Research Report Early Adopters of Trauma-Informed Care
Lisa Dubay, Rachel A. Burton, Marni Epstein
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This report describes lessons learned from six organizations’ efforts to become more trauma-informed, based on 69 interviews with staff and other stakeholders in 2017. These six organizations were selected to participate in a pilot demonstration as part of the Advancing Trauma-Informed Care initiative led by the Center for Health Care Strategies and funded by the Robert Wood Johnson Foundation. Through this initiative, these organizations received grant funding and participated in a two-year learning collaborative allowing them to share insights with each other and receive technical assistance from national experts. The six organizations worked to make organizational cultures more trauma-informed; educated staff about trauma and the impact of exposure to adverse experiences on patient behavior; and encouraged staff to engage in more “self-care” to prevent vicarious trauma and staff turnover. Some organizations also increased their use of patient questionnaires to identify patients with a high number of adverse childhood experiences (ACEs) who could benefit from additional services, and some began offering new trauma-specific services to their patients.

Interviewees reported that their efforts were facilitated when organization leadership strongly supported these activities; when middle management was involved in implementation of the activities; when staff were given the freedom to innovate, learn from failures, and revise approaches based on lessons learned; when skilled therapists were available on site to participate in warm handoffs from primary care providers; and when staff were released from clinical duties to participate in new activities such as trainings and meetings. Barriers included staff resistance to change; organizational hierarchies and power dynamics that can inhibit open exchange of ideas; not collecting enough patient input on the services patients actually want to use; lack of accountability when staff fail to make good faith efforts to engage in new trauma-informed efforts; pressure to see many patients a day to meet productivity targets; reliance on grant funding for organizational transformation and lack of stable funding sources for some services (e.g., screenings, social work case management, alternative therapies).

Research Areas Health and health care
Tags Community-based care
Policy Centers Health Policy Center