10 Lessons Learned on Essex County NY’s Journey Toward a Trauma-Informed System of Care

The first time I attended an ACEs training for human service providers, I found the trainer to be brilliant and the research fascinating. The trauma-informed practices were so promising, yet left me feeling dizzy with the magnitude of the work that needed to be done. I suddenly saw the impact of trauma everywhere but had little power or resources to implement meaningful change. I was the only one from my program attending, and there was no follow up. I was just one person and had little authority. I realized it would require a level of leadership and system change that felt unfathomable at the time. Even with buy-in, where would our organization even begin? Would it even be possible to measure an impact? And even if our organization became trauma-informed, but the system did not, would it even matter? Whomp whomp.
 
Many years later, I am in a new role, coordinating a coalition that convenes Essex County NY’s child and family services, with the goal of building a strong System of Care (SOC). We call it the BRIEF Coalition: Building Resilience in Essex Families. As our SOC grew more-coordinated, I got a glimpse of the potential of a collective approach to trauma-informed services.
 
I started to ask new questions. Could we leverage the system structure to build trauma-informed capacity at scale, instead of person-by-person, agency-by-agency, and silo-by-silo? Can an entire system become trauma-responsive? In Spring 2022, we contracted with CCSI, and took our first small steps. Many others, across the state, are much farther along on this journey, and we have much to learn from them. A year later, teams from nine Essex County agencies and five school districts are now engaged in CCSI-led learning communities that foster ongoing trauma responsive assessment, capacity building, action planning, implementation, and accountability. Teams from across the system gather, in-person and online, to participate in monthly or quarterly trainings that combine content with peer-to-peer learning.
 
I can think of ten ways this experience feels different than that first training I described. Here’s my first ever listicle:
 

1. As a System of Care, we center the families and individuals we serve, so a whole-system approach is understood by all to be essential. Terri Morse, Director of Essex County Mental Health and Community Services describes why. "There is great value in knowing we're working on this together so that when we make a referral to one of our partners, there is a better sense of comfort in knowing the referred individual will be greeted by a trauma-informed organization. This gives us a common language to use and also allows us to help each other improve our service delivery,"

 

2. The momentum of a collective effort attracts broad engagement. “When you can speak of being a part of a county-wide initiative, it provides for the start that is needed in many ways to get administrative buy-in," says Amy Gaddor, Director of Human Resources at Mountain Lake Services (Essex County's OPWDD service provider).
    
3. Engaging in the work as a system builds trust across agencies. This somewhat unexpected effect is well-articulated by Douglas Meyer, Director of Services Mental Health Association in Essex County, Inc. “Just being in the room with individuals from other agencies helps tremendously in building an atmosphere of cooperation for a common goal. The different agencies learning to trust one another is a byproduct.”
    
4. Organizations are learning as much from one another as they are from the trainer. This is by design. "The trainings are a great opportunity to reflect upon what our own agency can do to improve and be more trauma-informed, but it was even better getting to hear where other agencies are at and what their focus is on,” says Erin Velsini, Children's SPOA Coordinator at Essex County Mental Health.

 

5. We knew where to start. By beginning with assessment, organizations’ strategy is informed by the findings. Because each organization is using the same tool (TRUST for agencies and TRUST-S for schools), we share outcome measures and strategies across the system. In May, organizations will re-administer the assessments, and we will see where we are making progress and how we need to grow.
    
6. Mutually-reinforcing synergies emerge. For example, TRUST re-assessment and monitoring goals were included in Essex County's 2023-2025 Community Health Improvement Plan. This is possible, because the current NYS Prevention Agenda, that drives County-wide Community Health Assessment and Improvement Planning, prioritizes strategies to “Integrate trauma-informed approaches into prevention programs by training staff, developing protocols, and cross-systems collaboration.”
    
7. We focus on staff wellness. Many of our agencies and schools are short staffed and stressed, due to the pandemic, a nation-wide metal health crisis, and many other adversities. Trauma Informed Care (TIC) can feel like “one more thing” if there is not an intentional and direct connection to burn out reduction. Staff at agencies and schools want physical and emotional safety, healthy relationships, resilience, and everything else TIC builds. None of us can serve others if our cups are empty.

 

8. We started with resilience. Trauma is a painful word. Prior to beginning the TIC work, years of cross-agency capacity building had already grounded our SOC in an evidence-based resiliency framework developed by Dr. Nan Henderson at Resiliency In Action. It was a good place to start. By intentionally integrated trauma-informed training and the Resiliency Wheel staff were already familiar with, we maintain a focus on the protective factors that foster resiliency.
    
9. We connect the dots to integrate the work with existing initiatives and goals, such as workforce retention and development; Diversity, Equity, and Inclusion (DEI); resiliency; and peer support. For example, we frame implementation of DEI policies and initiatives as directly connected to the TIC foundations of cultural competence, equity, and anti-bias work.
    
10. Nobody leaves asking, “OK, but now what?” One-and-done trainings can feel demoralizing, when there is no resulting action. Instead, our participants are aware that they play vital roles in a system-wide ongoing mutually-reinforcing collective effort. Our progress is measured with ongoing assessment using the TRUST and TRUST-S. New strategies are being implemented and shared across organizations. Our aim is for the learning communities to become self-sustaining, peer learning exchanges. We are building our own network of local TIC trainers. In the big picture, these are still early steps. The journey will never end, and it’s not supposed to. Along the way, we are building trust and fueling what feels like a movement.

 
I have new, more complex questions these days, and I’m eager to learn from others about their best practices for implementing trauma responsive Systems of Care. I can be contacted at stefanie.v.miller@essexcountyny.gov. On May 9, 2023, at the What’s Great in Our State conference in Albany, I will co-lead a workshop with Deb Salamone (CCSI), and agency and school leaders in Essex County’s SOC initiative The workshop is entitled, Co-creating Trauma Responsive Systems of Care: Tools for Agencies, Schools, and Communities. Please say hello, if you are there. My November 2022 OMH presentation, Essex County NY’s Journey Towards Becoming a System of Care: Why, Who, How, When, What and Lessons Learned can be viewed here.