Sunday, February 16, 2014

Signs that Trauma Informed Care is Eroding- and What to Do about It

This post is part of my new focus on how to sustain trauma informed care. It describes indicators that a trauma informed approach to treatment may be eroding in a team, factors that may be contributing to that erosion, and actions to take to restore compassionate and effective treatment.

Signs that trauma informed care is eroding:
·         Grounding are more frequent and longer
·         Restorative tasks begin to look like punishments
·         People start talking about clients “getting away with” things
·         Behaviors are described as deliberate and attempts to get at staff
·         Team members are not trying to understand behavior or figure out how it is adaptive for the client. Instead they focus on how to change it. 
·         Divisions start between team members, there is more blaming of each other
·         Team members start asking for more rules to govern their interactions
·         Staff stay in offices and interact less with clients
·         The words “consistency” and “structure” are used more than usual
·         Activities begin to have to be earned, and clients are not allowed to attend fun events or arts or recreation activities due to recent problem behaviors
·         Clients are described in pejorative terms such as “manipulative” and “borderline
·         People say things like "she wants to be that way"
·         People make hopeless and cynical statements
·         Less laughter and fun
·         People are talking about returning to points and levels or adding more severe consequences

What to look for as contributing factors:
·       Client turnover
·         Staff vacancies and over work of remaining staff
·         A new, more severe type of client
·         Administration being less available
·         Any particular staff having severe problems
·         Personal issues and losses
·         New reporting or oversight demands
·         Difficult incidents and/or bad discharges

What to do:
·         Talk about it
·         Acknowledge changes and stressors
·         Make a plan to solve particular issues ( I.e. Hiring) with deadlines and responsible people and stick to it
·         Discuss vicarious traumatization (VT), do VT exercises, acknowledge difficulty of work
·         Provide opportunities to reflect on successes
·         Arrange team building retreats and fun events
·         Increase staff recognition
·         Emphasize the mission and the importance of the work
·         Increase administrative presence
·         Remember past successful clients, and how they started
·         Do not get sucked into making more rules for clients or staff- look beneath to the meaning     

 Let me know your thoughts- have you had any experiences with observing the erosion of trauma-informed thinking in your teams? What has been helpful?

1 comment:

Roia said...

This is a helpful and illuminating list, Patricia. I think looking at Vicarious Traumatization is so important. Often people aren't even aware they're experiencing it. Thanks for sharing your thoughts on this important topic!