Knowing is Not Enough

Hi Jane, Good additions.  Has someone written anything formally about the recommended process of organizations assessing their ACE scores? (ie. are most assessing clients, staff, or both? are they using a representative sample of those groups or assessing all?  how do you keep anonymous? how do you analyze data? etc etc).  I'm guessing this exists, but I have not seen such a piece.

Steve

Thanks for posting the info, Steve. I completely agree with your list. I would also add: Does the trauma-informed training include a solid foundation in ACEs science? Has the organization assessed its own ACE scores (anonymously)? Is it involved with a local ACEs/trauma-informed/resilience-building initiative?

Thanks Cathy! I couldn't agree with you more.

Steve

Steve,

And thank you for the additions! Klingberg Family Centers/Traumatic Stress Institute is setting the standard for more than just clinicians. It is time for the trauma informed "movement" to enter the next stage. 

~ Cathy

Excellent entry!!.  As trauma-informed care mushrooms, the lack of a clear definition of TIC and ways of operationalizing the philosophy are becoming glaring gaps in our field. More and more people are claiming "yeah, we're trauma-informed," yet when you ask them what that means, they say "our clinicians are trained in TF-CBT" or "we've had several trainings about trauma" or "we now do trauma screening."  I now do a workshop called, "Yeah, We're Trauma-Informed: But, Are You Really? What Does that Even Mean? And How Do You Get There?"

We need to be drawing on the lessons of the growing field of "implementation science." It argues convincingly that the VAST majority of innovations fail, not because the innovation itself is flawed, but because of the way in which it is implemented. One study (Joyce & Showers, 2002) found that training teachers about the theory of an innovation and having a discussion results in a 10% knowledge gain, but 0% use in the classroom. If you add demonstration of the innovation, knowledge goes up to 30% but 0% use in the classroom. If you add practice and feedback, knowledge goes to 60%, but only 5% use in the classroom. Only if you add coaching in the classroom, knowledge rises to 95% and use in the classroom goes to 95%.

I absolutely think there needs to be more consumer education about what a trauma-informed system really is, what implementation interventions, at what dosages, are likely to truly produce sustainable outcomes. 

To add to Cathy's list above, I'd add the following questions that organizations should ask themselves.

1. What is their readiness to implement TIC as an organization? Is there executive leadership support? Financing? How punitive is the culture currently? What's capacity to do system implementation? etc etc

2. Do the trainer/consultants providing services have expertise in system change using principles of implementation science?

3. Does the trauma training for staff have a track record and evidence that it is effective?

4. Is there a way to sustain trauma training for staff such as a Training-of-Trainer offering?

5. Does the consultant/trainer have expertise in program evaluation so that the organization can monitor progress of change?

6. Do consultants/trainers provide ongoing support, coaching, mentoring for the organization?

7. Do they provide consulting beyond staff trauma training on things such as: TIC supervision; trauma screening and assessment; integration of vicarious trauma awareness into the organization; move to less punitive behavior management techniques; policy revision etc. 

Thanks Cathy for raising this important topic.

Steve Brown, Psy.D., Traumatic Stress Institute of Klingberg Family Centers. Coordinator, Risking Connection Training Program. www.traumaticstressinstitute.org

Mary,

I am so glad I'm in the same community as you! I'd love to attend the next Viewpoints and the next Collaborative meetings to be part of the conversation as it moves toward deliberate and thoughtful action. 

~ Cathy

Mike:  I recently took some trainings from the Brazelton Touchpoints Institute.  Both included a series of follow-up reflective practice sessions (by phone) and there was a requirement to attend at least 80% of the sessions in order to receive the training certificate.  Following through with those sessions made all the difference in my ability to implement.

We absolutely know from research that a single training does not "stick."  I wonder if the lack of "stickage" is sensed by participants and perhaps contributes to the feelings of overload that some workers have expressed when offered training in new frameworks, etc.  A given training may be inspirational while it's happening, but finding the space in the workday to convert inspiration into action is impossible - until there is support!  I hope more of your trainees will take you up on your offers of post-training consultation and coaching.

Totally agree.  At my agency, whenever we facilitate a training on trauma-informed principles, we always offer individualized consultation to the organizations represented. Unfortunately, no one has ever taken us up on it, even after following-up with them.

Cathy:  Great article!  We were discussing this very thing at the Viewpoint meeting in Traverse City yesterday.  As our community moves toward becoming trauma-informed, how we will connect social services, healthcare, education and community through common trainings and how we will use reflective practice to support learners' growth in understanding and expertise becomes of highest the importance.  In 5toONE we have many parents who want to begin attending trauma training and I see this as a very good thing.  However, as you so beautifully point out in the article, we need to be ready to take the next steps.

When I was teaching science I used to tell my students (and I still say today) that facts are not the same thing as knowledge.  Knowledge is how you use the facts.  I hope we will soon be a community of knowledge-users!  Thanks for all you do.

Amen! 

We need a different term for trauma-informed, it's not "information," it's a total culture change.