Surpassing Structural Trauma: Post-Traumatic Growth in Teaching Health Center Clinical and Educational Systems

Proposal: Goals of Surpassing Structural Trauma: Post-Traumatic Growth in Teaching Health Center Clinical and Educational Systems are for participants to:
engage in discussion of trauma-organized, trauma-informed, and recovery-oriented, trauma-competent systems.
illuminate strategies for moving from trauma-organized to a recovery-promoting, trauma-competent culture
support exploration of home organizations to determine how application of intentionally designed, recovery-promoting, trauma-competent cultural development strategies may systematically support colleagues, staff, trainees, and patients, families and communities served.

Learning Objectives - As a result of engaging, participants will be able to:
describe and differentiate trauma-organized, trauma-informed, and recovery-promoting, trauma-competent systems
articulate strategies for moving system culture from trauma-organized to recovery-promoting, trauma-competent
appreciate how recovery-promoting, trauma-competent cultural approaches might benefit inclusive stakeholders in their home system(s)

Psychiatrists Sandra Bloom and Arnon Bentovim define trauma-organized systems as systems that have become organized around the impact of chronic toxic stress and adversity, perpetuating the trauma they are designed to help. Health professions’ and medical education institutions struggle under such implicit, trauma-organized frameworks, as do most healthcare delivery systems. At mercy of significant discordance between responsibilities and resources, primary care systems are undeniably impacted. It is not wholly unfair to assert that many of the ubiquitous challenges faced by trainees and practitioners are unfortunately, whether directly or indirectly, the expected outcomes of systems that are trauma-organized.

In “From Crisis to Growth: A Guiding, Pragmatic Model During a Global Pandemic,” Jones et al1 describe an organizing cognitive framework and leadership strategy to guide how an organization intentionally navigates through progressive zones of acute crisis, adaptation, and growth. Key inspirations include embracing disequilibrium and uncertainty; appreciating loss and fear; keeping grief constructive, productive, and future focused; leveraging connectedness and collective genius; and iteratively celebrating systematic adaptations and applied learning. This integral publication challenged sponsoring institutions to allocate resources toward reflection, repair, and renewal, not only through the unprecedented trauma of COVID-19 but also the complex trauma related to historical, systematic racism, classism, sexism, and other forms of oppressive hierarchy that plague our national healthcare and medical education industries.

From inclusive, individual and team growth coaching and wellness initiatives to promotion of active presence and able skills to remove oneself from grind culture and to settle collective disturbances, there are likely as many models of wellness, repair, and renewal as there are organizations that could benefit from such enhancements. The Surpassing Structural Trauma workshop will briefly review available strategies and then take a deep dive into Sanctuary Certification as one recovery-promoting, trauma-competent cultural transformation model for an organization to own, address, and thrive beyond its historical, trauma-organized structural foundation.

After various challenges related to the COVID-19 pandemic, the executive team and Boards of Directors for The Wright Centers for Community Health and Graduate Medical Education committed to investing deeply in the three year journey of Sanctuary Certification to transform both organizations into a recovery-promoting, trauma-competent enterprise. Founded by Dr. Bloom and continued by the work of the Sanctuary Institute, the Sanctuary Certification process employs four pillars of Shared Knowledge of Trauma Theory; Shared Values of Nonviolence, Emotional Intelligence, Social Learning, Democracy, Open Communication Social Responsibility, Growth and Change; Shared Language to guide reactions and behaviors in terms of Safety, Emotions, Loss and Future; and Shared Practice using Sanctuary tools and interventions to reinforce the model’s philosophy. Reliably demonstrating twenty-eight standards is required.

Presenters are the President and CEO and the DIO as well as the senior executive and project manager leading the implementation of the Sanctuary Model. The Surpassing Structural Trauma workshop will detail our experiential journey to date, sharing activities, “aha” moments, pearls, and hard-won lessons about emerging through complex crises to growth guided within the Sanctuary Certification framework.

Jones WS, Philibert I, Konopasek L, Hafferty FW. From Crisis to Growth: A Guiding, Pragmatic Model During a Global Pandemic. Journal of Graduate Medical Education. 2021;13(2):170-173. doi:10.4300/jgme-d-20-01146.1