Trauma-Responsive Organisations: The Trauma Ecology Model

In this chapter, an overview of the trauma-informed approach is described. The background and context to trauma, its impact on the person, and organisational responses are considered. More specifically, I distinguish between trauma specific and non-specific organisations by defining the characteristic of each. This chapter sets the tone for the remainder of the book by introducing a conceptual model for both specific and non-specific trauma organisations. In order to do this, I outline the differential components that are deemed necessary for organisations to be trauma-responsive; in doing so, I introduce the Trauma Ecology Model to the literature, outlining its various components.

In the previous chapter, I introduced trauma-informed care as an approach to organisational change and a shift in culture to recognise that many employees and people attending services have past trauma experiences. In this chapter, I recast servant leadership (SL) as a trauma-informed leadership model that naturally operationalises some of the principles discussed in the TIA literature. The first section of this chapter addresses the societal need for a more ethical and moral leadership approach, before briefly outlining the prevalence of trauma experienced by service users and employees. The next section provides an overview and definition of SL in a general sense, before articulating a trauma-informed model of SL and its characteristics. Finally, some of the outcomes associated with SL are discussed with a key focus on how this approach operationalises the principle of psychological safety, trust and empowerment found in trauma-informed approaches, as they relate to employees.

In the previous chapter, I introduced you to trauma-informed servant leadership as a unique approach that can be used to operationalise many of the ideas of the trauma-informed approaches in the literature. In this chapter, I build on this work by illustrating how we can extend this model of trauma-informed servant leadership to supervision in order to reduce burnout and secondary trauma in health and social care employees. The literature informs us that not only do employees in this sector have high rates of their own traumas, but secondary trauma is also prevalent in such organisations. An overview of the supervision and secondary trauma literature is briefly provided, followed by a description of how the trauma-informed servant leadership model can be used by supervisors, in conjunction with a supervisor model of servant leadership, to mitigate against these stressful experiences in organisations. Again this chapter not only builds on recommendations from the trauma-informed literature as it pertains to recognising that employees suffer their own personal traumas but I also take a multicultural approach to supervision in the final section of the chapter, thereby operationalising the diversity/multicultural principle in TIA.

In the previous chapters, I set out a conceptual model of trauma-informed servant leadership and discussed servant leadership supervision for working with burnout, compassion fatigue and secondary trauma in employees within trauma related health and social care settings. In this chapter, I further extend servant leadership to the peer support principle in trauma-informed approaches (Substance Abuse and Mental Health Services Administration, 2014). The first part of this chapter will examine peer support work (PSW) and report on the outcomes associated with it. Then, servant leadership will be discussed and used to operationalise the principle of peer support as set out in trauma-informed approaches. A servant leadership peer support approach is put forward with a theoretical basis. This theoretical model has been slightly changed from the previous servant leadership approaches discussed, in order to represent the PSW role more accurately. However, as discussed previously, it is not the characteristics of the Servant leadership (SL) model that define the approach, rather the philosophy and desire to serve first. In the last section of this chapter, Martha Griffin brings the characteristics of this model to life using her vast experience and discusses some of the potential challenges faced by peers in training and practice.

Organisations and systems of care working within both specific and non-specific trauma-informed approaches must adapt a multicultural lens, in design, delivery and evaluation of services and interventions. Cultural and social factors can directly influence the exposure of individuals to traumatic events (Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010). At the same time, social and cultural identities influence the development and experience of trauma and symptoms, including treatment outcomes (Marsella, 2010; Wilson, 2007). In this chapter, Ravind Jeawon and I provide some of the essential factors that trauma-responsive systems may wish to consider. The first part of this chapter deals with the idea of multicultural identities and practices and highlights some of the outcomes associated with accessing behavioural healthcare. The impact of intersectionality and microaggression on those from diverse backgrounds is also considered. Finally, a guiding framework is provided that examines what needs to be implemented across organisations in order to provide the system with a multicultural lens in which to view and deliver appropriate services. Crucially, multicultural responsiveness will not come from tick box training regimes, it is something that needs to be kept on the agenda and is a lifelong trajectory.

In this chapter, screening and assessments within specific and non-specific trauma-informed services will be discussed as integral to both the identification of trauma incidences and as an integral component of trauma therapy. The first part of this chapter will examine how those working in non-specific trauma services can use screening instruments to help identify and make referrals to trauma specific organisations. As outlined already, non-specific trauma services are those who are committed to working from a trauma-informed lens and come into contact with those more likely to have trauma experiences; however, they are not services specifically set up to work with trauma. Some of the challenges and risks when using such assessment are delineated, with helpful tips for their effective use. A table containing some of the brief screening measures found in the extant literature is provided, all of which are psychometrically sound. Moving forward, I explore some of the literature around the assessment process for those seeking trauma specific therapy in services. In doing so, this chapter demonstrates that safety, trust, choice, empowerment and culture considerations from the trauma-informed literature can operate throughout the screening and assessment processes and that ethical imperatives should always be front and centre of the practitioners mind.

In the previous chapter, the reader will have become familiar with the idea of screening for traumatic experiences within organisations as a way to identify those who may benefit most from interventions and support. In this chapter, I present an overview of the trauma therapy literature in the first instance and then explore some of the debates regarding specific trauma-informed treatments versus general therapeutic approaches. The multicultural competency literature is discussed, and the multicultural orientation approach of cultural humility, cultural opportunity and cultural comfort is highlighted in a practice context. This chapter concludes with a case study vignette that brings it all together with a clinical example of what trauma-informed therapy through a multicultural lens might look like. As such I operationalise choice, collaboration , trust and transparency, and cultural principles from the trauma-informed care literature. Although applied here to specific trauma-informed organisations, some of the methods and processes that I unpack can be used in non-specific organisations where social/case managers are employed and wish to operationalise choice and collaboration in a structured way.

Mental health services have changed significantly in the past few decades. Currently, our services are transforming from one that was biomedically led to one that encompasses a recovery orientation. Additionally, a new field of study as it related to mental health care is emerging that of trauma-informed care. In this chapter, we explore briefly what we mean by the terms trauma and trauma-informed care. This is followed by a critical examination of how co-production and servant leadership can work together to support individuals through their trauma towards recovery and well-being. From which, we suggest that peer support workers are suitable candidates to co-produce trauma-informed services as they embody the connecting principles of choice and empowerment needed for all three concepts to converge and work together to enhance recovery and well-being. While I focus on using co-production in the mental health space in this chapter, the principles and practices can equally apply to other health and social care services.

Up to this point, we have examined many components that make up the Trauma Ecology Model (TEM). In this chapter, the implementation of TEM in organisations and healthcare systems is explored. The aim is to guide organisations through the process of implementation completely. Practical strategies will be provided for each of the six stages of the Fixen model of implementation. This chapter also includes discussion of potential challenges as well as suggestions for resolving some common issues faced in the implementation literature. You will find the Trauma Ecology Model Fidelity Measure (TEM-FM) in the Appendix a useful resource. As you navigate through each stage, I discuss how best you can utilise the TEM-FM to assess and monitor your organisations progress against clear objectives. As you read this chapter, think about your individual organisational context, and how best to apply this implementation science approach in a meaningful way. This chapter provides a generic implementation guide based on the implementation science literature, as such, we don’t unpack how to implement each component of TEM as specific and non-specific trauma organisations may have some diverging needs. Rather, I provide a framework which can be used by individual organisations as a guide to support implementation at different points in the TEM.