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Knowing is Not Enough

Knowing is not enough. Just being informed about trauma, the neurobiology of trauma, epigenetics is not enough. The Substance Abuse and Mental Health Services Administration (SAMHSA) asserts an organization is more than just informed once the program or organization: 

"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."

But how is this accomplished, "fully integrating knowledge about trauma into policies, procedures, and practices"? There are many theories which offer the best ways to engineer organizational change and manage the change for lasting impact, however; few consultants and trainers are offering this as part of their trauma informed education. 

When looking to become a trauma informed organization or program it is important to ask these questions when working with a consultant or trainer:

  1.  What evidenced based research will be used to provide the trauma information?
  2. How will information be translated into skills employees or community members can use?
  3.  Who receives training? How will their involvement be crucial tor integrating knowledge into practice?
  4. How will change occur in the culture of the organization or community?
  5. How is "buy in" accomplished?
  6. What is the plan for sustaining change?
  7. How will change be measured?

Be wary of any program which promises sustained organizational or community change after one workshop or one presentation. Look for consultants or trainers who are invested in understanding your organizational or community culture before implementing programming.

Becoming a trauma informed organization or community is a process not just knowing information. Knowing is not enough. Skills + Action = Healing

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Hi Jane, Good additions.  Has someone written anything formally about the recommended process of organizations assessing their ACE scores? (ie. are most assessing clients, staff, or both? are they using a representative sample of those groups or assessing all?  how do you keep anonymous? how do you analyze data? etc etc).  I'm guessing this exists, but I have not seen such a piece.


Thanks for posting the info, Steve. I completely agree with your list. I would also add: Does the trauma-informed training include a solid foundation in ACEs science? Has the organization assessed its own ACE scores (anonymously)? Is it involved with a local ACEs/trauma-informed/resilience-building initiative?

Excellent entry!!.  As trauma-informed care mushrooms, the lack of a clear definition of TIC and ways of operationalizing the philosophy are becoming glaring gaps in our field. More and more people are claiming "yeah, we're trauma-informed," yet when you ask them what that means, they say "our clinicians are trained in TF-CBT" or "we've had several trainings about trauma" or "we now do trauma screening."  I now do a workshop called, "Yeah, We're Trauma-Informed: But, Are You Really? What Does that Even Mean? And How Do You Get There?"

We need to be drawing on the lessons of the growing field of "implementation science." It argues convincingly that the VAST majority of innovations fail, not because the innovation itself is flawed, but because of the way in which it is implemented. One study (Joyce & Showers, 2002) found that training teachers about the theory of an innovation and having a discussion results in a 10% knowledge gain, but 0% use in the classroom. If you add demonstration of the innovation, knowledge goes up to 30% but 0% use in the classroom. If you add practice and feedback, knowledge goes to 60%, but only 5% use in the classroom. Only if you add coaching in the classroom, knowledge rises to 95% and use in the classroom goes to 95%.

I absolutely think there needs to be more consumer education about what a trauma-informed system really is, what implementation interventions, at what dosages, are likely to truly produce sustainable outcomes. 

To add to Cathy's list above, I'd add the following questions that organizations should ask themselves.

1. What is their readiness to implement TIC as an organization? Is there executive leadership support? Financing? How punitive is the culture currently? What's capacity to do system implementation? etc etc

2. Do the trainer/consultants providing services have expertise in system change using principles of implementation science?

3. Does the trauma training for staff have a track record and evidence that it is effective?

4. Is there a way to sustain trauma training for staff such as a Training-of-Trainer offering?

5. Does the consultant/trainer have expertise in program evaluation so that the organization can monitor progress of change?

6. Do consultants/trainers provide ongoing support, coaching, mentoring for the organization?

7. Do they provide consulting beyond staff trauma training on things such as: TIC supervision; trauma screening and assessment; integration of vicarious trauma awareness into the organization; move to less punitive behavior management techniques; policy revision etc. 

Thanks Cathy for raising this important topic.

Steve Brown, Psy.D., Traumatic Stress Institute of Klingberg Family Centers. Coordinator, Risking Connection Training Program.


Mike:  I recently took some trainings from the Brazelton Touchpoints Institute.  Both included a series of follow-up reflective practice sessions (by phone) and there was a requirement to attend at least 80% of the sessions in order to receive the training certificate.  Following through with those sessions made all the difference in my ability to implement.

We absolutely know from research that a single training does not "stick."  I wonder if the lack of "stickage" is sensed by participants and perhaps contributes to the feelings of overload that some workers have expressed when offered training in new frameworks, etc.  A given training may be inspirational while it's happening, but finding the space in the workday to convert inspiration into action is impossible - until there is support!  I hope more of your trainees will take you up on your offers of post-training consultation and coaching.

Cathy:  Great article!  We were discussing this very thing at the Viewpoint meeting in Traverse City yesterday.  As our community moves toward becoming trauma-informed, how we will connect social services, healthcare, education and community through common trainings and how we will use reflective practice to support learners' growth in understanding and expertise becomes of highest the importance.  In 5toONE we have many parents who want to begin attending trauma training and I see this as a very good thing.  However, as you so beautifully point out in the article, we need to be ready to take the next steps.

When I was teaching science I used to tell my students (and I still say today) that facts are not the same thing as knowledge.  Knowledge is how you use the facts.  I hope we will soon be a community of knowledge-users!  Thanks for all you do.

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