Exposure to traumatic stress is increasingly understood as a common denominator among children, youth, and adults across service systems. Experiences surrounding Adverse Childhood Experiences (ACEs) and trauma impact individuals everywhere. The pandemic and other recent events, nationally and locally, have only amplified some of the structural and systemic problems surrounding trauma, making it all the more important and urgent to address trauma at not just an individual level, but also at the organizational and systemic levels.
In Westchester County, the Coordinated Children’s Service Initiative (CCSI) Trauma Subcommittee is comprised of stakeholders from various public sectors with a vested interest in creating a more trauma-informed system of care. In 2020, this committee administered a survey to 84 agency leaders of settings ranging from mental health, child welfare, and education, to peer advocacy, law enforcement and others to assess needs and readiness for trauma-informed systems change. Results indicated a strong desire across sectors to become more trauma informed, and a relatively high degree of awareness, knowledge and skills toward achieving these goals. The greatest challenges reported by survey participants were 1) reinforcement and support for these practices were not abundant enough to fully realize systems change; and 2) the need for a comprehensive, evidence-based approach for methodically achieving and maintaining environments of trauma informed care. In response, Blythedale Children’s Hospital and Kohl’s Eat Well, Be Well Community Wellness Program is sponsoring the first county-wide, trauma-informed systems change Learning Collaborative, which kicked off (virtually) on April 12.
The high number of applications received across the board from Westchester agencies speaks to the collective readiness and current sense of urgency to engage in this process.
“At a time when our community is experiencing such massive collective trauma, it is more important than ever to ensure that our community agencies are equipped to recognize and respond effectively to the signs of trauma in both the individuals we work with and in our staff members. This Learning Collaborative provides an opportunity to capitalize on the great work that has already been done in Westchester and go deeper in our efforts to become increasingly more trauma-informed and trauma-responsive,” said Jenna Velez, LCSW, Vice President of External Affairs at The Mental Health Association of Westchester and Co-Chair of Westchester County Trauma Subcommittee.
Trauma-Informed Care (TIC) is an approach that shifts thinking from “what’s wrong with you?” to “what has happened to you?” with an understanding of the pervasive nature of trauma. Organizations and communities can become more trauma-informed by making specific service and administrative-level modifications in order to be responsive to both the needs and strengths of those with a trauma history (Harris & Fallot, 2009). Five guiding principles serve as the backbone to these administrative and service modifications:
- Safety: Ensure physical and emotional safety for clients and staff.
- Trustworthiness: Maximize trust, ensure clear expectations and consistent boundaries.
- Choice: Strengthen staff and client experiences of choice and control.
- Collaboration: Engage in partnership and power-sharing between staff and clients, as well as among organizational staff.
- Empowerment: Prioritize validating and building on individual strengths and skills.
Blythedale Children’s Hospital, acting as the clinical leader in the initiative, had earmarked grant monies and began planning the training prior to the pandemic. When Blythedale set out to promote and support a shared approach that influences innovation and improvement in both organizational processes and individual care practices to achieve better experiences and outcomes for staff, patients, students and communities—Covid-19 and the global trauma tsunami it has triggered were unimaginable. Now, it is clear the destructive waves of this trauma tsunami may likely be hitting us for a long time to come—making the incorporation of universal precautions fundamental to Trauma-Informed Care all the more crucial across all public service sectors.
There is strong belief that the guidance and support of this collaborative workgroup will be impactful and have strong reverberations. When organizations across multiple communities and sectors move in the same direction, a deep ripple effect that results in better experiences and outcomes for staff, patients, students and communities can be expected.
“Many of us in Westchester have increasingly come to realize the pivotal role of trauma in social determinants of health, racism, physical health and emotional wellness. This awareness brings a renewed sense of urgency to take real and meaningful action that fundamentally changes how our systems operate,” said Andrew Bell, Ph.D., a Program Director at Westchester County’s Department of Community Mental Health and Co-Chair of the Trauma Subcommittee. “This Learning Collaborative has come just in time to help us tackle this daunting task together. Blythedale’s leadership and vision will allow us to create a comprehensive blueprint that will serve us for years to come.”
This six-month learning collaborative, which consists of 37 Champions from 24 organizations across various disciplines and service settings, is being facilitated by The Institute on Trauma and Trauma Informed Care (ITTIC). ITTIC is a University at Buffalo School of Social Work-based research center with nine years of experience in providing training, consultation, coaching, and evaluation for organizations and service delivery systems on trauma and Trauma-Informed Care. The Institute is dedicated to providing the public with knowledge about trauma, adversity and its impact, and promoting the implementation of Trauma-Informed Care. Recognizing the centrality of trauma is the key to accomplishing ITTIC’s overall mission of establishing a multidisciplinary trauma-informed system of care, thus ensuring that service systems are not re-traumatizing the individuals within them. As part of New York State’s University System, ITTIC remains eager to bring their services and expertise to other NY-based entities and communities.
“We are struck by the collective influence and diversity of experience represented among this learning collaborative’s Champion cohort,” said Whitney L. Marris, LMSW, Project Manager at The Institute on Trauma and Trauma-Informed Care, Buffalo Center for Social Research, University at Buffalo School of Social Work. “The last 14 months have been emotional, stressful, and potentially traumatic. These Champions come from cornerstone community spaces where they witness the indelible—and, indeed, often inequitable impacts that navigating this era continues to have on individuals, families, the workforce, the community, and service systems across Westchester County every day. Coming together to enliven a trauma-informed approach through participation in this Learning Collaborative will provide a framework for folks to honor these experiences in ways that are more helpful than harmful, while equipping Champions with the requisite strategy and intention to set the stage for healing, resilience, and growth in Westchester County moving forward.”
Blythedale’s vision goes beyond endorsing a shared framework and expanding Trauma-Informed Care throughout the county. Other key objectives related to the initiative include building a referral network of trauma-informed agencies, within and across service sectors to foster a continuum of care that better serves patients, students, Health Home families and communities and encouraging the Champions to join the county’s longstanding Trauma Committee to continue the work and foster sustainability after the conclusion of the Learning Collaborative. Ultimately, our goal for this Learning Collaborative is to provoke meaningful change with regard to addressing ACEs and trauma and add significantly to the growing list of advancements in Westchester County. With evidence-based models and best practices available to guide us forward, now seems like a vital time to prioritize a collective movement in the direction of Trauma-Informed Care.
“We are proud to bring together such an important cohort of community leaders to improve not only the provision of care at our individual organizations, but to bring about systemic change within the communities we serve,” said Blythedale Children’s Hospital President & CEO Larry Levine. “At Blythedale, we are caring for an extremely vulnerable population and the pandemic has only amplified the challenges our families face. It is only logical that we would support such a vital and much-needed initiative.”
Continued proof of commitment and momentum in this movement will also need to come from local and state policymakers who could eventually codify ACE, trauma and resiliency science into additional legislation. Two bills passed in late 2019 mark the first time ACE science has been signed into law in New York State. Serving as a fierce advocate for children and families, Blythedale’s leadership continues to work tirelessly to influence public policy. Champions of this collaborative along with other local entities are viewed as a coalition that possesses the unique opportunity and responsibility to use their leadership positions to speak out on important causes and issues that give a voice to the voiceless.
To spur change and progress toward becoming a trauma-informed county, we must collaborate and forge our efforts and resources. Like the old adage says — if you want to go fast, go alone. If you want to go far, go together.
This training is funded by Blythedale Children’s Hospital and Kohl’s Eat Well, Be Well Community Wellness Program. Through generous grants, the Kohl’s Cares program has supported vitally important community programs at Blythedale since 2000, donating nearly $3 million.
Marie Roth, MA, RDN, NBC-HWC, ACTRP, is the Director of Curriculum and Program Coordinator for the Eat Well, Be Well Community Wellness Program at Blythedale Children’s Hospital. For more information about Blythedale Children’s Hospital, visit www.blythedale.org.
Harris, M., & Fallot, R. D. (2009, April). Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and Planning Protocol. The Anna Institute.