Section 1 Executive Summary

The full mezzo-level report is extensive and highly technical. To make the content and critical findings of the report more useful to community stakeholders, Forsyth Futures staff are producing a series of blog posts in the Spring and early Summer of 2022 on the following topics:

  • What is trauma and why does it matter?
  • Stress and trauma experienced by staff at child-serving organizations;
  • Where are child-serving organizations in our community on their journey to being trauma informed?
  • What was learned from the assessment, and what are next steps?

These blog posts can be accessed at https://www.forsythfutures.org/trc-community-institutional-assessment/

1.1 Introduction

The Center for Trauma Resilient Communities (CTRC) Resilience Framework examines the concept of trauma resiliency within the context of community. Bronfenbrenner’s ecological systems theory, which considers the interpersonal and environmental factors that affect individual and community development, is the basis for understanding the Resilience Framework. This approach is also informed by John Ogbu’s cultural-ecological approach, which looks at the study of institutionalized patterns of behaviors and features of the environment. The Trauma Resilient Community (TRC) framework defines a community at three levels — the micro, mezzo, and macro levels:

  • The micro level focuses on individuals, peers, families, and schools.
  • The mezzo level focuses on the systems and institutions which impact communities, such as education, housing, transportation, employment/labor, law enforcement, health and human services providers, faith-based institutions, and community-based organizations. The CTRC will focus on the mezzo level for much of the initial work.
  • Macro level factors include public (government) and private (corporations) sector policies; political climate; culture; and socio-economic factors such as violence, race, gender, and income.

This Executive Summary includes the information that Forsyth Futures gathered at the mezzo (organizational) level through a literature review, survey, and interviews on the following research topics:

  • broad community context of trauma;
  • child-serving organization staff experiences of adverse childhood experiences (ACEs), COVID-19, and secondary traumatic stress;
  • child-serving organizations’ current familiarity and alignment with the TRC model;
  • the ability of organizations’ staff to bring about systems change through transformational leadership; and
  • ways in which child-serving organizations are approaching racial justice and experience or observe structural violence.

The information gathered on alignment with the TRC model include two subcomponents: an environmental assessment and the seven commitments of the TRC model.

  • The environmental assessment asks questions about the physical environment (or the physical work space) and the social environment, or questions about relationships and how people feel and are treated. The environmental assessment includes the seven commitments of the TRC model that promote organizational change and address the ways in which chronic stress, adversity, and trauma influence individual behavior; additionally, they recognize the ways in which whole organizations can be influenced by chronic stress, adversity, and trauma. The seven commitments are: non-violence, emotional intelligence, social learning, shared governance, open communication, social responsibility, and growth and change.
  • The staff practices scale asks about staff practices and attitudes being in alignment with the TRC model.

1.2 Research Sample and Methodology

The Stakeholder Advisory Committee (SAC) played a leading role in the determination of the mezzo-level research topics and the stakeholder groups who were included in the survey and interview samples. The stakeholder groups identified by the SAC were Winston-Salem/Forsyth County Schools, child care providers, home visitation programs, social service providers, and medical service providers.

A total of 255 surveys met the following criteria for inclusion in the analysis: the respondent was at least 18 years old, consented to participate, completed at least the first set of questions in the survey, and was currently employed at an organization included in the list of stakeholders described above. Analysts disaggregated survey responses by organizational position, experience with the TRC model, race/ethnicity, severity of impact experienced as a result of COVID-19, gender, education, and income. Disaggregated data was only included in the full report for cases in which differences between demographic groups were statistically significant.

A total of 23 in-depth interviews were conducted and analyzed for major themes. This analysis included an examination of how these themes varied across demographic groups.

1.3 Overall Conclusions

The following conclusions were pulled out across all of the topics that were covered in the study.

  • Staff in child-serving organizations had similar experiences of ACEs and racial discrimination to residents in the county, generally.
  • COVID-19 has significantly impacted staff in child-serving organizations, potentially increasing the level of stress and trauma they experience.
  • Survey respondents from child-serving organizations are not widely familiar with the TRC model, but generally have high scores on scales measuring the alignment of their organizations’ practices and environment with the TRC model. It is important to note that there is variation in scores on these scales indicating that some individual organizations may be experiencing less alignment.
  • Organizational leaders often had higher scores than other employees on the Environmental Assessment Scale and Staff Practices Survey. While this indicates that their practices and environments are more aligned with a trauma-informed model, program planners should consider that their perspectives and experiences may be different than those of other staff members.
  • Interview participants from child-serving organizations indicated that there is a greater sense of urgency for racial equity-based work within the past few years, largely due to a growing public awareness about racial equity issues. Some organizations have sufficient resources to engage in racial equity-based practices and policies, while others face barriers such as leadership, funding, and/or staff buy-in.

1.4 Conclusions by Research Topic

The following section includes high-level conclusions from each of the different topics covered in this study.

1.4.1 Community Context

  • Racial and ethnic inequities exist across various measures of economic well-being including income, educational attainment, and home values.
  • Educational attainment is a primary pathway to increase economic opportunity, but racial and ethnic disparities are prevalent throughout all levels of the education system.

1.4.2 System of Child-Serving Organizations

1.4.2.1 Staff Experiences of ACEs and Discrimination

  • Most staff members at child-serving organizations who responded to the survey reported experiencing at least one ACE, with almost half experiencing 1-3 ACEs.
  • Staff experiences closely mirrored those reported by residents in Forsyth County with the most common reports being emotional abuse, loss of a parent, household mental illness, substance abuse, and physical abuse.
  • About 44% of respondents reported experiences of discrimination with Black / African American respondents, respondents not identifying as white, and middle-income respondents being the most likely to report these experiences.

1.4.2.2 Impact of COVID-19

  • 78% of survey respondents at child-serving organizations reported being at least somewhat impacted by COVID-19, and 20% reported being “very much impacted.”
  • Interviews with staff found that the COVID-19 pandemic not only affected how community service providers served the community, but it also added extra personal and professional stressors and trauma.

1.4.2.3 Secondary Traumatic Stress

  • Scores on the Secondary Traumatic Stress (STS) subscales were generally low, but some respondents at child-serving organizations did report high scores, indicating that they may be experiencing symptoms of secondary traumatic stress.
  • Executive officers and administrators reported lower scores on two of the STS subscales, Arousal and Avoidance, than other respondents.
  • Avoidance measures how employees responded to questions about the avoidance of stimuli associated with the care of patients and the numbing of general responsiveness.
  • Arousal measures how employees responded to questions that assess symptoms like irritability, hypervigilance, and difficulty concentrating.
  • Respondents who reported not being impacted at all by COVID-19 and those with more years of experience in the field reported lower scores on the Arousal Subscale.

1.4.2.4 Trauma-Informed Practice

  • About 72% of respondents in child-serving organizations were not familiar with the TRC model, and an additional 26% of respondents reported familiarity with the model but no training.
  • Respondents with higher levels of training generally scored higher on the staff practices survey, indicating higher levels of alignment with trauma-informed care practice at their organizations.
  • Scores on the Environmental Assessment scale and Staff Practices Survey were generally high. Some respondents had lower scores, particularly on the Environmental Assessment and some subscales of the staff practices survey. This suggests that environments and staff practices at many child-serving organizations in Forsyth County are at least moderately aligned with the traits and values of a trauma-informed care model, but the range of scores suggests that this is not the case across all staff members or organizations.
  • Organizational leaders often had higher scores than other employees on the Environmental Assessment Scale and Staff Practices Survey. While this indicates that their practices and environments are more aligned with a trauma-informed model, program planners should consider that their perspectives and experiences may be different than those of other staff members.

1.4.2.5 Racial Equity and Structural Violence

  • Interview participants from child-serving organizations indicated that there is a greater sense of urgency for racial equity-based work within the past few years, largely due to growing awareness of racial equity issues.
  • Respondents indicated that some organizations have sufficient resources to engage in racial equity-based practices and policies, while others indicated they face barriers such as leadership, funding, and/or staff buy-in.
  • Respondents reported that, in general, their organization’s culture is inclusive and supportive of people from diverse backgrounds; however, some respondents indicated that it is common that staff members of color were expected to assimilate into dominant white cultural norms.
  • Many organizations serve members of the community who have experienced structural violence, which suggests there are many adverse experiences that the community encounters which can compound pre-existing trauma or lead to new forms of stress and trauma.

1.4.2.6 Transformational Leadership

  • Scores on the global transformational leadership scale were generally high, indicating that leaders in the child-serving organizations that completed the survey were likely to have the leadership skills necessary for institutional change, but these scores did vary across organizations.