Community-based Programming Research Articles

ScreenABLE: Breast Cancer Screening among Women with Disabilities from Community Identified Challenges to Community-Based Programs

BACKGROUND Women with disabilities are an unrecognized cancer disparities population who experience well-documented barriers to breast cancer screening. There is a critical need for targeted, community-directed programing to address these disparities. OBJECTIVES To describe the trajectory of a long-term community-academic partnership aimed at understanding and addressing breast cancer screening disparities among women with disabilities. METHODS Phase 1 was a thematic qualitative focus group study (n = 40) with women with physical disabilities to understand their breast cancer screening experiences. Phase 2 was the application of an equity-focused knowledge translation (KT) process that brought together breast cancer survivors with disabilities and graduate applied health students in KT collaboratives to create innovative, evidence-informed knowledge products. Phase 3 included the development of community-based programming. RESULTS In phase 1, women with disabilities identified provider and patient barriers to breast cancer screening, including a lack of provider knowledge and respect for individuals with disabilities, lack of accessibility, the history of stigma and mistreatment within the health care setting, and treatment fatigue. In phase 2, KT collaboratives created the short film "ScreenABLE" to educate providers and community members about physical and attitudinal barriers to cancer screening. In phase 3, community, academic, and clinical partners collaborated to create ScreenABLE Saturday, a wellness fair and free accessible mammograms, for women with disabilities with programming developed to directly address cancer screening barriers identified from the phase 1 research. CONCLUSIONS Long-term sustained partnerships between academic, disability, and clinical partners are needed to address the complex issues that perpetuate breast cancer screening disparities among women with disabilities.

Effectiveness of NGO-government partnership to prevent and treat child wasting in urban India.

This study reviews the performance of a community-based nutrition programme in preventing and treating wasting without complications among children under age three in urban informal settlements of India. Implemented by a non-profit organization, with national (Integrated Child Development Services [ICDS]) and city-level (Municipal Corporation of Greater Mumbai [MCGM]) government partners, the programme screened 7,759 children between May 2014 and April 2015. During this period, the programme admitted 705 moderately wasted and 189 severely wasted children into the treatment group and 6,820 not wasted children into the prevention group. Both prevention and treatment groups received growth monitoring, referrals to public health facilities, and home-based counselling (if <6months) by community health workers. Treatment groups received additional home-based counselling and access to medical screenings. Severely wasted children also received access to ready-to-use therapeutic food. The study assessed default rates, wasting status, and average weight gain 3months after admission. Factors associated with growth faltering in the prevention group were explored using logistic regression. Default rates for the severely wasted, moderately wasted, and prevention group were 12.7%, 20.4%, and 22.1%, respectively. Recovery rate was 42.4% for the severely wasted and 61.3% for the moderately wasted. For the moderately wasted, mean weight gain was 2.1g/kg/day, 95% confidence interval (CI) [1.6, 2.6], and 4.5g/kg/day for the severely wasted, 95% CI [3.1, 5.9]. Among prevention group children, 3.6% faltered into wasting-3.2% into moderate and 0.4% into severe. The paper gives insights into ways in which ICDS and MCGM can successfully integrate large-scale community-based acute malnutrition programming.

Substance use among urban youth of color: Exploring the role of community-based predictors, ethnic identity, and intrapersonal psychological empowerment.

Advances in the etiology of substance use in ethnic minority youth over the last 30 years have not adequately addressed factors and conditions that protect youth from substance use. This research has also failed to consider the impact of ethnic identity and empowerment-based processes among urban youth of color. The aim of the present study was to uncover, first, the mediating effect of ethnic identity between community-based predictors (e.g., community participation and neighborhood sense of community) and 30-day substance use, and second, the mediating effect of intrapersonal psychological empowerment (PE) between ethnic identity and 30-day substance use. Data were from a sample (N = 1,480) of African-American/Black (30.4%) and Hispanic/Latinx (59.1%) urban adolescents, who were largely female (61%) and between 16 and 18 years of age (70.5%). Main analytic procedures were carried out through AMOS structural equation modeling software. Results from this study displayed the importance of ethnic identity and PE as mechanisms associated with reducing 30-day substance use. Both PE and ethnic identity mediated the effect community-based predictors had in reducing 30-day substance use. In addition, PE was observed to also mediate the effect between ethnic identity and 30-day substance use, providing insight into the relationship between ethnic identity and PE. The salience of ethnic identity and PE as mechanisms associated with reducing 30-day substance use are discussed. In addition, findings provide useful insight into the development of youth- and community-based prevention policies and programming to help reduce substance use and empower adolescents of color. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Baby-Friendly Community Initiative-From national guidelines to implementation: A multisectoral platform for improving infant and young child feeding practices and integrated health services.

The Baby‐Friendly Community Initiative (BFCI) is an extension of the 10th step of the Ten Steps of Successful Breastfeeding and the Baby‐Friendly Hospital Initiative (BFHI) and provides continued breastfeeding support to communities upon facility discharge after birth. BFCI creates a comprehensive support system at the community level through the establishment of mother‐to‐mother and community support groups to improve breastfeeding. The Government of Kenya has prioritized community‐based programming in the country, including the development of the first national BFCI guidelines, which inform national and subnational level implementation. This paper describes the process of BFCI implementation within the Kenyan health system, as well as successes, challenges, and opportunities for integration of BFCI into health and other sectors. In Maternal and Child Survival Program (MCSP) and UNICEF areas, 685 community leaders were oriented to BFCI, 475 health providers trained, 249 support groups established, and 3,065 children 0–12 months of age reached (MCSP only). Though difficult to attribute to our programme, improvements in infant and young child feeding practices were observed from routine health data following the programme, with dramatic declines in prelacteal feeding (19% to 11%) in Kisumu County and (37.6% to 5.1%) in Migori County from 2016 to 2017. Improvements in initiation and exclusive breastfeeding in Migori were also noted—from 85.9% to 89.3% and 75.2% to 92.3%, respectively. Large gains in consumption of iron‐rich complementary foods were also seen (69.6% to 90.0% in Migori, 78% to 90.9% in Kisumu) as well as introduction of complementary foods (42.0–83.3% in Migori). Coverage for BFCI activities varied across counties, from 20% to 60% throughout programme implementation and were largely sustained 3 months postimplementation in Migori, whereas coverage declined in Kisumu. BFCI is a promising platform to integrate into other sectors, such as early child development, agriculture, and water, sanitation, and hygiene.

Understanding and Addressing Women's Use of Force in Intimate Relationships: A Retrospective.

This article surveys an evolving understanding of women's use of force in their intimate heterosexual relationships. It explores the common characteristics of women who use force and, using an intersectional lens, considers the experiences of women in marginalized communities. It also examines how the legal response to intimate partner violence has affected this population. In addition, the development of and best practices in community-based gender-responsive programming for women's use of force in their intimate heterosexual relationships are overviewed. In conclusion, this work identifies challenges that still exist in effectively responding to women's use of force.

Collective Efficacy: Development and Validation of a Measurement Scale for Use in Public Health and Development Programmes.

Impact evaluations of water, sanitation, and hygiene interventions have demonstrated lower than expected health gains, in some cases due to low uptake and sustained adoption of interventions at a community level. These findings represent common challenges for public health and development programmes relying on collective action. One possible explanation may be low collective efficacy (CE)—perceptions regarding a group’s ability to execute actions related to a common goal. The purpose of this study was to develop and validate a metric to assess factors related to CE. We conducted this research within a cluster-randomised sanitation and hygiene trial in Amhara, Ethiopia. Exploratory and confirmatory factor analyses were carried out to examine underlying structures of CE for men and women in rural Ethiopia. We produced three CE scales: one each for men and women that allow for examinations of gender-specific mechanisms through which CE operates, and one 26-item CE scale that can be used across genders. All scales demonstrated high construct validity. CE factor scores were significantly higher for men than women, even among household-level male-female dyads. These CE scales will allow implementers to better design and target community-level interventions, and examine the role of CE in the effectiveness of community-based programming.

Community-based organizations and environmentalism: how much impact can small, community-based organizations working on environmental issues have?

Community-based organizations (CBOs) have worked closely with communities to promote neighborhood democracy by taking on some executive functions of informal governance, and strengthening the sustainability of the community. The environment has been one of the issues engaged by CBOs using the models of civic environmentalism, environmental justice, and sustainability. But the impact of CBOS on environmental issues has been understudied. Focusing on The Natural Step (TNS) Monona, which engages local communities in the city of Monona, Wisconsin, this paper reports on the outcomes TNS Monona experienced in promoting civic environmentalism and sustainability in both local government and among Monona residents. An analysis based on a city-wide survey shows that it is possible for a small grassroots group focused on education and civic engagement to work with local community members to make a difference, through multiple well-planned and well-executed community-based programming.

Art and Mental Health Recovery: Evaluating the Impact of a Community-Based Participatory Arts Program Through Artist Voices.

This study sought to evaluate the impact of participation in a 6-month community-based participatory arts program on mental health recovery. Using a case study methodology, a total of nine recent graduates from one of five separate groups held during the study period (2012-2015) were interviewed. All but one of the nine participants reported positive personal, emotional, physical and/or mental health changes as a result of her or his participation in the program. Voices of all participants are explored. Analysis of the interviews revealed four key themes: safe space to create, change in identity, biggest impact, and program-related challenges. This study supports community-based arts programming as a positive experience for people living with mental illness. Employing staff and volunteers with lived experience of mental health problemsenhanced the overall participant experience.

Concept Mapping: Engaging Urban Men to Understand Community Influences on Partner Violence Perpetration.

Intimate partner violence (IPV) is a significant health concern rooted in community experiences and other social determinants. The purpose of this study is to understand community-based risk and protective factors of IPV perpetration through participatory research that engages men who use IPV. Secondarily, we assess the relative influence, as measured by ranking, of these factors regarding risk of IPV perpetration and stress. We conducted concept mapping with Baltimore men (n = 28), ages 18 and older, enrolled in an abuse intervention program (AIP), through partnership with a domestic violence agency. Concept mapping, a three-phase participatory process, generates ideas around an issue then visually presents impactful domains via multi-dimensional scaling and hierarchical clustering. Most participants were Black (87.5%) and 20-39years old (75%). Seven key domains, or clusters, were established. "No hope for the future" was the greatest contributor to IPV perpetration. "Socioeconomic struggles" (i.e., lack of employment) and "life in Baltimore" (i.e., homicide) were most likely to result in stress. Emergent domains related to IPV perpetration and stress were ranked similarly, but with some nuance. Having good support systems (i.e., family, community centers) were felt to prevent IPV and reduce stress. This participant-driven process among a primarily young, Black sample of Baltimore men speaks to the influence of perceived social disempowerment and underlying trauma on intimate relationships and the potential for mitigation. Few studies have engaged men who use IPV through participatory research to understand the comprehensive dynamics of an impoverished, urban environment. Results provide direction for community-based intervention and prevention programming to increase self-efficacy, particularly among younger men, and to enact trauma-informed violence prevention policy from the perspectives of male IPV perpetrators.

Peer-support intervention for postpartum depression: Participant satisfaction and program effectiveness

Objective: Postpartum mood disorders represent a serious problem affecting 10–20% of women and support groups offer a promising intervention modality. The current study examined participant satisfaction with and effectiveness of a peer-facilitated postpartum support group.Intervention: The program consists of a free, peer-support group, developed to increase social support and destigmatise postpartum mood symptoms. The weekly group is co-facilitated by former group attendees and maternal health professionals.Setting: The peer-support program is offered in an urban city in the southeastern United States.Design: To address study aims, a community-based participatory research approach was implemented. Participant satisfaction was assessed via mixed methods analyses. Differences in depression scores at follow-up between program attendees and a community sample were examined via weighted linear regression analysis following propensity score analysis. Finally, within-group change in depression scores for program attendees was examined using a repeated measures ANOVA.Participants: Intake program data were provided by the sponsoring organisation (n = 73) and follow-up data were collected via an online survey from program attendees (n = 45). A community sample was recruited to establish a comparison group (n = 152).Measurements and findings: Participant satisfaction was high with overwhelmingly positive perceptions of the program. Postparticipation depression scores were similar to those of the community sample at follow-up (p = .447). Among attendees, pre-post analyses revealed reductions in depression symptoms with significant interactions for time × complications (p ≤ .001) and time × delivery method (p ≤ .017).Key conclusions: Overall, findings indicate this peer-support program is not only acceptable to program attendees but also they provide a potential mechanism for improving mental health outcomes; however, further evaluation is needed. Findings also emphasise the importance of integrating evaluation procedures into community-based mental health programming to support effectiveness.Implications for practice: Peer-support groups are an acceptable form of intervention for women experiencing postpartum depression.

Implementation of Policy, Systems, and Environmental Community-Based Interventions for Cardiovascular Health Through a National Not-for-Profit: A Multiple Case Study.

In 2014, the Centers for Disease Control and Prevention funded the American Heart Association to implement policy, systems, and environment-focused strategies targeting access to healthy food and beverages, physical activity, and smoke-free environments. To understand factors affecting implementation and variations in success across sites, evaluators conducted a multiple case study. Based on past literature, community sites were categorized as capacity-building or implementation-ready, for comparison. A sample of six communities were selected using a systematic selection tool. Through site visits, evaluators conducted interviews with program staff and community partners and assessed action plans. Evaluators identified important implications for nationally coordinated community-based prevention programming. Differences in implementation varied by the communities' readiness, with the most notable differences in how they planned activities and defined success. Existing partner relationships (or lack thereof) played a significant role, regardless of the American Heart Association's existing presence within the communities, in the progression of initiatives and the differences observed among phases. Last, goals in capacity-building sites were tied to organizational goals while goals in implementation-ready sites were more incremental with increased community influence and buy-in. Using national organizations as a mechanism to carry out large-scale community-based prevention work is a viable option that provides coordinated, wide-scale implementation without sacrificing a community's priorities or input. In funding future initiatives, the presence of relationships and the time needed to cultivate such relationships should be accounted for in the planning and implementation processes, as well as both local and national expectations.

Adolescent mental health education InSciEd Out: a case study of an alternative middle school population

BackgroundMental illness contributes substantially to global disease burden, particularly when illness onset occurs during youth and help-seeking is delayed and/or limited. Yet, few mental health promotion interventions target youth, particularly those with or at high risk of developing mental illness (“at-risk” youth). Community-based translational research has the capacity to identify and intervene upon barriers to positive health outcomes. This is especially important for integrated care in at-risk youth populations.MethodsHere the Integrated Science Education Outreach (InSciEd Out) program delivered a novel school-based anti-stigma intervention in mental health to a cohort of seventh and eighth grade at-risk students. These students were assessed for changes in mental health knowledge, stigmatization, and help-seeking intentions via a classroom activity, surveys, and teacher interviews. Descriptive statistics and Cohen’s d effect sizes were employed to assess pre–post changes. Inferential statistical analyses were also conducted on pilot results to provide a benchmark to inform future studies.ResultsElimination of mental health misconceptions (substance weakness p = 0.00; recovery p = 0.05; prevention p = 0.05; violent p = 0.05) was accompanied by slight gains in mental health literacy (d = 0.18) and small to medium improvements in help-seeking intentions (anxiety d = 0.24; depression d = 0.48; substance d = 0.43; psychosis d = 0.53). Within this particular cohort of students, stigma was exceptionally low at baseline and remained largely unchanged. Teacher narratives revealed positive teacher views of programming, increased student openness to talk about mental illness, and higher peer and self-acceptance of mental health diagnoses and help-seeking.ConclusionsCurricular-based efforts focused on mental illness in an alternative school setting are feasible and integrated well into general curricula under the InSciEd Out framework. Preliminary data suggest the existence of unique help-seeking barriers in at-risk youth. Increased focus upon community-based programming has potential to bridge gaps in translation, bringing this critical population to clinical care in pursuit of improved mental health for all.Trial registration ClinicalTrials.gov, ID:NCT02680899. Registered 12 February 2016, https://clinicaltrials.gov/ct2/show/NCT02680899

Daily Occupations, Routines, and Social Participation of Homeless Young People

ABSTRACTHomelessness disrupts young people’s participation in the productive occupations that facilitate transition to adulthood, impairs social connections, and has a disorganizing effect on their time use. Semi-structured focus group interviews were used to explore how 19 homeless young people perceived their daily routines, meaningful occupations, and social participation to be impacted by the experience of homelessness. Occupational therapy practitioners can use the findings from this study to inform the development of comprehensive community-based programming aimed at increasing social opportunities, developing balanced, healthy routines, decreasing intrinsic and extrinsic barriers to residential stability, and promoting participation in productive and leisure occupations.

Pilot Evaluation of a University-Based Training in Trauma-Informed Services for Gang Intervention Workers

ABSTRACTThe purpose of this pilot study was to investigate the feasibility and efficacy of a course designed to bring trauma-informed practices into community-based intervention programming for gang-involved youth and families. There have been no formally evaluated trauma trainings for gang intervention workers to date. Thirty gang intervention workers completed a University-based course on trauma, which aimed to raise the level of knowledge regarding trauma exposure and its effects on youth, increase intervention workers’ confidence in their ability to identify and respond to posttraumatic stress reactions among clients, and build resilience among staff. Pre-post results revealed that participants significantly improved in their knowledge related to trauma and confidence in their ability to respond to trauma among clients. Participants also rated themselves significantly higher on these domains compared to gang intervention workers who did not take the course. Participants rated the course positively on dimensions that are associated with staff members’ willingness to implement evidence-based interventions following training. The findings indicate a number of important recommendations for supporting gang intervention workers and integrating trauma-informed practices into gang intervention services.

Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers

ABSTRACTThere is limited data regarding women who inject drugs, and how harm-reduction services can be made more women-centered. This study explored experiences of Kenyan women who inject drugs, with regard to access to HIV, harm reduction and sexual and reproductive health (SRH) services. A total of 45 women who inject drugs and 5 key stakeholders participated in-depth interviews and focus group discussions. Thematic analysis of the data revealed that stigma, long distances, lack of confidentiality, user fees, multiple appointments, drug users’ unfamiliarity with health facilities, disconnect in communication with healthcare providers, and healthcare providers’ lack of understanding of women’s needs were factors that impede women’s access to health services. Community-based services, comprising of outreach and drop-in centers mitigate these barriers by building trust, educating women on their health and rights, linking women to health facilities, sensitizing health providers on the needs of women who inject drugs, and integrating women’s SRH services into community-based harm-reduction outreach. Inclusion of SRH services into community-based harm-reduction activities increased women’s interest and access to harm-reduction interventions. These findings underscore the need to strengthen community-based programming for women who inject drugs, and to integrate SRH services into needle and syringe exchange programs.

Community perceptions of mental illness in rural Uganda: An analysis of existing challenges facing the Bwindi Mental Health Programme.

ObjectivesTo assess community perceptions of mental illness in the Bwindi Community Hospital (BCH) catchment area: to recognise beliefs about the causes and the treatments for mental illness. To provide community data to staff at BCH as they work to develop more effective community mental health programmes.BackgroundA shortage of mental health providers in Uganda has prompted research into community-based task-sharing models for the provision of mental health services in underserved communities.MethodsSix focus group discussions, with a total of 54 community members (50% male, n = 27; mean age + s.d. [39.9 + 10.9 years]) from the BCH catchment area, were conducted to assess community member and stakeholder perceptions of mental illness and belief in the feasibility of community-based programming. Qualitative study of data through thematic analysis was conducted to assess the presence of commonly occurring perceptions.ResultsQualitative thematic analysis revealed two major themes: (1) belief that any given patient’s metal illness results from either an intrinsic or an extrinsic cause and (2) belief in a need to determine treatment of mental illness based on the believed cause.ConclusionAs BCH designs community-based mental health services, our findings provide support for the need for further education of community members and training of community health workers to address and integrate the above-stated beliefs regarding mental illness.

Understanding the delivery of a Canadian-based after-school STEM program: a case study

BackgroundDue to the rising demands for a Canadian workforce with science, technology, engineering, and math (STEM)-related education, there is a need to increase youth engagement in STEM education and programming. Research, however, has shown that youth residing in low-income communities are disproportionately affected by psychosocial barriers, which often inhibit meaningful engagement in STEM programming. Visions of Science Network for Learning (VoSNL) was designed and implemented to address these existing barriers. VoSNL is a charitable organization in Southern Ontario, Canada, that provides weekly community-based STEM programming to low-income and marginalized youth during out-of-school time. VoSNL programming is delivered directly within the community and is free-of-charge for all youth in order to minimize barriers of physical and financial accessibility. The purpose of this report was to provide a detailed description of a core program within VoSNL—Community Science Clubs—and summarize the findings of a process evaluation, specifically the successes and challenges of implementing a community-based, out-of-school STEM program.ResultsProgram successes are outlined along with the challenges that have been identified through program implementation. Successes include (a) delivering the program within a community context, (b) opportunities for consistent engagement, and (c) establishing positive youth-staff relationships. Challenges include (a) navigating community-based issues, (b) conducting outreach and promotion, and (c) accommodating a wide age range of youth. Further, lessons learned from an evaluation of program implementation are also discussed.ConclusionsThis report provides one of the first program descriptions and process evaluations of a community-based, youth-focused STEM program within a Canadian context. The findings in this report have helped to improve the delivery and evaluation of the VoSNL program and may act as a catalyst for program expansion to reach more youth in marginalized communities. Further, the findings can also provide a strong framework for programmers interested in implementing STEM youth programming in a community context, assist in the replication of similar models in other locations, and enhance STEM learning amongst youth.

Mitigating depression among orphaned and vulnerable adolescents: a randomized controlled trial of interpersonal psychotherapy for groups in South Africa.

Children and adolescents affected by HIV are at elevated risk of depression, yet research on related interventions in this population is scarce in sub-Saharan Africa. This study sought to examine the effects of interpersonal psychotherapy for groups (IPTG) on depressive symptomology among orphaned and vulnerable adolescents in South Africa. A cluster randomized controlled trial wherein adolescents ages 14-17 enrolled in community-based programming for HIV-affected and vulnerable families were randomly assigned by geographic cluster to participate in a 16-session IPTG intervention or the standard of care (n=489). Baseline and postintervention surveys conducted with enrollees included standardized depression screening. Utilizing an intent-to-treat design, mixed effects models were performed to examine treatment effects for all participants and potential moderators including gender and baseline depression level (Clinical Trials registration: ClinicalTrials.gov NCT02386878). While 23% of adolescents in the intervention group did not attend any IPTG sessions, average attendance was 12 out of 16 possible sessions among participants. The intervention was not associated with changes in depression symptomology. Results underscore the importance of mitigating participation barriers prior to intervention roll-out and the need for increased evidence for psychological health interventions to mitigate depression among orphaned and vulnerable adolescents. This intervention and the study selectively targeted at-risk adolescents versus using diagnostic mental health criteria for enrollment; more research is needed to identify the potential benefits and disadvantages of these approaches.

Effects of a Translational Community-Based Multimodal Exercise Program on Quality of Life and the Influence of Start Delay on Physical Function and Quality of Life in Breast Cancer Survivors: A Pilot Study.

The purpose of this investigation was 2-fold: (1) to investigate the effects of a translational 12-week community-based multimodal exercise program on quality of life (QoL) in breast cancer survivors (BCS) and (2) to examine the influence of a start delay on physical function and QoL in BCS. Fifty-two female BCS completed a 12-week program consisting of 90-minute supervised exercise sessions at a frequency of 2 supervised sessions per week. Exercise sessions consisted of three 30-minute components: (1) aerobic conditioning, (2) resistance exercise training, and (3) balance and flexibility training. Significant (P < .05) improvements in QoL were identified post-program completion. Cohort stratification comparison between the early start (<1 year since completion of oncologic treatment) and late start (>1 year since completion of oncologic treatment) revealed no significant (P > .05) differences between the early start and late start groups on improvements in physical function. Regarding the influence of start delay on QoL, the early start group showed significant (P < .05) improvement in emotional well-being. No other significant differences in improvement in QoL were detected between the early start and late start groups. Regardless of start delay, meaningful improvements in physical function and QoL were found after completing the community-based multimodal exercise program. Early participation in community-based exercise programming may benefit BCS’ emotional well-being compared to later participation.

A Multi-Dimensional Conceptual Framework for Trauma-Informed Practice in Addictions Programming

ABSTRACTPrevious research has conceptualized trauma-informed practice in relation to five key values: safety, trust, choice, collaboration, and empowerment. This research identifies key organizational, programmatic, and interpersonal characteristics in community-based residential addictions treatment programming that exemplify each of these principles. Utilizing qualitative research methods, involving open-ended, one to one interviews with clients in residential substance misuse treatment (n = 41), respondents identified the importance of experiencing “safety” in relation to physical safety, confidentiality, reassurance, rule enforcement, and peer relationships. “Trust” was manifested in sharing, staff availability, nonjudgmental interactions, positive relationship dynamics, and caring. “Choice” was articulated in relation to individual needs, participation, opportunities, and focus of efforts. “Collaboration” was characterized in relation to opportunities for feedback, planning, goal setting, specificity, and support. Finally, “empowerment” was characterized by comfort in sharing, trigger management, trauma awareness, and understanding. The findings provide a conceptual framework for a trauma-informed social services organizational practice environment. Findings can inform adaptations to social service delivery processes and programs to become aligned with the values of trauma-informed practice. Future research can build on this framework by testing the study findings with quantitative methods along with replicating current methods in other social service delivery sectors.