Journey to a Paradigm
Posted on September 19, 2014
The last few months have been some of the most exciting in my entire career. After years of research, testing, and design, Coldspring Center has launched our Trauma Informed Excellence Series. Once only a dream, the passion of my team has helped make this ambitious project more successful than I could have ever imagined a few years back. In this post I want to talk about my journey into the trauma informed paradigm and how it has transformed my life and work forever.
On the Shoulders of Heroes
In 2004, my mentor, great friend, and then-boss, Dr. Jerry Yager, introduced me to the Adverse Childhood Experience Study and the evolving brain research concerning trauma. Even though I was only four years removed from my graduate work in psychology, I had never been exposed to this neurobiological research. For the first time in my educational and helping career, I found I finally understood clients in a way that enabled me to actually see paths to true healing and growth. Since Jerry opened my eyes to this new paradigm, I have not stopped reading and studying all aspects of the brain, looking for anything that I could bring to my work as a helper, and later as a trainer.
From those initial conversations with Jerry, a question started to form in my mind. “How could this new research be utilized to evolve and align helping organizations, systems of care, and society with our rapidly growing knowledge of the human brain and mind?” As with most questions in my life, this one led me straight to the library, and into a research project that continues to this day.
I started to devour everything I could from Sandra Bloom, Daniel Siegel, Bruce Perry, Daniel Goleman, Pat Ogden, Gabor Mate, Bessel van der Kolk, Judith Herman, and so many others. Soon a picture started to form in my mind of a whole new way of looking at clients, helping organizations, and the larger society. I realized that current approaches, based on traditional thinking, were often hurting and not helping clients and that a new paradigm was needed. As notes from these great authors piled up on my desk, I started struggling with the problem of how to bring this information together in a way that gives leaders and helpers a tool to transform organizations and systems.
Entry into the Paradigm: Trauma Informed Excellence Leadership
My first attempt at solving this problem was to address something I noticed happening quite often in helping organizations. Therapists, case managers, nurses, and other professionals would go away to trauma trainings and come back on fire. Like my experience with Jerry, they saw their clients in a whole new light, and had new ideas that often questioned how their programs and organizations operated. They also came back with an understanding that many of their co-workers and leaders were acting as if they too had been traumatized (this was before concepts like secondary trauma had entered our vocabulary).
These helpers wanted to align their programs with this new brain research. They would start conversations and advocate for change. Too often they were met with resistance and an inflexibility which did not allow new ideas to challenge traditional ways of thinking. Many of these helpers left their organizations, and those who remained often grew frustrated. It became clear to me that in order to deliver trauma informed care, you must first create trauma informed organizations and programs structured around this new knowledge of the brain and how it heals after traumatic events.
I was given the opportunity by the Denver Office of HIV Resources to present a two day training on Trauma Informed Leadership. I took this as an opportunity to take all the research on the brain and examine it from a leadership perspective. A few years earlier, I had completed a Master’s in Business Administration. The act of struggling with the question, “What is trauma informed leadership?” allowed me to bring my training in psychology into my study of organizational leadership.
During my preparation for the Trauma Informed Leadership training, I had an insight. If an organization is going to shift its paradigm to be aligned with trauma and brain research, why not include best practices shown to create the most effective programs possible? Why not include concrete ways to maximize staff performance and well-being? Why not include leadership strategies that lead to world class services? “Trauma informed” became more than just staying informed about trauma. For me, it became a call to create truly excellent centers for healing. The words Trauma Informed Excellenceformulated in my mind, and eventually became the title for our trauma training series.
Healing Built on Health: Thrive: Self-care
Prepping for the Leadership Training, I also found myself gathering a great deal of research on human performance and well-being. Every self-care training I had been to over the years talked primarily about how to not get burned out and how to handle high-stress work environments. I had never been trained on how to maximize my own performance as a counselor, therapist, or program director. Through the work of David Rock, Tony Schwartz, and others, I started to see self-care in the same light as I approached Trauma Informed Leadership.
Being healthy is only one area of focus – helpers needed to also ask, “How can I be my best at work?” In other words, how could the same focus on excellence utilized in the leadership training also be applied to self-care? Out of this question emerged the foundation for Thrive. Thrivecombined strategies for avoiding burnout, compassion fatigue, vicarious trauma, and secondary trauma with approaches that promote efficiency, robustness, resiliency, and excellence in work with clients.
The work of creating these two trainings, Thrive and Trauma Informed Leadership, provided a new context for my thinking concerning trauma informed care. I have concluded that true trauma informed care could only be delivered in emotionally regulated, healthy, and engaging work environments. Thriveand Leadership provide the cultural transformation needed to realize the healing potential of trauma informed care.
Revolutions in Care: Trauma Informed Care
The next focus was creating a unique way to bring the paradigm into the healing work with clients. Combining developments in neurobiology, genetics, physics, and other sciences, we worked to create a new conceptualization of clients, and what they need to heal from past trauma. Digging deeper into many different scientific areas opened up new concepts and opportunities for healing and post-traumatic growth.
The three main trainings, Leadership, Thrive: Self-care and Trauma Informed Care, which would become the Trauma Informed Excellence Model have allowed me to travel across the country and work with amazing helpers in a vast variety of settings. Just for fun, I tracked all these opportunities on a map a few months ago. I’m truly humbled to see the results. A few years back, it became clear that we had developed material that was really resonating with folks.
A Tool for Transformation: TIE Online Series
The next challenge was the biggest of my career. Now that we had a model and three strong trainings, we needed to find a way to maximize the impact of the transformational aspects of the trauma informed paradigm.
The first barriers were money and time. Paradigm shifts demand a great deal of energy, focus, self-reflection, and work. Models like Bloom’s Sanctuary can cost in the tens of thousands of dollars and take years to implement. In creating TIE, we dedicated ourselves to keeping it affordable for any organization. We also understood that traditional training models alone would not likely lead to systems change.
If we were going to make TIE affordable, we needed to utilize technology and build a new infrastructure to support this goal. We set out to become experts in online training. For months, we worked to take the proven in-person training sessions and turn them into engaging and interactive online trainings. Like most people, we have taken plenty of boring online trainings in our careers. We knew that we had to take a different approach, and pushed ourselves to create online trainings that match the energy and power of our in-person trainings.
During this creative process we had several insights. First, the online format gave our partner organizations the ability to digest the information over a longer time period. In-person trainings are great, but they throw a great deal of information at folks without the necessary time to fully digest how the information could impact their work and organization. In the online format, we suggest one to two hours of training a week. This gives people the opportunity to digest small amounts of information and consider implementation before moving on to the next concept.
The second insight was that this extended roll-out provided the opportunity to integrate a quality improvement process into the structure of the training. TIE has specific quality improvement tasks that provide opportunities for self-reflection and conversation that can lead to organizational and system change. This quality improvement process not only provides a roadmap to implement the paradigm, it also maps out the steps to transformation.
Finally, I’m extremely proud of our team as we were able to keep costs down and, I believe, have structured it in a way that is affordable to every organization. In the end, we are able to offer up to 19 hours of training for just $80 a person (plus a small set up fee). We created our own online learning management system to simplify implementation and further keep costs in check.
Measuring the Impact: Quality Improvement
Measuring success is integral to reaching excellence. TIE utilizes a pre/post assessment, surveys and quizzes as means to both learn from our customers, and document changes in knowledge and ultimately transformation of programs. TIE Pre-Assessment is a baseline measurement, taken prior to starting the TIE Series. This same assessment tool is utilized again six months after the TIE Series is completed, as a post-assessment. It can also be implemented in an ongoing fashion (i.e. annually) as a follow-up assessment to evaluate long-term progress. The TIE Assessment is based on best practices in line with Trauma Informed Principles, the Professional Quality of Life Measure (for burnout, secondary trauma and compassion fatigue), and the Gallup 12 (which measures staff engagement). Aggregate assessment scores are provided to the leadership team in order to help chart future initiatives and improvement efforts.
Future of TIE
We began rolling out TIE in April of this year. Our first two clients were a large mental health/substance abuse hospital, and an HIV system of care (containing several organizations). While these roll-outs are still in progress, the preliminary feedback has been amazing. As we had hoped, the implementation of TIE has reflected the diversity of the organizations and has adapted to meet the specific needs of the people who have taken on this challenge.
The roll-outs have also shown us the real challenges inherent to paradigm shifts. TIE is not a simple training series, but a call to transformation. The online format provides organizations and systems with the knowledge and flexibility to maximize the paradigm. TIE is a mountain to climb, but the format allows us to help organizations and systems to create their own unique path to the summit.
TIE has been implemented in settings ranging from libraries, health centers, social service organizations, mental health/substance abuse treatment centers, and collaboratives across the country. Our hope is that this knowledge will not only transform these organizations, but also reach those in positions to impact funding and policy decisions.
TIE is just a tool. Like any tool it is only as useful as the hand that holds it. We are confident that TIE, combined with the passion and dedication of those in the helping profession, will be transformative.