Written by: Andi Fetzner, LPC/PsyD

Fred McFeely Rogers (better known as Mr. Rogers) famously offered the advice during times of trouble: “Look for the helpers. You will always find people who are helping.” Many times throughout my life, I have needed that reminder and have found someone to lighten the weight of the stress of the situation. They didn’t always “fix” the problem but just them being there, listening, and witnessing was invaluable. 

 

Westbrook Health Services in West Virginia has a long history of being a helper in the community. Having started in 1949 by another group of helpers, The Junior League of Parkersburg, they have been serving the Mid-Ohio Valley by providing a broad range of services to support those struggling with their mental health.

 

All helpers at Westbrook including staff, volunteers, and interns complete background checks, a human resource review, and credentials before providing any clinical services. The leaders who support this process are Amanda Cornwell and Olivia Horne, Community Mental Health Trainers and Certified Person-Centered Trauma Informed Care (PCTIC) Trainers. They both participated in a cohort of a train-the-trainer program facilitated by Origins and sponsored by the West Virginia Department of Health and Human Resources in partnership with the West Virginia Health Affairs Institute in Spring 2023. The goal of this program is to help the helpers by training Direct Care Professionals throughout the state on the foundational concepts of PCTIC. 

 

Because the hiring process can vary, training doesn”t always follow the same order for everyone. However, each person eventually learns more about PCTIC and how to apply it in their role within the organization. This approach is less about what the activities are that the helpers are doing and more about how they are doing what they do. This can apply to the administrators and executives, too! “Everyone has Adverse Childhood Experiences (ACEs) and trauma, and it”s like a light bulb goes off when they realize it”s not just about the clients,” Horne explained. During the PCTIC training-of-trainers, one of the activities involved exploring the “why” behind people’s choice of work. Whether they were social service workers, educators, or administrators, the responses were often rooted in a shared motivation: some had received help when they needed it, others hadn’t and now want to be the helper for others or perhaps they saw a need in others and felt driven to fill that role.

The people served by Westbrook face challenges such as addiction and intellectual and developmental disabilities (IDD). As future helpers go through the training, many are surprised to find their own experiences resurfacing, with emotions they “weren’t expecting” being triggered. “Some don’t realize how much this work can affect them,” Horne remarked. Once they reach the PCTIC training, they begin to see common ground. For instance, we all have tough days,” Horne added. Cornwell reported that people also start to recognize, “it might be ME coming in with stress.” 

 

Horne  explained that when people start to understand that client behaviors stem from unmet needs—not an intention to cause trouble, but rather a way of communicating—it transforms how they provide help. She used the example of caring for a newborn: “When you have a newborn, you’re in fight or flight for the first two months of their life. The baby is crying because it needs something—they’re trying to feel safe and secure and are seeking to get their needs met.” This shift in perspective fosters empathy and connection among the helpers, encouraging them to be more gracious and considerate with one another. They also learn to reframe the word “consequence,” moving away from a punitive mindset and instead focusing on addressing the underlying need.

 

Another important lesson Horne and Cornwell have learned as they”ve integrated PCTIC is how the concepts and terms provide a foundation for a shared language among helpers. This common language helps them better understand how to approach their interactions with themselves and others. One example is the Right Response training, which focuses on de-escalation techniques based on universal principles for managing situations safely and skillfully. Cornwell highlighted four key points where these trainings complement each other: first, recognizing that ACEs and trauma are not just present in clients but also in the helpers; second, identifying what a “flipped lid” looks like in oneself and others; third, understanding that helpers need to manage their own emotional state before connecting with others; and fourth, acknowledging that fawning, which can appear as compliance, is often a stress response rooted in fear. Cornwell noted that when these insights were put together, the results were clear: “We got smiles out of it, and everyone understands.”

 

In the interest of broadening the application of a trauma-informed approach to other organizations that serve their clients, Westbrook also received a Mental Health Awareness Training Grant, which allows Horne to offer PCTIC training to the community at no cost. She has been collaborating with various counties, including working alongside the Family Resource Network and Recovery Houses, to support the helpers who serve these communities. By spreading the practice of this approach, the aim is to reduce trauma by increasing the chances that needs will be met for all children and families in the community—whether they are struggling with IDD, addiction, or other challenges. This proactive approach creates a more trauma-informed, compassionate environment that benefits everyone, not just those directly receiving services. By equipping helpers with these tools, Westbrook is fostering a culture of understanding and empathy, making the broader community a more supportive and resilient place for all.

At Origins, we call acting in a way that is trauma-informed humaning. Horne, as a trainer of PCTIC, reported that the simple, but not always easy, practice of integrating mindfulness has made a big difference for her in staying connected. “It’s about taking the time to reflect, breathe, and reconnect with oneself and others, as part of an ongoing commitment to personal growth and effective caregiving.” As the helpers at Westbrook and across the community gain this self-awareness and the practices of PCTIC, they become more attuned to the needs of those they serve and those they work alongside. This can be a lesson for others and we are here to help support you in your journey.

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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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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.”

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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:

 

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.

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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.