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Vol.
21, No. 2
April 2016
Creating Safe, Trauma-Informed Agencies
When it comes to safety, every human service agency faces the challenge of balancing two core goals: protecting the physical and psychological safety of staff while also promoting the physical and psychological safety of clients. Child welfare professionals increasingly recognize the importance of having a trauma-informed approach that attends to the needs of both staff and clients. SAMSHA (2015) defines a trauma-informed organization as one that:
- Realizes the widespread impact of trauma and understands potential paths for recovery;
- Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
- Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
- Seeks to actively resist re-traumatization.
A Balancing Act
Yet the balancing act of caring for those served by the agency and those who provide services is not always easy. On the one hand, agency leaders have an ethical duty to their staff to address the very real risk of physical and emotional harm involved in child welfare work. On the other hand, an agency that only considers potential risk from clients when establishing policies and procedures is likely to stigmatize and re-traumatize the very people it's designed to serve. The same security guard or metal detector or bullet-proof barrier that helps a staff member feel safe and valued is likely to make some clients feel decidedly unsafe and devalued.
Like families, every agency is unique. No two are likely to need the exact same mix of approaches in ensuring that everyone who walks through their doors feels protected. However, there are common principles of trauma-informed agencies (SAMSHA, 2015): safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and attending to cultural, historical, and gender issues. Here are some tips, based on a growing body of research, for putting those principles into practice.
Minimize Environmental Triggers
Part of keeping people safe is simply reducing the factors that can lead to aggressive behavior. Research has shown that a more comfortable and welcoming environment tends to improve behavior. For example, rooms that are crowded, noisy, uncomfortably hot or cold, or harshly lit are likely to leave people more frustrated and agitated. Conversely, having more space, comfortable seating and temperatures, more natural lighting, less noise, and soothing, neutral paint colors all contribute to a more pleasant, calming environment (McMurran, 2012; Wortley, 2002).
In fact, studies in assisted living facilities have shown a physical environment that's attractive, organized, and well-maintained correlates with improved behavior of the people served (Bicket, et al., 2010).
In terms of being trauma-informed, a welcoming and attractive environment helps not only on a physiological level, but conveys a clear message that those who work in and use the building are valued and respected. The decor and environmental conditions of the social service agency may tend to fall to the bottom of many county budgets; however, in a trauma-informed culture part of the leadership role is to advocate and engage community supports to provide a physical space that is as welcoming and well cared for as possible.
Re-consider Common Areas
We all know how our own anger can rise the longer we're kept waiting. Add to that the stress under which most clients come to your agency and you can see why problems escalate. If at all possible, waiting times should be kept under 20 minutes.
At the same time, workers have to spend as much time as needed to provide quality service and attention to each client. This not only reduces problems by giving people a chance to vent, but follows the trauma-informed principle of empowering people by allowing them voice and choice.
In reality this means the responsibility for keeping waiting times down falls to supervisors and leaders who may need to jump in and see clients themselves, call in additional staff or volunteers, or ask walk-in clients if they can return at a later time (Brown, et al., 1986).
Lack of privacy can also be a trigger for anger or shame that may be acted out in aggressive ways. In some settings people have to announce what their problem is in earshot of others, or they may worry that others can overhear them if they're meeting in a cubicle (Brown, et al., 1986; Bicket, et al., 2010). Agencies can reduce this risk with a small number of private screening and meeting rooms.
Use a Customer Service Approach
Consider the experience clients have from the time they walk into your agency to the time they leave. It is hard to create a culture of collaboration and mutuality if an agency is operating more out of fear of what might happen than out of hope for what may be possible. A number of studies have shown that what seems at first glance as an out-of-the-blue episode of violence by a client is often a result of feeling mistreated or unfairly controlled. Richter and Whittington (2006) found that staff in mental health settings typically described aggressive incidents by patients as happening unpredictably, with no triggering incident; patients, on the other hand, reported frustrating behaviors by staff or other patients as the cause.
Given the high prevalence of traumatic stress among families served by child welfare, it's likely many people who come into your agency may be hyper-vigilant about perceived threats or slights (AAP, 2013). Even interactions that seem neutral to an outside observer may feel unsafe to a trauma survivor. And given the frustration front-line staff may feel from overwhelming workloads, sometimes challenging clients, and the endless pile of paperwork, it's safe to say that not all interactions with clients are positive or even neutral. Sometimes staff understandably show their frustrations or even vent their irritation on clients or visitors. While we have all been on the receiving end of poor customer service, our individual histories and current level of functioning play a huge role in how we handle those episodes.
In settings where staff face a potential threat of harm, there can be a "tradition of toughness" that leads the professionals to distrust clients (Morrison, 1990, cited in Richter & Whittington, 2006). This, in turn, can lead to rigidly following rules, rather than allowing for some flexibility for individualized treatment. Such rigid adherence can create frustrating bureaucratic hurdles, which in turn can escalate clients' anger.
Being in a state of excitement typically makes people less psychologically flexible. In an agency setting, this can mean that both staff member and client can quickly feel they have no option other than to escalate the situation (Zillman, 1994, cited in Richter & Whittington, 2006). Sometimes staff who have been assaulted (or who perhaps have heard about threatening incidents from co-workers) cope with their fear by becoming more emotionally distant or confrontational (Whittington & Wykes, 1994). While such reactions may be an understandable extreme, we have all experienced organizations where a culture of wariness and mistrust towards clients is conveyed in some staff attitudes and behaviors.
The task of supervisors and agency leaders is to provide a safe forum for staff to share their fears and frustrations, and to be responsive to their need to feel protected, while at the same time modeling and insisting on a consistently respectful and collaborative approach to every client interaction. While child welfare professionals need validation and support around the risks they face, they also need encouragement to build a relationship of openness and trust with each new client.
Trauma-Informed Design
A new trend in building design takes an even more fundamental approach to creating environments that promote psychological safety and healing. Trauma-informed design is an attempt to create a sense of safety and comfort in the way buildings are made and used. The approach has been used across the country to design organizations, such as schools and homeless shelters, that serve populations at high risk for trauma exposure.
One practice in trauma-informed design is to recognize the healing properties of nature, and to bring as much of it as possible into the agency. This can include something as simple as using a wooden railing instead of a metal one, using muted colors instead of bright ones, maximizing natural light, and having as many views or images of the natural world as possible.
Understanding the need to balance privacy with the principle of transparency, buildings with trauma-informed design use open sight lines with glass dividers and curving hallways. Perhaps most importantly, staff members fill in areas with small details like pillows, throw rugs, and blankets to provide as much a feeling of comfort and home as possible. In the words of a school principal in Boston: "One of the things that is unique about this institution is that we try to not make it an institution. We try to really think about it as a family of learners, students, staff and parents….And in that we also have a lot of trust for the people we're working with" (WBUR, 2016).
Changing the Narrative
Child welfare agencies across the country increasingly recognize the need to create a trauma-informed system that provides a sense of safety and promotes healing for children, families, and staff. For families and staff alike, there is always a temptation to batten down the hatches and maintain a defensive posture against potential harm. Even small changes in how individuals and agencies operate can help convey a message of trust and possibility that changes the narrative for people who have experienced trauma.