In It Together: An Organizational Framework for Trauma-Informed Vaccination Decision-Making

Background and Rationale

The economic, social, medical and psychological crisis of the COVID-19 pandemic can likely be attenuated with population-based vaccination. Legacies of historical and racial trauma, scientific racism, and mistrust of public officials and institutions challenge vaccine uptake. Anecdotal reporting suggests that vaccination rates are lower among minoritized communities and that even when available, mistrust and misinformation may create disproportional rates of vaccination for racial and ethnic minorities. Accordingly, reporting suggests that many frontline staff at long-term care facilities and residential treatment centers who are at high risk of infection are choosing not to receive the vaccine. Trauma-informed practice recognizes the need to establish collaborative, transparent, and empowerment-based processes at all levels of care, from establishing policy to day-to-day practice. Mental health organizations who focus on trauma informed care have a role to play in supporting informed decision-making about vaccinations. This presentation uses a case study of one agency’s efforts to use a trauma-informed framework to support staff in their decision-making regarding vaccination. The goal of this work is to offer a model for these efforts at similarly situated organizations.

Methods

Utilizing the case study method, this project examines the work of a trauma-informed treatment organization to support vaccination decision-making among its staff. In January 2021, a COVID-19 vaccine became available to all staff at the agency. Uptake of the vaccine, however, was low initially with only 39% of staff signing up to receive a vaccine. Concerned about low uptake and aware of the legacies of historical trauma and scientific racism that likely were underlying some of the reluctance from frontline staff, the organization’s research team developed an informational sheet utilizing the five core tenets of trauma-informed care (safety, trustworthiness, choice, collaboration and empowerment. Safety was addressed through acknowledging concerns about vaccination, validating fears and contextualizing them within the legacy of historical trauma and scientific racism. Trustworthiness was addressed by including resources about how to discern reliable sources of information for a range of reading levels. Choice was supported by emphasizing that the decision was entirely up to the worker. Collaboration and empowerment were embedded throughout the document by offering resources, information, and support in talking through the decision. The formatting and content was intentionally brief and approachable.

Results or Conclusions

Between the first clinic and the dissemination of the information sheet, there was a 35% increase in registration for the COVID-19 vaccine. While the association between the introduction of the information sheet and the increased vaccine uptake is qualitative in nature and cannot be causally confirmed, it is suggestive of the role that organizations have to play in supporting their frontline staff in decision-making about vaccination. Specifically, trauma-informed organizations can utilize the central tenets of this approach to facilitate conversations with staff about difficult topics. Currently, debates about vaccination and staff center around a binary: Should organizations require vaccination as a condition of employment. There, perhaps, is a third way, with organizations supporting discussion and decision-making that may promote vaccination uptake within an empowerment framework.