Unmasking the Silent Impact of Trauma in Nonprofits

A trauma-informed culture enhances your nonprofit’s organizational sustainability, employee well-being, and overall productivity.

I want to start with a thought exercise: Imagine you supervise a dedicated, yet mercurial, hotline worker named Danielle, who has difficulty getting to work on time. To discuss Danielle’s regular tardiness, you call her into your office. You sit her down, and begin to explain, “Danielle, we need to talk about your being late so often— ”

Without allowing you to complete your thought, Danielle stands up and begins shouting at you — about how hard she tries, and how you just can’t understand. This shouting continues for five minutes while you attempt to calm Danielle down.

Think through your reaction to Danielle’s outburst. What would you do? Would you be inclined to fire her, or would you try to understand her anger and help her?

As if this situation was not complicated enough, let’s add another layer: What would you say if you knew that Danielle’s behavior was a reaction to a trigger that stemmed from her traumatic past?

As nonprofit leaders and supervisors, we’ve all had staff who were disruptive, erratic, and/or depressed to the point of decreased performance and troubled interpersonal relationships. My organization, a trauma-informed agency, understands that many — if not most — of our staff have had trauma in their past and may not have worked all the way through their trauma history.

However, we’ve learned that being truly trauma informed and trauma responsive can facilitate both staff and client recovery. And from what we know and continue to learn about trauma, being trauma responsive contributes to a healthy work environment where everybody flourishes.

So why should nonprofit leaders care about trauma?

Trauma is a pervasive problem. It results from exposure to an incident or series of events that are emotionally disturbing or life-threatening, with lasting adverse effects on the individual’s functioning as well as mental, physical, social, emotional, and/or spiritual well-being. Experiences that may be traumatic include physical, sexual, and emotional abuse; childhood neglect; and/or living with a family member with a mental health or substance use disorder.

A large study of childhood trauma found that more than half (60%) of American adults report experiencing at least one traumatic incident before the age of 18 —  and 25% report three or more. This is especially alarming because childhood trauma has been found to be related to physical ailments in adulthood (asthma, hypertension, stroke, cardiovascular disease), behavioral health challenges (depression, anxiety, substance misuse), and social challenges (unemployment, homelessness). The higher the number of traumatic incidents during childhood, the higher the likelihood of negative impacts in adulthood.

So, chances are a number of your nonprofit staff may still be trying to work through individual childhood trauma — perhaps a greater number than you imagine.

And then there’s collective trauma.

Trauma can also affect populations of people, such as neighborhoods, or even an entire country. For example, racism has a highly traumatic impact on people of color. Poverty and violence in the community can be equally traumatic to multiple groups.

Following the onset of the COVID-19 pandemic, experts began predicting that a behavioral health crisis would arise during the pandemic. Rates of depression, anxiety, and substance misuse would theoretically increase, as would family violence.

Unfortunately, the experts were right. In 2022, Mental Health America found that the number of people looking online for help with their mental health increased significantly from 2019-2021. In 2021, over 5.4 million people took an online mental health screen, a nearly 500% increase over the number in 2019 and a 103% increase over 2020. The study also revealed that there were significant increases in the percentage of people scoring at risk for post-traumatic stress disorder, severe anxiety, and psychotic-like experiences from 2019-2021. Not only were the predictions coming true, but we were also recognizing our own challenges as well as the need to reach out for help.

For many, COVID-19 not only caused collective trauma but also exacerbated past trauma. As the research indicates, this trauma — collective and past — presents significant lifelong challenges. As such, it is unrealistic for nonprofit leaders to expect that staff members would not bring trauma to work with them.

There are consequences to ignoring trauma.

Let’s assume that a meaningful number of our staff has experienced trauma in their past. Consider the impacts on our organization. What could happen if we ignore the behavioral health of our staff?

When thinking through potential consequences, here are five things to keep in mind:

1. Trauma often results in a loss of trust in others.

We know that interpersonal trust as well as trust in the organization are critical for weathering difficult times. A staff that does not trust each other or their organization most likely would not perform at their peak.

2. Unaddressed trauma can create trauma responses, often when triggered by an external stimulus.

Think back to our conversation with Danielle about being tardy. These reactions can create difficult interpersonal relationships within the organization as trauma responses are often out of proportion to the situation at hand. Reactions may come in the form of anger, sadness, or fear, and their unpredictability might cause both people — the triggerer and the person being triggered — additional frustration.

3. This line of work is rife with triggers.

Especially in human service organizations, working with clients (or even among organizational staff) can be triggering, evoking the memory of a past trauma. When an individual is triggered, a trauma response, such as depression, fear, or anxiety, may be produced.

There are as many triggers as there are people, so no list could possibly be exhaustive. However, here are some sample triggers:

Again, part of the issue with triggers is their unpredictability, and this volatility only increases interpersonal tension.

4. Unaddressed trauma can lead to higher turnover.

Individuals with a complex trauma history (meaning they have experienced multiple traumas) may have less armor to guard against triggers. This can result in their leaving employment prematurely (or job-hopping), causing your organization high turnover. As we are all probably keenly aware, recruiting and training new hires is expensive and labor consuming.^[1] For small to midsize nonprofits, the cost (and time) can be prohibitive.

Of course, there is also the added cost to the previous employees themselves. That is, the more job-hopping an employee does, the more likely they are (generally) to experience joblessness. And considering unemployment can itself be a source of great stress, the possibility of either being triggered or further traumatized (potentially both) greatly increases.

High turnover also results in job insecurity among the remaining staff. Job insecurity can foster a lack of trust in organizational leadership and increase anxiety.

5. Not being trauma-informed can result in re-traumatization.

As the previous point alludes to, a lack of understanding of trauma-informed care can retraumatize both our staff and us as leaders.

On the other hand, using trauma-informed practices can safeguard our employees and ourselves from the impacts of past and present trauma. A trauma-informed culture not only decreases negative responses to workplace triggers (i.e., “bad behavior”) but also reduces the likelihood of creating new trauma for employees.

So how can nonprofits be more trauma-informed?

While these consequences are not pretty, there are things you can do to create a trauma-responsive organizational culture.^[2] The federal DHHS Substance Abuse and Mental Health Services Administration (SAMHSA) and Center for Disease Control and Prevention (CDC) have used their work with behavioral health^[3] clients to inform their recommendations for trauma-informed approaches and practices in a variety of settings.

SAMHSA says there are four Rs to becoming trauma responsive. To be trauma responsive, all members of the organization must:

• REALIZE the widespread impact of trauma and understand potential paths to recovery.
• RECOGNIZE the signs and symptoms of trauma in clients, coworkers, friends, and family.
• RESPOND by fully integrating knowledge about trauma into policies, procedures, and practices.
• RESIST re-traumatization.

While the Four Rs are informative, they are a bit abstract. However, SAMHSA offers an alternative model of six areas which help to make these four Rs more actionable. These six areas include:

1. Safety

Throughout the organization, staff and the people they serve (both children and adults) feel safe physically, psychologically, emotionally, morally, and spiritually.

Within a safe environment, all members feel free to express themselves and to explore alternative methods of processes. This philosophy appreciates trial and error, understanding failure as an integral part of the process.

A part of this safety and security must be physical as well. For example, parking for staff and clients should be ample and nearby. Similarly, proper lighting in parking structures and walkways will promote a sense of security for employees working during dark hours.

2. Trustworthiness and Transparency

Organizational operations and decisions are conducted with transparency to build and maintain trust within the organization.

Discussions about operations and programming should include representation from all levels of the organization impacted by the discussion. Transparency such as this can be invaluable to building trust.

In addition, employees should be well-informed about policies and procedures that may impact their work. Moreover, organizations need to be transparent with staff about information about operations (including finances), visioning and strategic planning, and programming to staff.

3. Peer Support

Peer support must be encouraged and sustained. In my organization, for example, we are fortunate to have a psychologist on staff who holds a monthly peer support group for staff. Members of senior leadership are not invited to the group in the hopes staff feel freer to share. Staff are encouraged to discuss their experiences with vicarious trauma,^[4] in the hopes of alleviating it.

4. Collaboration and Mutuality

The power differential among staff is leveled through collaboration. Staff throughout the organization view each other as partners working toward a common goal, and hierarchy is minimized.

If we think back to the section on transparency, we realize that having members of all levels of the organization participate in discussions and decisions about issues that impact their work also fosters collaboration and mutuality. Additionally, within a trusting organization, staff feel their work is equally as important as their superiors’ and recognize the important part each individual plays in the operations and services of the organization.

5. Empowerment, Voice, and Choice

Staff members are given a voice in the decisions which affect them, rather than being silenced or treated with coercive control.

Organizational leadership must effectively communicate with staff about organizational goals to enable staff to actively support them. Staff concerns about either the goals or their implementation should be heard and considered (a suggestion box is one idea for collecting staff input). Organizational trust will ensure that staff feel safe enough to voice their thoughts.

Organizations can also disseminate staff surveys to gauge employee perceptions on how well the organization is living up to its commitment to becoming trauma informed.

6. Cultural, Historic, and Gender Issues^[5]

We must recognize our own biases and prejudices. Historical, racial, ethnic, and gender trauma should be acknowledged and addressed.

To transform into a trauma-responsive culture, organizational leadership (including the board of directors) and staff members need to recognize and eliminate any potential cultural, racial, gender, or other biases. One way to do this is to conduct training for staff and board members about implicit bias, anti-racism, equity/inclusion, and culture-specific content (e.g., BIPOC, LGBTQ, gender, etc.).

Organizations should devise processes and protocols to accommodate the cultural needs of staff, as appropriate. The potential for re-traumatization from the lack of sensitivity to cultural, racial, gender, or any other biases is a major concern when developing a plan to create a trauma-informed culture.

Of course, these six principles must be systematically aligned throughout the organization. To better understand your organization’s current culture, check out this assessment to ascertain your trauma responsiveness. The questionnaire is to be completed confidentially (i.e., with no identifying information attached to the responses) by staff with the aggregate data used to focus on improving low-performing areas. While the survey was designed for organizations that provide direct services to clients, many items can be reframed to focus on internal processes and relationships, instead of client work.

A trauma-informed culture may be the key to nonprofit sustainability.

While human service agencies are beginning to realize the benefits of adopting trauma-informed practices, other nonprofits (and for-profit organizations, certainly) are only just learning about the impact of trauma on their workforces. Given the prevalence of trauma in our society, practicing trauma-informed principles is critical to organizational sustainability, including recruiting and retaining talented staff while reducing health care costs and absences due to behavioral health needs.

Experts predict that we will be seeing the collective behavioral health impacts of the pandemic for at least 15-20 years, impacts which include increased depression, anxiety, suicide attempts, and substance misuse. We are not sure what the long-term effects of isolation and homeschooling on children will be. But of course, we must be cognizant that current-day children represent our future nonprofit employees and leaders.

With state and local government (e.g., State of Tennessee; State of Maryland; City of Baltimore, MD) leaders passing legislation to create trauma-informed dominions, organizations that don’t follow suit may find themselves out of step with their funders.

Let’s go back to the scenario with Danielle. What would you do now? Using trauma-informed care, how would you change your approach?

[1] Keep in mind that culture change can take years, so don’t expect to get it right on the first go. A shift towards providing a trauma-informed culture should be an ongoing process, not a one-time, rapid change.

[2] Behavioral Health here refers to both mental health and substance use.

[3] Vicarious trauma occurs in helpers and caregivers who make an empathic connection with a trauma survivor and experience trauma by proxy, so to speak.

[4] Not all trauma-informed cultural change models include Cultural, Historic, and Gender Issues as one of their principles. Instead, some make any or all of the following into equal principles Equity, Anti-Racism, and Anti-Bias. The Maryland’s Governor’s Commission on Trauma Informed Care is using one such model to create trauma informed cultures within state agencies.

[5] This assessment was adopted from the National Center on Family Homelessness Trauma-Informed Organizational Self-Assessment as well as an article by Roger D. Fallot, Ph.D. and Maxine Harris, Ph.D., entitled “Creating Cultures of Trauma-Informed Care: A Self Assessment and Planning Protocol.”

Sample Form

Culture Assessment

Sources

[1] According to the 2018 Training Industry Report, nonprofit organizations spent around $1,360 training each new employee in 2017.

[2] Keep in mind that culture change can take years, so don’t expect to get it right on the first go. A shift towards providing a trauma-informed culture should be an ongoing process, not a one-time, rapid change.

[3] Behavioral Health here refers to both mental health and substance use.

[4] Vicarious trauma occurs in helpers and caregivers who make an empathic connection with a trauma survivor and experience trauma by proxy, so to speak.

[5] Not all trauma-informed cultural change models include Cultural, Historic, and Gender Issues as one of their principles. Instead, some make any or all of the following into equal principles Equity, Anti-Racism, and Anti-Bias. The Maryland’s Governor’s Commission on Trauma Informed Care is using one such model to create trauma informed cultures within state agencies.

[6] This assessment was adopted from the National Center on Family Homelessness Trauma-Informed Organizational Self-Assessment as well as an article by Roger D. Fallot, Ph.D. and Maxine Harris, Ph.D., entitled “Creating Cultures of Trauma-Informed Care: A Self Assessment and Planning Protocol.”

About the Author

Inga James 

Inga James has been President and Executive Director of Heartly House since 2014 and has more than forty years working within the human services and nonprofit sectors. Dr. James sits on several boards dedicated to family violence, including the Maryland Network Against Domestic Violence, for which she is the immediate past president. In 2019, she was appointed to the Governor’s Workgroup to Study Visitation and Custody Decisions When Child Abuse or Domestic Violence are Alleged and, in 2021, she was named to the Governor Commission for Trauma Informed Care. In 2020, in response to the pandemic crisis, Dr. James founded, and now chairs, Trauma Responsive Frederick. Dr. James has a master’s degree in social work as well as an MA and PhD in organizational psychology.

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