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Case Study: Coordinated Children’s Service Initiative

CASE STUDY:


Coordinated Children’s Service Initiative, Westchester County, New York


THEIR CHALLENGE:


The Coordinated Children’s Service Initiative (CCSI) is an interagency initiative in Westchester County that maximizes health and well-being at the community, county, and state levels. CCSI has a rich history of operating through a community-based system of care model to support individuals and families to thrive that dates back to the 1990s and has continuously evolved to meet emerging and evolving needs.


Among other vital efforts to do so includes the more recent creation of a Trauma Subcommittee, a cross-sector, cross-systems collaborative that continues to work to facilitate and advance their vision toward a more trauma-responsive, resilience-focused, healing-centered organizational and community landscape throughout Westchester.


A community-wide survey administered to 84 agency leaders of settings (ranging from mental health, education, law enforcement, peer advocacy, community-based service providers, and other cornerstones of the community that works to support children and families to thrive) in 2020 revealed a couple of critical needs: reinforcement and support for trauma-informed approaches that are abundant enough to realize systems-wide change (versus piecemeal implementations based on fleeting funding), as well as a need for more a comprehensive, evidence-based approach to achieve and maintain environments of trauma-informed care methodically.


The pandemics of 2020 further amplified long-existing structural and systemic issues, making it even more urgent to address trauma not just at the individual level but also at the organizational and systemic levels.


Based on the needs revealed in the survey, the Trauma Subcommittee came together to consider how they could take collaborative action to build skills and capacity to implement sustainable change.


THEIR SOLUTION:


Trauma-Informed Learning Collaborative: Blythedale Children’s Hospital and Kohl’s Eat Well, Be Well Community Wellness Program sponsored a 6-month, county-wide, trauma-informed systems change Learning Collaborative, which was facilitated by the Institute on Trauma and Trauma Informed Care (ITTIC).


ITTIC is a University at Buffalo School of Social Work-based research center that provides training, consultation, coaching, and evaluation for organizations and service delivery systems seeking to implement and sustain trauma-informed approaches.


The Trauma-Informed Champion Learning Collaborative involved 37 champions from 24 organizations spanning many areas of service delivery and community enrichment. The Champions used a well-established process and framework consisting of ten organizational domains, which considered the core values of a trauma-informed approach and included validated tools and resources to implement trauma-informed care in the workplace.


Through this collaboration, Champions gained knowledge, motivation, and a shared vision of bringing this model county-wide. The Trauma Subcommittee leveraged the lessons learned to facilitate their own self-led 12-month learning collaborative countywide and keep the motivation and momentum for trauma-informed change going.


This collaborative approach has helped shift organizational practices, policies, and culture toward trauma-informed care – a significant step toward creating safer and more supportive environments for trauma survivors.


These initiatives led to many small but meaningful changes in participating organizations, which were tracked and shared at quarterly report-outs. Some highlights include:

  • Administration of the Attitudes Regarding Trauma Informed Care (ARTIC) survey to interested agencies to identify training priorities and establish a baseline against which to measure change; 891 staff of 13 agencies across four service sectors took the survey.

  • Quantitative and qualitative results revealed a need for training in trauma and resilience among support staff across all service sectors and leaders in the education sector.

  • An additional finding is that those who attended just a single training in trauma or resilience generated appreciably higher ARTIC scores and reported greater confidence and support from their organization than those who had not – revealing the importance of education and awareness to increase the likelihood that the “universal precaution” that a trauma-informed approach demands would be advocated for and adopted.

As a result of such findings, the Trauma Subcommittee facilitated an emphasis on providing foundational trauma-informed care staff training, which has produced its own champions to bring learnings back to their workplaces and lead and guide sustained organizational change.


The review and revision of hiring and orientation practices and training through a trauma-informed care lens were adopted across organizations and entities in the Trauma Subcommittee, including:

  • Interview questions

  • Job postings

  • Hiring processes

  • Orientation processes and training selection

  • The review and revision of language on intake forms and in written policies

  • Incorporating the trauma-informed lens into agency mission statements

To support the paradigm shift, companion posters capturing the values and guiding principles of a trauma-informed approach as well as several detailing ways to operationalize each value and principle were created and hung, serving as an ongoing reminder for staff to keep these principles front of mind in all of the work that they do.


Aligning trauma-informed care with diversity, equity, and inclusion and undoing racist initiatives has been a significant area of consideration for the group, and finding ways to integrate these frameworks in training as well as policies and protocol that shape everyday operations has further enhanced implementation with consideration for the unique needs of people seeking to access trauma-informed services and supports.


Post-pandemic prioritization of trauma-informed approaches within the Westchester County Department of Health continues to demonstrate the influence of the champions in making this a priority – ultimately touching a large swath of the workforce, with activities including:

  • Five supervisors participated in the trauma-informed supervision cohort (see below for more info)

  • Selection of a provider for a 2-year consulting contract for trauma-informed organizational change and leadership development

  • Administering of TICS-10 survey agency-wide and sharing the results at an all-staff Resilience & Wellness Day

  • Breath, Body Mind staff workshops and training opportunities

Demonstrating the power of modeling the model of being trauma-informed to existing partners in bringing about a universal precaution, the Department of Community Mental Health found themselves inspired by the Department of Community Health and themselves to re-invigorate their efforts in becoming more trauma-informed:

  • Staff-wide retreat on TIC based on Department of Health’s model

  • Department-wide training on trauma and resilience

  • Anonymous ACEs survey followed by debriefs and discussion

  • Incorporation of trauma lens into contract oversight process and key initiatives

  • A subset of the Trauma Subcommittee formed a workgroup to collaborate on learning and implementing trauma-informed supervision skills, recognizing that TI supervision is a crucial component in a system-wide approach to a TI system of care

    • This model was developed by members of the Westchester CCSI Trauma Subcommittee

Trauma-Informed supervision can help people to notice and address the potential impacts of working with those who have experienced trauma (E.G., compassion fatigue, burnout, vicarious trauma, etc.), which makes it an essential piece of the puzzle when looking to build a cross-sector, cross-system trauma-informed workforce.


With this in mind, the workgroup utilized a white paper developed by the Community Technical Assistance Center and The National Council for Behavioral Health (now the National Council for Mental Wellness) to shape their model:

  • Discussions and implementation have been centered on each of the five trauma-informed supervision skills outlined in that paper:

    • Reflective Listening

    • Honest Communication

    • Strength-Based Attitudes and Language

    • Elicit-Provide-Elicit

    • Assuming Staff are Doing Their Best

  • Given its importance, the team created an ongoing convening of a cross-sector group of new supervisors, experienced supervisors, and trained trauma-informed supervision facilitators for discussions centered on the pillars of Trauma-Informed Supervision and how to put this simple but powerful tool into practice within different work settings.

    • Since its launch in 2014, more than 80 supervisors in twelve cohorts in Westchester County have been trained in the Trauma Subcommittee’s Trauma Informed Supervision Model!

    • The Westchester team has supported others in utilizing the model they created that has been successful for them, supporting four cycles of supporting new cohorts in replicating the model – leading to a total of 112 individual supervisors participating over the past five years!

  • Westchester’s Trauma-Informed Supervision model has been successful and is currently being replicated by a large Independent Practice Association serving seven counties in the Mid-Hudson region

    • The effectiveness of trauma-informed supervision is determined by assessing group changes in the Professional Quality of Life Scale (ProQOL) at the beginning and end of each cycle. The most recent results among staff show:

      • significant increase in compassion satisfaction (t(53) = 2.32, p = .01)

      • significant reduction in secondary traumatic stress (t(53) = 1.65, p =.05)

      • highly significant decrease in job burnout (t(53) = 10.10, p < .001)


The power of partnership and joining together through leveraging each partner’s unique strengths and resources have proven to be critical to successfully promoting cross-sector, cross-system trauma-informed approaches.


Among other impressive actions and results, the above exemplars from the Trauma Subcommittee present a model for communities looking for actionable steps to make an impact to create and sustain meaningful change.


Want to share your community’s efforts to implement trauma-informed care? We want to hear from you!


Please contact CTIPP’s Director of Communications and Outreach, Laura Braden Quigley (laura@traumacampaign.org), to develop a case study for our Resource Center.


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