Trauma informed organisations

The experiences that make us peers are often painful ones. As an HIV peer navigator, and as someone working for a community service organisation, you are likely to be working with people who are living with HIV as well as personal trauma — and possibly a condition like post-traumatic stress disorder (PTSD). You may be living with trauma, yourself, and working alongside colleagues who have their own trauma.

As employees we have a shared responsibility to contribute to building trauma-informed organisations and workplaces.

Defining trauma-informed: the ‘4R’ model

A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.

Source: SAMHSA (2014)

A key element of the 4R definition is the concept of re-traumatisation. This occurs when traumatic past experiences come up in the present, and appropriate recognition and support is not provided, or worse, the trauma is denied, so there is new and additional traumatic experience layered on top of the existing trauma.

Cultural safety and trauma

Re-traumatisation is closely related to cultural safety and humility, because the trauma of colonisation and subsequent mistreatment of Aboriginal and Torres Strait Islander people is often unrecognised or denied in human service provision.

For example, a member of the Stolen Generation might be distressed by a question asking about family support for their HIV diagnosis. The distress might not be recognised, or it might even be denied (e.g. by the worker saying ‘we have to focus on the present, not the past.’) The Indigenous client may now remember this service being one that has caused them distress, making them unwilling or fearful to engage with the service (and possibly others like it) in future.

What could be done better here?

• The organisation provides workers with training on trauma informed practice for Indigenous clients;
• The worker recognises that an Indigenous client brings their own history including traumatic experiences;
• With this in mind, the worker asks more open questions about the client’s family relationships;
• The worker recognises the client might be distressed — e.g. they are taking longer to answer questions;
• The worker offers support — ‘I want to check in, how are you doing, would you like to pause for a bit?’
• The worker acknowledges they have caused distress — ‘I’m sorry for bringing up a painful topic.’
• If and when appropriate, they return to the work: ‘are there people who provide you with support around HIV?’

The goal is to be aware of trauma and to actively resist creating new traumatic experiences in human services practice.

Creating a trauma-informed workplace culture

The previous example (above) describes trauma-informed practice at the individual worker level. We also need to think about creating a trauma-informed workplace culture. This means the everyday way of doing things in an organisation or workplace acknowledges the potential for trauma to come up in our work. It avoids denying or minimising trauma and it finds ways to actively resist adding to existing trauma with new experiences of denial or invalidation.

Some strategies that can help create this kind of workplace culture:

• reflective practice and group supervision
• formal and informal debriefing after trauma comes up at work
• being flexible to allow people to ‘take a moment’ when they need it
• doing appropriate training and capacity building exercises

Exercise

Your colleague is doing an intake for a new client who describes becoming HIV-positive through a sexual assault.

In Australia, one-in-three women and one-in-five men are survivors of sexual assault. (You may have your own experience of sexual assault. Remember, this exercise is optional; if it may cause you distress, feel free to skip it.)

What could your team/workplace do to support workers who have their own experience of sexual assault, when this comes up as an issue for discussion in their work with peer navigation clients?

Should it require peer navigation workers to disclose this experience to the team or their managers ahead of time?