Session: Barriers and Facilitators to Trauma-Informed Systems (Society for Prevention Research 27th Annual Meeting)

A recent nationally representative survey found that 46.3% of children are exposed to adverse childhood events (Bethell, Davis, Gombojav, Stumbo, & Powers, 2017). These potentially traumatic experiences during childhood have a negative impact on biologic, social and behavioral, academic, and economic outcomes (Gilbert, Breiding, Thompson, Ford, Dhingra, & Parks, 2010). Due to the magnitude of these associations, many preventative interventions focus on reducing exposure to trauma (e.g., preventing child abuse, mental health interventions). While this is critical, it is also important for systems that work with these children and families to be aware of the impact of trauma, know how to identify signs and symptoms of trauma, and be able to be responsive to the needs of individuals who have experienced trauma. The National Child Traumatic Stress Network (www.nctsn.org) identifies these as trauma-informed systems and lists specific policies and practices of these systems. A broad range of systems across the country, including schools, hospitals, community mental health and juvenile justice, have embraced the notion of being trauma-informed. However, despite the popularity, barriers and facilitators of these policies and practices are not known.

The papers in this symposium all explore barriers and facilitators to trauma-informed care. They use different methodologies and focus on a variety of settings (community, healthcare, and schools). Specifically, the first paper in the symposium will utilize data from three studies to classify barriers and facilitators of trauma-informed care onto the dimensions of the Consolidated Framework for Implementation Research. This paper suggests the importance of focusing on facilitators to trauma-informed care including characteristics of the individual and inner setting. The second paper in the symposium concentrates on culturally-informed trauma-informed care. This paper supports an ecological understanding of barriers and a necessity of focusing on the family and building relationships as critical to the practice of trauma-informed care for Hispanic families. Finally, the third paper presents the results of a pre-implementation intervention to support Cognitive Behavioral Intervention for Trauma in School (CBITS). The intervention found changes in clinicians’ attitudes and intentions about the intervention, however, actual implementation was not impacted. These papers highlight a variety of challenges, but more importantly suggest opportunities to support trauma-informed systems. A discussant with expertise in creating community and school mental health systems will provide suggestions about strategies to overcome barriers and foster facilitators.