The Diffusion of Trauma-Informed Practices into a Head Start System: A Process Evaluation of Safe Start

Introduction: Adverse childhood experience (ACE) refers to the exposure of children to prolong or chronic traumatic events that have the potential for immediate and lifelong health impacts (Felitti, et al., 1998). ACEs include child maltreatment, family stress or dysfunction, community violence, and natural disasters (van der Kolk, 2005). The 2011-12 National Survey of Children’s Health (NSCH) found that 22.6 percent of children 0-17 years old experienced two or more ACEs (Bethell, Newacheck, Hawes, & Halfon, 2014). The high incidence of ACEs in the non-clinical child population has led to growing recognition of the need to build trauma-informed education and early learning systems capable of identifying and responding to the effects of toxic stress associated with ACEs (Walkley & Cox, 2013).

Methods: As part of the Safe Start Intervention (Blodgett, 2014), a Head Start program with 650 service slots implemented system wide, monthly professional development trainings (n=14) based on ARC model (Blaustein and Kinniburgh, 2010) to foster a shared trauma sensitive culture. The process evaluation used a purposive sampling method. All senior managers, center directors and Safe Start managers were interviewed annually during the 3 year study (n = 12) Ten percent of the teaching and family support professionals (FSCs) participated in annual interviews (n = 45). The protocol consisted of 5 open-ended questions and probes designed to elicit data regarding their understanding, beliefs and application of trauma informed practices.

Results: Results were consistent with the Diffusion of Innovation theory. In year 1, senior management, 2 center directors and a small portion of personnel were highly supportive of the ARC model, but uptake lagged among the majority of system personnel. Early supporters were often recruited to assume additional Safe Start responsibilities removing them from direct service. There was greater support for the ARC model in year 2 with estimates that 40% of teaching and family support personnel used the concepts and language in their work. Confusion remained between the Safe Start family intervention and the Professional Development program. Several perceived barriers were noted including: a top down implementation, overlap with previous mental health initiatives, diversion of personnel and time to support the research, and a one-size-fits all approach to training. Centers managed by the two early advocate directors had significantly higher estimates of diffusion.

Conclusion: The use of common, system-wide professional development for culture change shows promise, but may benefit from a phased implementation that targets mid-level supervisors followed by direct service professionals.