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Stewart SL, Cloutier S, King G, Withers A. Evaluating a Trauma-Informed Care Training Program for Mental Health Clinicians. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:981-998. [PMID: 39309338 PMCID: PMC11413404 DOI: 10.1007/s40653-024-00639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 09/25/2024]
Abstract
The aim of this study was to evaluate the interRAI Trauma-Informed Care (TIC) training program based on evidence-informed Collaborative Action Plans. Focus groups and the Attitude Related Trauma-Informed Care (ARTIC) questionnaire addressed clinicians' and mental health professionals' attitudes toward the application of TIC with their child and youth clients. An explanatory sequential design was conducted. In total, 105 clinicians and mental health professionals who participated in a 4-hour, in-person or virtual TIC training, two comprehensive seminars, and 28 trauma-informed training web-based modules completed the ARTIC questionnaire. Researchers conducted seven focus groups with clinicians/participants (N = 23) to discuss the views and effectiveness of the interRAI TIC educational training modules. To quantitatively measure the change of attitudes towards TIC, descriptive statistical analysis was completed using the means and standard deviation of the ARTIC scores at the initial time point, the follow-up time point, and the difference between scores at both time points. Paired sample t-tests were conducted on both the overall score and each of the subscales in each of the three samples (total sample, online subsample, and hybrid subsample). A thematic analysis was conducted to generate qualitative findings from the focus groups. Findings from the quantitative and qualitative analyses suggest that the interRAI TIC training provided clinicians with an improved sense of knowledge and ability to apply trauma-informed care planning with their clients.
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Affiliation(s)
- Shannon L. Stewart
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
| | - Sarah Cloutier
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
| | - Gabrielle King
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
| | - Abigail Withers
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
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Berring LL, Holm T, Hansen JP, Delcomyn CL, Søndergaard R, Hvidhjelm J. Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review. Healthcare (Basel) 2024; 12:908. [PMID: 38727465 PMCID: PMC11083630 DOI: 10.3390/healthcare12090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| | - Tine Holm
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark;
| | - Jens Peter Hansen
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Retspsykiatrisk Forskningsenhed, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - Christian Lie Delcomyn
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department for Forensic Psychiatry, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark
| | - Rikke Søndergaard
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
| | - Jacob Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Center Sct Hans, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark;
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Weindl D, Peper-Bösenkopf J, Mares T, Noske J. [Child and adolescent psychiatric and therapeutic treatment needs in care settings in the Lower Austrian industrial district. A survey of the demand situation]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:33-38. [PMID: 35581522 PMCID: PMC9113075 DOI: 10.1007/s40211-022-00419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
An increasing need for child and adolescent psychiatric care is clearly observed in recent years. The present study deals with 20 child and youth care facilities taking care of 439 children and adolescents, in the industrial district, in Lower Austria. The aim of the study is to evaluate treatment needs of this special group of patients. The care facilities reported that 270 children and adolescents (62%) show psychiatric problems. Of these, 220 (50.1%) are diagnosed with one or more psychiatric diagnoses, and 200 children and adolescents are receiving child and adolescent psychiatric treatment. Eleven care facilities reported the necessity for treatment in 80-100% of their accommodated children and adolescents. This results in highly stressful working conditions for professional psychosocial helpers and high treatment needs within their fosterlings. It is evident that more intensive networking and cooperation between institutions and helpers involved is necessary. Further, the development of new, low-threshold child and adolescent psychiatric services would be desirable to adequately meet the increasing need for psychiatric treatment in children and adolescents.
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Affiliation(s)
- Dina Weindl
- KJPP Hinterbrühl, 2371, Hinterbrühl, Österreich.
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Musicaro RM, Langer DA. Applying shared decision-making to screening for trauma and adversity in youth. CHILD ABUSE & NEGLECT 2022; 131:105762. [PMID: 35777339 DOI: 10.1016/j.chiabu.2022.105762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
Youth who have experienced adverse childhood experiences (ACEs) or trauma are at risk for negative outcomes that may be lessened by adversity screening and prevention efforts. However, experts and consumers do not universally embrace adversity screening efforts. Despite significant support for widespread adversity screening, and many guidelines on how to conduct such screening, successful implementation has lagged behind enthusiasm. This paper outlines the challenges of adversity screening and then proposes applying the shared decision-making (SDM) model to improve adversity screening by increasing youths' 1) engagement in adversity screening if doing so is appropriate for them, and 2) disclosure of honest information during screens. Using an SDM approach honors youth preferences and perspectives, which simultaneously accomplishes a third overarching goal: aligning adversity screening with the principles of trauma-informed care.
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Affiliation(s)
- Regina M Musicaro
- Yale School of Medicine, Child Study Center, 230 S. Frontage Rd., New Haven, CT, United States of America.
| | - David A Langer
- Suffolk University, Department of Psychology, 73 Tremont Street, Boston, MA 02108, United States of America
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Dolezal L, Gibson M. Beyond a trauma-informed approach and towards shame-sensitive practice. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:214. [PMID: 35791341 PMCID: PMC7612965 DOI: 10.1057/s41599-022-01227-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/09/2022] [Indexed: 06/01/2023]
Abstract
In this article, we outline and define for the first time the concept of shame-sensitivity and principles for shame-sensitive practice. We argue that shame-sensitive practice is essential for the trauma-informed approach. Experiences of trauma are widespread, and there exists a wealth of evidence directly correlating trauma to a range of poor social and health outcomes which incur substantial costs to individuals and to society. As such, trauma has been positioned as a significant public health issue which many argue necessitates a trauma-informed approach to health, care and social services along with public health. Shame is key emotional after effect of experiences of trauma, and an emerging literature argues that we may 'have failed to see the obvious' by neglecting to acknowledge the influence of shame on posttrauma states. We argue that the trauma-informed approach fails to adequately theorise and address shame, and that many of the aims of the trauma-informed are more effectively addressed through the concept and practice of shame-sensitivity. We begin by giving an overview of the trauma-informed paradigm, then consider shame as part of trauma, looking particularly at how shame manifests in post-trauma states in a chronic form. We explore how shame becomes a barrier to successful engagement with services, and finally conclude with a definition of the shame-sensitive concept and the principles for its practice.
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Buysse CA, Bentley B, Baer LG, Feldman HM. Community ECHO (Extension for Community Healthcare Outcomes) Project Promotes Cross-Sector Collaboration and Evidence-Based Trauma-Informed Care. Matern Child Health J 2022; 26:461-468. [PMID: 35013885 PMCID: PMC8747847 DOI: 10.1007/s10995-021-03328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adverse Childhood Experiences (ACEs) are traumatic events that occur before 18 years. ACEs, associated with increased health-risk behaviors and chronic health disorders, disproportionately impact people from marginalized communities. Evidence shows that toxic stress from ACEs and adverse social determinants of health can be prevented and treated with trauma-informed care (TIC). The purpose of this educational program was to train a maternal and child health workforce to bring evidence-based trauma-informed care to all impacted people. METHODS Participants were professionals recruited from Federally Qualified Health Centers, community behavioral health organizations, educational institutions, and agencies serving low-income children and families. 100 unique participants representing 3 counties and 54 agencies joined sessions. Twelve virtual educational sessions were convened over 6 months using the Project ECHO® model via Zoom technology. Sessions consisted of didactic lectures and case-based discussions. RESULTS After completion of the series, participants reported high satisfaction and increased knowledge and confidence in using TIC best practice skills. After participation, a significant number of participants voluntarily completed an additional online training about the specific TIC best practices that had been taught in the ECHO. Participants rated the opportunity for interprofessional collaboration and peer support for vicarious trauma as program strengths. DISCUSSION This project demonstrated feasibility and effectiveness in delivery of a curriculum on trauma-informed care to cross-sector, multi-agency maternal and child health workforce professionals using the Project ECHO® model. Robust interprofessional collaboration and participants' request for more sessions demonstrate the potential for this model to effect change at a local systems level.
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Affiliation(s)
- Christina A Buysse
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Barbara Bentley
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, 94304, USA
| | - Linda G Baer
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Heidi M Feldman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Engler AD, Sarpong KO, Van Horne BS, Greeley CS, Keefe RJ. A Systematic Review of Mental Health Disorders of Children in Foster Care. TRAUMA, VIOLENCE & ABUSE 2022; 23:255-264. [PMID: 32686611 DOI: 10.1177/1524838020941197] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVES This article summarizes the rate of mental health disorders of foster children, the specific types of disorders faced by this population, and how factors such as type of abuse or placement variables can affect mental health outcomes. METHOD A search in PsycInfo Ovid, EMBASE Elsevier, and Cochrane Library Wiley resulted in 5,042 manuscripts that were independently reviewed by two authors, yielding 25 articles. INCLUSION CRITERIA Published in or after 2000, written in English, and having a population sample of foster children (ages 0-18) in Western countries including the United States, Norway, Australia, and Canada. RESULTS Foster children have higher rates of mental health disorders than those of the general population. The most common diagnoses include oppositional defiant disorder/conduct disorder, major depressive disorder, post-traumatic stress disorder, and reactive attachment disorder. Variables such as type of maltreatment and type of placement predicted mental health outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Children in foster care experience more mental health disorders, as a response to either the circumstances that led to being removed from their homes or the experience of being placed in foster care. These results demonstrate the necessity for providers to consider mental health issues when caring for children in foster care and to perform appropriate screenings and assessments. With adequate trauma-informed training, providers can quickly become comfortable and competent in identifying mental health needs of children in foster care who have experienced trauma.
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Affiliation(s)
| | - Kwabena O Sarpong
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Section of Public Health and Child Abuse Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Bethanie S Van Horne
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Section of Public Health and Child Abuse Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Christopher S Greeley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Section of Public Health and Child Abuse Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Rachael J Keefe
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Section of Public Health and Child Abuse Pediatrics, Texas Children's Hospital, Houston, TX, USA
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Akin BA, Collins-Camargo C, Strolin-Goltzman J, Antle B, Nathan Verbist A, Palmer AN, Krompf A. Screening for trauma and behavioral health needs in child welfare: Practice implications for promoting placement stability. CHILD ABUSE & NEGLECT 2021; 122:105323. [PMID: 34537626 DOI: 10.1016/j.chiabu.2021.105323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although the child welfare field has initiated efforts to use standardized screening for trauma and behavioral health needs, research has rarely examined whether these screenings have influenced permanency outcomes. OBJECTIVE Using data from three states' federal demonstration projects, we examined whether receipt of trauma and behavioral health screening and results of screening were associated with placement stability (i.e., fewer placements). Our inquiry focused on whether similar patterns of statistical associations would be observed in three distinct state settings. PARTICIPANTS AND SETTING Samples comprised children in out-of-home care in three states newly implementing trauma and behavioral health screening. The states included a South Central state, New England state, and a Central Midwestern state. RESULTS In all three states, findings showed children who received screening had a higher number of placements (i.e., placement instability). Likewise, all three states found that children whose screening results indicated greater need, such as higher number of trauma symptoms or lower behavioral health functioning, were more likely to experience a higher number of placements (i.e., placement instability). CONCLUSION Despite differences in screening tools and state-specific approaches, findings suggest that early screenings may provide important information that could be used to identify children's needs, make appropriate service referrals, establish well-matched placements, and support resource parents and birth parents toward better permanency outcomes. Regardless of potential benefits of early screening, it may be underutilized in the field. Future research is needed to replicate these findings and continue to build an evidence base for trauma and behavioral health screening.
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Affiliation(s)
- Becci A Akin
- University of Kansas School of Social Welfare, 1545 Lilac Lane, Twente Hall, Lawrence, KS 66045, USA.
| | - Crystal Collins-Camargo
- University of Louisville, Kent School of Social Work, 2217 S 3rd, Julius John Oppenheimer Hall St, Louisville, KY 40292, USA
| | - Jessica Strolin-Goltzman
- University of Vermont, College of Education and Social Services, 309 Waterman Building, 85 South Prospect Street, Burlington, VT 05405, USA
| | - Becky Antle
- University of Louisville, Kent School of Social Work, 2217 S 3rd, Julius John Oppenheimer Hall St, Louisville, KY 40292, USA
| | - A Nathan Verbist
- Centerstone Research Institute, Inc., 44 Vantage Way, Nashville, TN 37228, USA
| | - Ashley N Palmer
- University of Texas at Arlington School of Social Work, 211 S Cooper St, Arlington, TX 76019, USA
| | - Alison Krompf
- University of Vermont, College of Education and Social Services, 309 Waterman Building, 85 South Prospect Street, Burlington, VT 05405, USA
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Jackson ML, Jewell VD. Educational Practices for Providers of Trauma-Informed Care: A Scoping Review. J Pediatr Nurs 2021; 60:130-138. [PMID: 33962302 DOI: 10.1016/j.pedn.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/25/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As more is learned about trauma and the ways in which trauma informed care (TIC) is provided, it is important to explore the education and training offered to those individuals who provide TIC. PURPOSE This scoping review examined training provided to individuals who interact with persons aged birth to 21 years old who have experienced or are experiencing trauma. METHOD The researchers searched six databases and identified 16 peer-reviewed articles in the areas of medicine/nursing, social work, and education published from 2012 to 2019 that met inclusion criteria. DISCUSSION Although most training protocols had a similar foundation, the findings from this review suggested that trauma informed care training practices vary across disciplines. CONCLUSIONS As training approaches varied greatly across disciplines, a conclusion on best practice guidelines cannot be stated for the professional environments.
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Affiliation(s)
| | - Vanessa D Jewell
- Creighton University, Department of Occupational Therapy, School of Pharmacy and Health Professions, NE, United States of America.
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Davis DW, Lohr WD, Feygin Y, Creel L, Jawad K, Jones VF, Williams PG, Le J, Trace M, Pasquenza N. High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid. BMC Psychiatry 2021; 21:303. [PMID: 34112146 PMCID: PMC8194140 DOI: 10.1186/s12888-021-03309-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits. METHODS A cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration. RESULTS High-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015-2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate. CONCLUSIONS Concerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.
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Affiliation(s)
- Deborah Winders Davis
- Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY, 40202, Louisville, USA.
| | - W. David Lohr
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Yana Feygin
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Liza Creel
- grid.266623.50000 0001 2113 1622Department of Health Management & System Sciences, University of Louisville School of Public Health and Information Science, 485 E. Gray Street, Louisville, KY 40202 USA
| | - Kahir Jawad
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - V. Faye Jones
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - P. Gail Williams
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Jennifer Le
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Marie Trace
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Natalie Pasquenza
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
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Purtle J. Systematic Review of Evaluations of Trauma-Informed Organizational Interventions That Include Staff Trainings. TRAUMA, VIOLENCE & ABUSE 2020; 21:725-740. [PMID: 30079827 DOI: 10.1177/1524838018791304] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Enthusiasm for trauma-informed practice has increased dramatically. Organizational interventions that train staff about trauma-informed practice are frequently used to promote trauma-informed systems change, but evidence about these interventions' effects has not been integrated. A systematic review was conducted of studies that evaluated the effects of organizational interventions that included a "trauma-informed" staff training component. A search was conducted in July 2017 and studies were identified in PubMed, PsycINFO, and the Published International Literature on Traumatic Stress database, limited to articles published in English after 2000. Six hundred and thirty-two articles were screened and 23 met inclusion criteria. Seventeen studies used a single group pretest/posttest design, five used a randomized controlled design, and one used a quasi-experimental design with a nonrandomized control group. The duration of trauma-informed trainings ranged from 1 hr to multiple days. Staff knowledge, attitudes, and behaviors related to trauma-informed practice improved significantly pre-/posttraining in 12 studies and 7 studies found that these improvements were retained at ≥1month follow-up. Eight studies assessed the effects of a trauma-informed organizational intervention on client outcomes, five of which found statistically significantly improvements. The strength of evidence about trauma-informed organization intervention effects is limited by an abundance of single group, pretest/posttest designs with short follow-up periods, unsophisticated analytic approaches, and inconsistent use of assessment instruments. In addition to addressing these methodological limitations, priorities for future research include understanding intervention effects on clients' perceptions of care and the mechanisms through which changes in staff knowledge and attitudes about trauma-informed practice influence client outcomes.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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12
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Keefe RJ, Van Horne BS, Cain CM, Budolfson K, Thompson R, Greeley CS. A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clin Pediatr (Phila) 2020; 59:252-258. [PMID: 31896282 DOI: 10.1177/0009922819898182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to compare the utilization of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system. The data for this study were analyzed from a clinical database of a multipractice pediatric health system in Houston, Texas. The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period. The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis. Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.
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Affiliation(s)
- Rachael J Keefe
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Bethanie S Van Horne
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Cary M Cain
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | | | - Richard Thompson
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Christopher S Greeley
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
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13
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Connell CM, Lang JM, Zorba B, Stevens K. Enhancing Capacity for Trauma-informed Care in Child Welfare: Impact of a Statewide Systems Change Initiative. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:467-480. [PMID: 31498465 PMCID: PMC7894977 DOI: 10.1002/ajcp.12375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Youth involved in the child welfare system (CWS) are disproportionally impacted by the negative effects of exposure to trauma. While efforts to develop trauma-informed CWSs are accelerating, little research is available about the effects of these efforts on system capacity to respond to the needs of youth exposed to trauma. No studies evaluate longer-term effects of these efforts. In 2011, Connecticut implemented CONCEPT, a multi-year initiative to enhance capacity of the state's CWS to provide trauma-informed care. CONCEPT used a multi-component approach including workforce development, deployment of trauma screening procedures, policy change, improved access to evidence-based trauma-focused treatments, and focused evaluation of program effects. Changes in system capacity to deliver trauma-informed care were assessed using statewide stratified random samples of child welfare staff at three time points (Year 1: N = 223, Year 3: N = 231, Year 5: N = 188). Significant improvements across nearly all child welfare domains were observed during the first 3 years of implementation, demonstrating system-wide improvements in capacity to provide trauma-informed care. These gains were maintained through the final year of implementation, with continued improvements in ratings of collaboration between child welfare and behavioral health settings on trauma-related issues observed. Responses documented familiarity with and involvement in many of the CONCEPT activities and initiatives. Staff reported greater familiarity with efforts to increase access to specific evidence-based services (e.g., TF-CBT) or to enhance trauma-related policy and practice guidelines, but less familiarity with efforts to implement new practices (e.g., trauma screening) in various sectors. Staff also reflected on the contribution of these components to enhance system capacity for trauma-informed care.
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Affiliation(s)
- Christian M. Connell
- Human Development and Family Studies and Child Maltreatment Solutions Network, Pennsylvania State University, University Park, PA, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jason M. Lang
- Child Health and Development Institute, Farmington, CT, USA
- Department of Psychiatry, UCONN Health, Farmington, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Bethany Zorba
- Connecticut Department of Children and Families, Hartford, CT, USA
| | - Kristina Stevens
- Connecticut Department of Children and Families, Hartford, CT, USA
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Swindle T, Johnson SL, Davenport K, Whiteside-Mansell L, Thirunavukarasu T, Sadasavin G, Curran GM. A Mixed-Methods Exploration of Barriers and Facilitators to Evidence-Based Practices for Obesity Prevention in Head Start. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1067-1079.e1. [PMID: 31350198 PMCID: PMC6788974 DOI: 10.1016/j.jneb.2019.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To identify positive and negative deviant cases using quantitative fidelity data from a previous implementation of a nutrition intervention, Together, We Inspire Smart Eating (WISE), and to determine barriers and facilitators to fidelity by conducting qualitative interviews with deviant cases. DESIGN Explanatory sequential mixed methods. SETTING Head Start Program agencies in 2 southern US states. PARTICIPANTS Quantitative fidelity data were collected in 42 Head Start classrooms. Recruitment for qualitative interviews prioritized those who were positive or negative deviants across fidelity components (African American, n = 21; white, n = 19; and Hispanic, n = 3). INTERVENTION WISE introduces children to fruits and vegetables using evidence-based practices of role modeling, positive feeding, mascot use, and hands-on exposure. ANALYSIS A directed content analysis approach informed by the integrated Promoting Action on Research Implementation in Health Service framework. PHENOMENON OF INTEREST Barriers and facilitators to WISE evidence-based practices implementation. RESULTS Qualitative analyses identified themes of culture, leadership support, and mechanisms for embedding change as key contextual factors. Key findings related to recipient characteristics were beliefs about what works, personalized strategies to use WISE, and classroom management. Primary themes for the innovation construct were time and preparation, degree of fit, and WISE advantage. Finally, findings relative to the construct of facilitation included trainer support and desire for additional training. CONCLUSIONS AND IMPLICATIONS The study of cases at the extreme ends of the fidelity spectrum can provide unique perspectives on barriers and facilitators to implementation of interventions.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Karen Davenport
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Gireesh Sadasavin
- Regional Family Medicine Center, University of Arkansas for Medical Sciences, Pine Bluff, AR
| | - Geoffrey M Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
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15
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Niimura J, Nakanishi M, Okumura Y, Kawano M, Nishida A. Effectiveness of 1-day trauma-informed care training programme on attitudes in psychiatric hospitals: A pre-post study. Int J Ment Health Nurs 2019; 28:980-988. [PMID: 31081263 DOI: 10.1111/inm.12603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
Many patients in mental health settings are likely to have histories of interpersonal traumatic experiences. Mental health providers are recommended to adopt trauma-informed care (TIC) to ensure sensitivity and responsiveness to the impact of trauma on patients. However, few studies have examined the effectiveness of a TIC training programme using standardized measures with follow-up assessments. The aim of the study was to evaluate the effects of a TIC training programme on attitudes towards TIC in mental health professionals. The study involved a pre-post design with 3-month follow-up assessments conducted between March and June 2018. In total, 65 mental health professionals from 29 psychiatric hospitals in Tokyo and its suburban prefectures participated in the study. Mental health professionals participated in a 1-day programme consisting of a 3.5-hour lecture and 1-hour group discussion. Development of favourable attitudes towards TIC was the primary outcome, as assessed by using the Attitude Related Trauma-Informed Care scale. The majority of participants were women (86%), and the mean age was 42.2 years. The mean score of the Attitude Related Trauma-Informed Care scale scores increased significantly from 5.1 during pre-training to 5.5 immediately after training (mean difference: 0.4; 95% confidence interval: 0.3-0.5) and 5.4 after 3 months (mean difference: 0.3; 95% confidence interval: 0.2-0.4). Furthermore, half of the participants claimed to have implemented TIC practice in daily clinical settings at the 3-month follow-up. These results suggested that this brief TIC training programme improved attitudes towards TIC practice significantly.
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Affiliation(s)
- Junko Niimura
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yasuyuki Okumura
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | | | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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16
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Bunting L, Montgomery L, Mooney S, MacDonald M, Coulter S, Hayes D, Davidson G. Trauma Informed Child Welfare Systems-A Rapid Evidence Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132365. [PMID: 31277339 PMCID: PMC6651663 DOI: 10.3390/ijerph16132365] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 01/30/2023]
Abstract
Trauma informed care (TIC) is a whole system organisational change process which emerged from the seminal Adverse Childhood Experiences (ACE) study, establishing a strong graded relationship between the number of childhood adversities experienced and a range of negative outcomes across multiple domains over the life course. To date, there has been no systematic review of organisation-wide implementation initiatives in the child welfare system. As part of a wider cross-system rapid evidence review of the trauma-informed implementation literature using systematic search, screening and review procedures, twenty-one papers reporting on trauma-informed implementation in the child welfare system at state/regional and organisational/agency levels were identified. This paper presents a narrative synthesis of the various implementation strategies and components used across child welfare initiatives, with associated evidence of effectiveness. Training was the TIC implementation component most frequently evaluated with all studies reporting positive impact on staff knowledge, skills and/or confidence. The development of trauma-informed screening processes, and evidence-based treatments/trauma focused services, where evaluated, all produced positive results. Whilst weaknesses in study design often limited generalisability, there was preliminary evidence for the efficacy of trauma-informed approaches in improving the mental and emotional well-being of children served by community-based child welfare services, as well as their potential for reducing caregiver stress and improving placement stability.
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Parker EM, Jacobson J, Pullmann MD, Kerns SEU. Identifying Psychosocial Problems Among Children and Youth in the Child Welfare System Using the PSC-17: Exploring Convergent and Discriminant Validity with Multiple Informants. Child Psychiatry Hum Dev 2019; 50:108-120. [PMID: 29961167 DOI: 10.1007/s10578-018-0824-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Youth who enter foster care are at risk of mental health need, but questions arise as to the validity of their self-reported symptomatology. This study examines the screening validity of the youth-report version of the Pediatric Symptom Checklist-17 (PSC-17) in a child welfare population. Data come from 2389 youth who completed a version of the PSC-17 adapted for youth report, and their biological and foster parents who completed the parent-report version. Youth also completed a shortened version of the Screen for Child Anxiety Related Disorders (SCARED). Convergent and discriminant validity of the PSC-17 was assessed using multi-trait multi-method matrices. The PSC-17's internalizing subscale was strongly correlated, attention subscale was moderately correlated, and externalizing subscale was weakly correlated with the SCARED's anxiety and PTSD subscales. Comparing youth and foster parent scores, the PSC-17 had moderate convergent validity and weak/fair discriminant validity. Comparing youth, foster parent, and biological parent scores, the PSC-17 had moderate convergent validity and weak/fair discriminant validity. The current study provides some support for the validity of the PSC-17 for the population of youth in foster care.
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Affiliation(s)
- Elizabeth M Parker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA.
| | - Jedediah Jacobson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA
| | - Suzanne E U Kerns
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA.,University of Denver Graduate School of Social Work, 2148 S High St, Denver, CO, 80208, USA
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18
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Jankowski MK, Schifferdecker KE, Butcher RL, Foster-Johnson L, Barnett ER. Effectiveness of a Trauma-Informed Care Initiative in a State Child Welfare System: A Randomized Study. CHILD MALTREATMENT 2019; 24:86-97. [PMID: 30200774 DOI: 10.1177/1077559518796336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Trauma-informed care (TIC) initiatives in state child welfare agencies are receiving more attention, but little empirical evidence exists as to their efficacy. The purpose of this study was to assess changes in self-reported practices and perceptions of child welfare staff involved in a multifaceted, statewide TIC intervention. Ten child welfare offices were matched and randomized to an early or delayed cohort. Staff were surveyed at Time 1 prior to any intervention, Time 2 postintervention for Cohort 1, and Time 3 postintervention for Cohort 2. The survey covered six domains: trauma screening, case planning, mental health and family involvement, progress monitoring, collaboration, and perceptions of the state's overall system performance. Linear mixed modeling assessed the effect of the intervention. Cohort by time interaction was significant for three intervention targets. We demonstrate, using a rigorous study design, the mixed results of a multimodal intervention to improve trauma-informed attitudes, practices, and system performance. TIC initiatives must account for complex, dynamic contextual factors.
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Affiliation(s)
- M Kay Jankowski
- 1 Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Karen E Schifferdecker
- 2 Department of Community and Family Medicine, Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Rebecca L Butcher
- 3 Geisel School of Medicine, Center for Program Design and Evaluation, Lebanon, NH, USA
| | - Lynn Foster-Johnson
- 4 Department of Community and Family Medicine, Geisel School of Medicine, Lebanon, NH, USA
| | - Erin R Barnett
- 1 Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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19
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Maltais C, Cyr C, Parent G, Pascuzzo K. Identifying effective interventions for promoting parent engagement and family reunification for children in out-of-home care: A series of meta-analyses. CHILD ABUSE & NEGLECT 2019; 88:362-375. [PMID: 30579168 DOI: 10.1016/j.chiabu.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND An important obstacle for family reunification following child placement in residential care and other temporary out-of-home care services is the lack of engagement among parents. OBJECTIVE The aim of this meta-analysis is to identify the most effective interventions to promote parental engagement and family reunification. METHOD AND PARTICIPANTS Eight studies, for a total of 2996 families, were used to conduct two series of meta-analyses. Each study examined the effectiveness of a goal-oriented parental engagement intervention, relative to a control group made up of parents who received standard services. Six moderators were analyzed: type of clinical modality, number of clinical strategies, sources of motivation for intervention, focus on the child care staff-parent relationship, child care staff training, and strategies to promote access to intervention. RESULTS Results indicate that parents exposed to goal-oriented engagement interventions showed greater engagement (effect size d = 0.71, CI: 0.35-1.07, p < 0.001) and likelihood of reunification (effect size OR = 2.49, CI: 1.22-5.10, p < 0.05) than parents who received standard services. In particular, moderator analysis showed that parents who specifically participated in a family-focused intervention showed the highest engagement in comparison to parents involved in other types of interventions or who received standard services (effect size d = 1.08, CI: 0.58-1.59, p < 0.001). No moderators significantly explained heterogeneity of studies on family reunification. CONCLUSION Overall, the results underline the effectiveness of family-focused interventions to promote parental engagement. Nevertheless, greater knowledge on the mechanisms by which interventions can increase parents' engagement and family reunification is still needed.
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Affiliation(s)
- Christine Maltais
- Unité d'évaluation des technologies et des modes d'intervention, Direction de l'enseignement universitaire et de la recherché, Centre intégré universitaire de santé et services sociaux du Centre-Sud-de-l'île-de-Montréal, 4565 Queen Mary, Montreal, Québe H3W 1W5, Canada.
| | - Chantal Cyr
- Département de psychologie, Université du Québec à Montréal, Québec, Canada
| | - Geneviève Parent
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Québec, Canada
| | - Katherine Pascuzzo
- Département de psychologie, Université du Québec à Montréal, Québec, Canada; Institut universitaire jeunes en difficulté, Centre intégré universitaire de santé et services sociaux du Centre-Sud-de-l'île-de-Montréal, Québec, Canada
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20
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Lindley LC, Slayter EM. Prior Trauma Exposure and Serious Illness at End of Life: A National Study of Children in the U.S. Foster Care System From 2005 to 2015. J Pain Symptom Manage 2018; 56:309-317. [PMID: 29890215 DOI: 10.1016/j.jpainsymman.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Children in foster care suffer with serious illness at end of life. However, the relationship between prior trauma exposure and serious illness has received little empirical attention. OBJECTIVES The objectives were to examine the prevalence and type of trauma exposure and investigate the relationship between prior trauma and serious illness among foster children at end of life. METHODS We used national longitudinal foster care data. We included children who were younger than 18 years with residence in the U.S. Serious illness (i.e., physical health, mental/behavioral health, developmental disabilities) was measured via the foster care files. Three measures of prior trauma exposure (i.e., maltreatment, drug/alcohol exposure, psychosocial stressors) were created. Using multivariate logistic regressions, we evaluated the influence of prior trauma on serious illness at end of life, while controlling for demographic, geographic, and foster care support characteristics. RESULTS Sixty-eight percent of children experienced maltreatment, 28% exposure to parental drug/alcohol misuse, and 39% psychosocial stressors before entering foster care. Maltreatment was positively associated with physical health and developmental disabilities, whereas parental drug/alcohol exposure was inversely related to developmental disabilities. Psychosocial stressors contributed to the prediction of poor physical, mental, and developmental health. CONCLUSION These findings suggest that trauma-informed end-of-life care may be a critical need among children in foster care with serious illness. Future directions are discussed, including collaboration between end-of-life clinicians and social service workers and the importance of future research to understand and improve the quality of health at end of life for this underserved population.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing University of Tennessee, Knoxville, Tennessee, USA.
| | - Elspeth M Slayter
- School of Social Work Salem State University, Salem, Massachusetts, USA
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21
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Barto B, Bartlett JD, Von Ende A, Bodian R, Noroña CR, Griffin J, Fraser JG, Kinniburgh K, Spinazzola J, Montagna C, Todd M. The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes. CHILD ABUSE & NEGLECT 2018; 81:149-160. [PMID: 29739000 DOI: 10.1016/j.chiabu.2018.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/12/2018] [Accepted: 04/27/2018] [Indexed: 05/16/2023]
Abstract
This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.
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Affiliation(s)
- Beth Barto
- LUK, Inc., 545 Westminster St., Fitchburg, MA, 01420, United States.
| | | | - Adam Von Ende
- Brazelton Touchpoints Center, Division of Developmental Medicine, Boston Children's Hospital, 1295 Boylston St., Suite 320, Boston, MA, 02215, United States
| | - Ruth Bodian
- Massachusetts Department of Children & Families, 600 Washington St., Boston, MA, 02111, United States
| | - Carmen Rosa Noroña
- Child Witness to Violence Project, Boston Medical Center, One Boston Medical Center Pl, Boston, MA, 02118, United States
| | - Jessica Griffin
- University of Massachusetts Medical School, 55 N Lake Ave., Worcester, MA, 01655, United States
| | | | - Kristine Kinniburgh
- Trauma Center at Justice Resource Institute, 1269 Beacon St., Brookline, MA, 02446, United States
| | - Joseph Spinazzola
- The Foundation Trust, P.O. Box 760995, Melrose, MA, 02176, United States
| | - Crystaltina Montagna
- University of Massachusetts Medical School, 55 N Lake Ave., Worcester, MA, 01655, United States
| | - Marybeth Todd
- Child Trends, 56 Robbins St., Acton, MA, 01720, United States
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Damian AJ, Gallo JJ, Mendelson T. Barriers and facilitators for access to mental health services by traumatized youth. CHILDREN AND YOUTH SERVICES REVIEW 2018; 85:273-278. [PMID: 29795708 PMCID: PMC5962297 DOI: 10.1016/j.childyouth.2018.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Polytrauma is a highly prevalent public health problem in the U.S. with even higher rates in urban areas. Children with polytrauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe. Providers within these child-serving systems have potential to serve as gatekeepers to trauma services by linking youth with trauma-informed treatments and supports that promote recovery. The purpose of our study was to assess the perspective of providers who participated in a nine-month, trauma-informed care (TIC) training intervention on 1) their capacity to make referrals to trauma-specific services following the training, and 2) factors external to the training intervention that supported or hindered their ability to link traumatized youth with services. A subset of sixteen participants from the TIC training completed individual interviews. These participants were predominantly female, African American, and based in the social services sector. The constant comparative method was used to derive three thematic domains related to participant perceptions regarding youth referrals: 1) Organizational and provider capacity to provide trauma treatment or to make referrals to trauma-specific services, 2) Barriers to youth accessing trauma services, and 3) Suggestions for improving coordination of care and referrals. Our study highlights the influence of contextual factors on whether a TIC training can improve the capacity of agencies and individual providers to support traumatized youth in accessing appropriate services. The development of a structure that formally connects youth-serving agencies and providers with specialists trained in addressing traumatized youth is recommended.
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Affiliation(s)
- April Joy Damian
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD 21205, United States
| | - Joseph J Gallo
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD 21205, United States
| | - Tamar Mendelson
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD 21205, United States
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23
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Collins-Camargo C, Antle B. Child welfare supervision: Special issues related to trauma-informed care in a unique environment. CLINICAL SUPERVISOR 2017. [DOI: 10.1080/07325223.2017.1382412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Becky Antle
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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