Innovations in Implementation of Trauma-Informed Care Practices in Youth Residential Treatment: A Curriculum for Organizational Change

Article excerpt

Children in the child welfare system frequently experience trauma within the caregiving relationship. These traumatic experiences may be compounded by system trauma and place these children at high risk of emotional disorders and placement in out-of-home (OOH) mental health treatment programs. This article reviews the literature on trauma and children in the child welfare system and discusses a study of trauma-informed practices in OOH treatment programs and the curriculum Creating Trauma-Informed Care Environments, which resulted from study findings.

Childhood traumatic stress refers to both physical and emotional responses of children to life-threatening events that cause or threaten injury, such as child sexual abuse, physical abuse, or family violence (Child Welfare Collaborative Group, National Child Traumatic Stress Network [NCTSN], and California Social Work Education Center, 2008). The types of trauma prevalent among children and families in child welfare include abuse and neglect, exposure to violence, and exposure to parental substance abuse. Child maltreatment also co-occurs with risk factors within disadvantaged environments, such as neighborhood violence and inadequate community resources (Edleson, 1999; Rudo, Powell, èc Dunlap, 1998).

As children move through the child welfare and juvenile court systems, they often encounter additional stressful, frightening, and emotionally overwhelming experiences through "system-generated trauma" (Ryan, Bashant, èc Brooks, 2006), such as multiple placements and frequent changes in schools and peer groups (Ko, Ford, Kassam- Adams, Berkowitz, Wilson, Wong, Brymer, èc Layne, 2008). Because of the increased risk for emotional and behavioral challenges experienced by children in child welfare (Landsverk, Burns, Stambaugh, èc Rolls Reutz, 2009), these placement changes often include out-of-home (OOH) mental health treatment programs, including residential treatment programs. Consequently, there are high rates of trauma exposure in the histories of youth in OOH settings (LeBeI èc Stromberg, 2004).

The high rate of dependent children and youth in OOH mental health treatment programs, combined with the recognition of the need for trauma-related training and resources from Florida's service provider community, provided the impetus for evaluating the degree to which trauma-informed care was being implemented in Florida's OOH mental health treatment programs. The findings from the eight nominated residential mental health settings in Florida who participated in the assessment were used to develop a comprehensive curriculum that highlights successful implementation and sustainability of cultural change within organizations that are adapting trauma-informed and trauma-specific care. This curriculum merges the current research on models of trauma- informed care with theories of organizational change and development (Hodges, Hernandez, Nesman &. Lipien, 2002) and implementation research (Fixsen, Naoom, Blasé, Friedman, 6c Wallace, 2005).

Background

There is a growing recognition that chronic and complex trauma is at the core of many behavioral and psychological disorders of children and adolescents (Cook, Blaustein, Spinnazzola, Van der Kolk, &. the Complex Trauma Task Force, 2003), and that research-proven practice is essential for effective treatment of this population. Complex trauma refers to problems from exposure to multiple traumatic events and the resulting short- and long-term effects of such exposure. This generally occurs within the caregiving system, which suggests that interventions that occur within the context of relationships are the desired avenue for healing (Perry, Pollard, Blakley, Baker, &. Vigilante, 1995). Exposure to early, repeated, and multiple episodes of abuse increases the risk for complex trauma, affecting the self-regulatory, behavioral, and emotional systems of traumatized children (Cook et al., 2007). Therefore, the need for intervention within the caregiving relationship also extends to relationships between direct- care staff and children in mental health treatment programs. …