Earlier this year, FPWA worked in partnership with a Capstone Team from New York University’s Wagner School of Public Service to explore best practices in designing People-Centered, Trauma-Informed (PCTI) public policy. Then, the students applied those practices to New York City’s cash assistance program – the state’s primary program for providing direct cash to individuals and families with the lowest incomes – to gain a better picture of what this framework looks like in practice and how it can improve the delivery of critical services to New Yorkers. They found that PCTI approaches can help alleviate access and retention barriers, improve program administration, and ensure a level of dignity and empathy for those seeking assistance. The recommendations from their research are included in our new report, Rewriting the Story, which shares findings from a series of interviews we conducted with recipients of cash assistance.
We sat down with Julia Casey, Senior Policy Analyst, and FPWA’s Programs team, Lauraliz Morales-Silva, Director of Programs; Silvia Mejía, Program Manager; and Clare Brennan, Program Coordinator, to learn more about the PCTI framework and its implications for programs and policy.
Q: Tell us more about how this work came about.
A [Julia]: This was really a continuation of work that FPWA has been doing for a long time. On the programmatic side, we focus on capacity building offerings such as trauma-responsive training and resources for nonprofit organizations and social service providers. And on the policy side, our work is focused on policies that promote economic security, and we do this work with an eye toward people-centered policy design. Building upon this work, the Capstone team conducted research into PCTI approaches and applied the framework to the cash assistance program. In their analysis, they focused on people with lived experience, conducting in-depth interviews with cash assistance recipients in NYC to inform their understanding of the current program design and identify the main barriers that prevent New Yorkers from accessing the program. The team then developed strategies to mitigate these barriers based on their research into PCTI policy design.
In our most recent report, Rewriting the Story, we not only include their PCTI-focused recommendations, but we also conducted another series of interviews with individuals with lived experience using this same approach. So we’re really thinking about using a PCTI approach in all aspects of our work – from the trainings we offer, to the policies we advocate for, to the way we center people with lived experience in our research and analysis.
Q: But what exactly do we mean by a People-Centered & Trauma-Informed (PCTI) approach? And what might this look like outside the context of one specific program?
A [Programs team]: We outline this in a 2-pager we published recently, but essentially, PCTI combines respect for individual needs (person-centered care) with an acknowledgment of the impact and prevalence of trauma (trauma-informed care). Using a PCTI approach is about creating a supportive, inclusive environment that resists re-traumatization and gives people autonomy to make decisions about their own needs. But traditionally, these approaches have been used separately. So the PCTI approach offers a more holistic model. It also considers the role of the environment and systemic forces like racism and how that impacts people’s day-to-day lives.
Q: Why was it important for FPWA to explore this topic?
A [Programs team]: The prevalence of trauma is staggering. It’s estimated that as many as 90% of U.S. adults report having experienced at least one traumatic event in their lifetime.[1] So we have to really begin recognizing the impact that has on folks and on how they move through the world. Individuals who experience trauma often come away from those experiences feeling unsafe, violated, or disempowered. People who experience trauma often also feel like they have lost control. So it’s critical that we have programs – whether they be through nonprofits, human service organizations, or government agencies – that create safe and supportive environments for everyone, where individuals have agency over their lives and the support they need to reach their goals. And in both public and non-profit services, these strategies have been shown to improve outcomes, because they help foster trust that then leads to better engagement and progress. These strategies also have been shown to empower staff, because understanding trauma helps them provide more effective support. They also help foster stronger relationships between service providers and clients, and they reduce costs by
Q: What are some ways to implement PCTI approaches?
A [Programs team]: Simply, it’s about having policies and procedures in place that center the person. That means creating safety through your physical space and demonstrating trustworthiness, consistency, transparency, and predictability. Policies and procedures should also restore power through choice, empowerment, strengths-based assessments, skill building, and avoiding shame and blame. Policies and procedures should also support self-worth through respectful relationships, peer support, collaboration, compassion, acceptance and non-judgement. So for example, this could look like developing goals and treatment plans with clients rather than for clients. Trust that they have expertise when it comes to their own well-being. example is moving away from punitive responses that cause further harm. If a client misses an important appointment, instead of kicking them out of the program and removing what might be their main support system, staff should work with them to understand why they missed it and how to best move forward. Do they need childcare? Are they struggling to pay for transportation? Training is also key – staff should be equipped with skills to recognize trauma and provide empathetic, culturally appropriate support. And this kind of training can’t just be one-off. It should be ongoing and made accessible to staff at all levels.
Q: And what does it look like to apply a PCTI lens to public policy?
A [Julia]: A PCTI approach should serve as a framework for public policy that has a direct impact on people’s lives. First and foremost, this means recognizing the impact of racism and other forms of oppression and promoting equity by supporting individuals and families to not just meet their needs but also to live with dignity. It also means ensuring supports are widely available and easily accessible, reducing bureaucratic barriers such as paperwork requirements, ensuring language access and accommodations for people with disabilities, and using accurate measures of need to determine eligibility. It also means people with lived experience should be involved in decision-making around policy design and implementation.
In Rewriting the Story, we included the Capstone team’s recommendations to improve access and retention to the cash assistance program and build a more equitable program utilizing a PCTI framework. Some of these recommendations are the same recommendations we’d make to nonprofits looking to implement a PCTI approach in their programs. For example, we recommend revamping social services offices to create a welcoming, accessible environment for folks applying for benefits, with clear signage, printed resources in multiple languages, a simple check-in process, ample seating, and designated private areas for individuals to complete their application/recertification. We also recommend offering individualized case management, because in the interviews for our report and for the Capstone team’s project, participants consistently expressed uncertainty about program rules and eligibility. This would help foster transparency and predictability, which are key tenets of the PCTI approach.
But we also include recommendations that apply the same principles of the PCTI framework to specific aspects of the policies and procedures that govern the cash assistance program and other benefits programs. And to summarize, it’s really about minimizing all the strings attached. For instance, we recommend that the state determine ways to ease the paperwork burden on applicants and recipients. A key feature of PCTI approach is predictability, so we also recommend improving communication and information regarding the application and recertification processes, eligibility, and program requirements. Not only is transparency important between the case workers and program participants, but transparency is also important to the public, so we recommend improving data collection to measure program’s impact, such as on recipients’ income, assets, employment, and educational outcomes. This data should also be disaggregated by race and gender to better identify and address disparities. Finally, we also recommend establishing better processes to foster collaboration where people with lived experience, advocates, and other key stakeholders can provide input on policies and procedures. These efforts not only provide valuable data, but they also demonstrate a level of respect for individuals navigating these programs on a daily basis.
For more information, check out these FPWA resources:
- Rewriting the Story report
- People-Centered & Trauma-Informed Approach (PCTI): A Better Way to Serve
- Trauma-Responsive Organization Checklist
- Trauma-Informed Service Delivery: Strategies and Actions when Working with Individuals
Sources:
[1] Kilpatrick DG, Resnick HS, Milanak ME, Miller MW, Keyes KM, Friedman MJ. National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J Trauma Stress. 2013;26(5):537-547. doi:10.1002/jts.21848
