Background on Agency-level and Systemic Trauma-informed Work

One of the key components to making our collaboration work with child welfare was trust. And we built trust through cross-sectoral trainings and regular consultations.
~ Women’s substance use treatment program manager

Recently, there has been movement towards developing trauma-informed values, principles, and "cultures" within agencies serving people with substance use and mental health problems.  Several groups of researchers and practitioners have developed principles for guiding and implementing trauma-informed care:

  • Eliot, Bjelajac, Fallot, Markoff and Reed initially identified ten principles during their study on Women, Co-occurring Disorders and Violence study 1 , See article here
  • Schacter, Stalker, Teram, Lasiuk and Danilkewich  developed nine principles for working with survivors of childhood sexual abuse within primary care settings 2, See article here
  •  Klinic Community Health Centre in Manitoba developed a toolkit to help providers implement trauma-informed practices 3.   http://www.trauma-informed.ca/ 
  • V Brown, Fallot & Harris Moving toward Trauma-Informed Practice in Addiction Treatment: A Collaborative Model of Agency Assessment, See article here

Trauma-informed services take into account how common trauma is and the wide range of impacts of trauma, and integrate this knowledge into all aspects of service delivery 4. In trauma-informed services there is attention in policies, practices, and staff relational approaches, to safety and empowerment on the part of the service user.  Harris and Fallot, for example, describe this “paradigm shift” towards recognizing the pervasive nature of trauma and strategies to create a safe environment for survivors. 5.  They propose a values-based framework for trauma-informed services which includes:

  • Safety: Emotional and physical
  • Trustworthiness: Are we clear and consistent about our policies, honest with service users and maintain program-appropriate boundaries?
  • Choice: Do our activities offer service users choices and control?
  • Collaboration: Do we use a collaborative approach with women instead of a top-down hierarchical model?
  • Empowerment:  Do we offer self-esteem and skill building?

Collaboration between agencies and systems is a key component of developing trauma-informed services.  Recent projects led by the anti-violence field that promote awareness and cross training among anti-violence, substance use and mental health services are creating recognition of the benefits of integrated or linked and holistic approaches. The Ontario Abuse Screening Project and the Building Bridges Project  are two other initiatives by the anti-violence community to link with, and do cross education with, mental health and substance use providers.
 
Working from newer understandings of substance use and violence connections are assisting anti-violence workers to provide more effective support to women and their children, as well as validating current approaches. For example, in a study done in British Columbia, it was found that women significantly reduced their use of alcohol and illicit drugs following a stay at a transition house, when either brief or significant support was provided on substance use 6.  

For the child welfare system, discussion and action on collaborative, harm reduction-oriented and trauma-informed approaches are making way for alternative, tailored, supports for mothers with substance use, mental health and trauma-related concerns 7,8.  In Toronto, the Jean Tweed Centre has built relationships with child protection authorities and the women in their services who are attending mother- and child-centred programs. From this collaboration they created cross-training and consultation opportunities that has informed the development and ongoing implementation of practice guidelines between substance use treatment centres and child welfare agencies in Toronto 9.

  1. Elliot, D.E., et al., Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 2005. 33(4): p. 461–477.
  2. Schacter, C.L., Stalker, C. A., Teram, E., Lasiuk, G. C., Danilkewich, A., , Handbook on sensitive practice for health care practicioner: Lessons for adult survivors of childhood sexual abuse, 2008, Public Health Agency of Canada: Ottawa.
  3. Klinic Community Health Centre, Trauma-informed: The trauma-informed toolkit, 2008, Klinic Community Health Centre: Winnipeg, MB.
  4. Harris, M. and R.D. Fallot, Using trauma theory to design service systems. Using trauma theory to design service systems.2001, San Francisco, CA US: Jossey-Bass.
  5. Harris, M., et al., Envisioning a trauma-informed service system: A vital paradigm shift, in Using trauma theory to design service systems.2001, Jossey-Bass: San Francisco. p. 3-22.
  6. Poole, N., et al., Substance use by women using domestic violence shelters. Substance Use & Misuse, 2008. 43(9): p. 1129-1150.
  7. Drabble, L., M. Tweed, and K. Oslerling, Pathways to Collaboration: Understanding the role of values and system-related factors in collaboration between child welfare and substance abuse treatment fields, 2006, San Jose State University of Social Work: San Jose, CA.
  8. Drabble, L. and N. Poole, Collaboration between addiction treatment and child welfare fields: Opportunities in a Canadian context. Journal of Social Work Practice in the Addictions, in press. 11(2).
  9. Chaim, G. and Practice Guidelines Working Group, Practice Guidelines between Toronto Substance Abuse Treatment Agencies and Children's Aid Societies, September 2005: Toronto, ON.

 
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