• A validated organizational assessment developed by the UCLA-Duke University National Center for Child
Traumatic Stress (NCCTS)
• Incorporates the knowledge of NCTSN members with expertise in child trauma and systems change
• Measures organizational practices related to trauma-informed care
• Designed for organizations serving children and families
• Comprised of 87 items across 9 domains
• Situated within an implementation framework to support organizational change
• Flexible process that allows for tailored implementation

• Measure your organization's trauma-informed practices
• Bring to light important areas for your organization to address related to trauma-informed practice
• Identify strengths and build on the expertise already available within the organization
• Create a roadmap for organizational change related to anti-racist trauma-informed practice
• Integrate anti-racist principles within trauma-informed practice
• Establish a common language around anti-racist trauma-informed practices within your organization and your broader community of child- and family-serving agencies
• Identify resources to help your organization better serve children and families who have experienced trauma and support staff working with children and families
• Elevate the importance of partnering with youth and families
• Assess progress and improvement over time
• Maintain a sustainable and continuous focus on the need to become an anti-racist trauma-informed organization

Organizations and individuals have used the TIOA in several ways:

• Administering the TIOA to all staff and partners within the organization (recommended)
• Taking the TIOA as a group, such as with a TIC Task Force
• Utilizing the full TIOA or selected domains for group discussions among staff within the same organization
• Administering selected domains at conferences, followed by group discussions
• Demonstrating how TIC principles can be operationalized using the TIOA
• Incorporating the TIOA into research and training

The TIOA is relevant across child-serving systems and has been successfully administered in a variety of settings, including outpatient mental health, in-patient behavioral health, residential, healthcare, social services, juvenile justice, healthcare, and others.

Since the TIOA focuses on specific organizational practices, it does not explore practices that may be central to specific child-serving organizations or systems. For example, the TIOA does not include items related to trauma-informed classrooms (Schools), practices that decrease medical traumatic stress (Healthcare), the environment of care in a detention center (Juvenile Justice), or communication between parents and foster parents (Child Welfare). Therefore, some agencies may want to consider an assessment designed specifically for their service system.

Because the TIOA is an assessment and organizational improvement process, it is a terrific complement to trauma-informed practices, interventions, and approaches that may be in effect in agencies. Essentially, it can be used to help agencies assess whether the practice, intervention, or approach resulted in creating the trauma-informed organization for which it was intended. Moreover, it can be used to identify areas of strength as well as ongoing opportunities, needs, and challenges. 

There are no overall trauma-informed cutoff scores for the assessment. Achieving high scores in certain areas doesn’t equate to a formal certification. The TIOA is designed to guide organizations in understanding and improving their anti-racist trauma-informed practices rather than functioning as a certification process. The results provide insights into strengths and areas for growth across nine domains. Re-assessment helps organizations determine whether they are making progress toward becoming more trauma-informed.

When developing materials or presentations involving the TIOA, please include the following:

• Disclaimer for materials: The views and opinions expressed in this product are those of the authors and do not necessarily represent the views and opinions of the National Center for Child Traumatic Stress, the National Child Traumatic Stress Network, or the Substance Abuse and Mental Health Services Administration.
• Disclaimer for presentations: The views and opinions expressed in this presentation are those of the authors and do not necessarily represent the views and opinions of the National Center for Child Traumatic Stress, the National Child Traumatic Stress Network, or the Substance Abuse and Mental Health Services Administration.
•  Citation/Reference: Halladay Goldman, J., Purbeck Trunzo, C., and Agosti, J. (2019). NCTSN Trauma-Informed Organizational Assessment. Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress.

You will be able to download the TIOA after you sign the user agreement found here. Once completed, you will be directed to download the TIOA and accompanying implementation materials. For the best experience, we recommend using Google Chrome to access the materials. 

Only one person per organization is required to complete the agreement. If someone outside of your organization is interested in the TIOA, please direct them to the NCTSN Learning Center to complete the user agreement for their site. If you have further questions, please email us at TIOA@nctsn.org.
 

The TIOA is free and available for download after completing a short registration. Even though the assessment is free, certain resources might be required to administer the assessment successfully.

Helpful resources may include, but are not limited to:

• Online survey platform to support electronic administration
• Paper copies of the survey and costs associated with manual data collection
• Staff and technology related to scoring and analyzing the data
• Incentives for staff to complete the TIOA
• Electronic devices for completing the TIOA electronically
• Dedicated time for an organization’s implementation team to plan the process of administration
• Protected time for staff to complete the TIOA
• Time for multiple staff meetings to review the results and plan next steps
• Staff time to sustain the implementation of trauma-informed practices

There are three main pathways that organizations may take to implement the TIOA:

Independent use of the TIOA. The TIOA (PDF version) and implementation support resources will be provided to registered users through the NCTSN Learning Center at no cost after completing a User Agreement. Implementation support resources include various materials to assist organizations in successfully implementing the TIOA independently, as well as creating organizational change. 
TIOA implementation resources include:

• Resource 1: NCTSN TIOA Implementation Guide
• Resource 2: NCTSN TIOA Readiness and Fit Worksheet
• Resource 3: NCTSN TIOA Implementation Work Plan
• Resource 4: Assembling the NCTSN TIOA Implementation Team Tip Sheet
• Resource 5: Engaging Staff in the NCTSN TIOA Process Tip Sheet
• Resource 6: NCTSN TIOA Rater Training Handout 
• Resource 7: NCTSN TIOA Terms Glossary
• Resource 8: NCTSN TIOA Mapping Tool: Turning Results into Action
• Resource 9: Step-by-Step Guide to Managing TIOA Data: Collection, Scoring, and Reporting

The NCCTS TIOA Team offers time-limited, short-term consultation to organizations wishing to administer the TIOA independently when capacity allows.

Working with a TIOA Coach. Trained by the NCCTS TIOA Team, TIOA Coaches are contracted by organizations and work directly with them to support all phases of TIOA implementation, including data collection and reporting. See Why Work with an NCTSN TIOA Coach? for more information. Access the list of rostered coaches here. 

NCCTS-Led TIOA Cohorts. Participation in an NCCTS-led TIOA Cohort is offered to funded NCTSN Centers and Affiliates at no cost. Participation involves an application process, and organizations that are further along in their readiness to implement anti-racist trauma-informed practices are prioritized (i.e., identified need, established readiness for change, capacity, and sustainability). Implementation takes place over a 12-15 month period. The NCCTS TIOA Team guides organizations through:

• Readiness
• TIOA customization and administration
• Reporting and interpreting results
• Action planning
• Trauma-informed practice implementation
• Sustaining trauma-informed practice

Much of the communication occurs through monthly TIOA Community of Practice meetings and includes individual consultation calls. The NCCTS TIOA Team supports one new cohort of 8-12 sites every one to two years. 

If you are an NCTSN Center or Affiliate and would like to receive updates about future NCTSN TIOA cohorts, please fill out the TIOA interest form.

The TIOA is derived from the NCTSN definition of a Trauma-Informed Child and Family Service System. The items in the TIOA have been developed by combining current research with NCTSN expertise, which includes families, youth, direct service providers, administrators, trainers, researchers, and intervention developers who work across child welfare, juvenile justice, education, healthcare, and mental health systems. A modified Delphi method was utilized, where subject matter experts further prioritized and refined the items to identify the most important practices to measure. Further, the items were expanded to include the sub-practices to give raters examples of the essential components of the practice. The instrument was beta-tested and piloted with a variety of organizations serving children and families and groups such as the NCTSN Parent Advisory Group.

Content validity was established through our Delphi process during the assessment’s development. Testing shows that the domains of the TIOA exhibit excellent internal consistency (Cronbach’s α ranging from 0.93 to 0.96) and stability.

You may wish to modify the TIOA; however, depending on the nature of the modification, there may be an impact on the validity and integrity of the assessment (e.g., some essential trauma-informed practices may no longer be assessed).

Some examples of how organizations have modified/adapted the TIOA include:

• Replacing the word “organization” in each TIOA question with the organization’s name or specific program/department/location. Note: We highly recommend this modification as it personalizes the assessment and enhances relevance.
• Modifying the survey to better fit the population served (e.g., changing the wording to include adults). Note: Consider the applicability of all TIOA domains to organizations that don’t serve children.
• Using display logic and omitting some domains from the survey for specific roles (e.g., environmental staff not answering questions regarding screening or assessment). Note: Even though not all items will be applicable to all staff in all roles, administering the assessment in an inclusive way provides the most comprehensive and complete picture of the organization and assists in developing a common language and common understanding of trauma-informed practices across participants. 
• Administering only certain domains (e.g., Workforce Development). Note: While each domain focuses on specific practices, many practices are interconnected across domains and are intentionally not repeated in the TIOA. By utilizing questions from only one domain, the organization may overlook essential relationships and components critical for a comprehensive understanding of the trauma-informed practices associated with that specific construct.
• Adding new items, removing items, and rewording existing items in the survey. Note: If you choose to make significant changes, consider conducting a formal study to evaluate the impact of these modifications on the assessment's validity and reliability.

If you plan on modifying or adapting the TIOA, please contact the NCCTS TIOA team at tioa@nctsn.org to obtain permission. 

If you're considering translating the TIOA, please contact the NCCTS TIOA team at tioa@nctsn.org to confirm that a translation doesn't already exist and to obtain the necessary permissions to proceed. 

The time commitment will vary depending on organizational readiness, availability of resources, and size. Based on our experience, most organizations can complete the TIOA within six months. However, it typically takes a full year to progress from preparing for the administration of the survey to implementing practices based on the TIOA findings.

For the complete TIOA process, organizations should expect to protect staff time and organizational time to build awareness, engage participants, administer the assessment, review results, develop an action plan in response to the results, act on that plan, and prepare for a re-administration. In addition to the time it will take respondents to complete the TIOA on their own, Team Leaders should expect to facilitate multiple team meetings ranging from one hour to a half-day each for planning, outreach, review, and response. Some organizations find it helpful and important to offer incentives to staff for completing the TIOA (e.g., a small gift, PTO, etc.).

The approach we found the most effective for administering the TIOA is all staff participation. This approach allows for a closer examination of results by program or role and provides an opportunity for every staff member to contribute to the assessment, as well as helps establish a common language and understanding. It may be challenging to achieve 100% participation; however, multiple sites have successfully reached full participation. When deciding on who will be asked to complete the assessment, the organization should remember that the TIOA implementation is an intervention in which all staff should be included.

Although the TIOA implicitly aligns with anti-racist values, it does not explicitly describe or highlight these values in the way an actively anti-racist organization needs to do so. Thus, anti-racist trauma-informed practice values (AR-TIP) have been developed to serve as the foundation for the administration and use of the TIOA that reinforces the need to be anti-racist. These values clearly articulate what it means to implement the TIOA in an anti-racist trauma-informed way, moving beyond the items contained within the assessment and emphasizing the overall process of the TIOA as intentionally trauma-informed and anti-racist. The AR-TIP framework values include:

• Embodiment of Anti-Racist, Trauma-Informed Practice
• Collaborative Journey
• Relational Nature of the Work

You can find more about the AR-TIP framework in Resource 1: NCTSN TIOA Implementation Guide.

If you decide to survey the entire staff, plan for an 80% completion rate with equal representation from each department, role, and identity. Make sure that no entire group is missing (e.g., environmental services or staff of a particular race/ethnicity).

The assessment may be administered using an appropriate online survey tool. You can also request a paper version of the TIOA. If there is a need, it is possible to administer some surveys electronically and some on paper; however, privacy must be ensured.

To collect the responses in your organization, you can use data collection software of your choice (e.g., Qualtrics, REDCap, Survey Monkey). A TIOA Qualtrics file that can be imported is available upon request. Typically results from the TIOA are shown by the average rating of responses in each domain and the average rating for each item. There are times when you may want to understand the responses by a specific role (clinician, administrative staff) or setting (main center, satellite office). Reports then display these sub-groups with some explanation of strengths and opportunities for growth. 

The NCCTS TIOA team has some capacity to support data collection, scoring, and reporting for a limited number of organizations. Due to our SAHSA funding, we prioritize NCTSN centers and NCTSN partners.

A critical component to organizational assessment and change is the integration of the voices of those who are directly served and affected. Organizations using the TIOA should identify how the organization will partner with youth and families throughout the assessment and organizational change process. Youth and families can be integrated in a variety of ways: as assessment team members; to provide input on key organizational strategic questions; to review and respond to agency evaluation findings; and to collaborate on change processes. You might (1) include TIOA feedback and consultation as a standing agenda item for your Youth and Family Partner Advisory Board; (2) convene periodic focus groups to get input and perspectives; or (3) invite youth and family partners to join your TIOA-focused Implementation Team.

Implementation leaders should review the TIOA with a representative group of staff beforehand to anticipate potential questions and identify any role-specific guidance that may be important (e.g., how administrative staff should address more clinically focused questions). To support staff, implementation leaders can prepare materials such as a "cheat sheet" or a glossary, or hold discussions about common terms. If assistance is needed with defining terms in the survey, please contact the TIOA team.

Administering the TIOA is just the first step in the process of becoming an anti-racist trauma-informed organization. The purpose of the assessment is to identify areas for improvement and implement changes. Once the TIOA has been administered, the results should be analyzed and shared broadly within your organization. This will help you identify key areas to focus on and create an action plan to track and support the priorities and improvements identified through the assessment. The NCTSN offers a variety of resources, tools, and practices that can support your organization during this process that can be found here.

While the initial administration helps identify key areas for improvement, the organization should consider re-administering the TIOA every 2-3 years. This periodic reassessment allows the organization to measure progress, evaluate the effectiveness of implemented changes, and identify any new areas that may require attention. Regularly revisiting the assessment ensures that the organization continues to evolve in its journey toward becoming more trauma-informed, maintaining accountability, and sustaining ongoing improvement efforts over time.