Capturing the Client Perspective within an Organizational Needs Assessment; A Project to Enhance 'Trauma Informed Care' (TIC) in a Homeless Health Clinic
Coleclough, Elizabeth C.
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PURPOSE This research occurred in partnership with a committee of staff and clients at a homeless health clinic. Their goal was to improve ‘Trauma Informed Care’ (TIC) within the agency. Trauma is a psychological reaction that can occur after physical harm, sexual assault, and childhood neglect. Research documents the risk of long-term consequences on physical, mental, and behavioral wellbeing. Literature further demonstrates how clients are vulnerable to triggering and re-traumatization within the systems intended to help them (social; legal; medical). As organizations recognize this issue, there is growing demand for strategies to (1) decrease this risk of accidental re-traumatization; and (2) assist clients towards meaningful, long-term trauma recovery. This bundle of strategies falls under the overarching category of ‘Trauma Informed Care.’ METHODS A first step in enhancing TIC involves an agency-wide assessment. The purpose is to identify: ways in which the clinic is already sensitive and prepared to address trauma; areas and barriers that require attention; and recommendations for improvement. My role concentrated on gathering the client perspective. In 2013 – 2014, I facilitated in-depth interviews with 30 participants. Their voice became especially valuable to the project. RESULTS Three primary themes emerged: 1. The lobby is a critical (though often forgotten) space for agencies to consider. It sets the tone for how safe clients feel. Trauma-informed agencies make effort to ensure adequate comfort in the environment, effective communication (particularly with new clients), and substantial support for front-line staff. 2. A wraparound structure, which integrates healthcare disciplines into a holistic team, is most prepared and efficient in addressing the complex consequences of trauma. 3. Client ‘empowerment’ is central to long-term trauma recovery. Trauma-informed agencies build opportunities for clients to enhance their sense of control. Strategies include patient-centered care; peer groups; client input to the agency; and client involvement in advocacy / community mobilization. CONCLUSIONS Overall, this research demonstrates why TIC is agency-wide, rather than restricted to clinicians. A client’s relationship with an organization extends well beyond the provider’s office. As such, the effort to be trauma-informed impacts everything from the clinic’s structure to the level of support for the front-line worker.