Research Bulletin July 2018: Adverse Childhood Experiences and Trauma-Informed Care

This month’s bulletin focuses on research, reports, and evaluations related to trauma-informed care, adverse childhood experiences, and the implementation of trauma-informed approaches to care.

The first two reports are companion pieces—the first looks at the significant impact of a system-wide implementation of trauma-informed care and the second is an evaluation of the implementation process itself. Also included is research and analysis on ways to manage, prepare for, and incorporate trauma-informed care as well as system-wide trauma-prevention prevention strategies.

  1. Trauma-informed child welfare systems and children’s well-being (2017)
  2. KVC’s Bridging the Way Home (2017)
  3. Adverse childhood experiences and life opportunities (2017)
  4. Laying the Groundwork for Trauma-Informed Care (2018)
  5. Preventing Child Abuse and Neglect: A Technical Package (2016)

In upcoming bulletins, we will focus on aging and senior’s care, mental health, substance use, welfare reform, and systems change. So be sure to forward this to colleagues and encourage them to subscribe.

Our goal with these bulletins is to share useful research and information in a useful way. If you have feedback about how we can make these more useful (and/or if you want to suggest issues or service areas for us to pay attention to), please contact our Research and Policy Analyst.

1. Trauma-informed child welfare systems and children’s well-being: A longitudinal evaluation of KVC’s bridging the way home initiative (USA, 2017)

This 2017 study focuses on the implementation of trauma-informed care across a large, private child welfare system in the US. The implementation of Trauma Systems Therapy (TST) was measured against children’s well-being, functioning, emotional and behavioural regulation as well as placement stability.

While the report is data-heavy, the implications and conclusions are significant and should be encouraging to a wide range of individuals both within the child welfare system as well as the broader child-serving system—practitioners, program developers, administrators, funders, and policymakers.

The findings indicate that the system-wide implementation of trauma-informed care has the potential to result in meaningful improvements in children’s functioning and well-being. Moreover, positive effects of implementing trauma-informed care were produced by both those who work closely with the child (caregivers, case managers, and therapists) and those who work more indirectly (case manager supervisors and family service coordinators). Since this suggests that no one staff member or caregiver is central to providing trauma-informed care; the authors claim that the confluence of trauma-informed approaches among the child’s entire care team is what produces better outcomes.

The authors make clear the implications of these findings for three distinct, but equally important, audiences: (1) practitioners, program developers and administrators; (2) policymakers and funders; and (3) researchers.

2. KVC’s Bridging the Way Home: An innovative approach to the application of Trauma Systems Therapy in child welfare (USA, 2017)

A companion piece to the above report, this article focuses on the same system-wide intervention but specifically evaluates the large-scale implementation itself. The authors explore the extent to which a trauma-informed intervention model could inform the work of everyone involved in the care of a foster child and how best to implement such broad systems change.

While the process of implementing and expanding TST on such a scale was demanding, iterative, and complex, the efforts were successful. However, the authors make very clear the fact that this system-wide effort required a multi-year commitment and was made possible by additional private funding.

The key lessons? Do not underestimate the extent to which communication across multiple systems and levels can augment system change efforts. Additionally, non-clinical staff (school staff, mental health, foster parents, judicial staff) need to be viewed as integral parts of a child’s care team.

To help other large-scale endeavours, the report includes approaches to training, coaching, and quality improvement, strategies that were used to integrate knowledge into practice, as well as the extent and timing of the training that took place.

3. Adverse childhood experiences and life opportunities: Shifting the narrative (USA, 2017)

Substantial research shows that early adversity—including child abuse and neglect—is associated with poor health outcomes throughout life as well as across generations. This paper looks at the less understood relationship between early adversity and adult socioeconomic status (including education, employment, and income).

The authors suggest that (1) understanding the full impact of early adversity is critical to breaking the intergenerational cycle of poverty and (2) that preventing early adversity can affect health and life opportunities that reverberate across generations. As such, they suggest that efforts to prevent and/or address early adversity might be more successful if practitioners can better understand their potential impact.

4. Laying the Groundwork for Trauma-Informed Care (USA, 2018)

Adopting a trauma-informed approach to care has the potential to improve both client outcomes and the well-being of practitioners and care providers. While created for healthcare organizations, this research brief offers a universal approach for adopting a trauma-informed approach to care.

This brief draws from the experiences of pilot sites and national initiatives and offers four foundational steps to help organizations move toward a more comprehensive approach to trauma. It includes practical recommendations for organizations interested in becoming trauma-informed as well as online training resources, trauma-informed interview questions, and more.

5. Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities (USA, 2016)

Developed in partnership by the National Center for Injury Prevention and Control and the US Centers for Disease Control and Prevention, this “technical package” represents a select group of strategies based on the best available evidence to help prevent child abuse and neglect.

The strategies include those with a focus on preventing child abuse and neglect from happening in the first place as well as approaches to lessen the immediate and long-term harms of child abuse and neglect.

The five strategies (e.g., “strengthen economic supports to families,” “enhance parenting skills to promote healthy child development”) are intended to help communities prioritize policies, activities, and approaches based on the best available evidence. Each includes a rationale, approaches, ideal outcomes, and evidence to facilitate coordination and collaboration among stakeholders.