Waiting to be asked: Trauma-informed care
Waiting to Be Asked:
A Population Crying Out for Trauma-informed Care
Interview with David Johnson, CEO, Navos; Megan Kelly, Vice President, Trauma Informed Services, Navos; Cheryl Sharp, Senior Advisor, Trauma-informed Services, National Council for Behavioral Health
Trauma is pervasive in our society. In the U.S., 61 percent of men and 51 percent of women report a history that includes at least one traumatic event, with many reporting more than one. Among people served by public behavioral health systems, a striking 90 percent have experienced trauma. People with mental illnesses and addictions whose trauma goes unaddressed have poor health outcomes including exacerbated mental health problems, increased risk of heart disease, suicide, and substance abuse. It would be impossible to effectively manage populations served by behavioral health without factoring in trauma-informed care.
Navos, a behavioral health center in Seattle, Washington, is a National Council for Behavioral Health member and has participated in many national practice improvement initiatives, including a National Council Trauma-informed Care Learning Community. Navos implemented many of the best practices discussed in the learning community and helped people impacted by trauma have a better healthcare experience and get on the road to recovery.
Navos serves some of the most vulnerable people in King County, Washington. People who are economically disadvantaged, who struggle with basic necessities like housing and food, who have had adverse childhood experiences, who are more likely to be assaulted and mistreated as adults, and who are at high risk of becoming re-traumatized.
The journey to extend trauma-informed care to this vulnerable population began when Navos CEO David Johnson was at a National Council Conference and heard Tonier Cain speak. Cain, a victim of 83 arrests, and innumerable rapes and beatings, homelessness, and substance use, shared the story of how her life changed when a trauma-sensitive behavioral health professional, for the first time, asked “What happened to you?” instead of the usual “What’s wrong with you?”
Johnson was deeply moved and returned home with a new lens and vocabulary. He points out that behavioral health has always known that people have had trauma in their history but has not paid attention to how common it is. “Now we know what can be done to free people from the legacy of trauma,” says Johnson. Trauma-informed care offers a structured way of eliciting the stories and of helping people understand how trauma might have shaped self-harming or self-defeating behaviors they’ve developed.
Navos’ mission to address trauma in the population it served began to take shape when Johnson met Megan Kelly, a long-time expert in trauma-informed care, and invited her to join his team as Vice President, Trauma-informed Services. Kelly notes that creating such a position is unique for a behavioral health organization. “It speaks to how important trauma-informed care is to an organization, and it speaks to the impact trauma-informed care can have on all employees, all consumers, and the community at large. Trauma-informed care is not just a clinical program, it’s a community and workforce program,” says Kelly.
Under Kelly’s leadership, Navos offers a range of specific, evidence-based treatments — such as Trauma-focused Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, and Dialectical Behavioral Therapy — to help alleviate the impact of trauma and adverse childhood experiences. But trauma-informed care is much more than treatments and clinical practices, emphasize Kelly and Johnson. It’s a way of being, of understanding what people are going through, of talking, and of offering care.
How has Navos implemented this way of being? They started with sharing the trauma-informed culture, language, and vision with every one of their more than 650 employees. From billing to front desk staff, from clinicians to executives and board members, everyone went through a 3-hour trauma-informed care training.
Just as a new employee coming to a mental health center is grounded in the organization’s mission and trained in everything from using electronic health records to compliance, they are trained in trauma-informed care to establish that these are values everyone at Navos holds dear and holds themselves accountable to in interactions with each other and with people served. As a result, says Johnson, it’s not unusual to have any staff, whether it’s an accountant or a data analyst, say “Now wait a minute, the way you ran that meeting — or handled layoffs, or talked to me during assembly — was not in keeping with trauma-informed care.” All staff know they have a responsibility to confront behaviors that aren’t in keeping with the values they learn.
Navos used an Organizational Self-Assessment offered by the National Council to guide its trauma-informed work. “The organizational self-assessment is a wonderful tool, and it has given us a broader framework and a way to measure and take steps to make sure that we’re including all areas of trauma-informed care in our work,” says Kelly.
The trauma-informed culture is evident in practices and care environments across Navos. At an inpatient unit for adults who are involuntarily committed, Kelly trained staff to begin each day with a community meeting where they review the principles of recovery and trauma-informed care, and talk about how they support safety. In the afternoon, staff reaffirms these principles and discusses specific situations. Kelly also helped to replace a seclusion and restraint room with a sensory “comfort room,” where patients can go and find scents, music, textures, etc., that they’ve identified ahead of time to help them feel safer. A children’s long-term inpatient program has a sensory comfort room that the children in that program named Rainforest Cove.
Most importantly, Navos is finding that people who come through their doors for care want to talk about their experiences. “It’s almost like they’ve been waiting for us to ask,” says Johnson. When people have an avenue to talk about what’s happened to them, their mental health symptoms are mitigated and they view the world as a safer place.
How do you measure trauma-informed care outcomes? Kelly explains with a trauma-informed care system, an organization should see a decrease in the number of psychiatric diagnoses, an increase in the diagnosis of PTSD, less use of seclusions and restraints, a decrease in assaults and incidences of violence, a decrease in lengths of stay, and a decrease in detentions and arrests. Ultimately, trauma-informed care enriches and enhances recovery from mental and substance use disorders.
Navos strives to share the trauma-informed culture throughout the community. Kelly’s expertise is sought after by different agencies in the community. Navos established a trauma-informed care action team in King County and has trained schools, primary care agencies, domestic violence organizations, and other community partners in how to approach and work with the population that goes to them for services. “When we give people a lens to look through and a vocabulary to use, all sorts of really cool things get unlocked. Everyone is aware of and respectful of the trauma someone has to overcome and their capacity to overcome it. I’d see it as a catalyst that taps into the strengths and best part of everybody: the caregivers, the people with lived experience, the advocates, the policymakers,” says Johnson.
Johnson has three top takeaways for other organizations embarking on the trauma-informed care journey.
- First, think of trauma-informed care as a transformational experience for the whole organization and community, NOT as a nice little tool to have in the toolbox when working with a certain population.
- Second, as a leader, hold yourself accountable to be congruent with trauma-informed care, accept feedback, and be responsible about changing where needed.
- Third, commit to resources in terms of funding, time, and people, even when times are tough. If you’re going to become a trauma-informed organization, you need to be prepared to spend five years doing so and to remain dedicated to making it happen.
Kelly adds that the lessons Navos has learned from experts and peers in the National Council Trauma-informed Care Learning Community have also been invaluable. She says trauma-informed care is growing, and we’re learning new things all the time — about the brain, about how people think and feel and react. Without the National Council, there isn’t a way to be part of that growth.
“My dream is that some day we’re not talking about trauma-informed care. My dream is that it just is, and we don’t have to define it and teach people, that it is a way of being. When trauma informed care is passé because people are naturally doing it, then I’ll know we’ve arrived,” concludes Kelly.