Collective Trauma and Building a Trauma-Informed Culture: Working with Staff

Editor's note: This text-based course is an edited transcript of the webinar, Collective Trauma and Building a Trauma-Informed Culture: Working with Staff, presented by Nadia Tourinho, MSW, LICSW, LCSW-C.

This is part three of a four-part series titled Collective Trauma and Building a Trauma-Informed Culture. Once you finish part three, move on to part four.

Learning Outcomes

After this course, participants will be able to:

• Describe how to use effective trauma-informed care techniques when working with parents, children, and staff.
• Identify how to look beyond children's behavior and actively listen to the message children communicate with their behaviors.
• Identify techniques nonclinical staff must develop to provide effective trauma-informed care in the workplace.
• Explain necessary strategies educators must incorporate in the classroom to create a trauma-informed sensitive environment.

As we go through this course, you'll hear me refer to staff, clients, and providers. When I say clients, I'm referring to children, parents, and families. When I talk about providers and professionals, it includes teachers, social workers, psychologists, and anyone working with the clients.

Trauma-Informed Care

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma-informed care "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; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatization."

Every time you think about trauma-informed care, I want you to think about those underlined words; realizes, recognizes, responds, and resists re-traumatization. When we are in a trauma-informed environment, we must be aware of all these things. We have to be able to put it into practice as well as policy because if we can put it into policy and practice, then it becomes a trauma-informed environment. Then it's not just the clinical staff that are providing the trauma-informed care, but it's in an environment that we're able to do that.

Trauma-informed care starts with our nonclinical staff. Nonclinical staff plays a critical role in an organization that practices trauma-informed care. For an organization to truly become trauma-informed, it needs to involve every single person in that organization. Despite the heavy emphasis on being trauma-informed among clinical staff, it is equally essential that nonclinical staff (receptionists, administrators, paraprofessionals, and others) are also given basic knowledge of trauma-informed care principles. Before I talk about what trauma-informed care looks like, I want to share a story about what it does not look like.

I used to work at a school and went to the main office to speak to the principal. While waiting, I noticed a parent come in to pick up her child. When she walked in, three staff members were all preoccupied. It took about three minutes for them to notice that she was there, and by that time, she was already frustrated because she had been waiting. When they finally did see her, they walked up to her and said, "How can I help you?" There was no friendliness or concern in their voices. She replied, "I'm here to pick up Johnny." They asked to see her license, and they realized that the last name on her license didn't match the child's last name. At that school, if the names did not match they would not dismiss the child.

The school staff told her they would not be able to dismiss this child because the names didn't match. She was immediately triggered and told them they would give her her child. She said, "I'm not leaving here. I need my child." One office staff said, "I'm going to call my principal because I can't give you the child right now. We can't dismiss the child because the names do not match. It's our policy, and this is what we have to do." The principal came out and told her the same thing. As I was sitting there observing everything, I thought, I can't imagine going to pick up my child and someone telling me that I can't take my child. I don't know if this particular parent had trauma or not, but I know that she was instantly triggered. That was not a trauma-informed environment.

In a situation like this, one thing that would help create a trauma-informed environment is to ensure that forms are correctly filled out at the beginning of the year, especially items related to names and other important information. If you have a similar policy about last names not matching, ask the parent to provide proof that the child is theirs and keep that on file. The other thing that was not trauma-informed was someone coming into an office and waiting so long to get recognized. Even if you are busy doing something, it doesn't take much to greet them and tell them you'll be right with them. Then when you walk up to them, thank them for their patience and ask how you can help them. Your tone of voice and friendliness changes things. Even if the same thing happened and the staff had responded this way, the parent likely wouldn't have been so upset.

Another way to approach it is instead of saying this is our policy, saying, "I noticed that your last name is different than the child. Do you have any other form of identification that can link you to this child? We're asking because we want to protect all children at all times. We want to make sure that children are being dismissed to the right people." This changes the focus from "you're keeping my child from me" to "you're keeping my child safe." Then if you do have to call in the principal or someone else for support, they should restate the same. "We're doing this to protect the children. Do you have any other form of identification we can see, or can we call the child's father to verify that you are the mother?" This might help the mother feel secure that the school is only looking out for her child.

This school was doing their due diligence because they dismissed a child to the wrong person in the past. Now the school has put a big emphasis on the names having to be the same. Unfortunately, the person that ended up suffering was the person that I observed. That is what trauma-informed does not look like, but I did provide some ways to make it trauma-informed.

How to Support Nonclinical Staff

Let's go a little deeper into how we can support nonclinical staff.

Learn How Trauma Affects Persons Served

Staff who understand how trauma affects an individual's mind and body will be more likely to approach their work with a trauma-informed lens. Understanding components such as triggers can help nonclinical staff identify ways to prevent or reduce the likelihood of retraumatizing a person. 

Pay Attention to Language

As I have stated, trauma-informed care is looking at why this person is acting a certain way and what happened to them. Pay attention to the terms used and promote language that removes judgment from the individual behavior. For example, patients often miss appointments and are referred to as no-shows if you work at a community health center. That term can be highly judgemental because we don't know why this person did not attend the session. Many times the nonclinical staff are the ones sending the letters to the no-shows. Think about what to say using a trauma-informed lens. For example, instead of focusing on the fact that they missed their appointment, say, "We know that you didn't come to your session, and we would love to reschedule another appointment. We hope that everything is okay. Please let us know if you need any support." Another example is when a parent is late picking up their child, it might be frustrating because you must also pick up your child. Attention to language means we control our emotions and can explain certain things. It's also important to set certain boundaries, but in a way where it's not judgmental, so we don't make the person feel worse about themselves.

Practice a Strengths-Based Approach to Care

Practice a strengths-based approach to care. Remember, a trauma-informed model of care asks not what is wrong with you but rather what happened to you and withholds judgment. All staff should keep this in mind when dealing with clients and families. Help everyone feel supported and not judge when a parent is late, or someone misses an appointment. Ask if everything is okay and how you might support them. This helps to provide a trauma-informed environment.

Focus on Building Relationships

Clinical staff must have a good relationship with the client to work with them and work on their trauma. It is just as crucial for nonclinical staff to foster a healthy and respectful relationship with clients. If a client has a good relationship with everyone they interact with at your program, it will make going there much more effortless. Whether going to a community health center or a school, getting there is sometimes tricky and can be triggering. As we discussed in part two, some kids do get bullied. When some of those bullied kids become adults, going to a school can also be traumatizing. Keep in mind the basic knowledge of what trauma looks like and how everyone, including nonclinical staff, can support people coming in.

Be Person-Centered 

Being person-centered means knowing and understanding that the client is the expert on their life. Identifying and keeping goals, making choices, and self-determination are at the core of the treatment. Being person-centered contributes to the client's ability to use empowerment, voice, and choice. On the clinical side, the client picks the goals and can select what things they want to work on. On the nonclinical side, how do we empower those clients? How do we help them have a voice? This could be as simple as giving them an option about making an appointment. Instead of saying, "Here's your appointment card for your next session," or "Here is your date for the IEP meeting for your child," ask what day works for them and if they prefer mornings or afternoons. Give them the choice to make that decision. A lot of times, people with some trauma weren't given that choice. They didn't have power. Giving them that little bit of a choice helps build the relationship and empowers the client. 

Leaders and Support

Here are three ways that leaders can support staff. First, leaders and supervisors can help staff build on a client's strengths and their own. They can help staff prepare for their emotional reactions to clients who have experienced trauma. Second, leaders and supervisors can work with staff to reflect on their practice. They can encourage staff to ask for help, focus on what they can do, and let go of what they can't. As you reflect on things you can do, also think about something you want to improve on, no matter your role. Third, leaders and supervisors can help staff value their passion and the healing power of their relationships, with the clients they work with and themselves. Staff shouldn't just be focused on the client and forget about themselves. We have to take care of ourselves to take care of clients.

Organizational Support

Here are some ways the organization can support staff. The first is general wellness, such as encouraging and incentivizing activities like yoga, meditation, and exercise. I used to work for a mental health child welfare program that had Wellness Wednesdays. Every Wednesday from 11:30 to 1:00, you could engage in any activity you wanted, whether within or outside of the organization. Every week that time was yours. Working within child welfare, you run into traumatic experiences that people face daily. Having that time for yourself was very important for staff, although it was not mandatory for people to utilize the time for a wellness activity. We were not allowed to schedule meetings during that time. It was helpful to have this opportunity in such a high-stress environment.

Organizational support is fostering a culture that allows staff and providers to seek support, keeps caseloads manageable, and provides good mental health benefits. If you're working as a teacher, case worker, therapist, or mental health provider and have a caseload that is too much or the cases are too complex, that can impact you. Let's say the typical caseload is 20 children, and you have 30 on your caseload. That's ten extra students you have to work with and is a lot for one person to handle. At that point, how can we support this particular person? As I just described, giving them time for general wellness would be very helpful to the teacher or other providers.

Another way to help is to provide additional supervision. Facilitate staff wellness through management strategies such as reflective supervision, a practice in which a clinician and supervisor meet regularly to address feelings regarding patient interactions. It's helpful to talk about and process situations with someone else, especially if you are having difficulty with that situation. It allows you to bounce around ideas that may help the child. This might be weekly supervision and could be with someone who can help provide a trauma-supported environment.

Education is another way the organization can support staff. Provide targeted training that creates awareness of chronic emotional stress and the importance of self-care. Training can be targeted to your position, whether you are in a clinical or nonclinical position. I feel like sometimes nonclinical staff gets pushed to the side, leaving things to the clinical staff to take care of. But to be a sound trauma-informed place, everyone should be trauma-informed.

Trauma Misconceptions

In part one, we discussed trauma misconceptions when working with parents. It is also essential for all staff to understand trauma misconceptions and biases because they may also have those. Remember, childhood trauma in adults doesn't necessarily mean they would be unable to build a fulfilled life. Many people have misconceptions when it comes to adults affected by childhood trauma. The first misconception is that an individual abused and/or neglected as a child will abuse and/or neglect their children. The second is that abused and neglected children will become deviant adults. The third misconception is that the effect of abuse and/or neglect are irreparable, and the adult won't live a full life of recovery. These are not true for everyone. Yes, some will fall into these situations, but most people do not, thus making these misconceptions.

I have a story too I would like to share with you. I teach at Denver University and showed my students a clip of someone coming into therapy. This person was mandated to attend therapy because their child was removed due to physical abuse. Right off the bat, my students thought that this person was probably abused as a child, and they're doing the same thing to their child because that's all they know. I asked my students to let me know what they were thinking. They said they were angry and thinking about how this person had abused their child, and I now had to sit and provide trauma-informed therapy.

Then one of the students asked me, what do you think? I mentioned that when I first saw this video, her demeanor made it seem like she was extremely overwhelmed. She was combative, and she appeared to be stressed. The other thing I noticed is that she mentioned she didn't want her son to be like his father. I told my students that we need to look at things in a clinical sense and consider where this person is coming from. It doesn't matter if you're a clinician or an educator; think about where the person is coming from. After she said she didn't want her son to be like his father, I probed and asked her what she meant by that.

The other thing that I would look at is someone so afraid their child will turn out like their father, and they're trying their best to prevent that right. Unfortunately, she does not have the proper tools to parent well. She uses physical punishment to keep her son from being like the father hopefully. This means what is going on with her isn't the first misconception that an individual who was abused and/or neglected will abuse and/or neglect their children. It's the fact that this person is so afraid.

Think about the why. Why is this person behaving this way? What is wrong with this mother? Why is she beating up her child? Think about why this person is doing that. In this situation, the answer is that she was so afraid that her son would go to jail. Later in the video, she mentioned that the father was in jail. She was so afraid of her son following in his footsteps. She didn't know any other way than to hit her child to prevent him from going down that path. After looking through the trauma-informed lens, the proper way to help this parent is to provide appropriate parenting techniques.

As a staff, we must recognize what's going on and not fall into these misconceptions, just like everyone else. We are not immune to these misconceptions and biases that are out there. Be aware of that and go a little bit deeper, not only to see what's on the surface but to find out the "why" behind what is happening. For example, when my students saw a little bit of the video clip, they saw that a person was beating her child and wondered what was wrong with her. We must dig deeper. That's something we can all do. You don't have to have a clinical background to be able to provide support and see where someone is coming from and what their fears are.

Impact on Staff and Providers 

Staff and providers address patients' traumatic experiences and associated health effects by implementing trauma-informed approaches to care. Securing time and resources for staff wellness is one essential element of trauma-informed care. Supporting staff's well-being helps them provide high-quality care. If staff members are not taking care of themselves, they can't be expected to care for children and their families properly. This includes clinical staff, teaching staff, administrative staff, and anyone working with the children and families.

Without safeguards in place to help staff and providers process their emotions, anyone working with patients who have experienced trauma may be subject to chronic emotional stress. This stress can then negatively affect their own physical and psychological health. As I previously discussed, supervision and education are safeguards for helping our staff be healthy. Hearing emotional, traumatic stories can become extremely difficult and emotional for people, whether you work at the front desk, in a classroom, or as clinical staff. We have to be able to provide high-quality care to our clients. But we cannot do that if we do not provide that same quality of care to ourselves. It is important for organizations to always have safeguards for you when you are working within the trauma-informed care environment.

Caring for Ourselves as We Care for Others

Learn about reactions to others' traumas and how to respond. We need to care for ourselves when working with people who have experienced trauma. The effects of those experiences on them can affect us too. They can cause us to experience vicarious trauma. They can also bring back, or trigger, the effects of trauma we may have experienced in our lives. We are not immune to feelings of vicarious trauma and feeling overwhelming stress that may occur after talking with a child or family member about their trauma and stress. Taking care of yourself is very important.

Understanding Vicarious Trauma

When we work with families who have experienced trauma, we may be deeply affected by their pain, anxiety, and other strong feelings. The result may be vicarious trauma. Vicarious trauma is a natural reaction. It is our emotional reaction to the helplessness, fear, and hopelessness that other people who have experienced trauma often feel. Vicarious trauma can leave us with similar feelings that can weigh us down and make it difficult for us to relax or experience joy. 

I would like to share another story about a time when I experienced vicarious trauma. I am now a trauma specialist, and my expertise is trauma, but this happened when I was an intern at a trauma center. The trauma center was busy day and night, and I had a caseload of about ten clients. These cases were all children and adults who had experienced significant trauma. It started to affect me to the point I was having a tough time concentrating. I had a hard time falling asleep without having nightmares. I had a hard time processing everything in my day-to-day routine and doing my work because I couldn't concentrate. Everything was really hard. I was experiencing vicarious trauma from the clients I had worked with. I was feeling extremely overwhelmed.

One day I was walking down the hallway, and the program director saw me walking and immediately stopped me. She said, "Nadia, what's wrong?" I told her nothing was wrong, and she told me to come to her office. When we got there, she said, "What's wrong? You don't seem like yourself. You're usually bouncing off the walls and happy-go-lucky, but now you're walking with your head down. What's going on?" I replied, "I don't know. I just feel weird. I just feel really weird." She said, "Oh, okay. I see what's happening." She didn't explain to me what was happening. She told me, "I want you to pick up your belongings and leave." I said, "What do you mean leave?" She said, "I don't want you to be here for the next two weeks." I was concerned about my hours, and she said to forget about the hours and go enjoy myself. She said, "Don't think about this place. Don't do any work around this place, nothing. I want you to just get out of here and do something you enjoy. Then when you come back, we will talk more about what I see is happening."

I was very confused, and she told me, "Nadia, please, don't try to figure this out. I know how you are. You're just going to go home and research it. Please, Nadia, go home and do things you enjoy." She was trying to get me to experience joy again, relax, and not think about all the cases I was carrying. I was still protesting and saying no, and she said, "Nadia, I don't want to hear it. Just go." I picked up my belongings and left. I didn't go back for two weeks as she had told me. When I returned, I met with her again, and she explained what was happening, which was vicarious trauma. I asked her, "Why didn't you tell me this before." She told me, "Because I know how you are. You were going to go home and do research on vicarious trauma. That's something I was trying to prevent you from doing. I didn't want you to continue to be so into it, so I told you to go home and completely relax."

The other thing that she mentioned to me is to have sound boundaries. This occurs when you do your best at work and try your best to help people. You do everything you can for people, whether nonclinical staff, clinical staff, teachers, psychologists, etc. Have set boundaries. If you don't, feelings start creeping into your life. Before you know it, you start feeling those same feelings that your clients are feeling. It doesn't necessarily mean it's the same thing, but you start feeling like that. There's also secondary trauma, where you start experiencing the same thing the clients are feeling with flashbacks, but your flashbacks will be different. They will likely be about when the client told you the story of how X, Y, and Z happened.

Remember, vicarious trauma includes feelings of helplessness, fear, and hopelessness. As I said, I wasn't able to concentrate. I wasn't able to write a sentence. It was so off-putting how I was feeling. The director and I talked about things I could do to help myself. I'll talk about that towards the end of part 3. The bottom line is that vicarious trauma is serious. It's very real, especially if you're just starting. Hearing many of these difficult stories is heartbreaking, to the point where I would think, wow, how can people do this to another human being? I would stay stuck on that. Please be aware of these things. If you start feeling like that, talk to your supervisor and always try to do something you enjoy. If you're feeling helpless, afraid, or hopeless, remember those are signs of vicarious trauma.

As I said, when I share my story about my vicarious trauma at the trauma center, I encourage people to always remember some ways to prepare for these natural reactions and learn how to handle them. One way is by honoring our gift of compassion, including our ability to feel the pain of others. These feelings are our guides in the work that we do with families. They may also stir up our feelings. This ability can take a toll yet is also a gift. It is an important part of who we are and why we do this work. At the same time, attending to our feelings with equal compassion is vital. Honoring our compassion is to honor the compassion that we have for our clients but also honor the compassion we have for ourselves. This is very important because when you don't have that compassion for yourself, and you're just putting all this work in, and you forget about yourself, you will burn out. You might develop vicarious trauma. At that point, who are you going to be able to help?

Another way to prepare for these natural reactions is to accept the limits of what we can offer. We feel deeply with others. We naturally want to fix things and make things better, even when we can't. We may hold ourselves responsible for changing things that are not in our control. We may feel guilty about not being able to do so. It's crucial, especially as a provider, to think about what you can do versus what you can't do. When we think about things we can't do for this person, it will not make us feel good about ourselves or our skills. We need to think about things that we can do. Try not to focus on the things that we haven't done or that we can't do, but notice how these thoughts impact the energy we put into our work.

We can learn to protect ourselves from feeling guilt that we do not deserve. Save your energy to focus on doing something that we can do. Feeling guilty is very common. I have supervised people in the past that I felt overly guilty that they were not able to do X, Y, and Z. Then I would say, let's talk about some of the things that you have done to protect this client and some things that you can do to continue protecting this client. It's almost as if we only focus on the things that we can't do versus focusing on the things that we can do.

For example, as we went over working with children, a teacher can provide a safe environment in the classroom where children feel heard and can make choices. Unfortunately, the child may go home to a toxic environment, but when they're in your class or office, that is a safe environment. Statistics show that as long as a child has one person they feel they can rely on, they already beat many of the odds. They might not have that anywhere else, and you may be the one providing that.

We also need to recognize that our supportive relationship may be more healing than we think. That means that if we feel that we need to fix everything and are distressed by the fact that we can't, we may underestimate the importance of what we do for children, families, and staff who have had traumatic experiences. Our ability to feel with them may be more powerful than we know. For example, someone may be focused on doing this to make this person feel better and may not realize that your relationship with this person is highly beneficial for them. You're helping them more than you think because maybe they don't have another relationship like that. Maybe when that child goes home, they don't have the power to say no. Perhaps that person doesn't have the power to select the time that they can come to your office, or maybe they have never been given any control. The relationship you provide that person can be a lot more beneficial than we think.

Find gratitude for the significant work that we do. The work that we do is very hard. I have been in the field for about ten years now, so I know how difficult it is. Be proud of some things you do, such as feeling with the families you work with. Be proud that you are here trying to learn trauma-informed techniques to be able to help clients. Be proud that you are doing hard work, whether you're a teacher, nonclinical staff, or clinician. Lastly, seek connection and comfort in your own relationships. Just like we tell people to reach out to connections, we also have to do that as staff. Enjoy time outside of work. Find comfort within our own lives and our own families. We can do things outside of work that we do daily by interacting with family and friends and doing things that we genuinely enjoy.

Professionals and Trauma 

Here are some statistics to think about.

• 60% of children and adolescents have been exposed to crime, violence, and abuse either directly or indirectly
• 50% of youth have been assaulted at least once 
• 39% of youth ages 12 to 17 reported witnessing violence 
• 34% of youth reported being emotionally bullied, and 13% physically bullied 
• 25% of youth were victims of robbery, vandalism, or theft 
• 16% of youth ages 14 to 17 were sexually assaulted or sexually abused 

Those children become adults, and they go into the workforce. Those children can be teachers, therapists, or nonclinical staff in your field. Professionals also have trauma. The reason why I'm sharing these statistics is, so you realize that those children that have been abused go into the workforce. 

Understanding Your Trauma Triggers

It's essential for you as the staff and the professional to be aware of your trauma triggers. We are not immune to the effects of trauma. Also, be mindful that each new traumatic experience can be a trigger for prior ones in our own lives. Each one may also remind us of the historical trauma our people have experienced and our families have taught us about. Retraumatizing experiences can bring back a sense of danger, powerlessness, and loss of our control over defining who we are. Common examples of trauma triggers can include:

• People or places
• Times of the year or holidays
• Certain kinds of weather
• Songs
• Separations, losses, or new traumatic experiences that bring back the memories of old trauma
• Parenting or teaching a child who is the age we were at the time of our traumatic experience
• Racist statements or acts

As a result of experiencing a trauma trigger, people may have flashbacks, which are powerful memories or visions of the traumatic experience, along with feelings of fear of that moment. They can have a panic attack where the heart pounds, skin gets flushed, break into a sweet, breathe hard and fast, and feel that something terrible is about to happen. They may experience dissociation, which looks like zoning out, losing track of time, and inability to stay in the present moment. Be aware of your triggers and what may happen if you are triggered. You may not experience these responses, but it's better to prepare them. If someone has untreated trauma and hasn't processed it, one of these triggers could send them into a downward spiral.

Other common reactions to trauma triggers could include:

• Perceiving more danger than there really is—for example, when a child loses control or when a parent is angry
• Retreating into our thoughts about the trauma, becoming preoccupied with these thoughts, and having trouble staying present or thinking about anything else
• Feeling the urge to blurt out what happened to us
• Feeling like disappearing or rushing away from the immediate situation
• Pulling away from others when there is conflict—real or perceived
• Retreating into our thoughts about the trauma, becoming preoccupied with these thoughts, and having trouble staying present or thinking about anything else
• Rejecting the help we need because it is difficult for us to trust it

These are some of the things that we need to be aware of when working in a trauma-informed environment because when you're in a trauma-informed environment, you're dealing with a lot of trauma a lot of time. You must be aware of your triggers and things that may upset you. You have to be able to self-regulate. 

Countertransference

We also need to be aware of countertransference, which is when the provider transfers their feelings onto the client. Countertransference is an excellent reminder that providers are human beings with feelings and emotions. Clients can remind you of someone you know currently or in the past. If you are working with someone who reminds you of you when you were younger or might remind you of a friend you know was also traumatized, you might see that person now as a friend rather than a client.

Think about if the therapy is therapeutical for the client. If you feel you're more of a friend to the client and the client is going on a venting storm, then at that point, it's not therapeutic. If you are a teacher, think about if you see a child that might remind you of yourself when you were younger or another child. Now maybe you treat this child a little bit differently or give them more chances than you would with other children. That's a huge red flag of countertransference. Countertransference can occur in many different ways and have adverse effects. It is a big deal when a provider brings in their outside experiences and loses their perspective, which can lead to a reaction that hurts the client. Countertransference doesn't only happen with clinicians but also occurs with teachers, psychiatrists, and other people within this field. Countertransference is common and can happen regardless of your experience.

Strategies to Strengthen Trauma-Informed Care Practices 

I have already touched upon some of the strategies to strengthen trauma-informed care. Having strengths-based and relationship-based practices is critical. Reflective practice means considering what we and others bring into an interaction before responding. Here are some questions we might ask ourselves in reflective practice or if you're dealing with countertransference:

• Why is this behavior bothering me so much?
• What might this person really be trying to say?
• Why am I finding myself thinking so much about this interaction?
• Is there something about this interaction that reminds me of others in my life?
• What may have happened in this person's past that might be driving this behavior?
• What have this person's past experiences with "helpers" been?

These are great questions to ask yourself when doing a lot of reflective practice, especially if you're considering whether your relationship with the client is therapeutic. They're also helpful if the client reminds you of people in the past, so you can be aware that there may be some countertransference, where you no longer see the person as a client, but more as you or a younger of yourself or a friend.

Strategies for Working with Clients/Families

The strategies for working with clients and families are very familiar because you've seen them in working with parents, but I want to restate them because they are essential when working with staff too.

• Don't take difficult reactions personally. Understand that parents' anger, fear, resentment, or avoidance may be a reaction to their traumatic experiences rather than to the child or you.
• Remember that parents who have experienced trauma are not "bad." Blaming or judging them will likely worsen the situation rather than motivate them to change. 
• Show parents that you genuinely care by complimenting their efforts to keep their children safe. Support them in their role as parents by asking for suggestions on how to care for their child. When differences of opinion in parenting beliefs and practices arise, understand that they may be reacting to feelings of fear, inadequacy, or losing control. Focus on the child to keep disagreements from becoming personal.
• Model direct and honest communication. Share your observations (instead of opinions) when presenting information that may be hard to handle. Similarly, be aware of and openly acknowledge your own mistakes. 
• Establish clear boundaries and expectations with birth parents and caseworkers. Be consistent, and, when you commit, follow it through. Work hard to come to an agreement, rather than staying stuck on being "right" or trying to "win." 
• Remember that visits, court hearings, and case conferences are difficult for parents and children. Work with them to set a routine for these encounters: decide together how to handle meetings, say goodbye, schedule phone contacts, and so forth. Tell birth parents and caseworkers about any event that might affect the quality of the meeting (e.g., the child had a tough day at school, didn't sleep well, etc.). 
• Stay calm, even-toned, and neutral during stressful situations – you'll be less likely to generate arguments. If not a kinship provider, always ask the birth parent how they would like to be addressed—this conveys respect.
• Remember that things will not always go smoothly, even if you try as hard as you can. Work towards mutual trust while keeping in mind that it may take some time. 

How to Support Staff in a Trauma-Informed Environment 

There are several ways to support staff in a trauma-informed environment.

• Promote flexible ways of communicating
• Offer supportive check-ins and debriefs
• Plan regular self-care and mindfulness training
• Use the mental health consultant's expertise to boost trauma-informed care across the program
• Create opportunities for staff to come together

Consultants are essential for Head Start and Early Head Start programs because they can help the teachers and point things out that the teachers might not be able to do.

Self-Care

The last thing I wanted to touch upon is when I met with the clinical director, and she mentioned that I needed to have a self-care plan. I was not aware of what self-care meant. Self-care refers to the ability to refill and refuel oneself in healthy ways, including engaging in behaviors that maintain and promote physical and emotional well-being and lessen the amount of stress, anxiety, or emotional reaction experienced when working with clients. Self-care refers not only to an engagement in various practices but also to having a caring attitude or "being" caring toward oneself. Self-care involves self-reflection and action in terms of knowing one's needs and consciously seeking out resources that will foster health and well-being. It is not a luxury but is a clinical and ethical imperative in the mental health profession. Self-care can include activities such as getting a haircut or massage, taking a trip, eating at one's favorite restaurant, and attending to one's basic daily needs. 

Working within the trauma realm, it's very important to have a self-care regimen. If we don't care for ourselves, we can't help our clients. In addition, make sure you set firm boundaries. All of this will help us provide high-quality care for our clients.

References

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Galindo, N. (2020, July 30). 6 tips to help your nonclinical staff practice trauma-informed care. Relias. Retrieved February 28, 2022, from https://www.relias.com/blog/tips-to-help-nonclinical-staff-practice-trauma-informed-care  

Gilmer, E. (2020, November 16). Trauma-informed care – nonclinical staff encounters. Health as a Human Right. Retrieved March 2, 2022, from https://healthasahumanright.wordpress.com/2018/09/12/trauma-informed-care-non-clinical-staff-encounters/  

National Child Traumatic Stress Network. (2011). Birth parents with trauma histories and the child welfare system: A guide for child welfare staff. Retrieved January 31, 2022, from   https://www.nctsn.org/sites/default/files/resources//birth_parents_with_trauma_histories_child_welfare_child_  welfare_staff.pdf  

Overstreet, K. (2021, January 26). Transference vs. countertransference: What's the big deal? Therapist Development Center Blog. Retrieved January 19, 2022, from https://www.therapistdevelopmentcenter.com/blog/transference-vs-countertransference-whats-the-big-deal/ 

Posluns, K., & Gall, T.L. (2019, May 23). Dear mental health practitioners, take care of yourselves: A literature review on self-care. International journal for the advancement of counseling. Retrieved March 3, 2022, from   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223989/  

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Schimmels, J.E., & Cunningham, L. (2021). How do we move forward with trauma-informed care? The Journal for Nurse Practitioners, 17(4), 405–411. https://doi.org/10.1016/j.nurpra.2020.12.005  

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