The next sections describe the components of TIC.
At the micro level, social workers can begin to engage in TIC by treating everyone with kindness and respect, and listening with curiosity and compassion. At the systems or macro level, implementation of TIC requires a paradigm shift within the organizational culture of an agency. It is beyond the scope of this article to address systemic application of TIC principles, but the reader can refer to other resources. For instance, SAMHSA has published guidelines for TIC imple- mentation including TIP 57, which offers strategies for incorporating TIC in behavioral health settings (SAMHSA, 2014b). There are also several tools avail- able to measure TIC attitudes, readiness for change, and operational barriers. The new ARTIC scale (Baker, Brown, Wilcox, Overstreet, & Arora, 2016) can be used to assess employees’ perspectives through- out the process of adopting TIC protocols. The scale comprises seven domains including attributions of causes for underlying problematic client behavior, preferred ways of responding to client symptoms, and systemwide support for TIC. Readers may even use the ARTIC tool as a self-assessment. Another instrument, the TICOMETER (Bassuk, Unick, Paquette, & Richard, 2016), can measure TIC in organizations at different points in time, making it useful for monitoring changes in service delivery, determining training needs, and refining agency policies and procedures.
Safety Recognizing the likely existence of a traumatic history in the lives of social services consumers is the first step in facilitating safety in the physical
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environment and in relationships between clients and providers (including staff ). Warm and welcom- ing surroundings will create a sense of serenity for clients (Elliott et al., 2005; Fallot & Harris, 2009). Just the experience of a smiling receptionist can be calming and comforting for some clients. Physical safety can be ensured through facilitating protection from hazards or dangers that might emerge within the physical space. For instance, good lighting, disability accommodations, and maintenance of the property can reduce the risk of physical injury. Security precautions can prevent threats from indi- viduals both within and outside the office. Respect- ful language, boundaries, and use of power can establish and model safe and appropriate limits with- out recreating the oppressive dynamics of authority figures in the lives of many clients (Harris & Fallot, 2001). In essence, safe relationships are consistent, predictable, and nonshaming (Elliott et al., 2005).
Trust Erikson (1993) proposed that trust in our earliest relationships with caretakers is foundational for establishing a healthy personality, and that with- out the successful acquisition of trust, subsequent developmental tasks of autonomy, initiative, compe- tence, and intimacy will likely be compromised. According to Maslow’s hierarchy, all humans have the same basic needs including survival, physical and psychological safety, social connection, self- esteem, and actualization (Maslow, 1943). When a client’s basic needs for safety, respect, and accep- tance in the helping relationship are understood, an atmosphere of trust can be established (Elliott et al., 2005). Trust is earned and demonstrated over time. By eliminating ambiguity and vagueness, the social worker can assist clients to clearly anticipate what is expected of them and what they can expect from their worker, diminishing the anxiety that comes with uncertainty and unpredictability (Harris & Fallot, 2001). For instance, workers can clearly explain the eligibility criteria, the process of receiv- ing services, and the expectations for successful program completion, as well as information about confidentiality, sharing of information, attendance, and fees. The style of interaction should be genuine and authentic, and in initial sessions, pressure should not be put on clients to disclose information they are not ready to share. There are stages of intimacy that all relationships go through, and by allowing the consumer’s risk-taking and disclosure to proceed
at his or her own pace, the worker actually models a healthy process of establishing trust based on deter- mining whether another individual is listening, hearing, and responding in a truly reliable and con- sistent fashion.
For example, a social worker noticed that soap and toilet paper were missing from the restroom after a criminal offender rehabilitation group meet- ing. Instead of confronting the group about the incident and reminding them of the consequences for stealing, she asked herself, “Who steals soap and toilet paper?” and remembered that some clients in the group are homeless. She got permission to use some petty cash to buy a basket and filled it with soap, toothpaste, toilet paper, and small bottles of laundry detergent. She placed it in the group room and said nonchalantly to all of them at the next meeting: “Here are some hygiene items, feel free to take a few if you need them.” The worker’s implicit message was clear: I hear you, I understand what you need, and I won’t shame you, so next time you need help you can ask me.
Choice Trauma-informed services attempt to embolden client decision making and a sense of control over one’s recovery (Fallot & Harris, 2009). All clients progress at their own pace as they explore their unique experiences and realize how those en- counters primed them to respond in a certain fash- ion to environmental stressors. As clients develop an expanded repertoire of coping strategies, they begin to recognize that they cannot always control others or the environment, but they can control their own responses. As a result, clients gain a new sense of control in the service delivery environment, while workers promote and reinforce autonomy and self-determination, which can transform a client from a powerless, overwhelmed victim to a survivor who directs and owns his or her life decisions and the associated outcomes (Elliott et al., 2005). Emo- tional and behavioral dysregulation can reinforce negative beliefs about oneself (“I’m a failure”), so it is important to help clients to improve impulse con- trol and problem solving by reframing their trig- gered fight-flight-freeze responses to environmental stress as only one of several alternatives available to them. As they learn and practice new skills, they increase their repertoire of available choices.
Facilitating choice can include asking clients about their preferences in service delivery, helping
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clients to identify options and ponder alternatives for themselves, and guiding clients in their own informed decision making. For instance, instead of shaming or punitive responses to resistance behav- ior, workers can help clients to assess their readiness for change; in doing so, we enable them to own their lifestyle choices and to explore obstacles to their goals. Sometimes, clients express preferences about their practitioners (for example, race, gen- der, ethnicity), and these requests should be dis- cussed and processed with clients in a way that gives voice to their underlying comfort level. For instance, a client may ask, “Do you have children? You look young. I want a worker who has kids.” The worker might respond, “I think you are won- dering if I can understand what it is like for you as a parent. Either way, my parenting experience would be different from yours; I really want to understand your situation, so that together we can work on finding solutions that are right for your family. Would you be willing to try that?”
Collaboration Trauma-informed programming is based on shared power between worker and client so the relation- ship offers a true alliance in healing (Elliott et al., 2005; Fallot & Harris, 2009; Morrison et al., 2015). The inherent power imbalance in the helping rela- tionship requires constant attention to the many (often subtle and insidious) ways that feelings of vulnerability and subsequent resistance can be gen- erated for clients. Because many ACE survivors were betrayed by those who were supposed to pro- tect and care for them, the helping relationship is fraught with potential for retraumatization when reminders of the capricious nature of past authority figures are activated. Most of us are motivated to please others, to conform to authority, and to seek acceptance and attention, generating opportunities for some people in a position of authority to exploit those in subordinate positions. Abuse survivors are particularly vulnerable to instinctive compliance and may need to be reminded that they have the right to ask questions, decline services, or make requests. A truly collaborative worker–client relationship is one in which the worker’s professional knowledge is combined with the client’s expertise about his or her own life narrative and scope of coping responses. By understanding each client’s life history and cultural background, and by allowing clients to participate in determining the course of the intervention, social
workers can engage clients and dislodge barriers to change. Using the helping relationship as a thera- peutic tool, the collaborative partnership facili- tates connection to others and thus exposure to an emotionally corrective experience.
Empowerment True empowerment occurs with a strengths-based approach that reframes symptoms as adaptation and highlights resilience instead of pathology. Too often, an intense focus on fixing problematic beha- viors neglects the importance of acknowledging and reinforcing strengths. Instead of asking “What’s wrong with you?” we should get in the habit of ask- ing, “What happened to you?” (SAMHSA, 2014a). Survivors of childhood trauma experience a pro- found sense of powerlessness when choice and predictability are absent from their daily existence. In fact, the very term “survivor” was designed to offset the helplessness implied by the word “victim”
(Harris & Fallot, 2001). Bandura (1977) described the crucial role of self-efficacy, defined as belief in one’s own capacity to achieve goals, accomplish tasks, and respond competently to challenges. By reframing trauma responses as normal reactions to threatening encounters, social workers can cele- brate survival strategies, channel those instincts into healthier relationship skills, and help clients to achieve a sense of control in one’s daily life. In this way, we can fertilize the seeds of self-efficacy to assist the survivor to embrace hope and belief that change is possible.