Trauma Informed Ecological Response (T.I.E.R.™)

A Model for the Implementation & Evaluation of Trauma-Informed Systems Change


Trauma-Informed Ecological Response T.I.E.R.™ was developed by Artemis Associates under the leadership of Carmela J. DeCandia, Psy.D. T.I.E.R.™ is grounded in practical, on-the ground, experience, and is based on best practices for building psychologically healthy workplaces, organizational culture change, and addressing trauma.

T.I.E.R.™ provides a concrete and flexible roadmap for implementing trauma-informed care in systems serving vulnerable populations. The Artemis T.I.E.R.™ model can be scaled up or down to meet an organization’s needs. Generally, 18 months is recommended for systems to begin to make changes that have a measurable impact. Agencies can choose to engage in a full 18-month engagement (recommended), or contract per phase as resources becomes available. A three-year engagement inclusive of community impact measures is also available.

Denial allows us to distance ourselves from the feelings and moral obligations to act. The consequence is that problems, and services, are over focused on the individual rather than in the culture or environment.

Bloom, 2000; Herman, 1992, McFarlane, 2000

What the Research Says

Exposure to traumatic stress is a common denominator of children and youth across service systems.

Traumatic experiences threaten one’s life or bodily integrity and invoke intense feelings of helplessness, powerlessness, and terror. According to Judy Herman, traumatic events “overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning.”

Advances in the neurological and developmental sciences have brought an explosion of evidence demonstrating the devastating, long-term impact of traumatic stress on the developing brain and body. As severe stresses and traumatic events accumulate, the physiological and psychological impact becomes more profound, resulting in a range of adverse responses including neurobiological changes, difficulties regulating affect, and problems forming supportive relationships. As a result, many survivors of trauma suffer the debilitating consequences for the remainder of their lives. (DeCandia & Guarino, 2015).

“Society should work to support and protect this vulnerable population,
as well as to prevent future trauma to the next generation.”

Bymaster et al., 2017

Trauma & Homelessness are interrelated.

Structural factors such as poverty, lack of affordable housing, and reductions in income assistance have created the conditions for increasing homeliness. However, individual factors have also been identified as predictors of experiencing homelessness. Childhood trauma can significantly increase the risk for adult homelessness.

The majority of homeless people have experienced massive trauma as children, including damaging abuse, neglect, household distress, traumatic brain injuries, and home and family instability. Compared with an average person, homeless individuals were 10 times as likely to have a household member go to prison, to live with someone who was using street drugs, and to live with an adult who physically abused them.

Bymaster et al., 2017

From Research to Practice: How to Implement Trauma-Informed Care(TIC)

Tips for Implementation

  1. Schedule a training and gain buy-in.
  2. Conduct agency wide assessment.
  3. Review results & identify domains of TIC to target.
  4. Develop and action plan for implementation.
  5. Build a feedback loop to keep agency informed.
  6. Implement with an eye towards sustainability.
  7. Re-assess.

TIER Framework

Needs and Readiness

The first tier in building a trauma-informed model is getting to know an agency and its readiness for implementation. This includes establishing a common language through awareness and knowledge building, conducting focus groups, reviewing documents, policies, and procedures, and planning calls with leadership to guide the process. During this time, following the knowledge building process, a workgroup is identified among representative staff who will participate in strategic action planning, building communication channels, and be the guides of the implementation process within the organization.

Evaluate and Action Plan

The second tier in building a trauma-informed model involves a process of evaluation. Although one-time evaluations are generally not effective in changing systems, conducting a basic evaluation of program’s level of trauma-informed care using a psychometrically validated instrument can be useful to determine readiness. During tier 2, quantitative data from organizational measures is obtained and integrated with the focus group and qualitative process data to develop an action plan for implementation. Tier 2 culminates with the development of an organization specific, strategic action plan to guide implementation.

Ongoing Implementation

The third tier focuses on ongoing implementation and evaluation. This may include ongoing work with leaders, supervisor training, consultation on implementation challenges, and additional trainings for specific staff roles and programs. During site visits, focus groups with staff and clients, and periodic re-evaluations are conducted, as is updating of action plan as needed.

Recommended:18-month Implementation and Evaluation Plan

To effectively implement and evaluate trauma-informed care, a minimum of 18-months is recommended. This allows time to evaluate baseline organizational functioning and implement required trainings, adapt policies and procedures, and measure changes in staff attitudes, knowledge, and skills. It also allows enough time to measure any initial changes in organizational culture. For maximum effectiveness, 3-years is generally needed to see deeper system level changes and client level impacts.

Are we ready to shift public service systems and respond
to trauma in coordinated, evidence-based ways?
When we look into the eyes of a child
who has experienced trauma,
the real question we must ask ourselves is:
how can we not?

Contact or 908-745-8993 to discuss how to help your organization become more trauma-informed.

Examples of Our Work

The Road Home — Salt Lake City, Utah (2016-2017)

“Artemis Associates has been a key in implementing a Trauma Informed Care (TIC) framework at The Road Home. Carmela adopted her training to meet the varied needs of staff and made the information accessible to a range of teams – from Operations to Administration. Carmela’s knowledge of organizational change and the time it takes to transform a culture has assisted us in pacing the implementation process so that we are set up for success. Under Carmela’s guidance we created an organization-wide work plan for our first year of TIC implementation and look forward to continuing the journey towards a trauma informed transformation.”
Jeniece Olson, Director of Supportive Housing Services

Bivona Child Advocacy Center – Rochester, NY

Bivona Child Advocacy Center delivers excellence in child abuse response, healing, and prevention through collaborative service, awareness, education, and leadership.

The Bivona Child Advocacy Center (Bivona CAC) secured the services of Artemis Associates to assist the organization in assessing and developing its level of trauma-informed care from January-December 2018.

Following an orientation with the Board of Directors, and a kickoff training with all staff, baseline evaluation was conducted using multiple organizational measures and qualitative interviews. The final report was presented to the trauma workgroup to create an evidence- based action plan to develop more trauma informed services. Ongoing consultation and additional training is being provided guided by the action plan and staff needs.

Center for Transforming Lives — Fort Worth, TX

“I would highly recommend Dr. DeCandia for any organization trying to increase effectiveness with traumatized populations or deepen their trauma-informed approach to services. We engaged her in Fort Worth and Tarrant County to bring a greater awareness to our work with homeless women and children. We found her to be equally effective with large and small groups, with staff who are new to the work or possess significant clinical and programmatic expertise. She is an excellent listener and is therefore able to tailor her presentations and consultation to the individual needs of the program or agency.”
Carole Klocek, CEO

The YWCA of Rochester and Monroe County, NY

“Dr. DeCandia was instrumental in helping all staff, leadership, Board of Directors and our stakeholders understand why this work is critical and to help us put skill into action. The work is emotional, exposing, but most importantly rewarding! Our entire organization has enthusiastically embraced the concept of trauma informed care. We continue to work with Dr. DeCandia to help us develop new competencies, implement policy and to help us navigate uncharted waters. We highly recommend her expertise and talent to help other organizations transform and have collective impact on those who have experienced trauma. This is truly a great investment!”
Carrie Michel-Wynne, VP, Strategic Partnerships and Donor Relations.