This policy is not a commentary on one specific Essential Standard. Instead, it serves as a foundation that informs many of the standards and can help any agency undergoing Accreditation to have strong practices in place to support their efforts to meet all NTSA Essential Standards.
Policy Purpose
NTSA’s Accreditation is committed to helping our members continue to grow and improve to ensure that survivors are receiving quality care, based on best practices. This includes the pursuit of a trauma-informed baseline where residential programs intentionally place the needs, well-being, and recovery of survivors at the forefront, while ensuring safety and care for the service providers themselves.
Creating a trauma-informed approach at your residential program is considered critical to identifying and responding to survivors with support and services that cover the spectrum of their needs. Central to a trauma-informed approach is an understanding of the physical, social, and emotional impact of trauma on clients, as well as the professionals and staff who are caring for them. Thus, a trauma-informed approach to the delivery of services includes an understanding of trauma and an awareness of the impact that trauma can have on the individual and across various settings, services, and populations, partnered with an ability to recognize and respond to signs and symptoms of trauma.
Principles & Practices of Trauma-informed Care
Residential programs utilizing a trauma-informed approach to care should:
- Realize the widespread impact of trauma and understand the potential paths for recovery
- Trauma is the response and impact on the mind, body, and spirit from a defining life event(s) with a complex course, which can profoundly shape a survivor’s sense of self and others.
- Understand that trauma plays a role in mental health disorders, substance use disorders, and behavioral addiction disorders and should be systematically addressed in prevention, treatment, and recovery settings.
- Recognize the signs and symptoms of trauma in clients, families, staff, and others involved in the system
- The client’s complaints, behaviors, and symptoms are coping mechanisms (as their original sources of strength may no longer be effective), and require use of a relational, rather than punitive or confrontational, approach to their solution.
- The client’s complaints, behaviors, and symptoms are coping mechanisms (as their original sources of strength may no longer be effective), and require use of a relational, rather than punitive or confrontational, approach to their solution.
- Respond by fully integrating knowledge about trauma into policies, procedures, and practices
- The primary goals of services are empowerment and strengths-based recovery (growth, mastery, and efficacy), which are prevention-driven and informed by survivor self-assessment and recovery needs.
- The service relationship is collaborative, with the client and provider having an equally valuable role and knowledge– the client should be an active planner and participant in services with choice and control.
- Seek to actively resist re-traumatization
- Re-traumatization can occur for survivors when they feel shamed, threatened, vulnerable, or feel a lack of control and can occur from experiencing an unexpected change thus, services should aim to assist survivors in combating these negative feelings and aid them to feel more in control.
Creating a trauma-informed approach at your residential program is considered critical to identifying and responding to survivors with support and services that cover the spectrum of their needs.
Key Principles of Trauma-Informed Approach
The trauma-informed approach should reflect adherence to the following key principles that are integrated into all practices or procedures at your program, such as in the examples of the principles in practice.
- Safety
- Ensure clients and staff feel physically and psychologically safe, both within the physical program environment and in the interpersonal interactions and relationships within the program.
- In Practice: Common areas are welcoming and privacy is respected.
- In Practice: Common areas are welcoming and privacy is respected.
- Ensure clients and staff feel physically and psychologically safe, both within the physical program environment and in the interpersonal interactions and relationships within the program.
- Trustworthiness & Transparency
- All program services and decisions are transparent with the aim to build and maintain a relationship of trust with clients, family members, staff, and the residential program overall.
- In Practice: Respectful and professional boundaries are defined and maintained.
- In Practice: Respectful and professional boundaries are defined and maintained.
- All program services and decisions are transparent with the aim to build and maintain a relationship of trust with clients, family members, staff, and the residential program overall.
- Peer Support
- Create an environment where clients with lived experiences of trauma are able to support and aid one another in establishing safety, hope, and collaboration within the program.
- In Practice: The program establishes an atmosphere that allows clients to feel validated and affirmed with each and every contact at the program, including other clients.
- In Practice: The program establishes an atmosphere that allows clients to feel validated and affirmed with each and every contact at the program, including other clients.
- Create an environment where clients with lived experiences of trauma are able to support and aid one another in establishing safety, hope, and collaboration within the program.
- Collaboration & Mutuality
- Every relationship and contribution from clients, staff, family, and other individuals is regarded as important in the healing process and clients themselves are given power and decision-making choices in their own healing.
- In Practice: Clients are provided a significant role in planning and evaluating services for themselves.
- In Practice: Clients are provided a significant role in planning and evaluating services for themselves.
- Every relationship and contribution from clients, staff, family, and other individuals is regarded as important in the healing process and clients themselves are given power and decision-making choices in their own healing.
- Empowerment, Voice, & Choice
- Client and staff strengths and experiences are recognized and built upon, promoting resilience, recovery, and empowerment. Clients are supported in their decision-making and choice to set their own action plan for healing, while staff are empowered to do their work as facilitators and collaborators in the recovery process but not as controllers.
- In Practice: Clients are provided a clear and appropriate message about their rights, responsibilities, and agency within the program and its services.
- In Practice: Clients are provided a clear and appropriate message about their rights, responsibilities, and agency within the program and its services.
- Client and staff strengths and experiences are recognized and built upon, promoting resilience, recovery, and empowerment. Clients are supported in their decision-making and choice to set their own action plan for healing, while staff are empowered to do their work as facilitators and collaborators in the recovery process but not as controllers.
- Cultural, Historical, & Gender Issues
- The program actively recognizes and responds to cultural stereotypes and biases and offers gender responsive services, traditional cultural connections, as well as maintains policies and procedures that are responsive to the racial, ethnic, and cultural needs of clients served, while addressing historical trauma.
- In Practice: Clients are offered the opportunity to engage in services and activities that respond to or address their various identity and cultural needs and are never forced into services.
- The program actively recognizes and responds to cultural stereotypes and biases and offers gender responsive services, traditional cultural connections, as well as maintains policies and procedures that are responsive to the racial, ethnic, and cultural needs of clients served, while addressing historical trauma.
Procedure for Building a Trauma-Informed Approach at Your Residential Program
- Review your programs’ policies and procedures to identify and remove any that are potentially unsafe and harmful to trafficking survivors with histories of trauma
- Assess the degree to which policies and procedures support a welcoming and program-wide, trauma-informed perspective
- Assess the degree to which policies and procedures support a welcoming and program-wide, trauma-informed perspective
- Provide education and training for staff, including those working directly with trafficking survivors, as well as other providers in relevant systems of care
- This may include on-going training on the complex nature and relationships of trauma, substance use, emotional disorders, and physical illness, as well as basic safety issues in working with survivors and approaches to treatment
- This may include on-going training on the complex nature and relationships of trauma, substance use, emotional disorders, and physical illness, as well as basic safety issues in working with survivors and approaches to treatment
- Screen for trauma in multiple settings
- Identification is the first and necessary step in assuring survivors get the help they need
- Staff who conduct these screenings will need adequate skills, supervision, and supports
- Ensure safety and basic service needs are met
- Establishing physical and psychological safety is considered a prerequisite in working with trafficking survivors with trauma histories
- This may mean collaboratively assessing the current level of client safety and developing together plans to remain safe, while also designing each component of service to prioritize safety
- Providers should emphasize several basic services that are critical components to comprehensively meeting the needs of individuals who have experienced trauma, including safe housing, emotional support, life skills, health care, legal services, and vocational supports
- Build long-term, sustaining relationships and provide opportunities for regaining valued social roles
- A critical part of trauma recovery and building new lives for trafficking survivors involves the development of trusting, long-term relationships
- Often relational and symptom stability need to occur well before a client is willing to engage in trauma-specific treatment
- Often relational and symptom stability need to occur well before a client is willing to engage in trauma-specific treatment
- A critical part of trauma recovery and building new lives for trafficking survivors involves the development of trusting, long-term relationships
- Provide access to trauma-specific treatment services
- Agencies working with trauma survivors must have access to a range of trauma specific interventions for clients, including using clinicians, mental health professionals, and individual and group therapy sessions
- Agencies working with trauma survivors must have access to a range of trauma specific interventions for clients, including using clinicians, mental health professionals, and individual and group therapy sessions
- Understand the role that culture plays in resiliency and the importance of community resources as potentially mediating the trauma experience, particularly for foreign-born survivors
- Lack of English skills for foreign-born clients limits their ability to access information about rights, services, and options, which consequently can further isolate them
- Forming outside supports is critical in fighting the isolation and ultimately, getting survivors the help they need
- Make peer models and supports available
- Successful programs should incorporate peer-to-peer counseling and supports among their core components to aid in developing trusting relationships
- Successful programs should incorporate peer-to-peer counseling and supports among their core components to aid in developing trusting relationships
- Engage survivors in programming
- Provide clients with a means of expressing themselves and engaging with activities to develop new memories, relationships, and interests
- Provide clients with a means of expressing themselves and engaging with activities to develop new memories, relationships, and interests
- Develop alternatives to traditional therapies
- Alternatives to traditional therapies, especially those that build self-esteem, empowerment, and re-connection with self, are considered important adjunct services for this population
- Examples: art therapy, journaling, poetry and songwriting, yoga, body work, drama, and outdoor physical activities
- Alternatives to traditional therapies, especially those that build self-esteem, empowerment, and re-connection with self, are considered important adjunct services for this population
Trauma-Informed Staff
A critical part of creating a trauma-informed approach and culture at your program is having staff and professionals who are informed and ready to provide the best trauma-informed practices and care to clients. This knowledge and understanding of trauma-informed care comes from professional consultation and/or on-going training programs that the staff complete to be educated on how to uphold the philosophy and method of the trauma-informed approach. All staff should receive an orientation and basic education on the prevalence and impact of trauma on clients, as well as the dynamics of re-traumatization and vicarious trauma and how to provide care without triggering trauma responses and further harm. Additionally, training should cover how trauma interacts with identity, including culture, race, ethnicity, gender, sexual orientation, and socioeconomic status.
It is best practice that programs provide adequate and ongoing trauma-informed staff training, partnered with the ongoing support of administrators, that facilitates the implementation and maintenance of an organization change towards sustainable trauma-informed service. Administrators should provide the time and resources for staff members to receive in-depth, trauma-informed training related to their position and service, which may include education on the relationship between trauma and substance abuse or evidence-based, trauma-specific interventions.
Your program should determine what form of training and/or consultation would best serve your clients, residential program, and staff needs. Below are characteristics and goals for staff to have and maintain in their day-to-day interactions with and care for clients and examples of trauma-informed staff training opportunities for your program.
Key Characteristics of a Skilled Provider Working with Trauma Survivors
- Understands that certain survivor behaviors are a response to trauma
- Is knowledgeable regarding the mental health [and substance abuse] effects of exploitation and in particular, sexual violence
- Is skilled and knowledgeable regarding trauma and trauma treatment and can recognize re-victimization
- Is able to provide culturally competent services and seeks supervision regarding cultural issues
- Is responsive to emergency mental health issues of clients
Examples of Trauma-Informed Staff Trainings
Trauma-informed, Resilience-orienting care (TIROC) training & consultation – National Council for Behavioral Health
- Organizational guidance for organizations in primary care, behavioral health, & community services
- Expert staff, within either short or long-term and virtual or in-person consultation and trainings, guide organizations through implementation of multi-faceted initiatives and complex strategies
- Utilize lens of cultural humility, diversity, equity, and inclusion in community resilience and trauma-informed supervision and care
- Goal of enhancing client experience, improving population health, reducing costs, and enhancing the work life of staff
Origins Training & Consulting
- Training and consultation for organization and communities to integrate resilience and trauma-informed practices based on science of adverse childhood experiences
- The Basics: a half-day workshop that provides the foundation to support trauma-informed and resilience practices in organization
- The Resilience Champion: Six-part online training program designed to walk organization through process of implementing trauma-informed and resilience-building approach
- Consulting & Custom Training: One-on-one organizational guidance to address program’s specific needs and support sustainable organizational change
Risking Connection Training or Organizational Consulting
- Training model utilized within youth and adult residential programs to implement sustained trauma-informed care
- 20-hour training: trains organizations on the Risking Connection framework when supporting trauma survivors
- Risking Connection’s organizational consulting: facilitates systemic change in environments where trauma survivors seek help, including human services and resources agencies and faith-based organizations
- Application Training & Consulting: highly customized training is available for agencies within the fields of residential child and adolescent treatment programs, domestic violence programs, faith-based and ministry programs
Commentary Sources
SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Substance Abuse & Mental Health Services Administration (US). https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf.
Treating the Hidden Wounds: Trauma Treatment & Mental Health Recovery for Victims of Human Trafficking” by Heather J. Clawson, Ph.D., Amy Salomon, Ph.D., and Lisa Goldblatt Grace, LICSW, MPH. Office for Victims of Crime. https://www.ovcttac.gov/taskforceguide/eguide/4-supporting-victims/41-using-a-trauma-informed-approach/.
Building a Trauma-Informed Workforce. Substance Abuse & Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK207194/.
Helping Sexual Assault Survivors with Multiple Victimizations and Needs: A Guide for Agencies Serving Sexual Assault Survivors (Davies, 2007), page 40. National Sexual Violence Resource Center. https://www.nsvrc.org/sites/default/files/2012-03/Helping-sexual-assault-survivors-with-multiple-victimizations-and-needs_0.pdf.
