Trauma Informed Care: Understanding and Implementing Culture Change

Debbie Zwicky
Director of Quality Assurance and Program Development
St. Rose Youth & Family Center

Nobody understands trauma better than the person who has experienced it, and only that person knows how best to heal. That’s the philosophy behind trauma informed care, which has been and is continuing to be adopted by human service agencies across the country.

Implementing this philosophy requires much more than changes in practice. It truly involves a change in agency culture; the significance of this shouldn’t be underestimated.

For the past 18 months or so, the agency I work for has been undergoing this culture change ourselves. St. Rose Youth & Family Center, an Alliance for Children and Families member in Milwaukee, is doing so as part of a statewide initiative to reduce the use of seclusion and restraint in youth treatment programs.

‘What Happened to You?’

In order to understand whether your organization is ready to change its culture and adopt this philosophy, you need to understand three of its central tenants: relationship building, skill training, and safety.

Relationship Building. Trauma informed care treats youth in a way that is understanding of  their traumatic experiences rather than focusing on their current “inappropriate” (possibly the most overused word in the field of youth care work) behavior. It is a philosophy that involves asking youth “What happened to you?” versus “What’s wrong with you?” or “Why do you continue to behave this way?”

By respecting the effects traumatic experiences have on youth, rather than focusing on behavior modification, organizations develop strong relationships with youth.

St. Rose has always believed that building healthy relationships with the girls we work with is essential to effective youth care work. Trauma informed care looks at these relationships in a different way, but still sees this as an important aspect of care.

Skill Training. Skill building, which leads to increased self-worth, is another important aspect of trauma-informed care. It is important to teach skills to youth, as well as provide them with a safe environment to practice these newly acquired skills. Because skill development equips youth with new options when making decisions in the future, this will hopefully lead youth to experience less trauma in the future.

Safety. Safety is a huge component of trauma informed care. Youth must feel safe in their treatment and/or residential program. Otherwise, they will not trust and respect youth care workers enough to talk about and discuss “What happened to you?”

Safety includes consistency, respect, environment, and trust. It is essential that youth care workers are trained in and understand safety concepts as they relate to trauma informed care.

Speaking of youth care workers, trauma informed care is also about the self-care of youth care workers. It recognizes that youth care workers are human and may also have traumatic experiences that affect the relationships they have with the youth. It also recognizes that only healthy youth care workers can develop healthy relationships with youth. It’s a refreshing change from the past, when so much youth care worker training focused on taking care of the youth without much focus on taking care of the workers. Trauma informed care respects both parties involved in the relationship.

Culture Change Requires Thorough Training

Training, which should include all staff at the agency, is a significant component of changing agency culture.

All staff members have contact with youth—even if it’s infrequent or somewhat indirect contact—and should understand trauma informed care, especially since the culture of the agency affects all staff, at all levels, in all the programs.

So that the philosophy continues to be part of day-to-day operations, the training has to be on a regular basis.

Our agency has been fortunate to participate in state-sponsored trainings to increase our knowledge of trauma informed care. Because of the statewide scope of this initiative, we’ve also been able to utilize the support of other agencies that have also committed to this culture change. It has allowed us to collaborate with each other to share resources, challenges, hardships, successes, and information. Support is essential when going through any type of culture change.

I truly believe that this change in culture will continue to allow our agency—and your agency if you’re considering a similar change—to provide the best possible care to youth within a philosophy and practice setting that is safe, respectful, and trauma informed. The young ladies we work with have experienced way too much trauma already in their lives. It is time to start asking “What happened to you?” and truly desire to hear the answer.

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