National Council for Behavioral Health

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Creating safe, secure and trusting environments enhances the ability of health care staff to provide services in a nontraumatizing manner and supports the health and wellness of employees and patients. A trauma-informed organization strives to address psychological, emotional and physical safety in policy and practice and makes an effort to ensure patients, family members and staff feel safe at all times.

Bulb iconQuick Tip: Safety

Safety, in the context of a trauma-informed approach, encompasses physical and psychological safety, which are equal priorities when creating a trauma-informed environment.

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Single check icon Action Steps

  • Conduct an environmental assessment. 
    A full range of sights, sounds, smells, touches and tastes may activate trauma survivors, leading to harmful stress responses, so be aware of the ways the senses are affected by the environment. The CIT should conduct a thorough assessment of the organization’s physical space beginning with an individual’s first contact with the organization to assess for safety and threats of retraumatization. A complete environmental assessment is provided to identify environmental improvements in primary care settings. In addition to assessing for physical safety concerns (e.g., entryway lighting), it is important to focus on the ways that the physical environment impacts patients’ psychological and emotional safety. Use the assessment questions included in the tool, Hotspots for Retraumatization or Activation for Patients Worksheet.
  • Assess patient safety. 
    Attending to the psychological and emotional safety of patients is as important as addressing physical safety. From the first contact with a prospective patient through the patient’s engagement with the organization, it should be clear that the health care setting is welcoming and supportive. Psychological and emotional safety draws heavily on both the physical and the interpersonal nature of the environment. Key areas to assess include: Initial Greeting by Phone, Initial Greeting in Person, and Initial Intake . The full chapter contains additional resources to support the assessment and adoption of environmental changes.
  • Establish trauma-informed rooming policies. 
    Empower patients to choose who is or is not present with them during their visit. Some patients will feel safer meeting with the provider one-on-one, while other patients will prefer having a friend or family member with them for support. It is important that primary care organizations establish policies that prioritize patient choice to help patients feel safe in the exam room.
  • Foster trust through trauma-informed patient interactions. 
    Earning trust and building positive relationships with patients are essential pillars of a trauma-informed approach to build a therapeutic relationship. There are several policies and practices providers and organizations can apply that help foster open communication, trust and sense of safety between providers and patients, including prioritizing conversation over accomplishing a checklist, engaging in collaborative documentation and conducting trauma-informed physical exams.
  • Provide universal education materials. 

    Universal education provides easy-to-understand information to all patients, usually through post-card sized handouts, pamphlets or posters. Providing universal education materials offers an opportunity to inform patients, families, staff and partners about trauma and its impacts and encourages patients to initiate a conversation about trauma.

    • Futures Without Violence offers a range of free digital and hard copy universal education materials, including posters.
    • Templates for universal educational materials can help clinics start to create their own materials.

    Educational materials should also disclose the limits of confidentiality (e.g., mandatory reporting laws). All universal education materials should provide support and information on how to access resources and services.

  • Ensure staff safety. 
    Many features that make environments safe, secure and trusting for patients are the same for staff. There should also be a safe and effective method for staff to report any verbal or physical altercations that occurred during their shift. Make an effort to prevent secondary trauma as discussed in Change Concept 3: Prevent and Address Burnout and Secondary Trauma Among Staff. A critical component in maintaining a safe environment for staff is ensuring a consistent process for soliciting and responding to staff feedback on this issue. Use the Staff Feedback Survey to operationalize and embed this into your existing continuous quality improvement process.

 

Tools icon Implementation Tools

 

Bulls eye icon Change Concept 1 Goals

  1. Our primary care service team adequately addresses the three components of comprehensive safety: Psychological, emotional and physical.
  2. Our primary care service team ensures a safe and secure physical and emotional environment.
  3. Patients are engaged in efforts to assess the physical and emotional environment.
  4. Our organization has a system in place to evaluate the social and emotional experience of patients and staff.
  5. Our primary care service team develops, disseminates and displays TIC-related informational materials.
  6. Our primary care service team has strategies to resolve conflict and address aggression between staff and between staff and patients.
  7. Processes related to the environment of care are culturally and linguistically appropriate.
  8. Our primary care service team promotes physical and emotional well-being through wellness-focused activities.