What led Klingberg to begin implementing trauma-informed care? The recognition that the vast majority of the children and youth that we serve have suffered some type of trauma and continue to struggle with unresolved issues related to it. And the recognition that the needs of those suffering from unresolved trauma are specialized and require approaches and interventions specifically designed to treat trauma.
What changes are you most aware of since you implemented trauma-informed care? That when we are working at our best in a trauma-informed manner we understand on both an intellectual level and in our gut that the behaviors that we find most troubling are the clearest and most compelling evidence of the depth of pain underlying them.
What have been some of the benefits of working this way? Certainly, that the our work is more effective. Also, that we find ourselves much more commonly working in a partnership with kids, instead of being at odds with them, though that certainly still happens more that we would like. I also think that the work has become much more meaningful to our staff, and there is pride among them about working in a more specialized, sophisticated way.
What are some challenges in implementing these methods? They really require that all staff engaged in the treatment enterprise open themselves up to recognize at some core level the depth of the pain that our kids suffer. That level of exposure is a great deal to ask of people, and it can trigger in some of us our own traumas. If we don’t have ways of addressing that, it can undermine our effectiveness and adversely impact our own well-being. That dynamic also places a greater responsibility on the organization for addressing the emotional needs of the staff, especially those related to vicarious traumatization.
What are the challenges in sustaining it? A big challenge is that there is a seemingly innate and very powerful pull to revert back to more controlling postures in our work with the kids. And somehow, perversely, the more troubling a child’s behavior, the more likely we are to do that, as if, when a behavior reaches some threshold of “annoyingness,” it has shifted from a maladaptive manifestation of pain to just plain old annoying horrible behavior. I have seen that happen among the best of our staff and in myself as an administrator. It can be an insidious process and the need to recognize and address it early on is critical.
As a leader, how do you contribute to the implementation and sustaining of a trauma-informed practice? There are several important roles for organizational leadership. Obviously, providing the resources necessary to train all of the staff in a trauma-informed model is critical. Beyond that, it is important to find ways to reinforce the mission through a variety of explicit and implicit communications. These include establishing policies and procedures that support it; measuring its effectiveness and communicating to staff the findings of that measurement; celebrating publicly the work or staff that exemplifies a trauma-informed approach; supporting staff with ongoing training; developing means for supporting staff (e.g., EAP services, support groups, frequent, effective supervision). Let me be clear that the fact that I recognize all of the needs shouldn’t be interpreted to mean that I think we’re on top of all of them. We have work to do to improve, and I see the goal of maintaining a trauma-informed organization, to be a bit clichéd, as a journey not a destination, though there are some pretty critical points along the way.
What are some ways you could undercut the effort? I can undermine all of that by standing in the doorway of our dining room with my arms crossed in front of me, a disapproving look on my face, and a comment about the broken window. I think leaders who want to “walk the talk” have to very consistently reinforce the message that our work is not about control; it’s about healing. And almost invariably the two are mutually exclusive. That means that things will get broken, and noisy, and messy. As a leader, I often find myself biting my lip and reminding myself that trauma work is not orderly and neat. When there’s a disturbance outside my door (even when I’m sitting with a Trustee or donor), I have to keep reminding myself that our goal is not a speedy resolution but a positive one.
Has your Board been involved? How? What has been their reaction? Our Board has been involved in a variety of ways, all significantly more removed from day-to-day implementation issues. Clearly, it plays an important role in establishing policy that is consistent with trauma-informed care and in making available at the 30,000-foot level the resources for staff training and development.
If an agency wants to work in a trauma-informed way, what are the implications for hiring and managing staff? The abilities and characteristics of all staff in a trauma treatment setting are critical, so the hiring process is very important. Screening candidates for their ability to manage the potential vicarious traumatization to which they’ll be exposed is especially important. Part of this process is being very explicit with candidates about what the demands of the job will be, on both an intellectual and emotional level. Interviews and in vivo observation in the milieu play a central role in the hiring process for the benefit of both the applicant and the organization. The ongoing “care and feeding” of staff is equally important. Regular training in trauma is a must, and the critical importance of regular, high-quality supervision to provide support, reinforce skills, and manage the emotional challenges of the work is equally important. The willingness of staff to share their thoughts and feelings about the work with each other, their supervisors, and organizational leadership is vital, and this requires constant vigilance about the organizational culture to ensure that it supports this process. That is one of the biggest challenges.
What has been the reaction of licensing and oversight agencies to this change? Overall, it has been very positive. These agencies have appreciated our commitment to better meet the needs of the clients whom they refer to us. We have also been invited to share our work with other agencies that our treating similar children and youth. They have praised our ability to work with children and youth facing greater challenges. They, like us, however sometimes lose sight of the fact that when we work in a trauma-informed way we’re not going to have the kind of tight controls that we used to. We have more chaos and damage, and it’s not uncommon for licensing inspections to identify physical plant issues related to damage, something that had been extremely rare in years past.
Have there been any business or financial advantages to making this change? The ability to provide high quality trauma treatment is critical to long-term survival in a climate in which the vast majority of children and youth in care are trauma survivors.
What would be your advice to a CEO who was just beginning this change? Be intentional, decisive, explicit, and very public in your commitment to the transformation; take advantage of a quickly developing pool of experts; establish a group of like-minded colleagues with whom you can share ideas, frustrations, and resources. Involve staff at all levels of the organization in planning.