Dissemination and Implementation of Evidence-Based Trauma-Informed Care (TIC) Trainings in Baltimore City Agencies

Background: There is growing recognition in Baltimore City that generations of exposure to poverty, racism, violent crime and domestic violence has resulted in extremely high levels of traumatic stress for individuals, families and communities across the City. The Baltimore City Health Department (BCHD) is leading an initiative to transform Baltimore into a city that is trauma-informed and is collaborating with The National Center for Trauma Informed Care to provide evidence-based trauma-informed care (TIC) training to all city workers through funding by the SAMHSA Center for Mental Health Services.

Methods: BCHD invited 40 senior leadership, middle management, and front line city workers from each of 12 Baltimore City government agencies working directly with Baltimore City youth and families to participate in the TIC training. Semi-structured and open-ended group interviews were conducted with participants to understand acceptability of training and to identify needs in implementing trauma-informed changes to policies and procedures of agencies represented.

Findings: Thematic coding of participants’ responses resulted in four major themes: 1) Greater understanding of trauma and impact of chronic traumatic stress on child development; 2) Recognition of high prevalence of trauma in both those being served and those in the Baltimore City workforce; 3) Need for strengthening referral system once youth and families who have faced trauma are identified, and; 4) Call for additional training on how to integrate trauma-informed training and practices into service with Baltimore City youth and families.

Implications for Dissemination and Implementation Research: This preliminary study on the use of the evidence-based TIC training with Baltimore City provider agencies has several implications for dissemination and implementation research. The next steps include further developing the implementation science to translate TIC trainings to clinical and community settings, and ensure City agencies and providers have sufficient capacity to implement trauma-informed changes to their respective policies and procedures. Additional focus groups with local trauma experts and City residents to identify and disseminate messages about trauma and healing that resonates with City youth and families is also warranted.