Trauma-informed Care Practices Research Articles

Trauma in Schools: A Review of the Impact of Childhood Trauma and Assessment of a Potential Intervention

According to the National Survey of Children’s Health (NSCH), nearly 30 million children in the United States have experienced one or more types of significant childhood trauma. In the average public school, this statistic translates to as many as half of the students in a given teacher’s classroom. Children exposed to the toxic stress of trauma often experience negative consequences that affect their academic, psychological, socioemotional, and behavioral health. To aid educators in addressing this reality, trauma-informed care practices have increasingly begun to be translated into professional development opportunities for educators. Using the theoretical frameworks of trauma theory and transformational learning theory, this review of the literature provides a brief overview of trauma theory, the short- and long-term effects on children, the mechanisms involved in how trauma affects developmental outcomes, and the relevance of trauma in an educational setting. It also reviews the implementation of trauma-informed care as professional development in educational settings, examines research on educators’ awareness of beliefs and attitudes, and reviews how/whether knowledge and change in attitudes affect behavioral change.

Trauma-Informed Care Practices in a Forensic Setting: Exploring Health Care Professionals’ Perceptions and Experiences

The prevalence of trauma within secure forensic populations is widely acknowledged, yet the implementation of trauma-informed care (TIC) in secure forensic settings (SFS) remains in its infancy. This qualitative study delves into the perceptions and experiences of healthcare professionals (HCPs) adopting a TIC framework in SFS, examining associated barriers and facilitators. 15 participants engaged in semi-structured interviews, and results underwent thematic analysis, yielding five overarching themes and 15 sub-themes. Themes identified include: 1) understanding the TIC experience in SFS, 2) organizational and personal barriers in TIC implementation, 3) facilitators and reflections on TIC benefits, 4) barriers to specific TIC practices, and 5) practical recommendations. Participants emphasized the prevalent nature of trauma in SFS and underscored the perceived advantages of creating spaces for reflection and emotional well-being. Interviewees explored the impact of organizational culture, the demands of frontline roles and training accessibility. Practice implications highlight the need to involve key stakeholders (staff and SUs) in decision making and in assessing the feasibility of implementing TIC. SFS should prioritize TIC by addressing training needs, allocating time for TIC in supervision, providing specialist support for trauma-informed clinical work, and ensuring dedicated spaces for reflection. While the study highlights the power of incorporating HCP perspectives, limitations arise from findings drawn from a single forensic service, emphasizing the importance of further replication. This research contributes valuable insights into advancing trauma-informed care practices within secure forensic settings.

Implementation outcomes of a digital, trauma-informed care, educational intervention targeting health professionals in a paediatric burns setting: A mixed methods process evaluation

Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package (‘Responsive CARE’) was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of ‘Responsive CARE’. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in ‘Responsive CARE’. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours.

Implementing trauma-informed care practices in the workplace: a descriptive phenomenological study

The effects of trauma are becoming more prevalent in the clinical setting, which has helped generate conversations about being more trauma-informed and providing trauma-informed care services. The principles centered around trauma-informed care could be applied to a person’s everyday life, including the work setting with the goal of creating a more trauma-informed environment for all employees. This qualitative descriptive phenomenological study aimed to investigate what trauma-informed care principles are needed in the workplace from the employee perspective to create a more trauma-informed environment. The survey instrument used in this study was a modified version of Fallot and Harris’s (2011) consumer satisfaction survey in their published article Creating Cultures of Trauma-Informed Care: A Self-Assessment and Planning Protocol. The instrument contained 13 questions, with each core question having an optional secondary question requesting additional details about the participants’ responses. The tool was categorized into four sections: safety, trustworthiness, choice and collaboration, and empowerment. Ninety participants accessed the survey through SurveyMonkey Audience, but four did not meet the criteria to participate and exited the study. The researcher was left with 86 completed surveys. The qualitative analytical tool Quirkos was employed to help analyze the data and generate themes. The category that produced the most themes was empowerment. Employees want to be viewed as a person rather than a resource to get the job done. Likewise, participants wanted to be valued and have their voices heard. To push this conversation forward, future researchers should conduct interviews face-to-face to produce more in-depth findings.

The use of Open Dialogue in Trauma Informed Care services for mental health consumers and their family networks: A scoping review.

INTRODUCTION: A large proportion of people who access mental health services have a lived experienced of trauma and are more likely to have a history of complex trauma. Open Dialogue and Trauma Informed Care practices identify previous trauma as a factor related to later psychosis. This scoping review has identified similarities and contrasts in how an Open Dialogue and Trauma Informed Care approach have been combined to complement one another for clinical work with people presenting with psychosis and previous trauma. We aimed to answer the following research question in this scoping review: What is known of the combined use of Open Dialogue and Trauma Informed Care practice when working with consumers and their family networks? As such, the purpose of this paper was to explore the application to practice and identify if any training existed and been evaluated. This scoping review was based on the Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Grey literature was also searched through Psyche Info and Google Scholar for books, Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2013 to January 2023. Five distinct themes were identified from the literature: (1) Linking open dialogue with trauma, (2) Response to treatment, (3) Empowerment and information sharing, (4) Interpretation by clinical services, (5) Staff training outcomes. Some tentative recommendations for practice recognised the individuals' unique story and perspective, suggested that trauma is an important concept to assess. Services practising as Trauma Informed Services that have incorporated an Open Dialogue approach have mixed experiences. The use of Open Dialogue may have some benefits for family work and exploring consumer narratives while building a network of support. However, consumers identified similar frustrations with service delivery as with the family therapy literature. For example, it was difficult to bring family members together and difficult to discuss previous traumatic events in front of family. People experiencing training in Open Dialogue reported it taking a slow pace and not what they were familiar with. Open Dialogue can facilitate engagement of consumers and their family networks and greater recognition of the peer workforce to promote collaboration in therapy is needed. Future research should also focus on evaluating the effectiveness of such services and comparing their outcomes across regions.

The role of adverse childhood experiences in obesity among adolescents with autism spectrum disorder: National survey of Children’s health 2018-2019

BackgroundAdolescents with autism spectrum disorder (ASD) are at an increased risk of overweight/obesity and adverse childhood experiences (ACEs). ObjectiveThis study examined whether ACEs increased the odds of overweight/obesity in adolescents with ASD. MethodsThis cross-sectional study used National Survey of Children's Health (NSCH) 2018-2019 data (N = 31,533 children ages 10–17 years, including n = 480 children with mild ASD and n = 423 children with moderate/severe ASD with normal or overweight/obese BMI). Parent-reported body mass index (BMI) was coded as overweight/obesity vs. normal weight. The independent variable was the count of nine ACEs. Binary logistic regression was conducted, controlling for social ecological factors. ResultsThe odds of overweight/obesity in adolescents with ASD with 1–2 ACEs (OR 1.3, CI 1.1-1.4) and 3+ ACEs (OR 1.6, CI 1.3-2.0) were higher than those with 0 ACEs; odds increased with higher counts of ACEs. Household income level was the most significant sociodemographic influence on odds of obesity in adolescents with ASD (0–99 % Federal Poverty Level: OR 1.9, CI 1.6-2.3). Adolescents with moderate/severe ASD (OR 1.7, CI 1.2-2.5) and mild ASD (OR 1.6, CI 1.0-2.4) had higher odds of overweight/obesity after accounting for ACEs, race/ethnicity, sex, household income, and physical activity. ConclusionFindings indicated ACEs are associated with ASD, which calls for integration of ACEs information within trauma-informed care practices for obesity prevention and intervention for adolescents with ASD. Persistent disparities of overweight/obesity exist by race/ethnicity, sex, and household income within this population, which indicates the need for tailoring trauma-informed approaches to the unique needs of this population.

Implementing the NCTSN Trauma-Informed Organizational Assessment (TIOA) for Improving Trauma-Informed Care in Inpatient Child Psychiatry.

Children and adolescents receiving inpatient psychiatric services have disproportionately high levels of exposure to trauma and adversity. The National Child Traumatic Stress Network Trauma-Informed Organizational Assessment (TIOA) is a comprehensive tool intended to guide implementation of trauma-informed care, but it has not yet been applied in inpatient settings. The purpose of this quality improvement project was to describe trauma-informed care in inpatient child/adolescent psychiatry with the TIOA, examine relatedness among trauma-informed care domains, and explore barriers or facilitators to applying trauma-informed care. This quality improvement project used mixed methods. We conducted a web-based survey in Summer 2022 with staff members (clinical and administrative) at two inpatient child/adolescent psychiatric units in California to assess trauma-informed care practices with the TIOA (87 items). Qualitative follow-up interviews were offered to interested participants. A correlation matrix and cluster analyses were used to examine relationships among TIOA domains; qualitative data were analyzed thematically. There were 69 survey respondents and seven qualitative interviews. TIOA domain scores ranged from a low of 2.3 to a high of 3.2, indicating that practices were occurring only "rarely" to "sometimes." There were two major themes identified from qualitive interviews: (a) barriers to trauma-informed care in an inpatient context that can be resource-constrained or coercive; and (b) discovering strategies to provide trauma-informed care despite structural barriers. Organizational interventions targeting any domains of trauma-informed care are needed in inpatient settings given limited uptake of trauma-informed care.

Primary Care Providers' Knowledge, Perceptions, and Practice of Trauma-Informed Care in a Public Health Care Setting.

Despite serving patients with especially high rates of trauma exposure and related sequelae, many primary care providers do not receive specialized training in the provision of trauma-informed care (TIC). This study sought to document primary care providers' baseline rates of TIC training and their knowledge, perceptions, and practice of TIC at a large, urban public hospital in the Southeastern United States. Participants (n = 67; 68.7% women; 44.8% white; Mage = 36.7 years, standard deviation [SD]age = 9.8 years) completed an online self-report survey on their TIC training status, trauma-related knowledge, perceptions, and practices, as well as burnout and secondary traumatic stress. Less than half of participants (43.3%) endorsed TIC training exposure. Participants generally had adequate levels of trauma-related knowledge (76.5% of items correct) and favorable perceptions of TIC (endorsed 89.7% of TIC-supportive statements). Most participants (86.6%) endorsed recently using trauma-informed practices, but only 47.8% reported routinely screening for trauma-related disorders. Participants who reported receiving prior TIC training scored better on knowledge items and endorsed recently using more trauma-informed practices than those who did not have training exposure. TIC training status' associations with current screening practices and perceptions of TIC were trending toward significance. TIC training status was not related to burnout, and trained participants reported greater secondary traumatic stress than those without training exposure. Results point to system-wide TIC training as a well-received, translational strategy that can enhance the trauma-informed nature of primary care provision.

Trauma Informed Care Can Enhance Whole Person Care to Meet the Quadruple Aim

Objective: Whole person care typically includes a biopsychosocial, interdisciplinary treatment approach with the intent of improved health outcomes and savings in total dollars spent on healthcare providers and services. Its multidimensional approach to a patient’s physical and mental health makes it the model of choice for achieving the quadruple aim of healthcare reform. However, we argue that whole person care is incomplete in its current form due to its lack of attention to the public health impact of stress and psychological trauma. Methods: We used seminal articles, original research and theory, and a variety of databases such as PubMed, and Google Scholar to research our topic. Results: Whole person care would benefit from the integration of traumainformed care practices, so that it can better meet the quadruple aim by addressing these broader public health concerns. Trauma-informed care was selected because it understands, recognizes, and responds appropriately to trauma in patients and providers, which enhances the effectiveness of healthcare delivery and reduces the impact of social inequity. Conclusion: Integrating traumainformed care into whole person care can help achieve the quadruple aim, as well as the newly proposed fifth aim of advancing health equity, because social inequity increases stress and exposure to psychological trauma.

Cliff or bridge: breaking up with the paediatric healthcare system.

Transition from paediatric to adult healthcare is a normal part of the care trajectory, yet the process often leaves much to be desired. In this commentary, I share my family's journey of this care transition, particularly the handover aspect, by providing examples of different ways that relationships were ended by paediatric healthcare professionals. The ending of these relationships often felt like 'breaking up'. I also share an example of a supported handover, which bridged the transition from paediatric to adult care. To improve transitions, we need genuine acknowledgement of the paediatric medical trauma stress (PMTS) experienced by families such as mine following years of interactions in the healthcare system. Along with following transition checklists, patients and families need authentic and meaningful closure to longitudinal relationships and trauma-informed care practices as we move forward into the adult care system.

Exposing the Role of Labor and Delivery Nurses as Active Bystanders in Preventing or Perpetuating Obstetric Violence

Obstetric violence is an issue of global scope and magnitude. Its widespread and continued presence indicates cultural tolerance enabled by policies and procedures that uphold paternalism. Labor and delivery nurses are the health care professionals who spend the most time at the point of care during birth, and their role must be examined. As active bystanders, labor and delivery nurses are uniquely positioned to prevent or perpetuate obstetric violence during labor and birth. Reflection on the nurse role is necessary to provide optimal care, enhance relationships with patients, and continue to evolve as a professional discipline. Perinatal nurses must lead the change to trauma-informed care practices to mitigate obstetric violence and reduce birth trauma.

Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey

BackgroundIndividuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada.MethodsWe conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no).ResultsA total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient’s gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0–10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training.ConclusionsEntry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.

Trauma-Informed Care in Digital Health Technologies: Protocol for a Scoping Review.

The use of digital health technologies is becoming increasingly common across the globe as they offer immense potential to enhance health care delivery by promoting accessibility, flexibility, and personalized care, connecting patients to health care professionals, and offering more efficient services and treatments to remote residents. At the same time, there is an increasing recognition of how digital health can inadvertently foment psychological trauma. This phenomenon has led to the adoption of trauma-informed care in designing and deploying digital health technologies. However, how trauma-informed care is defined and characterized, and the various trauma-informed care strategies used in designing and deploying digital health technologies remain unexplored. This scoping review aims to explore and synthesize the literature on how trauma-informed care is defined and characterized in digital health and the various trauma-informed care principles, strategies, or recommendations used in designing and deploying digital health. This review will draw on the Joanna Briggs Institute's updated methodological guidance for scoping reviews. A search will be conducted on CINAHL, PubMed, Embase, Compendex Engineering Village, Web of Science, Scopus, and PsycINFO. This review will consider published research studies and unpublished work (gray literature). Studies will be included if they applied trauma-informed care in designing or deploying digital health for patients across all geographical locations or provide trauma-informed recommendations on how web developers should develop digital health. Studies will be limited to publications within the past 10 years and studies in all languages will be considered. Two independent reviewers will screen the titles and abstracts, and then perform a full-text review. Data will be extracted into a data extraction tool developed for this study. The scoping review was undergoing a full search as of April 2023. The main results will synthesize the peer-reviewed and gray literature on adopting trauma-informed care practices in digital health research and development. The study is expected to be completed by December 2023 and the results are expected to be published in a peer-reviewed journal. This review is expected to provide the knowledge base on the adoption of trauma-informed care in designing and deploying digital health. This knowledge can lead to more engaging, and likely, more effective digital health interventions that have less potential for harm. A synthesis of the various trauma-informed care strategies in digital health will also provide a trauma-informed language by enabling researchers and digital health developers to consider trauma as a critical factor in each stage of the design process. DERR1-10.2196/46842.

Gender Differences in Barriers and Facilitators to Care among U.S. military Veterans at High Risk for Suicide: A Qualitative Study

Veteran engagement in care is imperative to suicide prevention. However, barriers to engaging veterans at risk for suicide in care remain a challenge, and women veterans may have unique experiences that promote or inhibit care-seeking behaviors. The goal of this study was to better understand barriers and facilitators to care among veterans at high risk for suicide and identify potential gender differences. We interviewed 25 women and 25 men veterans utilizing VHA health care across the United States (U.S.), who had a recent suicide attempt (6 months prior). Psychological safety was a dominant theme for veterans seeking and using VHA care. Women and men both needed to feel safe and comfortable in the VHA environment. Women described psychological safety as being able to let their guard down, while men desired to not feel judged for seeking care. Veterans felt a sense of comradery in the VHA environment; however, women did not always feel welcome as veterans. Findings suggest the need to attend to the psychological safety of women and men veterans at high risk of suicide in VHA. Strategies to attune VHA staff to trauma-informed care practices for women and expand trauma-informed care resources may facilitate care engagement.

Social Determinants of Health: Implications for Voice Disorders and Their Treatment

Adverse childhood experiences (ACEs) and related conditions, such as discrimination, are social determinants of health (SDOHs). Critical race theory (CRT) is a lens through which to understand SDOHs in a way that may impact our clinical care. When prolonged or chronic, SDOHs might cause toxic stress and trauma, which, in turn, adversely affect health and are shown to be relevant for some voice disorders. The goals of this tutorial are to (a) review the literature on SDOHs that potentially contribute to disparities; (b) discuss explanatory models and theories that describe how psychosocial factors influence health; (c) relate the foregoing information to voice disorders, highlighting functional voice disorders (FVDs) as a particular case in point; and (d) describe how trauma-informed care can improve patient outcomes and advance health equity for vulnerable populations. This tutorial concludes with a call for heightened awareness of the role that SDOHs such as structural and individual discrimination may play in voice disorders, and a call for research into SDOHs, traumatic stress, and health disparities in this patient population. A call is also made for more universal practice of trauma-informed care in the clinical voice domain.

Association of insurance status with financial toxicity and outcome disparities after penetrating trauma and assault

BackgroundFinancial toxicity, or the impact out-of-pocket medical expenses have on the quality of life, has not been widely enumerated in the trauma literature. We characterized the relationship between insurance status and the risk of financial toxicity after trauma and associated risk factors. MethodsAdults admitted for gunshot wounds, other penetrating injuries, or blunt assault were identified from the 2015 to 2019 National Inpatient Sample. The outcome of interest was a risk of financial toxicity with separate regression models for uninsured and insured populations. ResultsOf an estimated 775,665 patients, 21.2% were at risk of financial toxicity. Patients at risk of financial toxicity were younger, more commonly male, less commonly White, and had a lower Elixhauser Index (Table 1). A higher proportion of uninsured patients were at risk of financial toxicity (40.8% vs 17.7%, P < .001) than insured patients. Whereas the proportion of uninsured patients at risk of financial toxicity significantly increased from 2015 to 2019, it was unchanged in insured patients. After adjustment, non-income demographic and clinical factors were not associated with the risk of financial toxicity amongst the insured. Conversely, the Black or Hispanic race, gunshot wounds, and any in-hospital complications were some factors associated with increased risk of financial toxicity in uninsured patients. ConclusionAn increasingly larger proportion of uninsured patients are at risk of financial toxicity after trauma. The risk of financial toxicity among the uninsured was more complex than in the insured and associated with race, gunshot wounds, and complications. Increasing insurance access and the adoption of trauma-informed care practices should be used to address financial toxicity in this population.

The impact of being Black while living with a chronic condition: Inpatient perspectives.

The impact of being Black while living with a chronic condition: Inpatient perspectives.

Trauma-Informed Court

Trauma-informed practices recognize the widespread impact of trauma on individuals and the need to deliver services that avoid re-traumatization. In the context of the mainstream court system, trauma-informed care is crucial for ensuring that individuals who have experienced trauma are treated with compassion and understanding. Trauma-informed care can help court officials recognize the signs and symptoms of trauma, including the triggers that can cause individuals to experience distress, anxiety, or other mental health challenges, and take steps to address those triggers. The purpose of this research is to map the degree and extent of trauma-informed practices in two judicial districts within the criminal and juvenile court systems in Kansas. By mapping the results, we identified areas where trauma-informed practices are already being implemented effectively, as well as gaps and need for improvements. This information can be used to develop targeted interventions to increase the implementation of trauma-informed care practices throughout the criminal and juvenile justice systems.

A Blueprint for Collaborative Action to Build a Trauma-Informed School: A Case Study

Analysis of multiple forms of data from a high-need K–8 charter school led to the hypothesis that increasing disciplinary disruptions and poor student academic achievement were the results of endemic student trauma. The principal, the lead school counselor, and an advisory council created a plan to explore and address behavioral and social/emotional issues, and wrote grants to sustain programming changes. The school achieved success in multiple areas, including: improving its comprehensive school counseling program using the ASCA National Model framework; benchmarking its practice with the ASCA School Counselor Professional Standards &amp; Competencies; reducing noncounseling duties for school counselors and providing 80% direct and indirect services to students; reducing the school counselor-to-student ratio; restructuring student discipline policies through the implementation of school-wide trauma-informed care practices; and utilizing social/emotional learning and trauma-informed lessons in the classroom. This case study outlines how one school created multidisciplinary internal and community-based teams to support trauma-informed practices for students, teachers, staff, and families, while emphasizing school counselor–principal leadership to build social capital. The discussion includes a review of progress toward systemic change goals.

Balancing the Needs of the School Community: Implementing Trauma-Informed Behaviour Supports in an Australian Regional Primary School

Exposure to adverse and traumatic events in childhood has been found to lead to poorer academic and social-emotional outcomes in school settings. The psychological impact of exposure to such events, referred to as childhood trauma, has been identified as a key driver of these educational difficulties. First Nations students have been found to experience higher rates of childhood trauma compared to non-First Nations students, with historical and intergenerational adversity contributing to such difficulties. There are national guidelines in Australia for the use of trauma-informed care practices in schools to reduce the impact of childhood trauma on educational engagement. This pilot case study examines teachers' experiences in a regional school implementing trauma-informed practices with First Nations students. Findings highlight the complexities of balancing students' safety and belonging with teachers' professional and personal needs in sustaining trauma-informed practice. Implications for implementing trauma-informed education with First Nations communities are discussed.