# Trauma Informed Curriculum

MODULE 6

Trauma-Informed Systems Change

## Summary

This module provides a definition of trauma informed systems and give participants an opportunity to consider how assessment processes apply to organizational/systems levels.  There are three core components to this module: I) an overview to define and explore core elements of trauma-informed systems change, II) an exploration of domains and tools for assessing the current status of trauma informed systems change in an organizational context and III) illustration of possible strategies to for making environments and processes in agencies more trauma-informed.  An alternative activity for applying one specific assessment model is also provided, which may be applied in agency settings or used as a group learning project for advanced students.

## Learning Objectives

• Define key concepts, characteristics, and principles related to trauma-informed systems
• Identify possible questions and approaches for assessing current status of an organization/system in relation to trauma-informed systems changes.
• Explore strategies for facilitating trauma-informed changes in systems

## Module Outline

### I.  Lecture and Discussion:  Trauma-Informed Child Welfare System Overview (30-40 min)

Activity Name: Overview of Trauma-Informed Child Welfare System

Modality: Presentation and Discussion

Learner Level: All Levels

Duration: 30-40 min

Materials:

Facilitator Instructions:

• Presentation. Review PowerPoint slides excerpted from the National Child Traumatic Stress Network, Child Welfare Trauma Training Toolkit. Full toolkit, with PPT and facilitator notes, is available at: http://www.nctsn.org/products/child-welfare-trauma-training-toolkit-2008
• Facilitated discussion.  Provide participants a copy of the Essential Elements of a Trauma-Informed Child Welfare System handout from the Chadwick Trauma-Informed Systems Project - Dissemination and Implementation.  Divide participants/students into small groups and assign each group one or more of the essential elements. Each group is invited to discussion (and document key ideas) in response to two questions (also adapted from the NCTSN Toolkit): Why is this an essential element of child welfare? and What are some of the ways you are already doing this in your practice within your organization?

Note: The 3-page Essential Elements of Trauma-Informed Systems handout may be particularly useful for MSW programs that use an ecological/systems perspective.  Location: https://ctisp.org/ctisp-trauma-informed-child-welfare-resources-and-webinars/

### II.  Presentation and Activity: Trauma-Informed Systems Assessment (30 min)

Activity Name: How trauma-informed is my agency/system?

Modality: Brief presentation and experiential activity

Learner Level: Intermediate

Duration: 20-30min

Materials:

Facilitator Instructions:

• Presentation. Provide a PowerPoint brief presentation about key domains for trauma informed systems change.  Optional: Share examples of what "works" in leading collaborative systems change efforts based on qualitative research in Santa Clara County
• Activity: How trauma-informed is my agency/system? Pass out copies of the Trauma-Informed Systems Change Instrument and invite participants to complete the form (as best they can) using their own agency, or unit within a larger agency. Invite comments about strengths and opportunities in key areas, including safety, giving voice and choices to children/families, and addressing secondary trauma.

### III.  Using trauma-informed systems assessment to inform changes (45 min)

Activity Title: Illustration of trauma informed assessment process

Modality: Activity

Learner Level: Intermediate (may be appropriate for advanced)

Duration: 20-30 min

Materials:

Facilitator Instructions:

• Participants should review sections on Key Results and Findings from the Walkthroughs and Concrete Solutions section.  Ideally, participants would do this in advance of the class/training, but it is also possible to adapt as an in-class/in-person activity.
• Invite participants to write down 2-3 possible trauma-triggers from the document that may be present in their agencies and solutions for addressing triggers that might apply to their own agency setting. Encourage written notes.
• Invite participants in groups of three to discuss at least one trigger and one solution with other participants.   Facilitate de-briefing discussion with the full group.

## Alternative Activities

### Alternative 1: Experiential Activity: Finding Solutions and Overcoming Barriers in Moving from Trauma-Impacted to Trauma Informed Systems

Activity Title: Trauma-Impacted Systems vs. Trauma-Informed Systems

Modality: small group activity

Learner Level: Intermediate

Duration: 90min

Materials: blank pieces of paper and pens, large chart pad paper, tape and markers.

Facilitator Instructions:

• Co-Facilitators can distribute the materials to each small group – 8 blank pieces of paper and 4markers.  Each group is given 5min (time care vary pending time available) to consider what it looks like to witness a ‘Trauma-Impacted System” from 4 different perspectives.
• Each group should write a bullet point list of behavioral evidence of impact of trauma on the top half of the page, drawing a line horizontally across the middle and titling each page with the following (one per page):
1. new social worker (5min list of symptoms)
2. veteran social worker (5min list of symptoms)
3. parent, trauma-survivor (5min list of symptoms)
4. child, trauma-survivor (5min list of symptoms)
• Co-Facilitators help groups make quick transitions from one category to the next at 5min intervals to ensure there is at least some information in each category.
• Co-Facilitators then ask each group to pass their packet of 4 papers to the group next to it, all groups moving in a circle.
• Co-Facilitators then ask each group to take 4 new pieces of paper and repeat the activity, this time considering possible solutions to these behavioral lists.
• Co-Facilitators then ask each group to pass the packet of 8 pages to the table next to it again, moving in the same circular motion each time.  This time each group is asked to consider barriers to the proposed solutions.  Barriers should be listed on the bottom half of the same page that had the list of trauma-impacted behaviors or symptoms.
• Co-Facilitators then ask each group to pass the packet of 8 pages to the table next to it one final time.  This time groups will consider solutions to the barriers that include ‘out-of-the-box’ possibilities and use of broad teams.
• Co-Facilitators can debrief in a large group setting and chart responses and themes on large chart pad paper for all to see.   Participants are encouraged to keep the packets they have created to take back to their host agency for discussion about possible implementation of these ideas.

### Alternative 2:  Option for advanced "homework" or group project

Activity Title: Illustration of trauma informed assessment process

Modality: Webinar viewing and discussion

Learner Level: Intermediate (may be appropriate for advanced)

Duration: 45-60 min

Materials: Link to webinar/ audio/visual equipment for viewing.

Invite students to independently view a webinar segment describing trauma-informed walkthrough process and description of how the walkthrough was used in five site Trauma Informed Walk-Through Assessment Project in five sites in the U.S..  (Show background on walk-through assessment, assessment findings, and reported changes after 6 months)

Before viewing the webinar video, invite participants to identify trauma-triggers that may be present in their agencies and solutions for addressing triggers that might apply to their own agency setting. Encourage written notes (or discussion posts)

After viewing the webinar, invite participants in groups of three to discuss at least one trigger and one solution with other participants.

NOTE: Start at 15.13 min through to 44:30 min of webinar (Approx 30 min of time)[3]

NOTE: Trainer/Teachers may also opt to use written materials from the report for the Trauma-Informed Care Walk-Through Project as an alternative to showing the video for this component of the module. See key resources below.

One option for a practical activity for advanced used would be to organize and conduct a trauma-informed systems "walk-through" assessment in their own agency, using the process described in the Brown article or the (same process) in the National Center on Substance Abuse and Child Welfare report.

The following manuscripts and reports provide descriptions and illustrations of a trauma-informed "walk-through" assessment and systems change model (developed by V. Brown in collaboration with R. D. Fallot and M. Harris).

Brown VB, Harris M, Fallot R. Moving toward trauma-informed practice in addiction treatment: A collaborative model of agency assessment. Journal of psychoactive drugs 2013;45(5):386-393.

National Center on Substance Abuse and Child Welfare. (2015) Trauma-informed care walkthrough project report: Data and findings.  Available from: https://ncsacw.samhsa.gov/files/trauma_walkthrough_rprt_508.pdf

Drabble, L., Jones, S., & Brown, V. (2013). Advancing Trauma-Informed Systems Change in a Family Drug Treatment Court Context. Journal of Social Work Practice in the Addictions, 13(1), 91-113.

The following documents provide additional descriptions of trauma-informed systems assessment strategies.

Henry, J., Richardson, M., Black-Pond, C., Sloane, M., Atchinson, B., & Hyter, Y. (2011). A grassroots prototype for trauma-informed child welfare system change. Child Welfare, 90(6), 169-186.  (NOTE: Provides background information about self-administered Trauma-Informed Systems Change Instrument)

Fallot, R. D. & Harris, M. (2009) Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and Planning Protocol.  Washington D.C.: Community Connections.  Available from: http://www.communityconnectionsdc.org/web/page/673/interior.html

Other key sources for guiding principles and practices for trauma-informed systems change that may be particularly useful for behavioral health and interdisciplinary contexts may be found on the Substance Abuse and Mental Health Services Administration (SAMHSA) web site, including the national center for trauma-informed care site: http://www.samhsa.gov/nctic/trauma-interventions

[3]
Source: Webinar on trauma-informed care for families affected by substance use disorders; from the National Center on Substance Abuse and Child Welfare with Vivian Brown and Amanda Kellerman