training for trauma- informed supervision€¦ · design. findings supervisors who participated in...

Kristin Swenson, PhD

Utah Department of Human Services

TRAINING FOR TRAUMA-

INFORMED SUPERVISION

Background

• Evidence based practice is the provision of

services which have been shown, through

available scientific evidence, to consistently

improve measurable client outcomes.1

Evidence-based practice

• The evidence-based practice that is the focus of

this research is trauma-informed care: a

treatment framework for understanding and

responding to the effects of trauma.2

Trauma-informed care

Background

• A program, organization, or system is trauma-informed when it:– 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.3

Systemic trauma-informed approach

Background

Trauma-informed supervision training seeks to enable supervisors to enact a trauma-informed approach by disseminating knowledge about a set of skills supervisors can implement to reduce

– compassion fatigue – burnout – vicarious trauma

in supervisees.

Trauma-Informed Supervision

Background

Note the distinction, made by both the National

Institute of Health and the Center for Disease

Control and Prevention, between dissemination

and implementation of evidence-based practices:

– Dissemination increases knowledge about practices

– Implementation increases use of practices. 4 5 6

Difference between Dissemination and Implementation

Background

Research from the field of education has identified several key training feature that effectively increase knowledge and use of practices:• Form (training formats such as guided practice, mentorship and

coaching often outside of the classroom in authentic environments)

• Durations (total training hours as well as the span of time over which training takes place)

• Collective participation (people who work together are trained together)

• Active learning (learners become actively engaged in meaningful practices and analysis)

• Coherence (training is aligned with real-world experiences and expectations) 7

Best Practices in Professional Development

The Current Research

This research uses self-report data from participants engaged in a training format that adhered to those features to answer the following:

• To what extent had participants received prior training on trauma-informed care and trauma-informed supervision?

• What was the level of knowledge about trauma-informed supervision prior to training?

• Was the training effective in increasing knowledge about trauma-informed supervision?

• Were follow-up coaching sessions effective in increasing use of trauma-informed supervision?

Methods

• Fifty-seven supervisors from private, state, and tribal child-serving services in Utah completed surveys before and after the training– Juvenile Justice

– Mental Health

– Volunteers of America

– Health services

– Substance Abuse

– Child and Family Services

– Contracted providers

– System of Care

– Healthy transitions

Participants

Method

• Participants were invited to attend an eight hour training on trauma-informed supervision.

• Prior to the workshop, 28 of the supervisors were selected to participate in supplemental coaching sessions.

• Monthly coaching sessions were scheduled for six months after the workshop.

• All 57 supervisors agreed to complete follow-up questionnaires six and 12 months after the workshop.

• 38 supervisors (67%) completed six month questionnaires

Procedure

Method

The pre- and post-event questionnaires contained

a set of Knowledge Statements that respondents

could agree or disagree with using a seven-point

Likert scale.

The post-event and follow-up questionnaire

contained a set of Use Statements with the same

Likert-style response options.

Materials

Methods

(K) X (K)(U) c c c c c (U) (K)(U)

---------------------------------------------------------------------------

(K) X (K)(U) (U) (K)(U)

(K) =knowledge scale

(U) =use scale

X =8 hour training

c =1 hour coaching session

Design

Findings

Results showed that 89% of participants had

prior training on Trauma Informed Care and

25% of participants had prior training on

Trauma Informed Supervision.

To what extent had participants received prior training on trauma-informed care and trauma-informed supervision?

FindingsTo what extent had participants received prior training on trauma-informed care and trauma-informed supervision?

39% 49%

10%1%

Yes, I have had a fair amountof training

Yes, I have had limitedtraining

No, I have not had formaltraining but I am familiar

with the concept

No, Trauma Informed Care isnew to me

5%

20%

50%

25%

Yes, I have had a fair amountof training

Yes, I have had limitedtraining

No, I have not had formaltraining but I am familiar with

the concept

No, Trauma InformedSupervision is new to me

Figure 1. Frequencies of responses to, "Have you had previous training on Trauma Informed Care?"

Have you had previous training on Trauma Informed Care?

Have you had previous training on Trauma Informed Supervision?

Findings

The majority of respondents indicated that,

prior to the workshop, they understood

principles related to trauma informed care and

did not understand principles related to trauma

informed supervision.

What was the level of knowledge about trauma-informed supervision prior to training?

Findings

Statement Percent who agreed

I understand the definition of trauma. 91%

I understand the key elements of trauma informed care. 58%

I understand the impact of secondary traumatic stress on the

workplace.

46%

I know how to identify secondary traumatic stress in my supervisees. 21%

I know how to reduce the effects of secondary traumatic stress in my

supervisees.

19%

I understand how trauma informed supervision differs from

supervision-as-usual.

13%

I understand how to coach someone so that they can apply the trauma

framework.

8%

What was the level of knowledge about trauma-informed supervision prior to training?

Findings

All seven items on the knowledge scale showed

significant mean differences between pre- and

post-training administrations with higher average

ratings after training than before training. On six of

the seven items, the magnitude of change

exceeded standards for “large” effects.

Was the training effective in increasing knowledge about trauma-informed supervision?

FindingsWas the training effective in increasing knowledge about trauma-informed supervision?

Statement Percent who

agreed before

training

Percent who

agreed after

training

I understand the definition of trauma. 91% 97%

I understand the key elements of trauma informed care. 58% 88%

I understand the impact of secondary traumatic stress on the workplace. 46% 74%

I know how to identify secondary traumatic stress in my supervisees. 21% 84%

I know how to reduce the effects of secondary traumatic stress in my

supervisees.

19% 70%

I understand how trauma informed supervision differs from supervision-

as-usual.

13% 86%

I understand how to coach someone so that they can apply the trauma

framework.

8% 61%

Methods

(K) X (K)(U) c c c c c (U) (K)(U)

---------------------------------------------------------------------------

(K) X (K)(U) (U) (K)(U)

(K) =knowledge scale

(U) =use scale

X =8 hour training

c =1 hour coaching session

Design

Findings

Supervisors who participated in coaching sessions

endorsed each of the knowledge items more

strongly than did supervisors who did not

participate in coaching sessions. This effect was

significant for half of the items (significant at p<.05

for four items and p<.1 for one item).

Were follow-up coaching sessions effective in increasing use of trauma-informed

supervision?

FindingsWere follow-up coaching sessions effective in increasing use of trauma-informed supervision?

Statement r Coaching rNo Coaching

I coach supervisees in using a “trauma lens” to guide case

conceptualization. 0.69 0.25

I meet with my supervisees for formal supervision on a regular

schedule. 0.19 0.06

I employ concepts of Reflective Supervision during my

supervisory time. 1.19 0.29

I monitor for signs of secondary trauma in my supervisees. 1.38 0.41

I actively intervene to reduce the effects of secondary

traumatic stress in my supervisees. 1.00 0.25

I actively monitor and address my own secondary trauma. 0.31 -0.47

I encourage my supervisees to share the emotional experience

of doing trauma work in a safe and supportive manner. 0.81 0.47

I assist my supervisees in emotional re-regulation after difficult

encounters. 0.50 0.12

I have a defined plan of how to provide support to staff after a

critical trauma event. 0.81 -0.35

Discussion

The outcomes provided evidence that:

• Utah supervisors have not been involved in trauma-

informed supervision training

• Untrained supervisors lack understanding of trauma-

informed supervision principles

• The 8 hour workshop was effective for dissemination

• The coaching calls were effective for implementation

Summary of quantitative results

Themes from open-ended feedback:

• Appreciation for the training

• Appreciation for the coaching groups

• Disappointment in not being selected to participate in the coaching groups

• Desire for more trauma-informed training in general

• Frustration of being trauma-informed in a non-informed workspace

Summary of qualitative results (not reviewed)

Discussion

• Data collection still taking place (i.e., this is not

over)

• Ceiling effects limited ability to measure change

on some items

• Needed to have a “not applicable” option for staff

not in supervisory roles.

Limitations and lessons learned

References

• 1 https://depts.washington.edu/pbhjp/evidence-based-practice-institute/what-evidence-based-practice

• 2http://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_2/trauma_tip/

• 3 https://www.samhsa.gov/nctic/trauma-interventions

• 4https://www.nlm.nih.gov/hsrinfo/implementation_science.html

• 5Sogolow, E. D., Sleet, D. A., & Saul, J. (2008). Dissemination, implementation, and widespread use of injury prevention interventions. In Handbook of injury and violence prevention (pp. 493-510). Springer US.

• 6Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 24-34.

• 7Guskey, T. R. (2003). What makes professional development effective?. Phi delta kappan, 84(10), 748.