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Trauma Informed Care Influences Service Delivery and Staff Retention

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I was first exposed to the notion of Trauma Informed/Trauma Sensitive agency cultures in 2006 by Sandra Bloom, the creator of the Sanctuary Model. Her words and books about the Sanctuary model completely changed the way I looked at mental health programs and the challenge of fighting burnout and staff turnover. Eleven years later, it’s even more clear that the stress of providing treatment in agency facilities requires a focus on our staff as much, if not more, than our clients.

You can learn more about Dr. Bloom’s sanctuary model here  

Over this same period, as an administrator, staff retention grew to become one of my biggest challenges. It was not unusual for staff to “get out of the field,” find jobs that paid similar that were “way easier,” or left their positions because they felt the “grass was greener,” somewhere else. I learned that improving staff retention required a great deal of focus, planning, and a good understanding of trauma sensitive cultures.

Dr. Bloom’s teachings first taught us to rethink how we look at and understand trauma. Trauma in general is defined as, “a distressing experience that impacts an individual in a significant and negative way.” But a true trauma informed practitioner understands trauma in a completely different manner. For example, a co-worker yelling at us, road rage on the way to work, a supervisor being critical, a client telling us we are a bad counselor, or a colleague leaving their job all are significant traumas. More importantly, the potential impact is the same, as are the changes in our internal and biological reactions. Just as a victim of domestic violence, every day traumas can change us. And just like victims who benefit from debriefing and empathetic intervention, we too can benefit similarly. 

Providing treatment to traumatized individuals is traumatic. Painful stories, backsliding, new bumps in a client’s behaviors and experiences can wear on us.  What we have come to learn, is that trauma affects the brain and changes our emotional management skills. That’s when we were focused on thinking about our work with clients. Dr. Bloom wrote about “vicarious trauma,” the trauma of taking on the pain of clients, hearing their challenging stories and at times feeling their helplessness. Dr. Bloom also spoke of “parallel process,” the fact that staff also feel external pressures and can experience those in the same ways as our clients. We looked at trauma as something that happened to our clients that influenced their behaviors and emotions, not as something that influenced us.

So, just like our clients, without debriefing or processing traumatizing events there are no opportunities to address the impact. If you do not create and foster an open, trusting, and transparent environment, a staff member’s feelings will continue to build. In the client world, the client may not improve, not come back for treatment, or even deteriorate. Hopefully we find alternate ways to intervene and help them resolve their trauma.

When talking about staff however, one of two things can happen if ongoing work on trauma is ignored. Staff members will tend to burn out, are less energized by the work, and provide less than positive service. Or, they will leave the program, the agency, or the field.  All of which present costs and challenges to your agency.

In either case, our clients suffer.

  1. They get poor service or they deal with the loss of therapeutic relationships that have helped pave the way to better mental health and progress. Loss of relationships with trusted staff is considered significant trauma.
  2. Agencies lose because he cost of finding, training, and adjusting to new staff is significant. Positive client outcomes will suffer as a result.

Learn more about technology tools for implementing trauma informed procedures across your entire agency

On the other hand, staff longevity and turnover is directly influenced by supervisory support and the ability to manage and address daily traumas. This requires skilled and experienced supervisors who have learned to balance administrative supervisory needs with education and support. Many agencies have fallen short in these areas both by focusing primarily on management issues and pushing staff to the limit with large caseloads and client responsibilities. They often will not or “cannot” build enough supervisory supports into their systems.  If a staff member is not given minimally one supervisory session time per week that provides opportunities to deal with work traumas and stress, the chance of them remaining at the job is greatly reduced.

There are several models and literature on Trauma Sensitive practices. Many agencies have adopted some type of practice within their agency. The premise is more important than the model selected however; and the daily commitment, follow through, and use of the model is critical. Those agencies who have been able to maintain such a culture repeatedly report that the impact on staff retention is not only significant but a significant factor in their success.

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