Implementing change in any organization can be challenging. This is especially true in fast-paced settings that rely on precise time management to be effective and efficient. This section provides Action Steps and Implementation Tools to create optimal conditions for moving your organization’s trauma-informed initiative forward.
- Develop a Core Implementation Team.
The first step in the change process is to form a CIT that drives the work of the trauma-informed initiative. This Change Package is for the CIT to help lead the planning and execution of the project’s change management strategies and five Change Concepts.CIT Membership
Because trauma-informed practice involves staff at all levels, it is important that membership includes representatives from all levels of the organization. Table 4 contains recommended membership and responsibilities for your CIT.Table 4. Example CIT Members and Responsibilities
Team Member Responsibilities Project Lead Acts as communication liaison across team and as the internal champion of change (e.g., clinical executive, primary care clinician with leadership authority or executive backing). The CIT should include one or more people to carry out the change and someone in a supervisory role to ensure change implementation. Quality Improvement Lead Ensures accurate data collection and develops workflow for collection and communicating data (e.g., staff from information technology or quality improvement). Clinical Lead (including behavioral health clinicians, as available) Supports care integration and coordination in operations and for patients in need of specialized behavioral health care. May be internal staff or external referral partner (e.g., director or empowered clinician of behavioral health, social services). Trauma-Informed Champions from Executive, Human Resources, Primary Care and/or Behavioral Health Teams Supports functional implementation and integration of trauma-informed care into organizational culture. Individuals with Lived Experience Individuals with lived experience provide unique and valuable contributions in every stage of planning, implementation and assessment of a trauma-informed approach.Key Considerations for Choosing CIT Members
- Are there members from leadership positions who are responsible for guiding change processes?
- Do members represent all levels of the organization?
- Is the voice of lived experience represented on the CIT?
- Will members carry out the change in their day-to-day activities?
- Are members involved that will provide trauma-related services (e.g., behavioral health specialists and clinicians)?
- Are members able to access resources to support the ongoing adoption of trauma-informed approaches?
- Are members highly committed to the aims of the change?
- Have all members learned what trauma is, its impacts and its prevalence?
- How will your team explain trauma-informed primary care to others?
- Ensure continued support from leadership.
Throughout the planning and implementation process it is critical to grant the CIT authority to make decisions and take action. The CIT provides on-the-ground support by carrying out the planning, implementation, monitoring and quality improvement steps. Executive leadership removes any barriers to progress and provides the required approval, resources and support to enact the changes in the organization.
- Educate CIT members.
After assembling the CIT, provide education to team members on the principles of a trauma-informed approach and how implementing a trauma-informed approach will impact patients, staff and the entire organization. See Change Concept 2: Develop a Trauma-Informed Workforce for a more in-depth discussion of training.
- Conduct an OSA.
Conducting the OSA provides the CIT with a better understanding of how the organization currently aligns with trauma-informed primary care principles and practices. The OSA is a performance improvement tool designed to help engage primary care organization in a self-reflective process specific to becoming a trauma-informed organization. This process:
- Reinforces activities and interventions that are working.
- Identifies opportunities to change activities that are not working.
- Identifies new activities to advance efforts to become a trauma-informed care organization.
Results from the OSA will inform the CIT’s priorities and action steps as they develop an implementation plan. Repeat this process on an annual basis. The Organizational Self-assessment (OSA) Tutorial provides step-by-step guidance for conducting the OSA, utilizing the OSA Action Planning Workbook and communicating the results.Key Considerations for Completing the OSA
- Have you decided who will complete the OSA?
- How will you explain the OSA and why it’s important for participants to complete?
- Have you sent the OSA to those chosen to take it?
- Have you provided two-to-three weeks for participants to complete the OSA?
- How will you communicate the results of the OSA outside the CIT?
- After putting your aggregate results in the OSA Workbook, what key indicators stand out as possible Action Steps to support implementation?
- What can you learn from the highest and lowest values and those with the largest discrepancies?
- Align trauma-informed initiative with existing organizational initiatives.
To reduce the challenges of adding another initiative to an organization, the CIT should utilize the Initiative Alignment Tool to identify existing initiatives that align with implementing a trauma-informed approach. Organizations should consider areas of overlap and ways to avoid “reinventing the wheel.” The results of this assessment will help determine how to strategically align change processes within an organization.
- Communicate to stakeholders for engagement and support.
To gain support from leadership and other stakeholders it is important to communicate about the trauma-informed initiative in an effective manner. Understanding the needs and priorities of the leadership team and other stakeholders, such as patients, staff and community partners will help the CIT develop a tailored approach that will resonate for each audience. The Communicating for Buy-in Tool will help the CIT answer the following checklist questions:Key Considerations for Communicating for Engagement and Support
- Why are you proposing the initiative for the organization?
- Who are the stakeholders?
- What culturally relevant factors will be considered?
- What key points are likely to align with the felt needs, concerns or desires of the stakeholders?
- When will you deliver the message to keep stakeholders continuously engaged?
- Where will you deliver messages?
- How will you deliver messages?
- What are your expected outcomes and how will you measure them?
- Develop a plan.
One of the CIT’s main priorities is to develop a detailed implementation plan in response to the OSA that is adapted to the unique needs and resources of the primary care organization. This plan should include:
- Reasonable and feasible goals.
- Actions steps towards achieving the goals.
The CIT uses the results of the OSA to choose one or more of the goals listed under a Change Concept. A Practical Toolkit for Adopting Trauma-Informed Approaches in Primary Care is an additional tool to guide goal identification and development that is a modification of the Plan, Do, Study, Act model adapted specifically for implementing trauma-informed approaches in primary care settings.Key Considerations For Developing a Plan
- What were the results of the OSA related to your selected change concept-related goal?
- Was this a relative strength or area that needed considerable improvement in relation to the other change concepts?
- What organizational policies may you need to change as a result of the goal you selected?
- What practices and/or workflows are related to or affected by the goal you selected?
- What routine procedures are related to or affected by the goal you selected?
- Monitor progress.
It is critical that the CIT develop progress indicators related to each chosen goal and check, study and monitor these indicators to ensure the team has the needed information to evaluate progress and take appropriate action. The OSA Workbook facilitates performance monitoring through sample performance monitoring indicators and a tab for tracking progress. Based on findings and answers to the questions below, the CIT should take action to ensure they continue to make progress and /or revisit the initial plan.Key Considerations for Monitoring Progress
- What part of the plan worked well?
- What didn’t work well?
- What was surprising?
- What assumptions did you make that were accurate and not accurate?
- Do you need to do things differently?
- Do you need to put the next action steps on hold until you make needed changes?
- If it is too early to tell what needs to change? Should we continue the process and give it more time?
- Trauma-Informed Primary Care CIT Checklist
- Agency-wide Communication Checklist
- OSA Action Planning Workbook
- OSA Tutorial
- Trauma-Informed Primary Care Initiative Alignment Tool
- Key Factors to Successful Leadership
- Communicating for Buy-in Tool
- SMART Action Planning Tool
- A Practical Toolkit for Adopting Trauma-Informed Approaches in Primary Care