questions that further characterized their groups, a majority were affiliated with
private, not-for-profit organizations (county 27%, statewide 24%). 36% of participants were
involved in governmental organizations (county 20%, statewide 16%). For-profit private
organizations made up 13% (county 5%, statewide 8%) and informal groups consisted of 5%.
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4.5%
Informal Group
5.4%
8.0%
16.1%
26.8%
19.6%
24.1%
Governmental statewide
organization
Governmental county
organization
Private, not-for-profit statewide
organization
Private, not-for-profit county
organization
Private, for-profit statewide
organization
Private, for-profit county
organization
2. Professional characteristics of participants
Survey participants were asked to identify their roles in groups among suggested options1. 64%
were administrators/supervisors, 28% were counselors/therapists, and another 28% identified
their roles as a direct service provider. Advocates were 18% and rest identified themselves as
consumers (4%), peer providers (6%), board members (3%), or volunteers (2%). Other responses
included personnel involved in research reviews, program evaluator, TIC consultant, and a crossagency state-level work group facilitator.
63.7%
28.3%
28.3%
17.7%
6.2%
1
3.5%
2.7%
1.8%
Those who had multiple positions identified more than one role.
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As for their focus area, survey participants checked multiple major areas that they were working
on. Three quarters were involved in mental health and half responded with child welfare/child
maltreatment. The next most frequent areas were substance use (47%) and social service (41%).
75.2%
49.6%
47.0%
41.0%
32.5%
25.6% 23.9%
10.3% 10.3%
6.0%
The participants were asked which population groups they worked with, such as early childhood,
teens, children, adults, and families as a unit. More than three quarter of them (78%) were
serving teenager groups.
78.4%
76.0%
72.8%
68.0%
49.6%
Teens
Children
Adults
Families as a Early Childhood
Unit
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B. TIC Experience Questions
Question 1. If applicable, do you think your group is performing Trauma-Informed Care?
83% of participants reported their groups were performing TIC. Because there was no following
identifying question in the survey, it was not possible to infer why 13% of participants perceived
their groups were not doing TIC.
Question 2. How does your group define “Trauma-Informed Care?”
97% of participants answered that their groups followed the SAMHSA’s definition of TIC.
“A culture change process that includes an approach to engaging people with histories of
trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma
has played in their lives.”
Other definitions of TIC were “an organizational, professional and personal healing process
designed to grow the capacity of everyone involved to support and/or practice trauma-informed
care” and “the culture that despite all of the presence of trauma, kids and families can make the
changes necessary to overcome and manage their trauma and set high expectations for
themselves to achieve in any aspect of their lives.” One respondent answered they followed St.
Aemilian Lakeside’s definition of 7 TIC essential ingredients.
Question 3. Which of the following guiding values did your group agree upon? Check all
that apply.
Safety
82.3%
Trustworthiness
73.4%
Collaboration
71.8%
Empowerment
71.0%
Choice
64.5%
Our group has not adopted TIC guiding
values
Not applicable
13.7%
2.4%
Respondents’ groups were most likely to follow the five core TIC principles/values of Fallot &
Harris. Safety (82%) was the most frequently chosen value, followed by trustworthiness (73%)
and collaboration (72%). 14% of participants reported that their group did not adopted any
guiding values. Other responses were “understand the impact of trauma,” “six core strategies for
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reducing seclusion and restraint (NTAC) and caregiver capacity,” “specializing in the cutting
edge treatment of trauma,” and “a welcoming environment for mental health/AODA services.”
Question 4. How long ago did you start the process of integrating TIC into your practices?
4.9%
11.4%
Less than a year
15.4%
1 year to less than 2 years
2 years to less than 3 years
47.2%
3 years or more
21.1%
Not applicable
Survey participants were more likely to be involved in groups with longer experiences of TIC.
Approximately a half (47%) of respondents answered their groups had been implementing TIC
practice for three years or more. 11% reported their groups had less than one year experience of
TIC.
Question 5. Who initiated or drove the Trauma-Informed Care change(s) in your group?
Check all that apply.
Executive Leadership
44.5%
Direct Staff
38.7%
Mid-level management
37.0%
Internal Champion
20.2%
Consumer Advocates
External Champion
11.8%
9.2%
Required by funding
5.9%
Not applicable
5.9%
45% of respondents indicated executive leadership as a drive to TIC change in their groups. 39%
reported direct staff, and 37% answered mid-level management initiated TIC change. The rest of
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answers were internal champion (20%), consumer advocates (12%), external champion (9%),
and required by funding (6%). Other responses included “all levels,” “all staff,” and
“organization founders and a consultant.”
Question 6. Did your group use a specific model to guide your change process? Check all
that apply.
39.8%
28.7%
13.9%
10.2%
3.7%
Risking
Connection
Sanctuary
Community My group did Not aware of Not applicable
Connections
not use a
any models
model
my group
used
It was also asked whether their groups used a specific and structured model to guide the TIC
change process. More than a half (69%) of participants reported either that they did not know
any model used or that their groups did not use a model. Among three models suggested, Risking
Connection was used in 14% of respondents’ groups, and Community Connections and
Sanctuary were 10% and 4%, respectively. Examples of other responses were Therapeutic Crisis
Intervention (TCI), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), the Comprehensive,
Continuous, Integrated System of Care (CCISC), and Dr. Bruce Perry’s Neurosequential Model
of Therapeutics (NMT) model.
Question 6-A. If your group did not use a specific model, what actions did your group take
to begin the change process? Check all that apply.
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Met with a TIC consultant
38.9%
Created a TIC Champion Team
35.8%
Included top leadership as part of the TIC…
35.8%
Created action plans to address results…
30.5%
Performed a TIC organizational/community…
26.3%
TIC Champion team meets regularly
24.2%
Included people with experience as part of…
22.1%
Held an organization-wide TIC 'kick off'
Obtained funding
20.0%
12.6%
Not applicable
27.4%
For those who answered their groups did not use any specific models to drive the TIC change, a
follow-up question was asked to identify what actions made the change. Meeting with a TIC
consultant (39%), creating a TIC champion team (36%), getting involved in top leadership as
part of the TIC champion team (36%) were most reported along with other actions. Their
answers show the importance of TIC champion team and TIC consulting in initiating the change.
Question 7. What has your group done to 'operationalize' Trauma-Informed Care? Check
all that apply.
Utilized TIC strategies
69.4%
Required TIC training for existing staff
59.7%
Required TIC training for all incoming staff
54.0%
Shared information with partners
50.0%
Provided Trauma-Informed therapies
49.2%
Focused on the reduction or elimination of
harmful interventions
Screened and/or assessed program
participants for ACES/trauma
44.4%
38.7%
Provided staff with reflective supervision
36.3%
Incorporated ACES, toxic stress and TIC
information into curriculum
36.3%
Required TIC training for administration
33.1%
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To operationalize TIC, respondents’ groups utilized TIC strategies (70%), required TIC training
for existing staff (60%) and all incoming staff (54%). About a half of respondents also answered
their groups shared information with partners or provided trauma-informed therapies. The result
shows that many efforts to operationalize TIC have been made in respondents’ entities.
Question 8. What barriers did your group encounter to implementing TIC? Check all that
apply.
48.4%
Lack of staff time
42.6%
Challenges in meeting staff training needs
37.7%
Initiative fatigue/competing initiatives
35.2%
Lack of funding for training
30.3%
Staff resistance to change
27.0%
Lack of knowledge/information about how to proceed
24.6%
Outside 'systems' lack of cooperation
18.9%
Lack of funding for other needs
15.6%
Lack of buy-in from leadership/administrators/boards
Lack of interest from consumers
I am not aware of any barriers
Not applicable
1.6%
11.5%
6.6%
Most responded that barriers of TIC implementation were lack of staff time (49%), challenges in
meeting staff training needs (43%), initiative fatigue/competing initiatives (38%), and lack of
funding for training (35%). Overall, work overload and training issues among staff, and lack of
funding were major barriers in implementing TIC.
Question 8-A. If you responded lack of funding for other needs, please identify what were
those needs.
For those who reported lack of funding for other needs as a barrier of TIC changes, an
identifying question was asked. They indicated more funds were needed for TIC programs and
services, adequate personnel, staff retreat cost, and office equipment and spaces.
Question 9. How are barriers being addressed? Check all that apply.
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72.6%
41.6%
31.0%
8.8%
We are still
working to
address these
barriers
Collaboration with
outside groups
Increased
advocacy from
within the
organization
10.6%
6.2%
0.9%
Increased
Increased staffing
We have
funding/identified
abandoned our
flexible funds
plan for TIC
implementation
Not applicable
When survey participants were asked how their groups had addressed or are currently addressing
barriers, more than 70% reported they were still working to solve the problems. 42% answered
their groups collaborated with outside groups and 31% reported that they increased advocacy
within the organization to address the barriers.
Question 10. What strategies does your group have to continue TIC implementation?
Check all that apply.
Collaboration with outside groups
48.0%
Permanent training initiatives from incoming
staff
43.1%
Annual requirements for continued training
among staff
38.2%
I am not aware of any strategies my group has
Permanent funding allocation
23.6%
6.5%
The most frequently reported continued TIC implementation strategy was collaboration with
outside groups (48%). More than one third responded they used staff training as a major strategy
to continue TIC implementation: permanent training initiatives from incoming staff (43%) and
annual requirements for continued training among staff (38%).
Question 11. How will your group evaluate the efficacy of the implementation steps that
you have taken/will take? Check all that apply.
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Tracking of consumer outcomes
50.9%
Staff performance evaluations
47.4%
Direct observation of staff
39.7%
Our group has not identified any evaluation
measures
27.6%
Tracking of employee outcomes
19.8%
Exit interviews with staff who leave
19.0%
Performing annual organizational TIC
assessment
15.5%
Top three answers most reported as evaluation methods to assess the efficacy of the TIC
implementation steps were tracking of consumer outcomes (51%), staff performance evaluations
(47%), and direct observation of staff (40%). Approximately a quarter of respondents answered
their groups had not identified any evaluation measures.
Question 11-A. If you responded yes to 'tracking employee outcomes', which of the
following activities are/will you partake in? Check all that apply.
87.1%
64.5%
Tracking
employee
satisfaction
Tracking staff
turnover rates
38.7%
32.3%
32.3%
Tracking
employee
grievances
Tracking
employee
injuries
Tracking
employee sick
days
Those who reported their groups assessed/were assessing employee outcomes identified specific
activities to track the outcomes. Tracking satisfaction (87%), grievances (39%), injuries (32%),
and sick days (32%) of employees, and staff turnover rates (65%) were identified. Other answers
included tracking changes in practices, beliefs, knowledge and behaviors of employees.
Question 11-B. If you responded yes to 'tracking consumer outcomes', which of the
following activities are/will you partake in? Check all that apply.
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93.7%
66.7%
38.1%
20.6%
Surveying
consumer
satisfaction
Tracking relevant Tracking rates of Tracking consumer
consumer
consumer
rates of skipped
outcomes
grievances
appointments
Those who reported their groups assessed/were assessing customer outcomes further identified
specific activities to track the outcomes. Almost all of groups conducted a survey to assess
consumer satisfaction and more than one third tracked rates of consumer grievances. Other
responses were tracking restrictive intervention frequency and durations, surveying consumer
health and quality of life, and measuring client perception of and response to TIC.
Question 12. Are you aware of other efforts to 'operationalize' TIC within systems,
institutions, organizations and communities?
40% of respondents were aware of TIC efforts within other entities.
Question 13. What types of assistance would facilitate the continuing implementation of
TIC in your group? Check all that apply.
81.0%
69.0%
60.3%
60.3%
45.7%
27.6%
Training for
staff
Collaborative
relationships
with other
groups
Informational
resources
Increased
financial
resources
Training for
consumers
Increased
number of staff
Respondents thought training for staff (81%) and collaboration with other groups (69%) would
help facilitate the continuation of TIC implementation. They also indicated that increasing
information resources (60%) and financial resources (60%) would be critical in assisting TIC
implementation. 46% highlighted the importance of consumer training, and 28% answered
increased number of staff.
Question 13-A. If you listed 'increased number of staff' to the previous question, please
explain how additional staff would be used to facilitate implementation of TIC?
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Respondents that noted more staff, more/better staff training, or more peer mentoring would be
helpful to provide more programs and services explained that these would help to lower the
workload per staff, increase the quality of services, and serve more clients.
Question 13-B. If you answered 'increased financial resources' to the previous question,
please explain how additional financial resources would be used to facilitate
implementation of TIC?
Respondents explained that additional funding would be used for hiring more staff, increasing
the accessibility and quality of staff training, funding continuing education of staff on TIC (i.e.,
attendance to workshops/conferences), providing more TIC programs, measuring TIC outcomes,
and equipping more written educational/training materials.
Other comments about working on 'operationalizing' trauma-informed care into practice
“Difficulty is maintaining a number of initiatives in the agency at this time of rapid change due
to health care reform. This, in no way, decreases our commitment to TIC, however we have to
allocate resources (leadership, administrative) in other areas; our clinical staff and middle
management continue to champion TIC in our services.”
“There is a lot of talk. There are reports being written and claims made. But there is no real
investment of resources or personnel necessary to achieve the desired results.”
“I have been VERY interested in starting TIC in my county agency since 2008. It has been a
very difficult process and my supervisor and some higher administrators have not been
supportive. In fact, I have gotten in trouble for bringing forth different TIC ideas. I am reluctant
to give my name and contact information for fear of getting into more trouble. The cost has been
too great and now I feel I must look elsewhere to do my TIC work. I hope with more state
initiatives this county may be encouraged (forced) to do TIC and not just do lip service for this.”
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