Written by: Andi Fetzner PsyD

You may have heard the phrase “hurt people hurt people” and thought that it’s just some fluffy way for people to avoid accountability for their actions. But what if this is the foundation for doing just that? When I know I have an injury, I can work to heal it and healed people, heal people.  


This is the concept behind the first step in any self-help work. When we know there’s an injury we’ve experienced, we can do something about it. 

In June 2024, I visited an anger management class at Folsom Prison through the invitation by Kara Hunter, a longtime volunteer who has shared her experience and knowledge about conflict resolution through her previous role as Exective Director of Yolo County Resolution Center and continues her work today. We had been invited in December to meet with a group of Veterans but this was going to be different as the men had been going through a curriculum to learn more about anger and how to manage it and many were on the trajectory of thinking about life outside these four walls.


My role in meeting with the group was to share information about stress, its impact, and what we can do about it. After walking through the facility, I felt the stress that these men deal with every day. While there were huge trees, sounds of crickets, and deer and turkeys strolling around outside of the prison campus, the sensory experience on the inside consisted of slamming doors, stone walls, and concrete floors. Not to forget the quintessential rooms with bars as doors. The learning center was a different environment. The walls were white and the room was set up like a classroom with desks and chairs. 


One thing was clear once we started talking though. The men in this room were living the consequence of how their hurt had impacted others. Some men were in for life, others had decades, and a few could see the light at the end of the literal and proverbial tunnel and were going to be out in society within a matter of months. What they all seemed to have in common was a curiosity of self and a desire to understand why they did what they did and how they could do life differently.


We talked about the ACE study. One gentleman asked if there was any hope for people who experienced trauma 0-7 years old. He asked for himself and for his daughter. He was looking for hope. ACEs are not destiny. We shared Dan Siegel’s brain model to describe lid flipping, what happens when we experience toxic levels of stress and we get outside of our connection zone. Another participant made the link between his own behavior and his lid being flipped. He also mentioned that it wasn’t until he started serving time and was offered the stability of food, shelter, and the vocabulary to describe his emotional experience that he started to really be able to take accountability for his actions. We talked about resilience, aka what we can do about it. Mindfulness (noticing the present moment, non-judgmentally), doing the next right thing (controlling what we can and letting go of what we can’t), and sprinkling in this trauma-informed language of resilience-building as a foundation for other programs like 12-step, anger management, parenting classes, and others. When we name it, we can tame it. It’s simple, not easy. We don’t have to do it alone.

Candidly, I felt honored to enter the sacred space of healing in a place that was established to instill a sense of fear as punishment. The leader of the group, Steve, introduced the workshop and provided a capstone at the end to make the link to how anger, one of the many emotions that trauma can create, is part of the flipped lid response system and how building out the connection zone can provide a different pathway for how we interact with one another and with ourselves. The men were insightful, vulnerable, and willing to share and reflect in a unique way. They asked challenging questions, applied the concepts to themselves, and didn’t hesitate to offer gratitude and thanks.  


At Origins, we work with people across sectors who are at different places in their journey of healing. We never know what to expect when we enter a room, virtual or in-person. One truth rings loudly for us as we chime the bell in other spaces- we are different leaders when we lead from a healed place than when we lead from a hurt place. Thank you for allowing us to be a part of your journey and for sharing in our journey.


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Sharing Skills, Shaping Communities

Many of you have attended trainings on the ACE Study, trauma-informed principles, and resilience and have been left wanting guidance on how to put these concepts into action. That’s what our Basics, Resilience Champion, and Principles to Action training workshops offer. We often also hear, “How can I spread this approach in my organization or community?”

After hearing your requests, we developed the Train the Trainer workshops. Through a series of customized workshops, we coach community and organizational leaders on an approach that brings trauma-informed theories to life, building a culture in your community.

In West Virginia, the trauma-informed approaches are spreading across the entire state. Over the past two years, we have been partnering with the West Virginia Department of Health and Human Resources and the West Virginia Health Affairs Institute to train direct care professionals through a train-the-trainer model. An incredible group of people from this multi-agency, multi-sector coalition has been working side-by-side to build a person-centered trauma-informed culture in their communities and organizations. After taking our Train the Trainer workshop, they have spent the last year supporting each other to work more effectively and collaboratively to train their communities. Through a series of monthly follow-on meetings, they joined us in a welcoming and supportive environment to have their questions answered, collaborate and role-play on solutions, practice mock training, and share invaluable resources.

The measure of success for the new trainers in West Virginia is not just what they learned in the program, but how they are inspiring action and application in their communities and organizations afterward.

Across West Virginia, Origins-certified trainers have trained 479 direct care professionals! (Read the story of how one agency is delivering this training.)

We trained one more cohort this past April, and they will easily surpass their goal of training 500 people. To say we’re thrilled is an understatement.

As we look back on the past year, we’re filled with gratitude for the opportunity to work side by side with wonderful humans to make such a meaningful impact. We’re excited about the future as we continue on our mission to foster understanding, resilience, and healing, and can’t wait to train even more trainers in this movement.

If you’re interested in learning more about the Origins Train the Trainer program, let us know.

Defining a trauma-informed approach and figuring out how to put it into action has been a struggle since the inception of the term. At Origins, our answer to this predicament is simple (but not always easy)–a trauma-informed approach is a culture, not a checklist. In other words, this approach is less about what you do and more about how you are doing it. But culture can sometimes feel daunting and nebulous. How can we even get started?

Enter Aaron Scott. Scott is the Northern Training Manager for Burlington United Methodist Family Services, which offers a variety of community-based services, including two residential campuses, recovery support, and targeted case management throughout West Virginia. His experience offers some concrete tips on how to operationalize a trauma-informed culture. His approach speaks to two fundamental components of culture-building: creating a shared language and articulating concrete values.  


Scott is a certified Origins facilitator for Person-Centered Trauma-Informed Care (PCTIC). He participated in one of two cohorts of a train-the-trainer program facilitated by Origins and sponsored by the West Virginia Department of Health and Human Services in partnership with the West Virginia Health Affairs Institute in Spring 2023. The goal of this program is to train Direct Care Professionals throughout the state on the foundational concepts of PCTIC. 


As part of his role, Scott is in charge of the training program for his agency. His core training program is a 9-10 day training curriculum that uses the PCTIC training as a foundation to establish a shared language and connect the dots among the various other trainings that are offered to staff, including trainings on motivational interviewing and de-escalation. In this model, the PCTIC training is the capstone training that ties together the skills and concepts that have been introduced throughout the training sequence. 


Instead of offering a variety of siloed trainings, PCTIC offers an overarching framework  connecting the various trainings. As an example, the de-escalation training introduces the idea of behavior as communication, one of the key concepts of PCTIC. Motivational interviewing establishes collaboration–one of the PCTIC principles–as a key to providing support for people expressing uncertainty about change. 


Through this integrated approach, Scott’s overall goal is focused on developing a culture rooted in the values of connection, consistency, and safety. With these values in mind, a key part of building the agency’s culture is about how staff come together and relate to one another during the training. Says Scott, “It’s not about memorization of the materials but application of the principles…there is a soul to this training.” This starts with the culture created within the training environment. 


PCTIC helps create connection–both externally with clients and internally among staff. Everyone comes to this work with different life experiences and different stressors. Both of these can affect how we respond in situations. PCTIC encourages us to view the behaviors of others (and our own behavior!) through this lens. Scott noted that this lens has led to an increase in his own patience with others–both inside and outside of the workplace. For example, he says “How do I handle the situation at McDonald’s when my order is running late.”


 Working alongside other humans to support other humans (we call this humaning) can help build this culture of connection, consistency, and safety. Says Scott, “This is how we can build an agency’s culture. You can train empathy.”


If you’re interested in learning more about The Basics: Train the Trainer program, click here to learn more or schedule a time to talk with us today.

The other day I was at the gym and someone asked me what I do for work. I really love what I do, but I have to admit that I sometimes dread this question and often try to avoid it. When I tell people about the work we do at Origins to support leaders implementing a trauma-informed approach, I tend to get one of two reactions. The first reaction–from people who are familiar with a trauma-informed approach–tends to be one of excitement. They immediately know what I am referring to and are super excited to talk about it. The second reaction usually involves a blank stare and some version of “what the heck is that?” And then I have to try and explain.

At Origins, we define a trauma-informed as an approach to organizational culture that recognizes how stress affects people, promotes tools and practices to decrease its impact, and encourages opportunities for safety and connection. We also like to say that this approach starts with each of us so that’s where the supporting leaders part comes into play. But what does all of this actually mean?

I think the simplest way to explain what a trauma-informed approach looks like in action is that stress affects how we show up. We lead differently when we are stressed, we communicate differently when we are stressed, we engage in conflict differently when we are stressed. A trauma-informed approach recognizes that how we react to potential stressors is impacted by our current circumstances and our life experiences. It also provides concrete tools for managing stress (spoiler alert: half the battle is realizing you are stressed so you can be accountable and able to do something about it). Simple idea, rarely easy.

After I explain that to the second group of people (we’ll call them the blank stare people), their reaction tends to be like “Huh, that makes a lot of sense. But trauma-informed is really an awful name for it.” I tend to agree.

Other terms have been used as well–trauma-sensitive, resilience-building, healing-centered, etc. But I have to be honest that I am really not a fan of any of them. We use these terms because that’s what people are often searching for (thanks SEO), but I think what I like least about all of them is that they really encourage us to think about this approach in terms of “us” versus “them”.  We know from the original Adverse Childhood Experiences (ACE) study that ACEs are really common. We also know that the study only measured a subset of experiences at both the individual and community levels that can contribute to the development of toxic stress. And the impacts of COVID are layered on top of all of this. 

It is not to say that certain individuals and certain communities have not experienced higher levels of stress than others. Indeed, that is absolutely the case. But participating in some version of the trauma olympics only perpetuates the idea that a trauma-informed approach only applies to “those people over there” and not to all of us as humans. 

So what’s the alternative? Andi and I have spent more time talking about this question than is probably productive, but the term we keep coming back to is “humaning.” Humans experience stress. We adapt. We develop habits that are helpful in the moment but not down the line. We disconnect. This process is true for all of us. When we understand how this process works (for ourselves and others), we can connect with the humanity in all of us. We will continue to use the terms trauma-informed and resilience-building because that language has caught on and is meaningful. But we are also going to start integrating more human-oriented language. Because at its core, this approach is for humans and humans experience stress. 

And please let us know if you have met a human who does not meet this criteria–we would love to meet them.


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Curious about how to get started?

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More and more organizations are seeing the value of integrating a trauma-informed approach into their organizational culture!

At the 2022 National Association of Community Health Clinic (NACHC) Conference in Chicago, Andi Fetzner, PsyD, and Lori Chelius MBA/MPH presented a poster highlighting Eisner Health’s Journey Through Implementing Trauma Informed Care. It went so well that in 2023, NACHC invited Andi and and the Eisner Team, Deborah Lerner, MD, Dr. Chris Hillson, MD and Gretchen Gates, LCSW from NACHC to host a breakout in San Diego to share best practices and tips to help other community health centers start their own program. We reached 135 people total both virtually and in-person.

Worshop Description: 

How Healthy Is Your Health Center? How to Promote a Trauma Informed Care Environment for Patients and Staff  

This workshop session will provide participants with the opportunity to learn how to create and sustain trauma informed environments for both health center patients and staff. Participants will hear from the Eisner Health team about their trauma informed care implementation journey. Participants will also learn about leadership and frontline staff roles in the implementation process and have hands on experience with tools that can be used every day in a variety of settings.

Some of the audience question/answers included:

How are trauma informed care coordinators funded?

Andi Fetzner – Eisner Health: At Eisner Health, the trauma-informed care coordinator position is a full-time position funded through a HRSA grant. In the first year, they utilized additional funding from a smaller grant to support an external organization to train and coach the internal position on the process of integrating a trauma-informed approach into the organization. State-based or foundation grants can support this approach to include current staff or similar, more part-time positions. Yet another approach other clinics have taken is to have a clinical provider in this role and split their time between patient encounters (billing supports the position) and TIC work (grant-funded).

What is the return on investment? What metrics are you tracking to measure effectiveness of this training?

Andi Fetzner – Eisner Health: The metrics thus far have not been tracked by our QI team but we notice a marked difference in the culture of the organization when people start to use the language of the training in meetings and other interactions. The initial motivation for bringing trauma-informed care into the organization was to decrease escalations. The feedback from staff and managers within the clinics is that the training has given them the language and skills to decrease the impact of stress and increase the ability to connect.

When you train your team members on trauma informed care, do you combine with motivational interviewing techniques or do you keep it separate?

Andi Fetzner – Eisner Health & Gretchen Gates – Enso Integrated Health: The recommendation is to keep these topics separate, especially when first starting to implement trauma-informed care and/or training. When we’re talking about trauma-informed care within a health center or system, we’re talking about culture shift, so it can take some time to build the foundational knowledge and internalize the practices. Even on the clinical side, the goal is to have everyone trained and speaking the language of TIC, as it’s more of a philosophy and way of providing care, while motivational interviewing is more of a discrete technique for clinical interventions.

Since self reflection and self awareness is so central to showing up for others, how can you help improve those skills for yourself and colleagues?

Gretchen Gates – Enso Integrated Health: The best first step can sometimes be just making the time to do it — whether it’s journaling, seeking therapy/counseling, or reading a book on trauma and thinking about its application to my life, I simply have to make the time and prioritize. I think we all are a little afraid to look in the mirror at our pasts, our experiences with trauma, or our biases so it’s easy to avoid. A simple way to start the reflection process is by taking one of the assessments we discussed during the session — either the Professional Quality of Life Scale or Buffalo Self Care Assessment. Either will give you a good idea of what’s going on and where to start to make some changes.

Andi Fetzner – Eisner Health: Past life experiences show up every day in present behavior. Acknowledging this fact helps create a culture where self-reflection and self-awareness are celebrated. While intervening in these moments and debriefing after them is helpful, I find the phrase an ounce of prevention can be worth a pound of cure relevant here. Do things that your future-self will thank you for doing. To me that means saying yes to some things and no to others. Eat breakfast. Ask for help (we have a hard time with this one as helpers). Do something that brings you joy just for fun like wearing a fun nail polish color or your favorite socks. Listen to a song you like. Sing in the car. Go for a walk. Lastly, I am an outdoorsy person and was happy to learn that even having a picture of a mountain or beach or landscape (if you can’t make it out during the day) can help balance one’s mood.

How do you de-stigmatize coping behavior, such as anger, while not enabling actual bad behavior?

Gretchen Gates – Enso Integrated Health: First, I operate under the principle (and share this with others) that everyone is doing the best they can with the knowledge, skills, and information they have at the time. This allows us to see patients and colleagues from a strengths-based and person-first perspective. Second, I view ANY coping, especially coping in the face or history of trauma, as a survival skill. Substance use and abuse, self-harm, running away, anger, pushing others away, overdependence, etc. can all be a learned way to survive an unhealthy situation. When we frame unhealthy coping in this way and provide psychoeducation on trauma and the fight/flight response, I find that people are much more likely to be compassionate with themselves, open to understanding the negative effects of this skill/response, and subsequently be more willing to consider alternative options.

Andi Fetzner – Eisner Health: We get asked this kind of question frequently related to holding people accountable for their actions. I mentioned in the presentation that there is no other approach that allows for people to be as accountable as a trauma-informed approach. As Gretchen mentioned, when a person has the space to understand their emotions, thoughts, and behavior, they can decide whether how they are acting is helpful or not in the current situation. The emotion of anger specifically can be explored and we can understand if there is a frustration, sadness, fear or something else happening. Once a person knows that they are safe to talk about their experience, they can access their whole brain and decide, learn, and think through their actions and reconnect with the team.

Read more about Eisner Health’s journey here:


Lori Chelius MBA/MPH and Andi Fetzner PsyD presented a webinar titled Creating a Culture of Wellness and Connection: A Trauma-Informed Approach telling the story of Eisner Health’s experience integrating this approach…

I learned to ski as an adult so I will never be great, but I absolutely love it and can hold my own. As my two older kids have long surpassed me in terms of skill level, one of the things I now do when I go on a hard run with them is to let them go first and watch what they do. I look for the path they take, how fast they go, where they struggle, and then make adjustments based on my own strengths and challenges when we ski together.

When Origins Co-Founder Andi Fetzner and I started Origins back in 2017, the trauma-informed movement was still young. Sure, there were organizations and communities who had been doing trauma-informed work for years, or even decades, but it wasn’t quite mainstream yet. One of our observations was that there was an enormous opportunity for others to learn from those who had gone down the mountain first. There was so much wisdom from those early adopters, but there wasn’t much out there that formally documented the learnings–the wins, the struggles, the lessons learned.

Fast forward a couple of years and Andi connected with Eisner Health, a community health center in Los Angeles County. Eisner Health began it’s trauma-informed initiative in 2018 (although the seeds had been planted a few years before it formally began). Eisner Health shared many of the philosophies about trauma-informed care that we hold at Origins–the importance of focusing internally, the role of organizational culture, and the need for a shared language –and we saw an opportunity to partner. We applied for and received a grant from ACEs Aware to share their story and recently published a practice paper with those lessons.

Register here for a free webinar on February 16th from 12-1 pm PT to hear tips from Eisner Health’s journey implementing trauma-informed care, many of which are universal takeaways that can be applied across sectors. The full practice paper will be sent to everyone who registers for the webinar.

Because this mountain is challenging and we don’t need to go down it alone.


Register here: https://us06web.zoom.us/meeting/register/tZwrdOqorTMqH9VfeeFHMICZ8ryEmzR4hF1S

Lori Chelius, MBA/MPH is a Co-Founder of Origins Training & Consulting. Andi and Lori work with organizations across a number of sectors to build strong foundations based on solid values, build resilience, and provide even better care for the people they serve. She lives in California with her wife, three kids, and their dog, Oliver.


By: Lori Chelius, MBA/MPH

Eisner Health’s journey through implementing trauma-informed care (TIC) began more than six years ago when Chief Medical Officer Dr. Deborah Lerner attended a conference focused on community healthcare and wandered into a session hosted by a social worker who worked for the San Diego Police Department.

The social worker’s story of how TIC had transformed her work planted a seed in Dr. Lerner’s mind, which continued growing over time as she observed real-world challenges with staff, providers, and patients at Eisner Health. Regardless of the people involved, she noticed a similar pattern of escalation and conflict in high-stress situations. For example, a verbal complaint or threat from a patient often intensified quickly, frequently resulting in security having to intervene. In addition, providers sometimes used firm language toward other team members during tense situations, such as when front office staff wanted to add a walk-in appointment into an already crowded schedule. These interactions eroded trust and communication, creating even more of a hotbed for escalations and incidents.

Dr. Lerner observed that the common connection among these challenges was that Eisner Health’s staff members needed more support and tools to navigate stressful circumstances and conversations, as well as skills to help manage those feelings in themselves and their patients.

Dr. Lerner recalled the conference presentation she saw and recognized that TIC could be a way to address these issues on a deeper level and in a sustainable way. Many Eisner Health employees live in the chronically stressed communities that the organization serves, and all staff naturally bring life experiences and stressors to the workplace. By providing more knowledge about stress and tools for managing it, Dr. Lerner hoped Eisner Health could better support its staff, build internal resilience, and improve employee wellness.

As Brene Brene has said, “stories are data with a soul.”

In our recently published project paper, which was a collaboration between Origins and Eisner Health (funded by ACEs Aware), we share the lessons learned from Eisner Health’s experience implementing trauma-informed care, a process that formally began in 2018.

One of these lessons learned was the importance of knowing your “why” (a high-level vision or purpose) before beginning. For Dr. Lerner, her “why” was clear: to better support staff wellness and stress management in order to reduce escalations and improve the patient experience. The COVID-19 pandemic magnified the challenges Eisner Health was already feeling and reinforced the importance of pursuing this plan.

Clearly defining this “why” set the tone for Eisner Health’s TIC implementation and laid a strong foundation for long-term sustainability.

As said by an Eisner Health team member “When we take care of ourselves, that’s when we can provide the best care for others.”

Other top lessons include the critical role of organizational culture, the importance of buy-in, the value of creating a shared language throughout an organization, and recognizing the role of TIC as a foundation for ACE screening.

Sprinkled throughout the paper are stories that capture these and other lessons.

To learn more and download a free copy of this paper, CLICK HERE.


Lori Chelius is a co-founder of Origins Training & Consulting. Origins helps health care professionals, social service workers, educators, and other leaders integrate a trauma-informed approach into their work so they can build more resilient organizations and communities. She lives in California with her wife, three kids, and their dog, Oliver. Learn more about Origins’ and its online training offerings at www.originstraining.org.

Trauma-informed care (TIC) offers a way for organizations to start building a resilient organizational culture by understanding the impact of toxic stress and resilience on both patients and staff, then leverage that understanding to improve organizational culture and practices. Within community health, TIC provides a critical foundation for integrating screening for Adverse Childhood Experiences (ACEs).