Utilizing a trauma-informed approach in behavioral healthcare can potentially improve patients’ mental health and protect the well-being of providers. Integrating a trauma-informed approach, however, can seem overwhelming, as it requires resources, time, patience, and insight. Fortunately, the Trauma Informed Care Project, an organization devoted to understanding, recognizing, and responding to all types of trauma, offers guidelines to help agencies and institutions adopt the practice of trauma-informed care.
At the WJCS Trager Lemp Center for Treating Trauma & Promoting Resilience (TLC), we have taken a large, figurative bite out of the proverbial Trauma Informed Care Project to improve the quality of our trauma-informed care. Recognizing that trauma is not prejudiced or biased against anyone, we have been implementing changes within our organization at the micro- and macro-levels to ensure a sense of safety for those who serve and are serviced by our mental health clinics.
The Trauma Informed Care Project outlines several foundational steps to integrating trauma-informed care: 1) Building awareness and generating buy-in for a trauma-informed approach; 2) Supporting a culture of staff wellness; 3) Hiring a workforce that embodies the values of trauma-informed care; and 4) Creating a safe physical, social, and emotional environment.
Respecting the brevity of this article, and in light of the ever-rising pressures mental health professionals and auxiliary staff experience daily, I have chosen to discuss the importance of supporting a culture of staff wellness. Like any good recipe, establishing and maintaining staff wellness require some key ingredients. They include educating staff on identifying and addressing vicarious trauma, promoting a culture of wellness, incorporating wellness activities into staff meetings, and offering internal and external staff wellness activities.
Educating Staff on Vicarious Trauma
Vicarious trauma, often synonymous with secondary traumatic stress, burn out, and compassion fatigue, is a concept that grew from the burgeoning reality that individuals who provide services to trauma survivors can develop similar mental health and somatic symptoms as their clients, by virtue of being chronically exposed to their clients’ life stories. We have all heard of the notion “leave it at the door,” but sometimes our thoughts and feelings insidiously creep in, without invitation, right through that doorway. When it happens so inconspicuously though, how do we know when vicarious trauma is something we are experiencing?
Within WJCS we have a Trauma Committee, composed of trauma experts who practice in various settings, including schools and outpatient clinics. Those individuals are charged with the task of training all agency staff and external community providers about vicarious trauma. The first part of the training focuses on how to identify trauma sequelae. This initial portion of the training is crucial because, without it, how are employees supposed to notice when those stealthy trauma symptoms are claiming stake in their minds and bodies?
The trainers define vicarious trauma, provide examples of how it is manifested, and offer practical ways to combat vicarious trauma symptoms. An example, and my personal favorite, is challenging yourself to think about how understanding vicarious trauma has changed your life positively. I used to experience intense tension in various parts of my body after the work day. After learning about vicarious trauma, I became much more in tune with my own mind-body connection and started practicing deep breathing and positive reframing. It has made me appreciate the value of having balance and serenity in my own life so I can be fully available to my patients.
For employees who detect signs of vicarious trauma in themselves, WJCS offers an Employee Assistance Program, which is a wonderful resource. The Trauma Informed Care Project suggests that employee education about vicarious trauma can come in the form of displaying posters in the office that delineate signs of burnout. Encouraging work/life balance is also key. This may be manifested by a manager appreciating an employee’s long commute and offering the opportunity to work a compressed work week to avoid a day of travel, or allowing that employee to work from home when possible. This can also mean encouraging an employee to take available vacation time.
Promoting a Culture of Wellness
Our CEO Seth Diamond leads our agency with a firm conviction that employees need to feel valued which, in turn, helps to alleviate or avoid the development of vicarious trauma. His belief is evident in his manner of relating to all staff. As he says, “caring for workers is essential economically, practically, and morally, especially in this day and age of relatively low unemployment.”
A culture of wellness is most effective when it is driven by its leaders. They have the power to create policies that promote a culture of wellness, like paid time off for physical and mental health needs, maternity/paternity leave, and vacation time. They also have the ability to encourage the use of these benefits without shame and set an example to their staff by taking advantage of these benefits to mitigate their own burnout. This, in turn, sends a message to their staff to also practice self-care. Dr. Liane Nelson, Director of TLC, and Sylvana Trabout, LCSW, Assistant Director of TLC, invariably give staff permission to care for themselves when we are on the verge of burnout. They never shame us. We are thankful.
Incorporating Staff Wellness Activities
A sage pre-doctoral psychology intern once diagnosed our entire team with PTSD. The intern pointed out that at trauma clinic meetings, “You are all talking right over each other.” She explained how disorganized our thought processes seemed, perhaps because that is very much what trauma exposure does to cognitive abilities. We now start each team meeting with a mindfulness exercise. Voila! We are all much calmer and productive in these team meetings.
Similarly, our outpatient clinics recently underwent a “Clinic Transformation,” which includes the use of daily, brief clinical staff meetings. The topics discussed during the meetings can feel draining at times. However, every Wednesday we practice “Wellness Wednesday” during which attendees have fruitful, thought-provoking, clinically-oriented discussion on various topics (e.g., what’s our favorite self-care practice we use in the office, strategies we use to work with challenging cases) or practice a mindfulness exercise. Sometimes, the agency splurges and buys pizza for the staff. After all, eating lunch with colleagues away from our desks is an important wellness activity, as well.
Internal and External Staff Wellness Activities
By partnering with local gyms, yoga, or meditation studios, employers can offer staff discounted wellness activities, an excellent way to promote self-care. We are fortunate to have several colleagues that are “yogis” who have led very relaxing yoga exercises during our yearly TLC staff retreats. Our retreats are also filled with creative mindfulness activities, great food, and an abundance of laughter and companionship. These gatherings are vital to reducing the emergence of vicarious trauma within our team, reinforce the notion that employees are cared about by our team leaders, and enable us to do our work unimpeded by vicarious trauma symptoms.