Supporting the Public Health Workforce with Trauma-Responsive Leadership Skills

December 19, 2023 | Omar Khalid, Kelsey Tillema

The public health workforce has faced extreme challenges in recent years. The associated stress and trauma have contributed to a wide range of poor outcomes, from decreased engagement and turnover to poor mental and physical health (all of which jeopardize public health agencies’ ability to serve their community). As organizations look to recover and support the healing and wellbeing of the public health workforce, prioritizing a supportive response to this widespread trauma can be critical in bringing about systems-level change.

The PH-HERO (Public Health – Hope, Equity, Resilience, Opportunity) Learning Community is comprised of 13 governmental public health agencies* committed to a trauma-responsive approach to supporting their workforce. It is a flagship program in ASTHO’s work on the Public Health Infrastructure Grant. In early November 2023, each agency sent a delegation to participate in a PH-HERO Kickoff and Lodestar Consulting’s BRAVE Leadership Training conducted in Denver. The training focused on the fundamentals of a trauma-responsive leadership framework and how it can help improve psychological safety and organizational culture in public health agencies.

What is Trauma-Responsive Leadership?

Understanding the universality of harm and how to mitigate toxic levels of stress is a crucial component when it comes to creating a culture of healing from burnout, moral injury, and trauma. PH-HERO seeks to move health agencies from being trauma-informed to being trauma-responsive.

Experienced trauma and subsequent activations have an observed neurological effect on the prefrontal cortex, and this knowledge has been employed in healthcare delivery and understanding conditions like post-traumatic stress disorder (PTSD). Trauma-informed leadership is founded upon the awareness and recognition of toxic stress and trauma and how it affects the individual as well as workplace culture. Trauma-responsive leadership is not about treating or diagnosing, but it does provide leaders with tools, strategies, and skills to disrupt continuums of harm and to implement policies that can mitigate the harmful effects of trauma to foster an environment of psychological safety.

Key Takeaways to Integrate Trauma-Responsiveness into Your Leadership Practice

Participants in the BRAVE leadership training spent three days learning and discussing how to build trauma-responsiveness within their health agencies. ASTHO staff who also participated in the training have shared some key and actionable takeaways to help you explore ways to support your workforce and improve organizational culture.

What Is Trauma?

Trauma can be anything too fast, too soon, too long, without a mitigator. Trauma is subjective—that is, it is defined by the person experiencing it (and by the presence or absence of mitigating protective factors). Trauma is universal—the penetrance of trauma is 100%.

We typically think of trauma as traumatic events, but it can also be exposure, such as witnessing traumatic events or sustained exposure to a traumatized organization. Trauma in a person, decontextualized over time, looks like personality. Trauma in a people, decontextualized over time, looks like culture. Finally, trauma comes out as a reaction. Sometimes, we see the reaction without making the connection to the underlying trauma. Trauma activation (sometimes called triggering) can look like aggression, apathy, or avoidance.

We Can’t Eradicate Trauma

If the penetrance of trauma is 100%, we can look to limit some sources of trauma (especially those found in the workplace), but ultimately, we can be more successful in the workplace by considering how to mitigate the effects of trauma.

While the prevalence and complexity of individual and organizational trauma can seem overwhelming, fortunately, the disruptors and protective factors are also commonplace and not dependent on clinical or technical intervention—things like trust, agency, safety, clarity, and connection. What is hopeful for organizations is that resilience, like trauma, can be vicarious and contagious once it begins to take hold.

Components of Psychological Safety

It’s easy to say you support psychological safety, but simply saying “you’re safe” doesn’t make it so. Psychological safety exists when people feel safe to challenge, admit mistakes, and speak the truth. Safe brains learn, are more engaged, and operate with more creativity and collaboration. Meaningful diversity and inclusion are specifically important to psychological safety.

Rest Is Not a Reward

Rest is not a reward from our jobs; it’s a requirement. Public health workers are dedicated and passionate about ensuring that everyone in our communities can lead a healthy life—that work can be extremely draining (more so in times of crisis). Everyone carries some trauma, but leaders should be particularly sensitive to traumatic stress experienced in the workplace. In some cases (such as emergency response), it can be difficult to prevent stress, but rest and other mitigating factors then become even more critical.

Connection Mitigates Trauma

We know that everyone has experienced the effects of trauma in one way or another, but also that there are mitigating factors that can reduce trauma’s negative effects. Social connection is one of these mitigators. Having social support activates neural regions in the brain that process safety signals and inhibit physiological stress responses. While there’s not much we can do in the workplace to address past trauma, there are many opportunities to foster meaningful social connections to support a productive and healthy workforce.

Applying the Concepts

Organizational change is slow work, but tangible steps can be taken immediately towards building trust and repairing relationships and norms. Trauma-responsive leadership not only helps address the effects of the past but can also provide a scaffolding of psychological safety and organizational competency that will benefit public health agencies for future challenges. These concepts are not about perfection or mastery but about becoming a more supportive and effective public health leader and modeling these skills for others over time.

Following the kick-off meeting, PH-HERO Learning Community participants will work alongside ASTHO to conduct customized planning workshops to create goals and plans for improving organizational resiliency, morale, and wellbeing within their agencies in 2024. ASTHO will support agencies with these plans through regular communication, technical assistance, and training opportunities to meet these wellbeing improvement goals.