TIO/iLab Trauma Informed Care Organizational Self-Assessment Report
Background
Trauma Informed Oregon’s Trauma-Informed Care (TIC) Implementation Tool provides a framework for incorporating trauma-informed policies, practices and care into any organization’s structure. It was originally created in 2022 by Trauma Informed Oregon (TIO) and the Human Services Implementation Lab (iLab)at Portland State University’s Regional Research Institute. Implementation of Trauma-informed Care is an ongoing process and is not expected to happen all at once. Systematically assessing TIC implementation accomplishes two things. First, it documents the extent that the organization is trauma-informed and clearly identifies systemic strengths, weaknesses and gaps. Second, it helps the organization decide on overall goals, and identify and prioritize specific practice changes to make. The tool itself was based on TIO’s 10 years of consultation and training in the field as well as SAMHSA’s six key principles of trauma-informed care and its ten implementation domains. Funding for the 2022 development and pilot of this instrument was provided by the Oregon Health Authority. For more information on TIO, visit https://traumainformedoregon.org. For more information on the PSU iLab and the development of this instrument, contact Karen Cellarius, Senior Research Associate, Portland State University Regional Research Institute for Human Services at cellark@pdx.edu.
Explanation of Elements and Standards
TIO’s Standards for Trauma-Informed Care are grouped under five key elements: (1) Organizational Commitment (2) Culture and Climate, (3) Training and Education, (4) Policy, Procedure, Practice Review, and (5) Feedback and Quality Assurance. Each standard has been rated on a scale for 1 to 5, where 1 equals “Organization has not yet demonstrated awareness of the need for this standard” and 5 equals “Standard is sustainably in place and monitoring for continuous quality improvement occurs regularly.”
How to Use this Implementation Assessment
Review
Once the organization has been scored, use the snapshot on the following page to determine which TIC Elements and Standards to concentrate on during a group discussion. Next, turn to the longer tables for a detailed explanation of why that score was assigned. At this point, organizations may want to adjust their score based on a group discussion or additional information that was not available for the preliminary assessment. Justifications for any changes should be added to the report comments.
Plan
Use the finalized scores and notes to identify a set of goals to work on over the next few months, then develop a plan and a timeline for reaching those goals. A common reaction to the self-assessment is that the magnitude of possible areas to address is overwhelming. However, we do not recommend that organizations take on more than they have resources or capacity to undertake. We suggest using the companion TIO TIC Implementation Report Review Worksheet to plan your next steps. It is available at https://traumainformedoregon.org.
Reassess
Use this TIC Implementation Assessment Tool to track progress over time. When you are in active implementation mode, you could self-assess your progress quarterly with a more intensive external assessment in 6 months.
Repeat
Repeat as necessary to improve or maintain progress. Once TIC is firmly in place at your organization, reassess annually to maintain your level of trauma-informed care. Both leadership and frontline staff should review results and make plans for continued improvements.
The Five Elements of Trauma Informed Care
Five key elements of TIC are needed in order to have a sustainable infrastructure. Within those five elements are standards that need to be attained and maintained in order to achieve full implementation of each one.
Element #1: Organizational Commitment
Organizational commitment is demonstrated through dedicated support for a trauma‐informed infrastructure that includes specific funding and employee time for implementing trauma‐informed care. Organizations acknowledge that an understanding of the impact of trauma is central to effective service delivery and make operational decisions accordingly. Organizational commitment is evident within all four domains outlined in SAMHSA’s TIC Guidance: (1) Governance and Leadership, (2) Policy, (3) Financing, and (4) Engagement and Involvement. Leadership collaborates with other organizations to create a trauma‐informed community that follows the principles of trauma‐informed care across sectors.
Element #2: Culture and Climate
Culture and climate is the cohesive narrative, the glue, that holds a trauma-informed community together. It is the embodiment of all that is seen, heard, done, and experienced in spaces and settings. Trauma-informed practices and settings demonstrate an understanding of the impact of trauma and toxic stress on the body (both individual and organizational) and the power of relationship and belonging. This understanding appears in the language used, protocols that are followed, and behaviors that are witnessed.
Element #3: Training and Education
The professional development plan for staff is demonstrated by staff competency and skills, as well as how the principles and values of trauma-informed care are applied in the training methodology. The plan’s goal is staff embodiment of the content shared. Training is paired with educational opportunities that promote competence (knowledge) and confidence (skill) to apply to trauma-informed approaches (TIA). This learning is done at a reasonable pace, is role specific, and performed throughout the job cycle (Ask “who needs to know what by when?”).
Element #4: Policy, Procedure, and Practice Review
Policies and procedures offer a mechanism to sustain TIC, allowing helpful practices to evolve over time in response to feedback and growing knowledge about the field. Policies and procedures are reviewed through a TI lens with a process that defines how misalignment with TI values is handled. The process will continuously examine “who is at the table” and whose voice and experience is centered. Changes are made in areas within an organization’s locus of control. The limitation of regulatory bodies is recognized and system change is sought.
Element #5: Feedback and Quality Assurance
Feedback and quality assurance techniques are used to impact practice. Trauma-informed organizations demonstrate inclusive and effective feedback practices that solicit how staff and service recipients feel and experience the organization. The feedback process is routine, multimodal, and centers those most impacted by the work. The feedback received and plans for practice, policy, and procedure change are shared. These processes demonstrate knowledge about the impacts of trauma in the organization’s methods, language, how the feedback that is sought, and how the information is used.
Suggested Citation: Cellarius, K., Davis, M., Tuttle, A., & daRosa, C. (2023). PSU/TIO Trauma Informed Care Implementation Assessment Instrument, v1.2.1. Portland, OR: Portland State University.
Survey developed by Trauma Informed Oregon and the PSU Human Services Implementation Lab. Last updated 05/11/2023.
Assessment Results
Definition of Implementation Ratings
| Score of 1 | Score of 2 | Score of 3 | Score of 4 | Score of 5 |
|---|---|---|---|---|
| Organization has not yet demonstrated awareness for the need for this standard. | Organization has demonstrated awareness, but work on this standard has not yet begun. | Organization is actively working to implement standard. | Standard is in place, but it is not yet sustainable or monitored. | Standard is sustainably in place and monitoring for continuous quality improvement occurs regularly. |
Overall Mean Score for
Current Assessment
Month and Year of
Current Assessment
| Assessment Score as of | |||
|---|---|---|---|
| Element | Number of Criteria | Current Assessment Score Means | |
| Element #1: Organizational Commitment | 3 | ||
| Element #2: Culture and Climate | 6 | ||
| Element #3: Training and Education | 4 | ||
| Element #4: Policy, Procedure, and Practice Review | 8 | ||
| Element #5: Feedback and Quality Assurance | 5 | ||
| Overall | 26 | ||
Scores By Standard
| Element #1: Organizational Commitment |
|---|
| Standard |
| Total Element Mean Score |
| Element #2: Culture and Climate |
|---|
| Standard |
| Total Element Mean Score |
| Element #3: Training and Education |
|---|
| Standard |
| Total Element Mean Score |
| Element #4: Policy, Procedure, and Practice Review |
|---|
| Standard |
| Total Element Mean Score |
| Element #5: Feedback and Quality Assurance |
|---|
| Standard |
| Total Element Mean Score |
Detailed Implementation Scores
Element #1: Organizational Commitment
Organizational commitment is demonstrated through dedicated support for a trauma-informed infrastructure that includes specific funding and employee time for implementing trauma-informed care. Organizations acknowledge that an understanding of the impact of trauma is central to effective service delivery and make operational decisions accordingly. Organizational commitment is evident within all four domains outlined in SAMHSA’s TIC Guidance: (1) Governance and Leadership, (2) Policy, (3) Financing, and (4) Engagement and Involvement. Leadership collaborates with other organizations to create a trauma-informed community that follows the principles of trauma-informed care across sectors.
Element #2: Culture and Climate
Culture and climate is the cohesive narrative, the glue, that holds a trauma-informed community together. It is the embodiment of all that is seen, heard, done, and experienced in spaces and settings. Trauma-informed practices and settings demonstrate an understanding of the impact of trauma and toxic stress on the body (both individual and organizational) and the power of relationship and belonging. This understanding appears in the language used, protocols that are followed, and behaviors that are witnessed.
Element #3: Training and Education
The professional development plan for staff is demonstrated by staff competency and skills, as well as how the principles and values of trauma-informed care are applied in the training methodology. The plan’s goal is staff embodiment of the content shared. Training is paired with educational opportunities that promote competence (knowledge) and confidence (skill) to apply to trauma-informed approaches (TIA). This learning is done at a reasonable pace, is role specific, and performed throughout the job cycle (Ask “who needs to know what by when?”).
Element #4: Policy, Procedure, and Practice
Policies and procedures offer a mechanism to sustain TIC, allowing helpful practices to evolve over time in response to feedback and growing knowledge about the field. Policies and procedures are reviewed through a TI lens with a process that defines how misalignment with TI values is handled. The process will continuously examine “who is at the table” and whose voice and experience is centered. Changes are made in areas within an organization’s locus of control. The limitation of regulatory bodies is recognized and system change is sought.
Element #5: Feedback and Quality Assurance
Feedback and quality assurance techniques are used to impact practice. Trauma-informed organizations demonstrate inclusive and effective feedback practices that solicit how staff and service recipients feel and experience the organization. The feedback process is routine, multimodal, and centers those most impacted by the work. The feedback received and plans for practice, policy, and procedure change are shared. These processes demonstrate knowledge about the impacts of trauma in the organization’s methods, language, how the feedback that is sought, and how the information is used.