The intention of trauma-informed practice and care is an increased understanding of how present behaviours and difficulties can be understood in the context of past trauma.

The approach offers a framework for a common set of values, knowledge and language. Trauma-informed care (TIC) can also be applied to understanding and protecting the workforce from secondary or vicarious trauma as a consequence of the emotional demands of their work.

Practice changes supporting a therapeutic, trauma-informed model of residential care do not happen in isolation. Ongoing support, supervision, and consultation are vital ingredients that reinforce therapeutic residential workers training in trauma-informed (TI) practice and care and ensure compliance with practice standards and consistency over time. Often, considerable energy and resources are spent on the transition to new therapeutic approaches, without long-range planning to support and embed those changes over time. Consequently, the new approach either never gains traction or fades quickly.

Working with young people in the context of trauma and other adversities place high emotional demands on those operating in the residential care environment. They may be exposed to frightening situations where their safety may be compromised. Responding with empathy to traumatised individuals and disturbing situations can have an impact on workers’ personal and professional life.

Experience of secondary trauma (also referred to as vicarious trauma) in a non-supportive environment can affect workers individually and also undermine team working environments, leading to:

• feelings of helplessness
• isolation from colleagues
• reduced critical thinking skills
• impaired judgement
• low motivation and poor quality work
• difficulty recognising and monitoring emotions
• increased absences
• high levels of staff turnover

(Quinn et al., 2018; Tullberg et al., 2012)

Ongoing trauma-informed supervision supports the organisational message that TIC is the standard of practice. It normalises secondary trauma as a systemic issue (not the individual pathology of the worker) and reinforces the need for staff self-care to prevent and lessen the impact of secondary trauma. Quality TI supervision for therapeutic residential staff demonstrates the organisation’s commitment to implementing a fully integrated, trauma-informed system of residential care.

Supervisory Functions

A skilful supervisor needs to take on different roles and draw from a variety of approaches depending on the circumstances. The most common supervisory functions include being able to:

Values and Principles for Trauma-Informed Supervision

Supervision of trauma-informed residential care shares with other types of supervision, the major components of educational, support, and managerial oversight. However, because constant interaction with traumatised young people may have adverse effects on therapeutic residential workers, some elements of TI supervision require special attention.

TI supervision combines knowledge about trauma and supervision and focuses on the characteristics of the interrelationship between the trauma, the worker, the helping relationship, and the context in which the work is offered. A supervisory model consistent with this approach should itself promote safety, trust, choice, collaboration and empowerment and ideally model the relationship or interaction desired between the therapeutic residential worker and the young person.

There are very few supervisory models that incorporate these aspects within the model (McPherson & Macnamara, 2017).

Let’s explore what these principles look like in the context of supervision.

Safety

Safety in TI supervision mirrors that which should exist in the therapeutic relationship. A supervisory alliance in which the following factors are present facilitates safety:

1. Supervisor checks the emotional state of the supervisee
2. Supervisees feel accepted and understood
3. The boundaries and expectations are clear
4. Supervisees are encouraged to take an active role in their learning and engage in honest and open discussion

These requirements emphasise the importance of the supervisor attending to the relational aspects of the supervisory relationship.

TI supervisors assist therapeutic residential workers in minimising the impact of their work and be proactive in taking care of themselves. As educator, supporter and advocate, the TI supervisor helps the worker understand their reactions to their work. This knowledge normalises and validates manifestations of secondary trauma which, in turn, makes these reactions easier to manage. Together, the TI supervisor and therapeutic residential worker identify strategies that minimise the impact of secondary trauma and allow the worker to engage in self-care. The TI Supervisor also models these behaviours in their own practice.

Trust

Trust and safety are interdependent. Trust, which is based on the supervisor establishing clear boundaries and expectations, listening without judgment, assisting supervisees with reflecting on their practice, giving feedback about their performance in a non-critical fashion and remaining present.

Trust is also established in the supervisory relationship when the TI supervisor addresses the workers’ affective reactions but clarifies and maintains appropriate boundaries. This approach reflects the appropriate use of the supervisory role, limiting the possibility that the supervisory relationship will take on aspects of a therapeutic one. The TI supervisor’s exploration of workers’ personal reactions is intentional and designed to enhance self-awareness.

Choice and Collaboration

Inexperienced therapeutic residential workers may need more guidance and instruction as they transition into trauma-informed practitioners, underscoring the educative role. However, the TI supervisor recognises and conveys to the residential worker that “(their relationship) is a mutual one in which the knowledge and wisdom of the TI supervisor are not privileged over that of the residential worker. Each learns from the other’s experience. TI supervisors must be able to balance the teaching role—in which they take on more of the role of the expert—with that of a consultant who fosters autonomy, independence, and empowerment.

An approach to supervision that has relevance for TI supervision was described by Fontes (1995) and referred to as “sharevision.” In this approach, TI supervisors create a more egalitarian relationship with the therapeutic residential worker; this in turn promotes more open and honest discussion. The concept of sharevision is consistent with relational approaches to supervision, which emphasise the attention that both parties pay to their relationship. This more egalitarian approach lessens the power differential between supervisor and supervisee that can impede honest discussion, particularly around the therapeutic affective responses.

Empowerment

Empowerment includes providing learning opportunities so that the therapeutic residential worker can practice skills on their own while being monitored. The therapeutic residential worker may also feel empowered by validation and consistent feedback not only on challenges but on successes as well. For example, they should come to supervision with a list of successes as well as challenges.

Conclusion

An essential element of trauma-informed residential care is TI supervision. It is only when therapeutic residential workers have knowledgeable and supportive TI supervision that they can operate from a trauma-informed perspective. The basic requisites of TI supervision include knowledge of trauma and its effects on young people, secondary trauma, core skills of supervision, and core precepts of trauma-informed practice and care.

Look out for the upcoming webinar on Trauma-Informed Supervision.

Noel MacNamara
Senior Advisor, Centre for Excellence in Therapeutic Care

References

Fontes, L. (1995). Sharevision: Collaborative supervision and self-care strategies for working with trauma. Family Journal, 3, 249–254.

McPherson, L & MacNamara, N 2017, Supervising child protection practice: what works? Springer International Publishing, Switzerland.

Peterson, S. (2015) Trauma-Informed Supervision: What They Didn’t Teach us in Grad School. (www.reliaslearning.com/webinars).