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).