Trauma-Informed Policing and Building Trust
By Christopher Freeze, M.A., M.S.
At the heart of any healthy and productive relationship is trust. People instinctively understand this fact because humans are built and long for relationships. However, if their formative years were characterized by physical, emotional, or traumatic abuse, they can be robbed of the ability to trust others both at home and in the workplace.
For individuals working as a law enforcement professional, they have accepted the general mission to protect and serve. Each day, agencies around the country ask themselves, “How do we ensure we are serving and protecting all community members, to include the weak and oppressed, against violence and disorder?”
Given the current level of trust in society, finding ways to build or rebuild trust is imperative.
During this time of social unrest, the policies and practices of law enforcement agencies are being questioned and reviewed.
Many have alleged police treat nonwhite citizens differently from white citizens, resulting in an overrepresentation of minorities incarcerated. In one survey, 43% of respondents said they personally knew people unfairly treated by police, while 30% indicated they personally knew people unfairly sent to jail.1
Mr. Freeze retired as special agent in charge of the FBI’s Jackson, Mississippi, office.
Similarly, 58% of all Americans agreed major changes were needed in police departments. In the more extreme responses, some advocates have called for the disbanding or defunding of police departments. However, those ideas have little support (15%).2
The surveys reported two ideas with broad public support: 1) officers must be required to have good relations with the community (97%), and 2) there must be community-based alternatives, such as violence interventions that place a “greater reliance on other community organizations, such as family services and programs that intervene with young people at high risk for violent crime (82%).”3
Restated, these two reform-minded initiatives focus on 1) building trust and 2) being trauma informed. Achieving these goals requires a deeper understanding of how a person’s mental health history affects the community and its law enforcement officers.
According to the nonprofit Blue H.E.L.P., 228 current or former law enforcement officers committed suicide in 2019, up from 172 in 2018.4
The U.S. Department of Justice’s National Institute of Justice (NIJ) reported in 2016 the results of a study that found increased stress resulted in “sleep problems, obesity, heart problems, sleep apnea, and an increase in the number of officers who snore.” The study also found “a link between PTSD and increased rates of depression and suicide.”5
These findings indicate a profound impact on officers’ ability to perform their responsibilities from not only a physical but also a mental health perspective. The law enforcement profession is inherently stressful, which is exacerbated by each officer’s lifelong experiences and conditioning.
An officer’s mental health is an important factor in building trust and minimizing violent encounters within the community. To complicate matters, many law enforcement officers do not want to discuss any issues dealing with physical or mental health out of fear they will look weak and potentially be fired.
A researcher at NIJ acknowledged that overcoming resistance to programs that deal with mental health must start at the police academy. Further, such programs should be held away from the actual department because officers do not want to “show any indication that [they are] under stress or anything like that” out of concern “it could impact your career.”6
Successful efforts at building trust and reducing violence require developing a trauma-informed approach to policing. This approach is built on understanding adverse childhood experiences (ACEs), employing crisis intervention concepts, and applying trauma-informed leadership principles.
Adverse childhood experiences are defined by the Centers for Disease Control and Prevention (CDC) as “potentially traumatic events that occur in childhood,” such as “experiencing violence, abuse, or neglect; witnessing violence in the home or community; [or] having a family member attempt or die by suicide.” Additional ACEs include “substance misuse; mental health problems; [and] instability due to parental separation or household members being in jail or prison.”7
Crisis intervention is commonly defined as “emergency first aid for mental health.”8 One explanation of crisis intervention invokes two Chinese characters to help illustrate the tension between the critical or dangerous events as they unfold and the simultaneous opportunity for change.9
Trauma is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”10
Trauma informed, as recognized by SAMHSA, implies a program, organization, or system that “realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist retraumatization.”11
Trauma-informed leadership is the convergence of trauma-informed concepts with commonly recognized leadership skills and philosophies to produce a more effective and enduring result than before. Succinctly, the framework involves coping with childhood, dealing with crisis, and leading with conviction.
Defining the Challenge: Coping with Childhood
“If you accept the expectations of others, especially negative ones, then you never will change the outcome.”
Knowledge of ACEs
The first leg of the trauma-informed policing framework begins with understanding the lifelong challenges associated with adverse childhood experiences.
In 1998, medical doctors found widespread exposure to 10 commonly reported ACEs had a high correlation with disease, quality of life, and mortality risk factors.13 As the CDC later confirmed through its research, an average of 1 in 6 adults reported having 4 or more of the original 10 ACEs. The percentages are even higher for children living in nonparental care or under the care of a child welfare system.14
Since then, researchers have demonstrated that toxic stress compounds ACEs and leads to impaired decision-making, a lack of impulse control, the adoption of risky behaviors, and an “early onset of disease, disability, and death.”15 Not surprisingly, behaviors leading to the commission of crimes, particularly violent crimes, are directly related to the childhood trauma and ACEs too many children face regularly.
Researchers found that “90% of juvenile offenders in the United States [have experienced] some sort of traumatic event in childhood, and up to 30% of justice-involved American youth … meet the criteria for post-traumatic stress disorder due to trauma experienced during childhood.”16 Too often, once individuals enter the criminal justice system, the probability they continue to encounter the system increases.
In January 2016, a study was conducted that focused on the precursors of crime in Jackson, Mississippi. It sought to explain or provide insight into an increase of crime, specifically homicides committed by juveniles, not seen since the mid-1990s.17
The study found adolescents “who acted criminally had heavy exposure to poverty, to violence and other crime (as victims and witnesses), and ‘street justice.’” In addition, “an individual arrested as an adult in Hinds County or Jackson is 240% more likely to have dropped out of school at some point, 160% more likely to have been involved in the juvenile justice system, and 67% more likely to have been chronically absent while enrolled in school.”18
These findings demonstrate the increased challenges society faces as a result of ACEs.
Potential Among Law Enforcement
On average, the CDC reports 1 in 7 children will suffer abuse or neglect,19 and 1 in 3 women and 1 in 4 men will experience sexual abuse during childhood.20 These statistics do not exclude law enforcement officers.
Agencies must understand and expect that a similar percentage of their officers have experienced the same or similar ACEs as other individuals. That means they are equally at risk for impaired decision-making, a lack of impulse control, the adoption of risky behaviors, and an “early onset of disease, disability, and death.”21 In short, they are in a state of crisis.
Likewise, that means law enforcement officers potentially experience mental health challenges at the same percentage as those in the ACE studies. Consequently, when agencies speak of the need for trauma-informed leadership to build trust, often the individuals needing that help and trust are within a department’s ranks.
What often impedes effective reforms and intervention programs are the historical models of and responses to trauma on all sides of the equation. From the perspective of the officers, those who understand their own experiences and challenges with ACEs can more easily move from asking the typical questions of “What did you do?” or “What’s wrong with you?” during the fact-gathering stage to questions such as “What happened to you?” or “What is (or was) your childhood like?”
This shift in approach can provide insights that will make a difference in successfully resolving the service call if the officers are open to listening to the answers provided.
Developing the Process: Dealing with Crises
“You cannot shame or belittle people into changing their behaviors.”
“During this time of social unrest, the policies and practices of law enforcement agencies are being questioned and reviewed.”
The second leg of trauma-informed policing involves developing simple processes and procedures for dealing with a person in crisis.
Since the deinstitutionalization of state mental health hospitals in the 1970s, police have reported increased interaction with individuals experiencing mental health illnesses. Often, these challenges are exacerbated by homelessness, poverty, and unemployment.23
To address these challenges, the first Crisis Intervention Team (CIT) was created in Memphis, Tennessee, in 1998. Consequently, crisis intervention is typically associated with assisting individuals who have a diagnosed or undiagnosed mental illness. The CIT model places heavy emphasis on developing partnerships, providing training, and reviewing law enforcement’s policies and procedures.24
While the CIT model has proven an effective tool, not every officer is CIT trained, nor is there always time to request a CIT response during a potential crisis. Further, most officers are not trained as social workers or equipped with extensive de-escalation training.
Instead, officers are required to deal with and resolve the potential crisis based on their inherent skills or basic academy training. Ironically, every encounter or service call provides the opportunity for a crisis in which the officer must intervene.
If law enforcement desires to have good relations with the community (i.e., build trust) and implement violence-intervention alternatives (i.e., be trauma informed), then three challenges must be considered: 1) amount of time required for crisis-related calls, 2) officers’ attitudes toward individuals exhibiting mental health-related behaviors, and 3) prevalence of ACEs in both subjects and officers.
Time Needed for Calls
Research has confirmed that mental illness-related calls where the person is demonstrating schizophrenia or other disorders, such as bipolar, depressive, anxiety, cognitive, and substance abuse, are time intensive for police.25 Due to the time commitment, the potential for violence, and the pressure to respond to the next call, these interactions often result in higher levels of force, especially by untrained or inexperienced officers.26
The use of force should not be a surprise given the inherent increased stress. Research has shown “subjects with mental illnesses were more likely to possess a weapon than subjects without apparent mental illnesses (42.9% v. 4.9%).”27
Successful resolution requires officers to effectively listen to what is being said or not said, gather as much information as quickly as possible, and find an equitable solution to resolve the crisis.28 However, as noted, the presence and history of ACEs can lead to impaired decision making, a lack of impulse control, and the adoption of risky behaviors by both subject and officer, which also heightens the stress and can limit an officer’s options.
Typically, an officer’s options during a call involving an individual with a potential mental health issue are arrest, referral to a mental health facility, transport for an involuntary psychiatric evaluation, or an informal (mutually agreeable) resolution.29 If the interaction between the subject and officer devolves to physical or verbal resistance by the subject, then the potential for force by the officer increases 20- or 4-fold, respectively.30
Finding the best solution that involves the right de-escalation techniques, avoids the use of excessive force, and results in transportation to a mental health facility instead of incarceration is a challenge, especially for individuals officers encounter regularly, often due to a lack of mental health resources.31
Attitudes of Officers
The intersection of mental health challenges and police officer attitudes is best demonstrated when dealing with people under the age of 18. Researchers found nearly 20% of adolescents involved with the juvenile justice system have a mental health problem, approximately twice the rate found in the general youth population.32 Given that ACEs, which include mental health issues, can result in displaying antisocial or high-risk behaviors, the cycle between youths and police officers seems unabated and destined to continue from generation to generation.33
ACEs in Subjects and Officers
How does understanding ACEs help achieve a successful resolution to a crisis? The answer can be found by examining research results pertaining to CIT-trained officers. One study found that approximately 80% of CIT officers reported they knew at least two people with mental illness, and over 90% said they knew a person who recovered from mental illness. Further, 16% of CIT-trained officers self-disclosed they had received mental health assistance.34 In other words, they had firsthand experience with ACEs and the potential for problems.
Not surprisingly, officers personally familiar with individuals dealing with mental health issues had a more positive attitude toward persons they encountered with mental illness.35 Consequently, officers who were CIT trained were more likely than their non-CIT-trained counterparts to make referrals, follow up with a doctor or caseworker, or provide information about available community resources. In addition, reports of the use of force were fewer among CIT-trained officers than non-CIT-trained officers, and CIT-trained officers were more likely to use de-escalation and active listening techniques to resolve a crisis.36
In summary, these findings regarding crisis intervention principles demonstrate a willingness to 1) communicate a different set of expectations in dealing with individuals suffering from mental health illnesses and ACE-related behaviors and 2) embrace the inherent vulnerability associated with seeking a different, less certain outcome focusing on treatment rather than resulting in arrest.
CIT-trained officers exemplify the paradigm shift from asking questions such as “What’s wrong with you?” to asking questions like “What happened to you?” All officers willing to explore the connection between ACEs and crisis intervention training can increase their tools for an effective and satisfying resolution and be on track for becoming trauma-informed leaders.
Discovering the Difference: Leading with Conviction
“Leadership is not a position or a title; it is action and example.”
—Senator Cory Booker37
The framework for trauma-informed policing is complete with the principle of leading with conviction.
Leading with conviction means understanding that people are shaped and conditioned by their past experiences and that their decisions are not made in a vacuum. It means leaders engage people where they are, not where they wish they were.
Leading with conviction means understanding people’s expectations of themselves and others is influenced by early childhood relationships and affects their ability to be resilient during times of crisis.
Leading with conviction means understanding past paradigms and methods must change with the acquisition of new information, especially when it better ensures the building of trust and the elevating of people, regardless of their circumstances or status in life.
Law enforcement officers, by nature of their profession, frequently see people at their worst. Too often, these interactions occur during a crisis or require a crisis intervention. Applying the knowledge of ACEs and the positive results obtained by CITs, all officers, regardless of rank, can lead with conviction if they communicate expectations and embrace vulnerability.38
Benefits of a New Paradigm
If, according to the National Alliance on Mental Illness, CITs can reduce: 1) officer injuries by up to 80%, 2) the number of service calls for mental health issues, and 3) a community’s costs by over 60%, then such a model should benefit everyone when CIT trauma-informed principles are applied during crises.39
The antithesis of trauma-informed leadership is toxic leadership.
Toxic leaders shame, humiliate, or coerce their employees to take actions or stop taking actions because the leader has created a hostile and threatening environment. Instead of working in harmony and promoting the success of others, employees who are scared stop speaking up out of fear or the need for self-preservation, belittle other people’s ideas, or spread rumors and misinformation to gain an advantage. Predictably, in such an environment, toxic leaders stop rewarding exceptional performance and instead highlight average performance or promote their lackeys.40
A trauma-informed approach to leadership can remove the barriers often created by shame, humiliation, or coercion.
Journey Toward a Better Approach
In 1990, the Harvard Business Review (HBR) published an article by John Kotter that was instrumental in the revitalization of the leadership movement. In essence, he was the first to claim leadership is teachable, can be learned, and is not reserved for just a few people with special skills.41 A 1996 HBR article by Daniel Goleman started the emotional intelligence movement. Goleman stressed that “people who want to become leaders have to be motivated to want to take on hard and difficult work.”42 Both articles confirm that the principles supporting trauma-informed leadership are teachable by leaders motivated to put in the effort.
“Successful efforts at building trust and reducing violence require developing a trauma-informed approach to policing.”
Interestingly, although trauma-informed leadership appears new or different, the foundations of this movement have been hiding in plain sight among the traditional leadership philosophies. One author surveyed the history and state of leadership and found there were five primary attributes widely understood as constituting effective leadership: “modesty, authenticity, truthfulness, trustworthiness, and concern for the welfare of others.”43
While critical of “leaders” who sell inspirational and comfortable promises and stories without any substance or evidence that their ideas work,44 the author inadvertently demonstrates that these five common leadership traits are only truly effective when seen through a trauma-informed lens. Trauma-informed leadership requires seeing people with fresh eyes and in a fresh light without prejudice or bias.
Trauma-informed leadership is, in many ways, an extension of three widely understood, if imperfectly practiced, leadership styles: transformational, ethical, and servant.
Transformational leadership is “characterized by inspirational leaders who motivate employees through the achievement of group or organizational goals.” Leaders who practice this style are usually inspirational in their message and motivate people through a shared vision. Such leaders value creativity that promotes intellectual challenges and discussions. They strive to develop their followers through engaging them regularly by exploring personal and professional interests.45
Ethical leadership is “characterized by leaders influencing followers by demonstrating moral and ethical behavior.” Being an ethical leader does not imply perfection, but these individuals’ motives are usually altruistic and not self-serving. How results are obtained is more important than doing whatever it takes to acquire them. Such leaders are honest, treat people fairly, and tend to motivate employees by working hard and demonstrating loyalty to a company or cause.46
Servant leadership is “a holistic leadership approach that engages followers in multiple dimensions (e.g., relational, ethical, emotional, spiritual), such that they are empowered to grow into what they are capable of becoming.” Servant leaders also seek to develop followers with altruistic and ethical motives. They emphasize the importance of being authentic and true to oneself and others and are driven by a higher calling based on a strong desire to serve other people.47
During a time of great crisis, people desire great leadership. Some say that the two are inextricably linked and that a crisis provides an opportunity for great leadership to be displayed.48 Similar to a lump of coal put under extreme pressure to transform it into a diamond, so goes the argument that stress molds a person into a great leader.
If stress is the precursor to great leadership, then every officer can become a great leader. In the law enforcement profession, each service call can be one bad decision away from a potential crisis. Implementing a trauma-informed paradigm requires the public, politicians, and senior officers to appreciate that rank-and-file officers are most likely dealing with 1) their own historical trauma stemming from ACEs, 2) vicarious trauma resulting from their interactions with volatile events or horrific violence, or 3) compassion fatigue from witnessing years of trauma that robbed them of empathy toward others.49
Law enforcement officers could also have higher levels of stress because of the threats and challenges they may encounter within their own organization. As reported by the NIJ, when officers are adamant they will not seek mental health treatment out of fear of retaliation or demotion, they are experiencing an additional source of stress instead of support. Without the proper support, these officers are dealing with their personal crisis alone and may need a trauma-informed intervention themselves.
Because of the role law enforcement plays in society, many people believe there is no room for mistakes on the part of officers. They are expected to have an exemplary reputation that is considered necessary to build trust. This unrealistic expectation can be a significant source of stress and drain a person’s psychological resources, leading to emotional exhaustion and poor performance over time.50
Bridging the Gap
Whether one practices a positive model, such as transformational-, ethical-, or servant-based leadership, or any of the other positive models, all leaders must be both ethical and effective.
During a crisis or the need for crisis intervention, law enforcement leaders should understand that the events leading to the crisis are often based on a complete life history, not the heat of the moment. How officers respond during those critical moments is influenced, if not defined, by the policies, procedures, and practices written, implemented, and enforced by senior leaders.
Bridging the gap between the traditional leadership models and trauma-informed leadership means the whole system of how things have been done may need to change. This means that policies, procedures, and practices must conform to SAMSHA’s guidance.
A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatization.51
“We see the world, not as it is, but as we are — or, as we are conditioned to see it.”52 Regardless of who we are, our background, or our best intentions, we have all been conditioned to see the world and its problems a certain way. Changing that paradigm to see the world as it really is can be hard, but change is necessary.
In today’s environment where an officer’s split-second decisions can be broadcast around the world and result in protests and riots, implementing a trauma-informed approach to policing will help build relationships, resilience, and trust within departments and communities.
A trauma-informed approach to leadership is a step in the right direction for successful policing in the 21st century.
“A trauma-informed approach to leadership is a step in the right direction for successful policing in the 21st century.”
Mr. Freeze can be reached through his website, mrchrisfreeze.com, or at email@example.com.
1 Camille Lloyd and Dalia Naguib, “Implications of Inequitable Policing in Fragile Communities,” Gallup, June 16, 2020, accessed March 31, 2021, https://news.gallup.com/opinion/gallup/312707/implications-inequitable-policing-fragile-communities.aspx.
2 Steve Crabtree, “Most Americans Say Policing Needs ‘Major Changes,’” Gallup, July 22, 2020, accessed March 31, 2021, https://news.gallup.com/poll/315962/americans-say-policing-needs-major-changes.aspx.
4 Luke Barr, “Record Number of U.S. Police Officers Died by Suicide in 2019, Advocacy Group Says,” ABC News, January 2, 2020, accessed March 31, 2021, https://abcnews.go.com/Politics/record-number-us-police-officers-died-suicide-2019/story?id=68031484.
5 Jim Dawson, “Fighting Stress in the Law Enforcement Community,” National Institute of Justice Journal 281 (April 2019), accessed March 31, 2021, https://nij.ojp.gov/topics/articles/fighting-stress-law-enforcement-community.
7 “Preventing Adverse Childhood Experiences,” Centers for Disease Control and Prevention, accessed April 6, 2021, https://www.cdc.gov/violenceprevention/aces/fastfact.html.
8 Brenda A. Stevens and Lynette S. Ellerbrock, “Crisis Intervention: An Opportunity to Change,” ERIC Digest, EDO-CG-95-34, 1995, accessed April 6, 2021, https://www.counseling.org/Resources/Library/ERIC%20Digests/95-034.pdf.
10 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, SMA 14-4884 (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014), p.7, https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf.
12 “Michael Jordan,” BrainyQuote, accessed April 7, 2021, https://www.brainyquote.com/quotes/michael_jordan_167380?src=t_expectations.
13 Vincent J. Felitti et al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14, no. 4 (May 1998): 245-258, accessed April 7, 2021, https://pubmed.ncbi.nlm.nih.gov/9635069/.
14 Margaret B. Hargreaves et al., “Advancing the Measurement of Collective Community Capacity to Address Adverse Childhood Experiences and Resilience,” Children and Youth Services Review 76 (May 2017): 142-153, accessed April 7, 2021, https://www.sciencedirect.com/science/article/abs/pii/S0190740917301664.
16 Bryanna Hahn Fox et al., “Trauma Changes Everything: Examining the Relationship Between Adverse Childhood Experiences and Serious, Violent, and Chronic Juvenile Offenders,” Child Abuse and Neglect 46 (August 2015): 164, accessed April 7, 2021, https://www.ncbi.nlm.nih.gov/pubmed/25703485.
17 BOTEC Analysis, Precursors of Crime in Jackson: Early Warning Indicators of Criminality (Woodland Hills, CA: BOTEC Analysis, January 2016): 1-85, accessed April 7, 2021, https://www.botecanalysis.com/publications/precursors-of-crime-in-jackson-early-warning-indicators-of-criminality.
19 “Preventing Child Abuse and Neglect,” Centers for Disease Control and Prevention, accessed September 30, 2021, https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html.
20 “Preventing Sexual Violence,” Centers for Disease Control and Prevention, accessed April 7, 2021, https://www.cdc.gov/violenceprevention/sexualviolence/fastfact.html.
22 “25 Brené Brown Quotes on Courage, Vulnerability, and Shame,” Goalcast, accessed April 7, 2021, https://www.goalcast.com/2019/06/19/brene-brown-quotes/.
23 Horace A. Ellis, “Effects of a Crisis Intervention Team (CIT) Training Program Upon Police Officers Before and After Crisis Intervention Team Training,” Archives of Psychiatric Nursing 28, no. 1 (2014): 10-16, accessed April 7, 2021, https://www.psychiatricnursing.org/article/S0883-9417(13)00121-0/pdf.
26 Natalie Bonfine, Christian Ritter, and Mark R. Munetz, “Police Officer Perceptions of the Impact of Crisis Intervention Team (CIT) Programs,” International Journal of Law and Psychiatry 37, no. 4 (July-August 2014): 341-350, accessed April 7, 2021, https://pubmed.ncbi.nlm.nih.gov/24630739/.
27 Amy C. Watson et al., “Understanding How Police Officers Think About Mental/Emotional Disturbance Calls,” International Journal of Law and Psychiatry 37, no. 4 (July-August 2014): 351-358, accessed April 7, 2021, https://pubmed.ncbi.nlm.nih.gov/24656216/.
32 Sheryl Kubiak, Daria Shamrova, and Erin Comartin, “Enhancing Knowledge of Adolescent Mental Health Among Law Enforcement: Implementing Youth-Focused Crisis Intervention Team Training,” Evaluation and Program Planning 73 (April 2019): 44-52, accessed April 7, 2021, https://pubmed.ncbi.nlm.nih.gov/30508702/.
35 Bonfine, Ritter, and Munetz.
36 Bonfine, Ritter, and Munetz.
37 “Cory Booker,” AZ Quotes, accessed April 7, 2021, https://www.azquotes.com/quote/1172712.
38 For additional information, see Christopher Freeze, “Adverse Childhood Experiences and Crime,” FBI Law Enforcement Bulletin, April 9, 2019, accessed April 7, 2021, https://leb.fbi.gov/articles/featured-articles/adverse-childhood-experiences-and-crime.
39 “Crisis Intervention Team Programs,” National Alliance on Mental Illness, accessed April 7, 2021, https://www.nami.org/Advocacy/Crisis-Intervention/Crisis-Intervention-Team-(CIT)-Programs.
40 Dan R. Weberg and Ryan M. Fuller, “Toxic Leadership: Three Lessons from Complexity Science to Identify and Stop Toxic Teams,” Nurse Leader 17, no. 1 (February 2019): 22-26, accessed April 7, 2021, https://www.sciencedirect.com/science/article/abs/pii/S1541461218301733.
41 Jim Fisher, “A Model of Integrated Leadership,” Organizational Dynamics 47, no. 2 (April-June 2018): 70-77, accessed April 7, 2021, https://www.sciencedirect.com/science/article/abs/pii/S0090261618300160.
43 Jeffrey Pfeffer, Leadership BS: Fixing Workplaces and Careers One Truth at a Time (New York, NY: HarperCollins, 2015); and ibid.
45 Heather J. Anderson et al., “What Works for You May Not Work for (Gen)Me: Limitations of Present Leadership Theories for the New Generation,” The Leadership Quarterly 28, no. 1 (February 2017): 245–260, accessed April 8, 2021, https://www.sciencedirect.com/science/article/pii/S1048984316300467.
47 Nathan Eva et al., “Servant Leadership: A Systematic Review and Call for Future Research,” The Leadership Quarterly 30, no. 1 (2019): 111-132, accessed April 8, 2021, https://www.sciencedirect.com/science/article/pii/S1048984317307774.
48 P.D. Harms et al., “Leadership and Stress: A Meta-Analytic Review,” The Leadership Quarterly 28, no. 1 (February 2017): 178-194, accessed April 8, 2021, https://www.sciencedirect.com/science/article/pii/S1048984316300923.
49 Dorien Wentzel and Petra Brysiewicz, “The Consequence of Caring Too Much: Compassion Fatigue and the Trauma Nurse,” Journal of Emergency Nursing 40, no. 1 (January 2014): 95-97, accessed April 8, 2021, https://doi.org/10.1016/j.jen.2013.10.009.
50 Harms et al.
51 SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach.
52 “Stephen Covey,” QuoteFancy, accessed April 8, 2021, https://quotefancy.com/quote/909276/Stephen-R-Covey-We-see-the-world-not-as-it-is-but-as-we-are-or-as-we-are-conditioned-to.