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Trauma Responsive Care Outcomes: Measuring the difference


You know that whenever you try something new in my agency, you had to feel confident that the change will make a measurable difference. We’ve described the top 7 improvements Trauma Responsive Care made in one agency, including a nearly 40% drop in Unusual Incidents and Major Unusual Incidents.

Our client is a large, urban-based provider of services to people with intellectual and other developmental disabilities. This agency serves people with high needs and confusing or challenging behavior, including non-verbal and/or medically complex situations. These outcomes, measured over an 18-month project, reflect the story of Trauma Responsive Care. They are impressive and reflect the great work of strong leadership and dedicated staff, including implementing Trauma Responsive Care.

Here are some of the outcomes:

  1. Overwhelming positive reactions from staff to the training. The overall evaluation (on a 5-point scale) averaged 4.5.

  1. Measured improvements in staff’s level of knowledge of trauma and Trauma Responsive Care. Using a pre-test/post-test model, we measured a 3.2% increase in knowledge base through the pre-test post-test evaluation. One class showed a 6% increase. Given that the agency had been training on and discussed some key elements of Trauma Informed Care with all staff before the initiative started, this result is impressive.

  1. 153% improvement in self-assessed trauma readiness. Significant organizational improvements on two scales measuring preparedness for trauma-informed and trauma-responsive care. The agency improved their score on the Creative Cultures of Trauma Informed Care (CCTIC) Fidelity scale from 2.2 to 4.7. This is an improvement of 114%. On a separate scale, the APG Organizational Assessment, developed for use in Medicaid Waiver services, the agency jumped from a pre-TRC score of 5.17 to 13.06 (on a 15-point scale) at the end of the project. This is a 7.9-point increase.

  1. Improved staff retention by 20%. In 2015, the baseline year, turnover at the agency was 70.6. In 2016, the year of implementation, turnover dropped to 48.3, a decrease of 31.7%. There are many factors that contribute to this impressive improvement in turnover, including a change in leadership in 2015. However, this reduction occurred amid rapid expansion, which makes it all the more impressive. TRC is only one of many factors, but is in indicative of improved job satisfaction and improved retention.

  1. 38% drop in Unusual Incidents (UI) and Major Unusual Incidents (MUI).  Most striking is the overall drop in UI’s and MUI’s following the implementation of the CALMER Approach. (See graph). The sharp decline starts in the 3rd quarter of 2016, with the training of all agency staff in that same quarter. This downward trend has persisted for a year.


  1. 43% decrease in the use of restraints and a 29% decrease in the use of emergency services. This is a critical issue for Medicaid.

  1. 37% increase in positive staff interactions. The agency also measured, through sampled observation, over the course of the initiative.

Visit RoseMary Center, where these outcomes were realized.