Understanding Practitioners' Perspectives of Culturally Sensitive Trauma-Informed Care

Introduction: Latino children are at preferential risk for trauma exposure, have worse social and behavioral outcomes following exposure, and are at greater risk for re-victimization (Gjelsvik, Dumont, & Nunn, 2013; Shapiro, 1995; Stewart, Orengo-Aguayo, Gilmore, & de Arellano, 2017). Many practice guidelines exist and continue to be developed that support trauma-informed care across different settings (https://www.chcs.org/project/advancing-trauma-informed-care/). Unfortunately, it is not clear how, or if, these guidelines account for culturally sensitive practices and what challenges practitioners face in applying them. This is critical as research has indicated numerous barriers to engaging Latino families in mental health and social services that extend beyond language (Kouyoumdjian, Zamboanga, & Hansen, 2003). Using a mixed methods approach, this project examined important cultural considerations that support successful implementation of trauma-informed care within culturally diverse populations. In conceptualizing key practitioner perspectives in a multi-level framework, we hope to further trauma-informed care by suggesting culturally sensitive practices in order to increase engagement in services.

Methods: Key informant interviews and electronic surveys (n=20) were conducted with community practitioners (child welfare and healthcare) in the Phoenix, AZ metro area. A structured interview guide included questions about training, current practices and barriers to service engagement.Transcripts were coded in ATLAS.ti using a template approach (Patton, 2002). A systematic process of coding was utilized which included having all transcripts double-coded to ensure trustworthiness and rigor of the findings. Surveys were analyzed in SPSS.

Results: Preliminary findings suggest that trauma-informed practice in Phoenix is driven primarily by experiential and informal learning experiences. Regardless of the lack of formal training, practitioners were overwhelmingly confident in their abilities to define, understand the sources of, and recognize signs and effects of trauma. Respondents were least confident in their ability to respond to children who have experience trauma, supporting the need to bolster training in this area. Themes, which emerged from interviews, summarized macro, meso, and micro barriers to effectively implementing community-based trauma-informed care. Specifically, multi-level barriers to implementation include societal values, socioeconomic circumstances, normalization of trauma exposure, and the transgenerational impact of trauma. Practitioners reported approaching their work using relationship focused and family centered frameworks, which may represent an important component of culturally sensitive trauma-informed care.

Discussion: In an effort to increase service accessibility within culturally diverse populations, culturally congruent community practices are greatly needed. It is therefore essential to understand how challenges at multiple contextual levels influence culturally sensitive service implementation to inform practices that lower barriers to service accessibility.