Darshan: Good morning, friends. Thank you for joining us on this webinar on Training complex skills like trauma-informed approach in workplaces through online self-learning programs. This webinar is brought to you by Integra and Institute for Community Living, New York City.

My name is Darshan, and I’ll be your host for today. Before we get started some housekeeping tips-

• If you cannot hear the audio:
  • Ensure you have selected the right speaker for audio output.
  • Test your speaker to ensure it is working fine from the “Audio Settings” option on the lower-left corner of your screen.
• All attendees will be on mute by default; please post your questions in the chat window
• We will try and attend to all questions during the session
• Any unanswered questions during the session will be answered via a follow-up email

A quick introduction about Integra. We are a content and digital solutions organization with over 26 years of experience in the industry. Our expertise is in the education content solutions and corporate eLearning. With a global workforce of 2200+ content and technology experts we offer ‘Learning strategy + Content development + Instructional design + Development services’ to our customers across industries. We also offer content and digital solutions using emerging technologies like AR, VR and MR.

You can call us a one-stop ‘learning solutions’ shop. Now, it’s time to meet our speaker for the day. It is our pleasure to have Naomi Weinstein, Vice President – Innovations, Institute for Community Living, New York City. Good morning Naomi! Thank you for taking the time to present on this webinar today and on a fascinating and important topic. 

Naomi: Thank you, Darshan. It’s my pleasure to be here today. 

Darshan: You’re welcome, Naomi. To start with, could you please help the audience know you a little better. Could you briefly tell us about yourself?

Naomi: Sure, My name is Naomi Weinstein and I’m the Vice President of Innovations at ICL, Institute for Community Living. Part of my portfolio includes overseeing professional development. I have a background in public health and my career has been spent in what we call here in the United States as behavioral health, which basically focus on addiction and mental health services. My specialty is working with vulnerable population here in New York city.

Darshan: Thank you so much, Naomi. And now may I request you tell us a bit of ICL, as an organization, who you are, what you do.

Naomi: Of course. ICL provides services to some of the vulnerable residents of New York city. We work with people with psychiatric illnesses like schizophrenia or bipolar disorder, people who have substance use disorders, addiction and people who have developmental disabilities, chronic health problems or situational crisis such as homelessness.

We serve about 10,000 people a year. We provide a variety of services. We have residential services – a place to call home, a bed to sleep in at night. We provide out patient services. Some of the services like mental health clinic services are provided in ICL buildings and some of the those services are actually brought to clients directly in their community. We also provide outreach services.

The belief of ICL is that if we support recovery, we treat every person as individual, we recognize their trauma and attend to their whole person health needs. People can and do get better with us.

We are an organization with about 1300 staff which includes social workers, psychiatrists, nurses, care managers, case managers, outreach workers and others. I just want to mention, since we provide residential services such as homeless shelters and residences. Many of our staff had to work on sites throughout the pandemic and are considered essential workers. 

Darshan: Thanks Naomi for the brief about your work as critical service at does out there. Let us now take a deep dive into today’s topic: Training complex skills like trauma-informed approach in workplaces through online self-learning programs.

As we all know, the pandemic has affected everyone across all walks of life, across the strata in society. Everyone has had one or the other forms of trauma manifesting in various ways – like anxiety, fear, powerlessness, helplessness, worry, anger, restlessness. Many of us here on this webinar would acknowledge the traumatic experiences we have gone through.

• What do you mean by the term “trauma”?
• The course you developed with us is called Trauma Informed Approaches. What does that mean?

Naomi: Sure, Let me start by explaining the concept of trauma. Trauma can be either a single event, series of events that cause an individual to fear for their safety or life, causing them to  feel overwhelmed and out-of-control. It could be for example, surviving a violent attack, a rape or a beating, being a survivor of child abuse, neglect or sexual abuse/domestic violence. It could also include surviving a disaster such as a flood or an earthquake, or even contact with a police or being jailed. We also consider historical trauma, which are injustices or stigma discriminations which are done to communities over generations that created a lasting impact on those communities.

Trauma is a kind of continual of stress, you can think about little stress to big trauma, little stress is the kind of  things that cause our hearts to beat a little faster, to cause some anxiety, some discomfort, but ultimately we tolerate it and deal with it and we move it. Covid is a great example of trauma with a ‘T’. Trauma with a ‘t’ can became a trauma with a ‘T’, so Covid for some people has really evolved into trauma significantly. People have gotten ill themselves, people have been hospitalized, family members who have lost loved ones to Covid, people who have had an escalation of mental health symptoms, anxiety, depression because of the isolation caused by Covid. Those are all pieces of trauma.

Trauma causes long lasting scars for most people, sometimes it is a clinical designation, so we call it post traumatic stress disorder (PTSD). But it doesn’t always raise to that level, but still last for a long time. So it means that when people have histories of trauma, their sense of safety and control is completely be destroyed. They may always be on the look out for the next bad thing to happen. They may have intrusive thoughts or flashbacks. They maybe avoiding anything that reminds them of the trauma. If you ever have been in a car accident, you can think about how long it will take to get comfortable to be back into a car again.

It also shows up as disproportionately intense responses to stressful situations. The concept of trauma informed approaches is a way of responding to trauma. So when a person has a trauma triggered response, the behavior is often exaugurated disproportionately intense and typically we label the person who is acting that way is crazy or bad or something else negative. And then we interact with that person from that perspective.  

When you are trauma informed, we avoid the unnecessary labelling, we avoid retraumatizing people, and we also find new ways to interact and support each other. So the first part of trauma informed approach is being aware. You know that trauma is at play, you don’t blame people for their trauma responses. In fact you think about whether their behavior is seem as a possible trauma response and avoid retraumatizing people whenever possible.  

We also though know that awareness is not the only thing that has to happen. There are also action steps which help people re-establish a sense of safety and control. So we want people to feel physically safe knowing they aren’t going to get beaten on the way to the store, but also to feel emotional safety or trust. People should feel like they have some choice and control over what happens to them and they should also have opportunities to develop new skills to manage the strong feelings that they get when they encounter a trauma trigger.

Darshan: Thanks Naomi for giving us some good insight. Many of us now have a better understanding now on what trauma informed approach means.

The term ‘trauma’ always has an association to a negative experience. Many of us on the webinar are from organizations who are not in the human service field. So my next set of questions for you are

• So is the topic relevant only for people who have problems?
• Considering what all of us had to go through due to COVID and many of us are continuing to work from home, can we call the continuing stress, anxiety and restlessness as trauma?
• Why is it important to use Trauma Informed Approaches?

 Naomi: Absolutely.

The first question you asked now is this relevant for people who don’t have psychiatric illness or addiction problems. Absolutely! Trauma is pervasive. Everyone of us knows people who has experienced traumas and even if we don’t know it, we still observe some these long term trauma responses in the people in our lives, our co-workers, our family and friends, our neighbors. We might have friends who fly very quickly into a rage with very little provocation, people who never seem to come through on things that they promised and seem to avoid stuff.

People who always anticipate that worse is about to happen and can not settle down. One gentleman I remember and this is an example of someone who had an addiction problem but I think the story is relevant. There was a man he was working with was incarcerated, he was in jail for a while. While he was in jail, he had been stabbed. Now he is finished with his incarceration, he is out in the community and every time he  had to wait in a line, he couldn’t do so comfortably. He was always afraid of literally stab him in the back, and so when he was supposed to be waiting in the line quietly, he will be looking over his shoulder, be very fidgety, he will be very anxious and that cause problem because you have to wait in line to get on a bus or subway or all sorts of different daily activities that cost him a lot of difficulty.

So I think we all know people who behave through their trauma responses. In terms of the fact that we are going through COVID, how does this relate to trauma, I think the first thing is to realize and know the very fine line that says this is trauma and this is not. It depends on how we individually experience the event and what kind of support we have after the event as to how it impacts us long term. I think we are talking about COVID though, it definitely is a trauma and has resulted in a huge number of  mental health challenges for our children, for teams, for families, for older people, for adults across the world.

And then finally for your question about why do we even care about using a trauma informed approach is because people who have had trauma don’t need to be re-traumatized over and over again. It is a very unpleasant way to be labelled as crazy or difficult means that the people you are interacting with you as not yourself. Another way is about common humanity. It makes life easier for everybody. And everybody relies on the sense of safety and control to move through our world and we deserve to have those feelings of safety and control as in before the trauma informed approaches help us get past the trauma to build up a new reality.

Darshan: Thanks Naomi. All this was very important and the examples which you quoted were relevant and I’m sure all of us will be able to relate to the topic. Now to my next questions Naomi

• How important is trauma in the work that you do?
• Is this a standard part of your staff trainings?

Naomi: Most definitely. In the world of behavioral health and addiction services and mental illness, most clients have experienced traumas, Big and small. Sometimes those trauma are actually are the cause of the behavioral health problems. For somebody, for example who lost a parent to incarceration might later suffer from severe depression. Somebody who was abused or raped or attacked might end up with suicidal feelings or lots of anxiety. We also know that trauma can be a result of the behavioral health problem. So a very simple example is of somebody who has addiction are more likely to engage in drug sales or perhaps gang violence and that gets them exposed to violence that can result in trauma.

When our staff recognize a trauma is playing a role in the situation, they tend to act differently and even more supporting of the person. So as an example we had a women, who really complained about wanting her own apartment and she would complain all the time about her roommate’s visitors. She did not like the fact that she had a roommate, she kept calling the police that the roommate’s visitors are drug dealers. And the staffs saw her as very manipulative and it was a ploy so she can get her own apartment. And everyone was focused around on helping her on being more honest about her intentions, and not being so manipulative. But we realized that she had some past violent traumas with strangers that lead to an extreme level of anxiety that really would go out of control, when she was encountering people she didn’t know. So when her room mate had friends over, this anxiety would spiral out of control and she will have a trauma response and so she would call the police repeatedly. Once we figured out that the behavior she was showing was about trauma, and not manipulation, we could focus on different ways of helping her get better.

Finally, I guess you were asking about is if trauma the central part of our staff training. Absolutely. At ICL, we choose to train every single staff personal who comes to the agency in the basics of trauma. That includes our finance people, IT people, the people who provide janitorial services in our programs or in our office. Every single person gets some training in trauma because our clients have it, our staffs have it, all of us are encountering trauma all the time. Once we become a little bit sensitive towards these issues, we can help people across the board. 

Darshan: Thank you such, for again sharing some excellent examples to help us understanding better and we are talking about training. Most of us these training sessions seemed to have have happened in a classroom setting led by an instructor.

• How does the course you’ve developed with Integra provide you with the results you’ve sought, particularly during the COVID times and now when there are still restrictions?

• What specific instructional strategies did you choose to implement in the training content that would positively impact the learning outcome, on complex behavioral skills topics like this?
• How about learning engagement? How do they engage with the learning content when taking the course remotely with no instructor to facilitate the learning?

Naomi:  Prior to COVID, we were doing in person trainings. With COVID, we had to switch up our work because we had lot of people working remotely and we found that long term trainings, did not work. We cant sit for 2-3 hours on a zoom training but at the same time, we needed to get a lot of information out with a particular focus on the human experience. So the eLearning model was great because it allowed us to cover a broad range of topics very cleanly and quickly. That said we understand it as our introduction to online content not the only exposure. In terms of specific strategies, trauma is about people. This is about empathy, it is about recognizing people’s stories and e-Learning is a fantastic vehicle for story telling. The interactivity forces empathy and with the use of both simple and branching scenarios, has allowed us to communicate pretty complicated situations.

With the help of Integra’s team, we focused heavily on scenarios from our tab interaction feature example, scenarios with multiple choice questions, we added an intensive branching scenarios… It was all about scenarios. These scenarios help people connect. As human service professionals, we are attuned to hearing people stories, we are prone to respond. This sort of  scenario based training eLearning course was a natural extension of our in-person training.

Darshan: Thanks again and that’s very impressive. Do you think one time-training event would suffice to bring behavioral changes? Wouldn’t these skills require practice? Some sort of reinforcement over a sustained period? How do you think this is possible?

Naomi: The way I think about training is that the first time you hear something, its an introduction to the concept, the second time you hear it, you start absorbing it a little bit, the third time, you actually start practicing skills. So eLearning is actually an wonderful tool to be able to return to content repeatedly.  That said we do not expect anybody will be able to master trauma informed approaches after an one hour eLearning course. Training in this kind of complex interactions is really a long term effort. So we are going to be creating microlearning blocks as reinforcements to support sustained learning. We also work closely with supervisors and program directors to make sure they are holding their staff accountable for putting this concepts into actions. Because when the rubber meets the road, is in terms of program level and what are people doing to sustain this. We cant be everywhere with 13000 staffs on a daily basis, so it is up to the program  directors and supervisors to put this stuff into play.

Darshan: Thanks, Naomi. Reinforcement via effective micro-learning strategies sounds just perfect.

This brings me to my last set of questions. This subject deals with attitudes like care, empathy, and kindness. We interact with collogues, families and friends daily. Many of us are people managers in our respective roles.

• Do you have any advice for using Trauma informed approaches for those of us who are working in organizations that are not focused on vulnerable populations?
• Are there techniques we can practice too, and right after this webinar?

Naomi:  Absolutely. The first thing for people to be a bit more aware that trauma is a factor for people. So, on the simplest level, every time

you start feeling annoyed, frustrated, angry or start blaming for someone for being so stupid or whatever it is. Just ask yourself, stop for a second and ask if it is possible for another explanation for this behavior and a lot of times, we will realize that something else is going on. That is your first step. Considering whether trauma is at play, and particularly for those people you are gonna be wanting to, as a manager, helping people develop skills like how to handle disappointment, how to move on without getting stuck, how to manage anger/frustration without losing control. So this is just not managing, but supervising, coaching, and supporting your team. We also think about universal precautions. If you think about the concept of universal precautions that we developed through the HIV epidemic, where we started wearing masks every time, When we were at the dentists, people wear gloves every time when people were working with needles and syringes. It was universally accepted that people might have HIV, so we have to take care of ourselves. Same thing here, we universally assume that people have traumatic experiences and so we need to take special care. A lot of that looks like respect, like customer service at basic level. We don’t need to yell at people, that’s replicating a traumatic event. For someone who is a survivor of domestic violence, yelling from a boss might feel a lot like feeling yelled at by a spouse. And yelling might have lead to a beating later on. So even though you as a boss never beat your staff, they may not see it that way and they respond as if that is going to happen.

We treat everyone with respect. Every time you get a mail or phone call, try to reply immediately. Don’t let it sit for two days, four days or a week. For someone who has experienced abandonment, or feels invisible those unanswered emails/phone calls feel supremely disrespectful. From my own experience working with Integra, they are great. If I send an email, I get a response every single time. And that’s really great! And another thing is to be trustworthy. Do what you say, and say what you are going to do. Don’t talk about people behind their backs. Earn someone’s trust. Don’t expect to be trusted because you have a certain position, you need to earn it. You can help people develop a sense of choice and control by offering options whatever possible. So, although you may not be able to say “Would you want to work on this project?”, you can as a manager work with someone together to determine what is the right time for a deadline. I might think to myself that with one of my team members, I need this by five, but I can frame that as “I need to get them done today. When do you think you can get this done?”. And if they say “I cant really get it it done until tomorrow.”, I say “I need it done today. When is the good time that I can expect it?” So I’m giving them some control of the situation. So these are just a few ideas.

Darshan: Well, Naomi, thank you very much for this wonderful conversation and for sharing these insights with us. I am sure there are many takeaways for our participants and that they found this helpful session. With this we now come to our Q & A section. We do have few minutes and we can take couple of questions that the participants have sent. The first question for you, Naomi is

How has your language changed working with clients in the last few years, especially being to deal with addicts, victims etc.,?

How does the staff come to consensus over the language used?

Naomi: That is a great question. And the one that we struggle with deeply. It is interesting here, in New York state, we have a different program  modalities for the offices of mental health. Some programs refer to themselves as participants, some as clients, some as residents and some as guests. We are always struggling with language, there is no consensus in addition to the way the programs are supposed to respond, use language and that is also politically correct in any given time and that means we are also tracking carefully what the federal government is saying and also what the young people, the politically correct and the very woke people are saying. So we talk a person centered language, so I would not talk for example about a schizophrenic but about a person having schizophrenia because it is just one part of who they are and not their entire identity. The word victim is a very loaded term whether they are a survivor or a victim, addict is another one but we now use the term ‘substance user’ as supposed to addict. Because addict carries so much judgement and user is a fact and so I am somebody who goes home and has a glass of wine at night then I’m also a substance user and that equalizes the playing field a little bit, and the judgement pulls back. But that is a very complicated and thoughtful question. I appreciate that one.

Darshan: Thank you so much for the question, Naomi. We have another question.  How well can we deal with the person with a displaced aggressive behaviors and refuses to accept coaching or even take responsibility for their own behavior. What would you recommend to a supervisor on this person?

Naomi: That is also an interesting question. I think there are couple pieces here. One piece is how is the coaching therapy action being proposed. So I say “Darshan, you are out of control. The way you are responding is rude and you need to change”. We can be pretty clear that  you find that an aggressive way of talking, dismissive and disrespectful, not helpful and you are going to feel pretty defensive about it. If I say instead, “Darshan I’m not sure if you notice, but the way Joe responded didn’t seem like he was comfortable with what you said. What do you think was happening there?”. That’s another way of responding by inviting you into the process, it maybe something different. I think it depends on how the need to change is communicated and how that is presented as something supportive to being problematic. So I think that is one piece of it.

There are people who however who are not open to making changes. Ultimately it maybe that the person can’t continue to work in that position if their behavior is not aligned with the organization. I think you can set a culture of accountability and responsibility, one where changing or growing is a good thing  rather than you got problems. I think it has to do with that approach. There are theses concepts being a learning organizations about what happens if you make any mistakes, or are you punished for making mistakes or somebody is saying that they are glad you recognized it and that is great and how can I help you move forward. So that’s the different piece of it. That said, if somebody refuses, and doesn’t change and it isn’t working, then you have to do what you have to do, even with trauma.

Darshan: Thank you, Naomi. A very interesting response. I’m sure our audience will love the answers to all the questions. Many of you have typed in questions in the Q&A section. We will make the answers available via our webpage. And with this, we are end this session. Please note all registrants will also have access to the recording of the webinar. Please d o wait for an email notification on the same.

Thank you all once again.