Implementing Trauma-Informed Care in Congregate Care Settings Serving Children: Successes and Challenges

INTRODUCTION: Trauma-informed care (TIC) is an approach in which mental health agencies recognize the pervasive impact of trauma and aim to ameliorate rather than exacerbate its effects. The curriculum-based Risking Connection (RC) trauma training program is one of several models used nationally and internationally as a pathway toward TIC culture change in child residential settings. Our previous research has demonstrated that RC increases staff knowledge about RC and staff beliefs and behavior favorable to TIC. RC also aims to improve professional quality of life, including burn out (BO), secondary traumatic stress (STS), and compassion satisfaction (CS), or the pleasure staff derive from being able to do their work well (Stamm, 2005). The purpose of this study is 1) to replicate and 2) to better understand the implementation of TIC via RC trauma training for staff at a rural mental health agency in Northwest Canada.

METHOD: Congregate care staff (N = 67, ages 24 to 66, M = 39.80, SD = 10.94; 65.7% female) participated in pretest evaluations, which occurred immediately before the three-day RC training, and posttest evaluations, which occurred at the conclusion of the training. Staff reported being employed in the field of mental health for 11.73 years on average (SD = 8.38) and in their current position for an average of 5.70 years (SD = 5.00). Staff self-reported on beliefs and behavior (pretest only) favorable to TIC, as well as professional quality of life. Twenty-three staff also participated in 6-month follow-up evaluations. Following this quantitative analysis, a qualitative analysis including a) one-on-one interviews (n= 10), and b) participant observations was conducted to inform the quantitative findings.

RESULTS: As hypothesized, staff significantly improved in beliefs favorable to TIC from pre- to posttest, t(66) = 10.37, p < .001, with these high scores maintained at follow-up. Contrary to hypotheses, staff behavior in the milieu did not improve, t(20) = .003, p = ns. Staff improved on CS from pre- to posttest, t(65) = 2.06, p = .04, which was maintained at follow-up. BO and STS both increased from pre- to posttest, contrary to hypotheses t_BO(65) = 3.92, p < .001, and t_STS(65) = 5.80, p< .001. These increases were maintained at follow-up. Qualitative analyses suggest that the milieu measure may miss important indicators of TIC culture change, and that the higher incidence of BO and STS reporting may be due to increased awareness following RC training. 

CONCLUSIONS: Understanding and evaluating the process of TIC implementation is complex. Implications of this study include a call for more reliable and valid measurement approaches to evaluate the dissemination and implementation of evidence-based approaches in community agencies.