Catholic University of America Social Work Essay

Six Key Principles of Trauma-Informed Services
In your reading for this module, the six key principles of trauma-informed services were
outlined. This video will go into each principal in more detail and provide examples of what the
implementation looks like in action.
According to recent guidance from the Centers for Disease Control and the Substance Abuse and
Mental Health Services Administration, there are six key principles that are followed in all
trauma-informed organizations. They are a set of principles that are interconnected and rely on
one another to create the whole system of care. They are safety, trustworthiness, peer support,
collaboration, empowerment, and culture and identity.
We start with safety because it is the bedrock of all relationships. All people in every part of the
program or organization must attend to safety, not just those who will engage clients directly in
services. This means everyone, from the person who greets the client when they come in to the
custodial staff who may interact with clients while attending to the physical environment of the
program to those in fundraising who may ask a client to provide an account of how the services
have helped them.
Safety is also felt in the physical environment. Are there private spaces to discuss sensitive
matters? Is there good lighting around the building? Are there security guards or cameras that
may make some people uncomfortable while making others feel safe? As safety is often
subjective, it will be important to include consumers of your services in discussions about safety
in your environment.
The second principle is trustworthiness. When working with trauma survivors, it is important to
remember that trust is earned. Since experiences of trauma violate trust, we must demonstrate
trustworthiness through honest, clear, and thorough communication. Our behavior must match
our words. We have to do what we say we will do and act with integrity and authenticity.
Programs and services must have clear rules that are followed by everyone. Confidentiality and
its limits should be clearly explained and followed so that everyone knows what to expect.
Predictability is also key to trustworthiness. So having reliable schedules and consistency helps
with trustworthiness.
Peer support is the third principle. And it speaks to the importance of having those who have
gone through traumatic experiences help others. This means that programs and services provide
options for different forms of self-help or mutual support.
This type of support is not led by clinicians and doesn’t follow a standard medical model of most
social services. The focus is on power sharing, following the Alcoholics Anonymous style of
survivor-led groups and services.
In my past experience working in a trauma-specific agency, this can be an opportunity for
consumers to give back when they feel ready. These relationships are respectful, reciprocal, and
empathic.
The fourth principle is collaboration, which continues the theme of sharing power in the third
principle and extends decision making to include those impacted by the decisions. This addresses
hierarchical and elitist practices that we often find in agencies where there is a “them” versus
“us” dynamic between practitioners and clients. Collaboration sends the message that all
contributions and contributors are valued and lives out trauma-informed values by ensuring that
consumers of services have a place at the table when discussing programs and services that are
supposed to be designed for them.
Empowerment is the fifth principle of trauma-informed services, which speaks to the need to
extend opportunities for voice and choice to people who have experienced trauma. Loss of power
and control are hallmarks of trauma. Therefore, it is essential that we consider this in program
design. Empowerment also speaks to the need to explore strength and resilience and not focus
solely on problems or pathologies and build capacity for decision-making so the consumer no
longer needs your services.
The last of these principles is cultural identity. Trauma is experienced through the lens of
identity, and it is crucial to remember that identity is intersectional. An individual’s culture,
gender, history, and other dimensions of identity are central to trauma-informed services.
Coming from a place of cultural humility, of learning about the identities and experiences of
others, allows us to treat each individual as the expert on themselves. Historical trauma,
oppression, and marginalization all impact current traumatic experiences. And trauma-informed
services strive to be responsive in that area.
The six principles of trauma-informed services provide us with a framework for thinking about
how to design and implement programs for trauma survivors and really anyone seeking support.
They should guide your thinking on ways to improve upon what you are already doing and to
implement new practices as you strive to be truly responsive to the needs of trauma survivors.
Trauma-Informed Services: A Universal Design for Services
The idea of a universal design comes from the field of architecture and others concerned with the
physical environment. Essentially, it means creating systems and structures that are accessible to
all, regardless of ability or disability. The application to social services is not just about physical
spaces, although all should be easily accessible by anyone with visual, hearing, or mobility
impairments. The way universal design applies to trauma-informed services is more about how
we engage with those we serve.
Many programs and services are not designed specifically to address past trauma. However, this
does not mean that they should not be trauma-informed. Trauma-informed services focus on
avoiding inadvertently retraumatizing clients while providing services by attending to the
dynamics present in complex trauma. Trauma-specific services provide treatment that directly
addresses traumatic experiences and healing from the effects of trauma. Trauma-informed
services do not necessarily address traumatic experiences, nor do they need to include trauma
treatment at all levels of services.
This is an important distinction for many reasons. Trauma-specific organizations are typically
the only ones who should be providing mental health services to trauma survivors. However,
using the concepts of universal design, if all social service organizations were trauma-informed,
they would be accessible and feel safe to all.
The idea for trauma-informed services grew out of the understanding that most clients seeking
mental health services have experienced some type of trauma. As we have reviewed in previous
modules, research shows that there is a strong connection between adverse childhood
experiences and health and mental health disorders. Many programs and services designed to
support clients in achieving mental health stability have inadvertently created environments and
policies that can be retraumatizing.
For example, asking people to give details about traumatic experiences in order to qualify for
services, using cookie-cutter treatment plans that are not responsive to the individual’s unique
needs, and employing interventions that are not responsive to ethnicity and cultural trauma. By
providing services to all clients in a manner sensitive to past trauma, we create a means of
providing services that are designed to minimize trauma triggers for those who are survivors.
The concepts of universal design, trauma-informed care, and trauma-specific services are all
important to understand as they will guide how you go about adjusting your programs and
services to be more responsive to the needs of all your clients. The next video will explore the
principles of trauma-informed services, which are an essential part of a universal design.
Interview Coral Acevedo
My name is Coral Acevedo. And my previous role that we’re talking about now, I was the trauma
grant specialist. So, I oversaw a five-year trauma grant that was provided to us by the Health and
Human Services Administration.
And my role was to ensure the implementation of all the assessments for the children, and
making sure that we were meeting the needs of children and family who enter the child welfare
system, that they were getting the right mental health evaluations, behavioral, psychotropic
medications. And we made sure to assess their needs every 90 days. And so, this report was kind
of just our story of how through the years what we saw in terms of what our needs were in the
system, what our barriers were in order to provide the best care that we could to our children and
families.
And now my role has kind of shifted. I’m the program specialist for the Office of Well-Being.
So, I still do some work with trauma, what I just mentioned before, but I also do more on kind of
a macro system. So, I also do work with domestic violence, substance abuse, education, tutoring,
transportation. But my work is mainly on contracts, grants, and report writing, so all the
nonclinical stuff that we need in our department.
And I think when we look at systems and how systems operate, all those things are needed?
Right.
For the clinical services to get delivered. And we often lose sight of that. There are crucial roles
that have to get fulfilled if we’re going to deliver trauma-informed care. Someone’s got to fund it.
Someone’s got to measure it. Someone’s got to evaluate it.
Exactly. We have to know how many people that we’re serving in terms of how many people that
need to be hired. I can show you in the report as well, but we also kind of implemented our
inhouse mental health therapy kind of system, because that was one of the needs that we learned
from our trauma grant is we need something in-house. Because when referring children outside
to our community providers, there’s a big lapse in time from the time from when they’re removed
from their home to when they first receive services. So, it closed that gap. We have our own
mental health evaluation, behavioral health therapies in-house now, which is a good thing.
Great. Because in thinking about trauma-informed care, you never know when you’re referring
out how trauma-informed is this other system that I’m referring this child or this family to.
Exactly.
That’s great. Were there other things you learned about taking this huge system and making this
big change? Creating trauma-informed care often seems like this big change in a system. What
else did you learn about how to set up trauma-informed services in a big system?
Yeah. So, one of the first things that we really focused on was training. So we wanted to
become– we wanted to move from being trauma knowledgeable to being trauma informed. So
that meant everybody who works at the agency, no matter what their position was, they had to
have some type of knowledge base and what it meant to be a trauma-informed system.
So, with that, we had– we started with doing a lot of trainings. We partnered with the KVC
Institute, who is based out of Chicago. They came in and helped us kind of create modules,
create trainings to really kind of start from a macro to micro level in terms of what people’s roles
were at the agency, how to kind of formulate that language and that lingo.
What is trauma? How do you digress a situation? How do you calm down a child or a family?
Kind of what services are needed? What do those services look like?
So based on your role, if you were a case-carrying social worker, if you were a nurse, if you
were– we also did stuff in the community to the police department, judges, lawyers. And we
tailored each of the trainings to that person’s role to really try to spread the knowledge of what a
trauma-informed system was, and have everybody on the same page in terms of the lingo, and be
able to look out of what the signs were for a child of a family who may be experiencing trauma,
and how to best serve them, both at the agency and in the community.
Another barrier that was really big was our data sharing platform. So, when social workers,
nurses, clinical staff were doing assessments and the assessments were kind of populated into our
SACWIS system, which is our State Agency Child Welfare Information System, when it was
time to share that information with other community providers, our systems always didn’t line
up. So that information would kind of get lost in that translation. And reports had to be done
multiple times.
And as you know, if you’re doing additional reports for the same child or family, here we go with
retraumatizing that child, that family. So, we really had to figure out a way how to improve our
data sharing platform. That’s kind of one of the biggest challenges that we had. We are better
now, but it took a good two years to get to the point that we’re at now. So, I would say those are
kind of the two biggest issues that we had.
Did you encounter any resistance among staff to buy into the trauma-informed care principles?
Yeah.
Yeah.
Definitely. It’s like, why are we doing another assessment? I don’t understand why we can’t just
use this previous one. How is this one helping?
So we introduce– I don’t know if you’re familiar. Have you ever heard of the CAFAS and
PECFAS assessment?
Yeah.
OK. So, we?
Let’s tell the students a little bit about what those are, because [INAUDIBLE].
So CAFAS stands for Child and Adolescent Functional Activity Scale, I believe. But it measures
a child’s level of involvement in the community, and how they perform in school, at home, in the
community, if they’re on any drugs or alcohol.
So, there’s like eight domains that are measured, and each domain is given kind of a score
between 10 and 30. 10 being very minimal, kind of not much going on. 30 being kind of a severe
impairment. And then out of all the eight domains, the total score is calculated.
And based off that total score and how they scored in each of the domains, our social workers are
able to formulate a case plan, identifying three goals, which may include– OK, I see you scored
a 30 at school, meaning that either you’re not attending school, or you’re not going.
Let’s look at the school. What are your barriers there? Is that because– are you failing the grade?
Are you not doing– so do you need tutoring help? Do you need access? Do you need help with
transportation?
So social workers are able to help the child and the families identify these goals to improve their
well-being. And then that assessment was kind of done every 90 days. And so, we were able to
track progress.
A similar assessment was given to the parents called the CSBA. That’s the Caregiver Strengths
and Barriers Assessment. Instead of a score from 10 to 30 for each domain, they were given a
letter grade– A, B, C, D, E, F. And kind of the same thing, what are their needs? How can we all
work together to improve the quality of life for this family?
So that was one assessment that was kind of hard for social workers to get on board with. But
once they saw the importance and they could visually see– in our SACWIS system we also had
one called FACES, where the assessments were stored.
We also had a visual kind of a graph representation every 90 days. And they could really see like
this child is getting better. This family is improving. Maybe this assessment is working. So once
they were visually able to see it, it was easier for them to get on board with doing it. But we had
a lot of issues, like similar like that with our assessments. Yes.
Yeah. And who are your biggest allies or champions in the initiative? Who could you turn to for
help and support?
Definitely our social workers. I mean, at the end of the day, it’s their job to really help with these
cases. And they’re our front-line workers who every day are touching the children, the families.
So they are really our biggest allies in making sure this work got done.
Also, we have a 24-hour clinic in-house. So, we have nurses. And we have– well, now we have
a psychiatric nurse practitioner on board. So, they’ve dealt more with the immunizations, with the
psychotropic medication management, those types of things. So, they are also our champions in
making sure, hey, is this child still on these medications? And can you tell me more about how
they’re improving in terms of the clinical side?
Also, our community providers, those that we reached out to for mental behavioral health
services, therapy. Or like I said, now at that time we had to outsource, but now we do everything
in-house. But they were also our big allies in making sure that these children and families were
getting the help that they needed.
Great. Great. Did you involve consumers of services in this process at all in terms of design or
evaluation? Any consumers involved?
Yes. So, I mentioned KVC earlier in terms of the training. They helped us with that. We also
partnered with NYU’s child and adolescent unit on trauma.
Have you heard of TST, Trauma Systems Therapy?
Oh, yeah.
OK. So that was our platform in terms of how we were basing all our trainings and things on. So,
we partnered with NYU, who are the developers of the trauma systems therapy.
And also, we had– our evaluation team, who is based out of Rochester, New York, they were
called CCSI. And their specialty is just evaluating child welfare and other government agencies
in terms of taking that data and helping us tell the story.
We had a lot of data. From all our assessments, evaluations, our screenings, we had focus groups
that we did. So, breaking down all of the questions that were answered by the focus groups, and
kind of turning those from qualitative information, something that’s quantitative that we can
measure over time. So, they were a huge part in this grant.
Every year we attended a conference. We were one of– I believe there were about maybe 16-18
other agencies, child welfare agencies in the country that we came together from across the
country, kind of shared our barriers, our successes.
And it turns out that we, being DC, it was kind of like the champion that the rest of the country
was actually looking at in terms of how we were able to work so closely with our allies, our
providers, our community partners, because most states don’t have that. We’re so lucky in DC,
how small we are, just to have a good relationship with the Department of Behavior Health. We
5 have a good relationship with all of our systems. And it was just so shocking that other states
didn’t have that.
You think about like, for instance, California. They really didn’t have a good relationship in
terms of sharing data, sharing information. I think one– I think the main child welfare agency is
based out of LA. And then they had other agencies all across the state. So, it’s really hard for
them to kind of come together and share their information. So, we were a champion in that
aspect in terms of our relationships with our allies.
And any families that were involved, families who received services, how did you engage them?
It would be difficult at first– the families to be on board. But once we were able to explain to
them the purpose of these assessments, and once they were able to see how it was helping their
families– a lot of our families there, their resistance in terms of going to therapy, or really
coming into the building.
A lot of our stuff had to be done at our main headquarters in Southeast. And a lot of families,
they didn’t want to come to our building. So how do we get them to come in? How do we show
them that, hey, this is really working. But once it became– honestly, once it became part of their
case plan, it’s something that’s also seen over by the judge when families go to court to get their
children back in their care is when they came on board.
So yes, it’s something that they had to had to do. At the same time, once they were doing it, it
was easier for us to continue the process with the families.
That’s great.
Yeah.
What advice do you have for organizations and the leadership of those organizations? Having
gone through this, what would you tell them now about getting started in creating
traumainformed systems of care?
To be patient, that’s the biggest thing. I mean, one of the biggest things we learned was that every
new program or initiative is going to take between like three and five years for it to really start
working, and for results to really kind of be shown, to be tracking over time. That was another
barrier that we did come into contact with.
This was a five-year grant. So, I came in on the second year, but it turned into a six-year grant.
We had a no cost extension for our final sixth years. I worked on it for a total of four years.
In those four years we had three changes in leadership in terms of the director of our agency.
And each time a new leader stepped into the role of director; aspects of the grant would change.
Well, we don’t want to do this assessment anymore. We’re going to let this one go. Or we want to
implement something.
So I guess the biggest thing I can tell leadership is to just be consistent throughout, because those
kind of like blips in what we are– our story that we’re trying to tell with the changes of
assessments, or how often we would assess over time kind of was really like a hindrance in the
end.
And I just wish that it would remain the same throughout. It would have saved us a lot of
headache, a lot of kind of retraining our staff. We had– I believe the third year we revamped our
whole training to our staff. So instead of– well, first, it was like a big umbrella training to all
staff, and that is when we kind of did the individual training modules. So that was a big change.
But I would just say consistency throughout, just doing the same assessments over time
throughout the duration.
That’s great. And I think in the patient’s piece, too often we think change can happen very
quickly, or we hope it will. And there’s a lot that has to get changed. And depending on the size
of the organization, the number of players and programs and services, five years seems like a
long time.
Right.
But over the arc of history in an organization, it’s really not.
It’s not.
Having the long view sounds like the best way to approach this.
Exactly.
That’s great. Well, Coral, thank you so much. You’re welcome.
This has been really helpful just to get the perspective of someone who’s seen this change over
time, and some of the barriers, and how to keep going, and persisting, and seeing that it is
possible to get everybody on board. And we will encounter resistance.
Yep.
And we can overcome that by demonstrating the value. I think what you said about having kind
of a visual representation so that you can see the change over time being really helpful.
Always have your data. Always have your data to tell your story. That’s the best advice I can
give, because data doesn’t lie. That’s it.
Great. Well, thank you so much.
Welcome.
I really appreciate you had time to come and talk to our students, and share your experience, and
share the report, and give some advice on how to create trauma-informed systems.
You’re welcome. Thank you so much for your time.
Factors for Success, Common Barriers and How to Overcome Them
Change is difficult, and organizational change is particularly challenging. When changing
organizations to create trauma-informed services, you need to pay attention to the culture of the
systems involved. All too often, the prevailing attitude is that things are done the way they are
because we have always done them this way. Creating systems of care that are trauma-informed
can feel like a daunting task, and there can be many barriers that arise. In this video, we will
review some strategies for success.
A good first step in planning for change is conducting an agency self-assessment for readiness to
implement trauma-informed principles across the domains. The agency self-assessment should
examine staff development and training, environmental safety, consumer involvement, policies,
and an assessment of the current state of services. Addressing ways to assess self-care among
staff should be part of this planning.
Another strategy for success is to plan ahead for administrative support for the process. Having a
team to plan for the change will lighten the load, but will also help to develop a sense of trust
from frontline workers, clients, and the community if you engage them in the team early on.
Finally, collaboration across all services is an important factor for success. Many organizations
have multiple services, and some may be trauma-specific while others are not. For example,
those who work in securing safe and supportive housing should be part of the planning process,
even if they are not providing direct therapeutic services to trauma survivors. All staff involved
in the organization should be part of the transition to trauma-informed care.
Even with most careful planning, you will likely come up against barriers. Lack of leadership
buy-in to the concept is a major barrier. Finding a champion of your efforts among the board of
directors or leadership team can help overcome this barrier. There must be support from the top
in order to create this kind of change.
Another barrier is the presence of trauma-skeptical staff. These are often folks who will carry a
bias that the trauma history of clients they serve does not have an impact on their ability to be
successful in other areas of their life. For example, they may not see the connection between
trauma and addiction or between trauma and mental health. A way to overcome this barrier is to
conduct some training and education about trauma before having discussions about more
systemic change. By sharing some research and data about the connections, you can help staff
overcome their biases.
Another common barrier is financial. Many organizations operate on a shoestring budget, and
there can be a belief that shifting to trauma-informed services will be costly. The response of,
there’s no money for that, can be addressed by looking at the expenses already budgeted.
For example, if there is a training budget, why not have the training agenda for that year focus on
trauma? If there is funding for environmental upkeep, why not do a safety audit of the physical 2
space and see where safety concerns can be fixed? The changes that need to be made to become
a trauma-informed program are often not costly, but require thought, planning, and coordination.
Hopefully, this video has helped you think about the barriers that may arise in your own
programs when you plan to make changes to create trauma-informed services. Most of the
barriers are those that can be overcome with some creative thinking and planning, as well as by
finding allies who can help you. It is human nature to resist change. But if we understand why
that change is necessary and how it can help us serve people in need, we can be successful.

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