Becoming Trauma Informed in Our Workplace: Creating Safe and Brave SpaceAugust 19, 2022Jennifer Maguire, City ManagerKelli Parmley, Assistant Director, Human ResourcesDr. Donielle Prince, Director State Initiatives, PACES ConnectionErin Hawkins, Co-Director Hannah InstituteZeke Cohen, Baltimore City Council Member1 City Enterprise PriorityPowered by PeopleWe recognize that our more than 6,800 employees power the City of San José and our success as a City is dependent on our ability to create a dynamic and engaged workforce. Our employees’ ability to provide excellent service is strengthened when we invest in attracting talent, providing opportunities for career growth, enabling an environment focused on health, safety, and wellness, and retaining a diverse workforce in a workplace that is equitable and inclusive.2 2 Powered by People: ObjectivesBust Down Silos to Build Trust + TransparencyInvest in interdepartmental partnerships by removing barriers, building capacity, and engaging with departments through deeply collaborative relationships Build Processes that Work for PeopleEquip and empower teams with the tools and skills necessary to reimagine and redesign processes and experiences across the employee lifecycle Nurture Employee Growth, Safety, + WellnessAttract, retain, and engage a diverse workforce with opportunities to thrive and serve residents while keeping employees safe and supported in a flexible work environment 3 Agenda1. Setting the Table: Learning and Engagement2. Trauma, Impact of Trauma, and Resilience3. Break4. Framing the Conversation5. Panel Conversation – Trauma Informed in the Workplace6. Q&A7. Public Comment4 Gratitude and Thanks5
Becoming Trauma Informed in Our WorkplaceAN INVITATION TO A BRAVE SPACE by Micky Scottbey JonesTogether we will create brave space Because there is no such thing as a “safe space” We exist in the real world We all carry scars and we have all caused wounds. In this space We seek to turn down the volume of the outside world. We amplify voices that fight to be heard elsewhere, We call each other to more truth and love We have the right to start somewhere and continue to grow. We have the responsibility to examine what we think we know. We will not be perfect. It will not always be what we wish it to be But It will be our brave space together, And We will work on it side by side.
Creating Safe and Brave Space
6 Setting the TableLearning and Engagement7
January 30, 20208
City Council Study Session on Emergency Management
9 Grounding Practice
10 Our Community AgreementsTake space, make space.Build and maintain brave space.What is said here, stays here.What is learned here, leaves here.Offer what you can, ask for what you need.One mic, one speaker.
Credit: Tim Mossholder11
Creating Learning Spaces: Values for Communities of PracticeA Community of Practice (learning environment):●isinclusive○Creating space that considers and works to mitigate power dynamics,ableism and the digital divide, issues of classism, systemic racism andunconscious bias●Is anencouraging and judgment free environment, recognizing the unique lensesand personal experience that people bring into the conversation.●Is asafe space to practice (and even fail)without fear that it will affect your workperformance.●Creates opportunities todemonstrate and recognize personal growth,effort, and skill development.●Supportsnetworking and busting down silos, across departments as well asacross teams.●Prioritizes/values learning as a part of one’s work at the City●Encourages agrowth mindsetanduplifts skill- and knowledge-sharing Process[Developed by CSJ Employees]
12 What are we here to learn?
Trauma Transformed, Oakland13
Set an Intention14
15 Employee Assistance Program
16 Creating Language: Ambiguous Loss, Collective Trauma, Vicarious TraumaAmbiguous Loss -“a loss that remains unclear and without official verification or immediate resolution, which may never be achieved.” (e.g. loss of routines, certainty of safety, traditions or rituals, freedom, trust)Collective Trauma – “the impact of a traumatic experience that affects and involves entire groups of people, communities, or societies. ...it can not only bring distress and negative consequences to individuals but in that I can also change the entire fabric of a community”Vicarious Trauma – “sometimes called compassion fatigue...cost of caring for others...hearing the trauma stories and become witness to the pain, fear, and terror that trauma survivors have endured” 17 Let’s set the table…What you are about to see. Visual prompts from the imagery and artifacts of Item 3.1 to:1. Remind ourselves of our collective journey2. Bring back memories from the time period3. Open us up to learnings of trauma conceptsCall to action. Use your notebook to take your “story” notes along the way as well as the stories of others you may be carrying18 Item 3.1City Manager’s COVID-19 Update19
March 17, 202020
One TeamOpen, Candid, and DirectCompassion in Action
COVID-19 Response & Recovery Principles
21 Roadmap through the Epidemic: City Response – Highest Priority Actions1. Compliance with Public Health Orders ("Shelter in Place”)+ Education, enforcement and engagement2. Continuity of Essential City Services+ Ensuring essential services are provided safely for the duration of the epidemic3. Support for At-Risk Communities and Populations▪Food & Necessity Distribution and Feeding‒ Senior Support and Services‒ Medically At-Risk Support and Services▪Homeless Support and Services (Shelter Delivery and Quarantine)▪Local Assistance for:‒ Individuals and Families‒ Small Business and Non-Profit Support+ County wide food distribution, focusing first on the most at-risk and then, scale and sustain+ Support seniors in isolation+ Support medically at-risk populations in isolation+ Increase shelter, hygiene services and health support to homeless population+ Local assistance for individuals and families+ Support small businesses and develop understanding of new forms of assistance (e.g. SBA) and begin to operationalize4. Powered by People – Support our people so they can act▪Ensure Safety of City Staff Performing Essential Services ▪Families Support for City Staff Performing Essential Services (including childcare)▪Redeploying Staff to Essential Services and Response+ Support safety of City Staff performing essential services+ Prioritize testing, child care, and other support services for staff performing essential services+ Temporarily re-assign staff in non-essential services to essential or emergency management functionsEnabling Actions Supporting the Response5. Silicon Valley Strong Campaign+ A public campaign amplifying public health messages, raising funds, and volunteers6. Communications and Engagement with Community+ Messaging to broader community with focus on engaging our most at-risk communities in multiple languages 7. Funding and Cost-Recovery▪Maximizing Cost-Recovery (CalOES and FEMA)▪Securing Funding State, Federal and Private Grants+ Coordinated approach to federal, state, local, and privately raised funds with a focus on effective response and cost recovery for the City organization8. Future Planning+ Understanding future trajectory and impacts of COVID-19 Slow and reduce the spread of COVID-19, and support our most at-risk people 22 Powered by People : ObjectivesSafe WorkplaceEnabling employee and customer safety through modified facilities, practices, and deployed resources.Employee Health & WellnessDrive toDigitalProvide resources and develop practices that facilitate employees to be physically healthy, mentally well, and financially supportedReplace face-to-face, paper, and manual transactions with automated processes and digital self-service that enables safety, creates efficiencies and delivers a high quality user experience Effective Virtual TeamsDeliver tools and resources to support development of effective virtual, hybrid, and on site teams 23 New normal, prepare for next pandemic
24 We will move together through recovery to resilience in the same wayCITY OF SAN JOSE COVID-19Response StagesStage 6Initial Reopening No VaccineStage 7Expanded Reopening No VaccineStage 8Near Full ReopeningNo VaccineStage 9Full Reopening Vaccine ScalingStage 10New Normal -Prepare for NextWhat happens in this Stage?Shelter-in-place orders begin to ease, begin limited reopening of City services that were shut downShelter-in-place eased considerably, wide resumption of City services and facilitiesFurther easing of remaining restrictions, expansion of City services and facilities toward normal operationsCity functions, City operations, businesses, and communities return to near complete normalcyIterative planning and preparation for the next pandemicLower risk of infection, greater public health capacity, fewer restrictionsMove back into work and lifeVaccine scaling Move to new normal as vaccines scale
25 City Recovery Plan matches the State’s Blueprint for a Safe EconomySTATE RISK TIERTier 1 –WidespreadTier 2 –SubstantialTier 3 –ModerateTier 4 –Minimal-CITY RESPONSE STAGEStage 6Initial Reopening No VaccineStage 7Expanded Reopening No VaccineStage 8Substantial ReopeningNo VaccineStage 9Near Full ReopeningNo / Initial VaccineStage 10Move to New NormalVaccine ScalingWhat happens in this Stage?Highly restrictive shelter in place orders begin to ease, limited re-entry/re-opening of City services, programs, and facilities that were previously shut down.Progressively decreased restrictions allow further resumption of City operations, with non-essential indoor activities still mostly closed.Further easing of restrictions and expansion of operations, resulting in closer to normal conditions, with some non-essential indoor activities open with modifications. Easing of restrictions to greatest extent possible without a vaccine, return to modified normalcy where most indoor activities are open with modifications. City adjusts to new normal, monitoring vaccine effectiveness and conducting iterative planning for the next pandemic.
Lower risk of infection, greater public health capacity, fewer restrictionsMove back into work and life
WE ARE HERE
Imperative 1 Save LivesPublic HealthSlow and reduce the spread of COVID-19 and support our most at-risk peopleImperative 2 Save LivelihoodsEconomicSupport individuals, families and businesses so they make it through the shelter in place and safely return to workImperative 3 Preserve our Fiscal HealthFiscalEnsure the continued fiscal health of the City so we can meet imperatives 1, 2, 4, and 5 while providing essential services.Imperative 4Address Systemic Racism and Advance EquitySocietalReimagine how we serve our community to reverse patterns of systemic racism and create an equitable valley of opportunity for allImperative 5Respond to Wildfires and Power ShutoffsEnvironmentalCreate a sustainable model of response to acute threats and hazards while continuing our prolonged response to COVID-19 The Three Four Five Challenges of Now
26 Bay Area News GroupBay Area News Group
Complexity and AmbiguityStories of creativity and dedication of people responding to intersecting disasters28 Compliance with Public Health Orders
29 Compliance with Public Health OrdersReestablished a Compliance OfficerRequested Coordination with CountyWording of OrdersConflict with State OrdersLack of direct agreement on how to support each otherHousing CollaborationFood DistributionActions Taken ChallengesSuccess 30 Food Distribution 11,000,000 Meals
Bridge Housing Construction
Encampment Dumpster Pilots
Bridging Digital Divide with11,000 New Hotspots
Supporting People At-Risk
31 3232
Scale for a Widespread Food Crisis
Maximize Existing Food Networks
Feed Our Most Vulnerable
Food + Necessities Distribution Objectives
33 Caring for the Most Vulnerable In Our Community5,100 Hotline calls1,164 Placements844 Permanent Housing$2m Hotel VouchersMonterey / Bernal Opens Aug 5Rue Ferrari Opens End AugustEvans Lane Opens End AugustHygiene StationsHousing SolutionsStreet OutreachTemporary HousingInterim HousingEncampment Support 34 Continuing to Deliver Core ServicesStories about how “business as usual” got harder35 Continuity of Operations | 100% at SIP, Now 100%Fully Re-Opened | <100% at SIP, Now 100%Re-Opening + Expanding | <100% at SIP, Now 25-99%Suspended | 0% at SIP, Now 0%EOC |New City Services, Now 100%679BudgetedVacanciesCity Operations Sized by EffortEffort = # of City Staff264TotalServices6177Benefitted, Budgeted FTEs 36 37
Keeping our promise to keep essential services intact
60% workforce stayed in-person40% workforce went virtual 37 Al Fresco Out Door Dining
Child Careand Summer RecreationVirtual Public Meeting Pilots Keeping Construction Open and SafeSafely opening more amenities in parksContinuity of Essential City Services 38 Counting and AccountingStorytelling beyond the numbers39 24 Jan. Stage 1Active Preparation31 Jan. Stage 226 Feb.Stage 3 MediumResponse5 Mar.Stage 4 HighResponse15 Mar. Stage 5 Extremely High Response7 Jul. Stage 6 Initial Re-Opening15 Jul. Stage 7 Expanded Re-Opening20 Jul. Stage 6 Initial Re-Opening Pandemic Response PhasesWe coordinated our pandemic response by moving through a clear series of stagesPandemic Response Phases 40 Number of Staff Activated to Support EOC Operations
41 Communication Efforts to Reach Our CommunityTotal Type2,411 + Posts11.5 Million + Impressions33,000 + Link Clicks307,000 + Video Views305,000 User EngagementsTotal Type127 Flash Reports662,000 + Opens45% Average Open Rate5,002 New SubscribersTotal Type275,000 + Website VisitsSocial MediaFlash ReportsWebsite Views42
52.5 Million Meals Since March
Summary of Food Distribution: COVID-19 Response
43 050100150200250300350400Testing on the East Side at the Police Activities League – Verily Participants SeenTOTAL TESTS: 16,284 Digital InclusionTwo Additional Major Lifts
44 EventResponseState and Federal AssistanceCommunity-Facing Work + Concurrent Funding/Reimbursement TimelineRecoveryExpedited FEMA ApplicationTBDTBD
COVID-19 Response and Recovery
45 October 20, 202046
City Manager’s COVID-19 UpdateOctober 20, 2020Public Health Order Update: Move to Stage 8 / Tier 3EOC UpdateCity Services UpdateHolding the Moment: San José Artists Reflect on COVID-19COVID-19 Related Items To Be Heard Separately Today:•3.4– Preliminary Review of Documentation for COVID-19 Related Costs (City Auditor) •3.5– Actions Related to the Agreements for Food Distribution and Related Services for COVID-19 Pandemic•3.8– Actions Related to the Purchase Orders for the Removal and Disposal of Trash, Debris, and Bio-Waste at Homeless Encampment Sites•7.1– Age-Friendly City Initiative Update and San José Age-Friendly 3-Year Action Plan•8.2– Actions Related to the Temporary Emergency Shelter Operations for COVID-19 Emergency Response•8.3– Ratify Grant Agreements with PATH and HomeFirst Services of Santa Clara County to Operate Three Emergency Interim Housing Locations to Provide Emergency Non-Congregate Shelter for COVID-19 Vulnerable Individuals47 December 8, 202048
December 11, 202049
50 August 19, 202251
August 19, 2022 - Both AndIn the City of San Jose Employee Experience Conversations (EECs) development work, it was abundantly clear that the managers and supervisors are highly skilled and relationship-focused people. They have tremendous workloads, yet approached the EECs with fresh energy and interest. This is consistent with what we experienced overall: employees focused on serving the community well, as they have strong, supportive connections with each other.Hope Jones and Danielle Harlan – Center for Advancing Leadership and Human Potential Very challenging season of life. Workload is high, vacancies are high, and many have dealt with or continue to deal with trauma during COVID. There needs to be an understanding from management that some things will not get done and many things will be delayed.52 “How do you take healthy responsibility not just for yourself, but the whole web of life?What if all we need to do as leaders is this: take healthy responsibility for what matters to us, as we grow increasingly attuned to the complexity of the web of life and expand our ability to weave authentic connections. Lather, rinse, repeat.”A lot of what I suggest goes against the grain of our culture:• That work has to be hard• That if we’re not suffering, we won’t be effective• That it’s unprofessional to be emotional at work• That it’s more important to be polite than to be realThis book is going to challenge these assumptions because they’re sucking the life out of all of us. 53 54 Dr. Donielle Prince •Director of State Initiatives, PACEs Connection•Studied education, counseling psychology and human development, and race and racism, earning her Ph.D. at Stanford University.•20 years’ experience as a program evaluator, focused on education, community-based youth programming, and mental health.•Donielle’s research, policy and reform is reflected in her deep commitment to advocating for social justice. This work has included youth mentoring, community-based organizing against state violence, educational inequity, and lack of access to mental health supports, particularly for members of marginalized communities. 55 Council Study SessionBecoming Trauma Informed in Our Workplace: Creating Safe and Brave SpacePart I: Introduction to PACEs ScienceDonielle Prince, MS.Ed, Ph.D.Director of Statewide Initiatives, PACEs Connection 56 ACEs = Adverse Childhood Experiences PCEs = Positive Childhood ExperiencesPACEs= A comprehensive approach to addressing the impacts of trauma and resiience
INTRODUCTION TO PACES SCIENCE
57 A Word About Today’s ContentA Word About Today’s Content➔Learning about the impact of trauma can be emotionally challenging➔Take breaks during this workshop as needed ➔Later today or even another day, reach out to someone you trust to talk about anything unexpected that comes up for you➔Call 988: Our new 24/7 national mental health support line for crisis or anyone needing emotional support. Learn more about this initiative at samhsa.gov 58 59
ACEs & Resilience ScienceACEs & Resilience Science
EpidemiologyACE study and expanded definitions of ACEsImpact on the brain toxic stress caused by ACEs impact children while they (and their brains) are developingImpact on the body health consequences of toxic stress (short & long term)Epigeneticsgeneration-to-generation impact/ historical traumaResiliencebody can heal. Brain is plastic. Positive Child Experiences (PCEs) among resources that build resilience. 60 EpidemiologyACE study and expanded definitions of ACEsINTRODUCTION TO PACES SCIENCE 61 EpidemiologyIn the 1990s, two doctors stumbled intowhat would become one of the most significant public health discoveriesof a generation.Felitti VJ et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventative Medicine; 14: 4, 245-258.
Adverse Childhood Experiences Study (ACE Study)Original ACEs Study, published in 199862 Centers for Disease Control and Kaiser Permanente in San Diego, 17,300 adultsTracked health outcomes based on childhood traumaThey all had jobsand great health care(median age 57 yr. old)CaucasianCollege graduateSome college75%39%36% EpidemiologyACE Study Background
63 Epidemiology
64 1)Child physical abuse 2)Child sexual abuse3)Child emotional abuse4)Physical Neglect5)Emotional Neglect6)Mentally ill, depressed or suicidal person in the home7) Drug addicted or alcoholic family member8) Witnessing domestic violence against the mother9) Loss of a parent to death or abandonment, including abandonment by divorce10) Incarceration of any family member What are theAdverse Childhood Experiences?Original ACE Study – 10 QuestionsEpidemiology 65 Key Findings from the ACE Study● Direct link between childhood trauma and adult onset of chronic disease, as well as mental illness, social and economic problems● About two-thirds of the adults in the study experienced one or more typesof adverse childhood experiences. Of those, 87 percent had experienced 2 or more types. In other words, ACEs usually don’t happen in isolation.●Dose-dependent outcomes: More adverse childhood experiences result in a higher risk of medical, mental, social and economic problems as an adult.
Epidemiology
66 Epidemiology
67 Overall Impact on Population
Epidemiology
68 ACEs & population attributable risks
Epidemiology
69 Consequences of lifetime exposure to violence and abuse Epidemiology
70 Impact on the body Health consequences of toxic stress (short & long term)INTRODUCTION TO PACES SCIENCE 71 Risk of health problems in people with 4 ACEs
ACE= Adverse Childhood Experience. Source: Adapted by Felitti et al (1998)EmphysemaHealth problemRISKamong people with four ACEsCancerTwice the risk of participants with no ACEs4 times the risk of participants with no ACEsDepression4.6 times the risk of participants with no ACEsAlcoholism7 times the risk of participants with no ACEs Health/Mental Health Impacts (Body)
72 Impact of ACE Score with 4 or moreHealth BehaviorsMental Health10.3times more likely to use injectable drugs7.4times more likely to be an alcoholic3.3times more likely to engage in risky sexual behavior3.23times more likely to binge drink2.93times more likely to be a current smoker12.2times more likely to attempt suicide5.13times more likely to suffer from depression4.22times more likely to be diagnosed with dementia Health/Mental Health Impacts (Body)
73 ●They weren’t born bad.●They weren’t responsible for the things that happened to them when they were children.●They coped appropriately, given that they were offered no other ways – it kept them alive.●They can change.
Knowing about ACEs changes what people believe about themselvesKnowing about ACEs changes what people believe about themselves 74 75
3 Types of ACEs
76 Original ACE StudyOriginal ACE Study
77 ACEs and Population Attributable RisksACEs and Population Attributable Risks % that ACEs contributes to these issues% that ACEs contributes to these issues 78 ZEROONETWOTHREEFOUR36%26%16%9%12%38%28%16%9%9%34%24%15%10%15%WOMEN MEN# of ACEs How Common are ACEs?
79 Impact on the brainToxic stress caused by ACEs impact children while they (and their brains) are developingINTRODUCTION TO PACES SCIENCE 80 ●Concentration and Creative problem solving skills ●Body regulation (feeling calm) ●Empathy●Communications skills Toxic StressOur unstressed brain: the pre-frontal cortex 81 ●Anxiety, fear, and anger “live” in the amygdala●Both the Amygdala and Hippocampus are associated with our emotions.●They work together when a threat is sensed or experienced●They send signals through our emotions, intended to protect us from that threat●AKA: Fight, flight, or freeze response Toxic StressOur Stressed Brain: Amygdala and Hippocampus 82 SOURCE: Mcewen, Bruce. (2006). Protective and Damaging Effects of Stress Mediators: Central Role of the Brain. Dialogues in clinical neuroscience. 8. 367-81.
Toxic StressOur Brain Plays a Central Role in Our Response to Stressors 83 SOURCE: Mcewen, Bruce. (2006). Protective and Damaging Effects of Stress Mediators: Central Role of the Brain. Dialogues in clinical neuroscience. 8. 367-81.
Toxic StressBrain is “remodeled” due to effects of toxic stress 84 Psychological Impacts Health ImpactsDepression CardiovascularAnxiety EndocrinePsychiatric Disorders EverythingToxic StressOverview of Impacts from Trauma & Emotional Distress 85 From SAMHSAWhat is trauma?“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” Toxic Stress
86 From StressHealth.org What is toxic stress?The biological response to severe and/or repeated adversity absent buffering support from a caring and trusted adult.Toxic Stress 87 Biological mechanisms underlying toxic stress●Excessive release of the hormone cortisol ●Meaurable increase in levels of fear and anxiety in response to stress●Changes in genes predisposing the body to chronic inflammation & a suppressed immune response Toxic Stress
SOURCES:Bellis MA et al (2015) Adverse Childhood Experiences and their Impact on Health-harming Behaviours in the Welsh Adult Population.Nakazawa D (2015) Childhood Disrupted: How Your Biography becomes Your Biology, and How You Can Heal. New York: Simon & Schuster88 Childhood Trauma & Health Risk●Babies are not born with fully developed nervous systems.●Exposure to toxic stress causes prolonged activation of stress response mechanisms ●This condition disrupts the development of the brain and other organs●Long-term result is the increase in risk of stress-related disease and cognitive impairment Source: American Academy of Pediatrics(2014) Adverse Childhood Experiences and the Lifelong Consequences of Trauma.
Toxic Stress
89 Toxic StressExtreme, frequent, or extended activation of the body’s response without buffering presence of a supportive adultPositive StressMild/moderate and short-lived stress response for healthy developmentTolerable StressMore severe stress response limited in duration which allows for recoveryStress LevelsStress Levels Intense, prolonged, repeated and unaddressedIntense, prolonged, repeated and unaddressed Social-emotional buffering,parental resilience, early detection, and/or effective interventionSocial-emotional buffering,parental resilience, early detection, and/or effective intervention Toxic Stress
90 ●When we are experiencing stress, or haven’t recovered from trauma, our amygdala stays activated.●Our memory and ability to learn in the moment is compromised●We don’t feel safe●Our bodies suffer from an activation of the disease process, due to chronic activation of the amygdala Toxic StressWhen our amygdala stays activated
91 ●Difficulty thinking logically●Poor judgement●Hard to “read” others and judge their needs, including of children/vulnerable people●Difficulty calming down●Quicker than normal temper●Excessive feelings of impatience Source: www.stresshealth.org, Center for Youth Wellness Toxic StressSigns of Stress Overload
92 ●Concentration and Creative problem solving skills ●Body regulation (feeling calm) ●Empathy●Communications skills Toxic StressGoal is to get back to the unstressed brain: the pre-frontal cortex 93 When there is no immediate threat, the goal is to be able to reconnect with your prefrontal cortex… to be able to calm your central nervous system.
Toxic Stress
94 EpigeneticsGeneration-to- generation impact/ historical traumaINTRODUCTION TO PACES SCIENCE 95 …and so can humans
SOURCE: Dias BG, Ressler KJ. Parental olfactory experience influences behavior and neural structure in subsequent generations. Nature and Neuroscience,. 2014 Jan;17(1):89-96.96 ResilienceBody can heal. Brain is plastic. Positive Child Experiences (PCEs) are among resources that build resilience.
INTRODUCTION TO PACES SCIENCE
97 Definition of resilienceResilience is the adaptive characteristics of an individual or community to cope with and recover from adversityGoals of resiliencePromote well being after adversity… including strengthening environments to be resilient in advance of adversityResilienceWhat is Resilience? 98 ● Ability to withstand stress● Ability to interpret the environment● Restoration of functioning● Ability to avoid future traumatic events (protective environment) What does psychosocial health look like in resilient individuals? 99 ● Evidence of community wellness is measurable physical and mental health outcomes● Systems adaptive capacity to intervene in disturbance/adversity and move forwardWhat does psychosocial health look like in resilient communities? 100
•Resilience is a process and an outcome. •All people have the capacity for resilience. Some people have a pattern of resilience throughout their lives, whereas others have periods of resilience•Resilience is relational.Development of Resilience Resilience 101
Resilience Science & Practice: Individuals & FamiliesResilience Science & Practice: Individuals & Families●Safe and Supportive Relationships●Exercise●Adequate Sleep●Healthy Environments●Mindfulness●Nutritious Food●Mental Health Support Resilience
Source: Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health102 Positive Childhood Experiences Research Resilience
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●Able to talk to family about feelings.●Family stood by you during hard times.●Participated in community traditions.●Felt a sense of belonging in high school.●Felt supported by friends.●2 adults (not parents) who took interest in you.●Felt safe, protected by adult in home.
ResiliencePositive Childhood Experiences
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The same steps for healing individual trauma:• Empowerment• Choice• Collaboration• Safety• Trustworthiness Healing through empowerment and resilience
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“People with 6 or more ACEs died nearly 20 years earlier, on average, than those without ACEs.” ACE’s and trauma are not just a mental health issue, this is a public health issue and needs to be addressed at the community level. 107
● Building resilient and trauma-informed communities is essential to improving public health and well-being. ● Communities can be places where traumatic events occur, and they can also help keep us safe. They can be a source of trauma, or buffer us against the negative effects of adversity. ● Communities can collectively experience trauma much like individuals do, and communities can be a resource for healing Healing through empowerment and resilience
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What does a trauma-informed community look like?• Employs a community-driven, multi-sector approach• Inclusive, viewing all residents as assets • Cares for the most vulnerable• Focused on prevention, early intervention, and healing • Uses data and research to guide decisions • Breaks cycles of trauma and stops re-traumatization • Includes dialog about structural violence and oppression • Has teachers, police, social workers, youth workers, and other members of the workforce trained in trauma-informed practices 109
Building Trauma Informed Policy, Practice, and ProgramsKnowledge about the impacts of trauma and toxic stress help motivate us to guide how we design environments - workplaces, institutions, systems, and communities
INTRODUCTION TO PACES SCIENCE
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Moves from Moves from
Trauma Informed OrientationTrauma Informed OrientationRather than usual approach of Rather than usual approach of What happened to you?What is wrong with you? Resilience
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Trauma-Informed ApproachesINTERPERSONAL“What happened to you?”“How can we help?”Rather than: “What is wrong with you?” ORGANIZATIONS & SYSTEMS“What has happened to the organization/system and how can we help heal the organization/system?”Rather than: “What is wrong with the organization/system?”112 A Trauma-Informed Organization & System...●Realizesthe widespread impact of trauma and understands potential paths for healing; ●Recognizesthe signs and symptoms of trauma in staff, clients, patients, residents and others involved in the system; and ●Respondsby fully integrating knowledge about trauma into policies, procedures, practices and settings. ●Avoids Re-traumatization 113
•Avoid unintentionally cause harm•Re-traumatizing someone unintentionally is a real possibility •Vicarious/Secondary Trauma may impact our emotional and physical well being as well as our work success and satisfaction Why is Trauma Informed Care Important? 114
A Trauma-Informed Organization & System...To be trauma informed is to understand the impacts of trauma on those you work with: whether a client, patient, student, or program participant… ...Your co-workers......And yourself 115 “When people perceive their organizations to be supportive, they experience lower levels of vicarious trauma” - Golie Jansen A Trauma-Informed Organization & System...
Source: Quoted in Trauma Stewardshipby Laura van Dernoot Lipsky116 A Trauma-Informed Organization & System...
Source: Help for the Helper: Preventing Compassion Fatigue and Vicarious Trauma in an Ever-Changing World by Babette Rothschild117 A Trauma-Informed Organization & System...Knowing is half the battle. Recognize that when working with people who may be experiencing active crises, or who have a trauma history (known or unknown), you are a person in need of a self-care plan, as disciplined as your work plan. We all need support. Recognize that many of us have our own triggers from our own trauma histories, and that this impacts our ability to stay calm when working with those whose behavior or conditions are triggering for us. 118 Stress Reactions in the Workplace● Lost sense of safety, connection - Arledge & Wolfson● Lost sense of efficacy - Arledge & Wolfson● Depleted ability “to stay connected and grounded in a strong sense of self … when [your] inner resources are depleted” -Arledge & Wolfson● Loss of compassion (to protect from overwhelm, including our own triggers) - Lipsky & Burk● Service rationing (to recover sense of efficacy) - Lipsky & BurkSOURCE:Tauma Stewardshipby Laura van Dernoot Lipsky 119
Trauma Transformed - TIS Change ModelTrauma-Informed Systems (TIS): This is an organizational change model aimed to create contexts that nurture and sustain trauma-informed practices and to create organizations, agencies and schools that reduce trauma. ● Transforming systems from inducing trauma to systems that can sustain healing practices and wellness● Change occurs along a continuum from Trauma Organized to Healing Organizations and Systems of Care.120 http://traumatransformed.org/121
Break122
Our Employees and our Workplace123
“Addressing Employee Burnout: Are you solving the right problem?” (McKinsey, May 2022)“employers can and should view high rates of burnout as a powerful warning sign that the organization – not the individual in the workforce – needs to undergo meaningful systemic change”Sandra Bloom“this impact of chronic stress and adversity robs organizations of basic interpersonal safety and trust and thereby robs an organization of health” Individuals AND System
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•Dr. Amelia Roeschlein, DSW, MA, LMFT•Consultant, TIROE Services•National Council for Mental Wellbeing ACES are not DestinyCity of San JoseTIROC Learning Community125 Principles of Trauma Informed Systems (TIS)Principle DescriptionUnderstanding Trauma & Stress"Learning about the psychology of stress, toxic stress, and trauma is liberating for people. It gives us explanatory reasons for some of the puzzling behaviors we engage in and the feelings that can come to dominate us."(Bloom, 2014, p.48)Safety and StabilityTrauma unpredictably violates our physical, social, and emotional safety resulting in a sense of threat and need to manage risks. Increasing stability in our daily lives and having these core safety needs met can minimize our stress reactions and allow us to focus our resources on wellness.Compassion and DependabilityTrauma is overwhelming and can leave us feeling isolated or betrayed, which may make it difficult to trust others and receive support. However, when we experience compassionate and dependable relationships, we reestablish trusting connections with others that foster mutual wellness. 126
Cultural Humility & EquityWe come from diverse social and cultural groups that may experience and react to trauma differently. When we are open to understanding these differences and respond to them sensitively, we make each other feel understood and equity is advanced.Collaboration & EmpowermentTrauma involves a loss of power and control that makes us feel helpless. However, when we are prepared for and given real opportunities to make choices for ourselves and our care, we feel empowered and can promote our own wellness.Resilience & RecoveryTrauma can have a long-lasting and broad impact on our lives that may create a feeling of hopelessness. Yet, when we focus on our strengths and clear steps, we can take toward wellness we are more likely to be resilient and recoverPrinciple Description Principles of Trauma Informed Systems (TIS)
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Employee Voices128
Understanding Trauma & Stress"Learning about the psychology of stress, toxic stress, and trauma is liberating for people. It gives us explanatory reasons for some of the puzzling behaviors we engage in and the feelings that can come to dominate us."(Bloom, 2014, p.48)I really appreciated the course and feel that it helped me grow personally in a direction I want to grow. I also really appreciate that the city is providing this course – I hope that City leadership will work on integrating the trauma informed perspective into City processes, systems, and organization.Trauma response is “normal” – Phew!As we transition out of the pandemic, I believe an emphasis on mental health training should be considered. A lot of people may have experienced trauma not only in the workplace, but personally.Considering how ACEs affects all of us as adults in varying degrees. This is important for understanding ourselves, for understanding those with whom we have close relationships, with whom we work and those whom we serve.Asking the question “what happened to you” rather than “what’s wrong with you” – this is a reframe that is somewhat novel.129 Safety and StabilityTrauma unpredictably violates our physical, social, and emotional safety resulting in a sense of threat and need to manage risks. Increasing stability in our daily lives and having these core safety needs met can minimize our stress reactions and allow us to focus our resources on wellness.We get the go ahead to implement and consensus from leadership, but when it comes down to it, you can tell leaders are conflicted and do think they can take a break for wellness and this is exactly why we tried doing it. Leaders should not have to stack meetings and have no time, so they try to connect during a lunch meeting, but that does not feel good to employees ... they struggle the most or contribute to the problem the most... they have the same issue.Physical safety has become a huge concern....our behavior policies don't go much further other than what we expect our patrons to follow when it comes to behavior in our physical spaces. There isn’t a framework for when patrons don’t follow these guidelines, especially when they become adverse for staff. Safety concerns are slow to be addressed. There is also no true support when staff have exhausted their own tools for conflict management.I’m not in a private area, so I don’t feel comfortable speaking honestly, candidly during the small breakout sessions. Other people outside the class can hear me. 130 Compassion and DependabilityTrauma is overwhelming and can leave us feeling isolated or betrayed, which may make it difficult to trust others and receive support. However, when we experience compassionate and dependable relationships, we reestablish trusting connections with others that foster mutual wellness.Maybe HR or other staff can put into place actionable steps to address concerns raised by staff where it has to do with the organization’s structure of things that is contributing to staff’s compassion fatigue.Learning about the physiological responses for a number of reasons. It helps to explain why people react the way they do, it gives a framework with which to work with, and it validates a person’s response and provides an easier avenue toward compassion and understanding. Employers should focus on connection since, if you don’t feel safe, its hard to work effectively. Not to mention impacts on quality of life. Perhaps they should focus on connection for that reason first. Less self-serving.131 Cultural Humility & EquityWe come from diverse social and cultural groups that may experience and react to trauma differently. When we are open to understanding these differences and respond to them sensitively, we make each other feel understood and equity is advanced.Learning that trauma is not the event itself, but comes from how we deal with the event. It made me better understand why an “event” that happens to me, might not cause me to experience trauma, but the same event might cause someone else to experience trauma[there’s a need] for a counselor or therapist or something for staff who are struggling with micro aggressionsI don’t work in a respectful, inclusive or safe environment. The City wants to portray a respectful culture but somehow there is a huge disconnect between leadership and staff.As a woman of color coming from a low-income family where English was not the primary language, I often feel the heavy effects of imposter syndrome. I am grateful the city provides training and educational opportunities. I’ve also taken advantage of the city’s free counseling services. Seeing how difficult is its to move up in your roles has been a challenge [how do I gain supervisory experience if I don’t come with it]132 Collaboration & EmpowermentTrauma involves a loss of power and control that makes us feel helpless. However, when we are prepared for and given real opportunities to make choices for ourselves and our care, we feel empowered and can promote our own wellness.(learning lab quote) – I was doubting myself before participating in the learning lab. I was thinking of leaving the city because I felt pressure to be a stern manager, which is not compatible with my more human-centered management style. But through the learning lab I got myself back. I don’t need to be a tough manager. I found my voice again.Make sure all cultures, races, genders, etc are represented in decision making and implement checks and balances to ensure there is no bias.Everyone relayed a story of how we were asked for our “input” in meetings, but we are told what to implement, and input while given and received, very rarely impacts the predetermined agenda of high-level administration and council. I feel that we often point our challenges at our jobs and nothing is very done about it. We’re told to learn to deal with it. I agree leadership needs to more involved in these trainings.133 Resilience & RecoveryTrauma can have a long-lasting and broad impact on our lives that may create a feeling of hopelessness. Yet, when we focus on our strengths and clear steps, we can take toward wellness we are more likely to be resilient and recoverWe need to top saying “just do the work” and “we’ll get through it”... stop piling massive amounts of work on under-trained... no one has time to care about mental health. We need more time to effectively train our staff, and more time to write, teach, and implement resilience-oriented protocols.Continued efforts on employee wellness. We continue to forget to focus on ourselvesThe fact that it would make a difference for myself to give myself care, and mindfulness. I did not believe that, and clearly it’s key to know and believe in the value of self care.Allowing/providing space for employees to share their stories to know they aren’t alone in their experiences/thoughts and to start to heal.Note: HR has received multiple requests for healing sessions134 Dr. Donielle Prince - Director of State Initiatives, PACEs Connection•Studied education, counseling psychology and human development, and race and racism, earning her Ph.D. at Stanford University.•20 years’ experience as a program evaluator, focused on education, community-based youth programming, and mental health.•Donielle’s research, policy and reform is reflected in her deep commitment to advocating for social justice. This work has included youth mentoring, community-based organizing against state violence, educational inequity, and lack of access to mental health supports, particularly for members of marginalized communities.
Erin Hawkins, Co-Director of the Hanna Institute•Master’s Degree in Community Development from the University of California, Davis•Previously served as the Director of Community Health at Petaluma Health Care District•Member of the Board of Directors of COTS: Committee on the Shelterless•Advocate for community health equity and social justice in Sonoma County.Zeke Cohen, Baltimore City Council Member since 2016•Master’s degree in Public Policy from John Hopkins University, and founder of the nonprofit, The Intersection that is designed to help young people learn community organizing and civic leadership.•Introduced the Elijah Cummings Healing City Act in July 2019 as the first city in the country to comprehensively legislate trauma-responsive care. •In February 2020, the bill was signed into law to help Baltimore heal from our enduring legacies of trauma, racism and violence.135 Panel Moderation + Q&A136
Public Comment137