Trauma-informed Services Research Articles

Profiles of refugee-related trauma exposure and depression among North Korean refugees in South Korea: A latent class analysis.

North Korean refugees (NKRs) exhibit alarmingly high levels of depression prior to or immediately after entering South Korean society, which is likely attributable to their pre-migration traumatic experiences. However, prior research on NKRs has simply examined the cumulative effect of trauma on depression. Despite calls for research identifying trauma exposure patterns that co-occur among refugees, to date, no study has investigated distinct profiles of NKRs' pre-migration trauma exposure and their associations with depression in this high-risk population. To better understand the unique mental health needs of NKRs and provide them with tailored care, it is imperative to identify meaningful subgroups of NKRs with distinct profiles of trauma exposure. Using latent class analysis (LCA), which is a person-centered approach, this study aimed to identify subgroups of NKRs based on trauma exposure and their associations with sociodemographic characteristics and depression levels. A sample of NKRs (N = 405) in South Korea were assessed for depression, pre-migration trauma, and sociodemographic covariates through a self-administered survey. LCA was conducted to identify trauma exposure classes and multivariate ordinary least squares regression analysis was performed to examine associations between trauma exposure classes and depression. The prevalence of clinically significant depression was 47.2% for our study sample. Three classes of trauma were identified: deprivation trauma and witnessing death (59.3%), complex and pervasive trauma (23.7%), and low exposure (17.0%). Members in the complex and pervasive trauma class demonstrated very high probabilities of exposure to all traumatic events and had the strongest association with elevated depression. Our findings underscore the importance of identifying subgroups of NKRs to unravel heterogeneity in trauma exposure and provide more nuanced explanations for different risk profiles regarding depression. These findings also provide evidence for a framework for clinicians to provide individualized resources and trauma-informed services to NKRs.

Pathway to Trauma-Informed Rehabilitation Counseling: Vocational Rehabilitation Counselors’ Training Experiences and Use of Trauma-Relevant Knowledge in Daily Practice

The compelling evidence regarding the prevalence and profound impacts of traumatic experiences on individuals with disabilities underscores the need to establish trauma-informed service environments within vocational rehabilitation (VR). In an initial endeavor towards cultivating trauma-informed service, this study investigates the VR counselors’ professional training experiences in the topical areas of trauma. Further, the applicability of the Technology Acceptance Model (TAM 2) is examined in elucidating the utilization of trauma knowledge by VR counselors in their practices. A needs assessment focusing on trauma training was distributed to 169 VR counselors to measure their trauma-related training history and utilization of trauma knowledge in practices. Path analysis was employed to examine the relationship between training experience and the actual use of trauma knowledge in counseling based on the TAM 2 framework. Participants reported having 9.71 hours of post-graduate training. Path analysis suggested adding three additional paths to the original research model, explaining how post-graduate training leads to the use of trauma knowledge in VR service through perceived ease of use, usefulness, attitude toward using, and behavioral intention. The profession of rehabilitation counseling needs to incorporate more trauma-related training into its practice, education, and research to better serve individuals with disabilities and improve the effectiveness of services.

Supporting victim-survivors during investigations of health practitioner misconduct: early learnings from a trauma-informed service

ObjectiveIn 2021, the Australian Health Practitioner Regulation Agency established a support service to provide additional assistance to victim-survivors involved in complaints related to sexual boundary violations. This study evaluates the...

Development of a Human Trafficking Flowsheet for Clinical Forensic Examiners.

When trafficked patients are identified in the healthcare setting, clinical forensic examiners, including sexual assault nurse examiners (SANEs), may be consulted to provide medical care and to collect forensic evidence. However, using a standard sexual assault protocol and documentation form may not completely identify or address the unique needs of these patients. Our SANE program sought to improve the healthcare approach to trafficked patients by developing a trafficking-specific documentation flowsheet. The goal of this quality improvement project was to guide a clinical forensic examiner through a comprehensive examination while addressing specific patient needs and optimizing trauma-informed service delivery. We gathered several local multidisciplinary human trafficking specialists together to provide expert recommendations and feedback during the creation process. Both paper and electronic forms of the flowsheet were designed. SANEs completed the flowsheet on 22 patient encounters and filled out a utilization review survey describing their experience. Feedback data collected through the utilization review process guided further modifications to the flowsheet, which were then implemented into clinical practice guidelines. We found that engaging multidisciplinary specialists and community partners both enhanced the effectiveness of the flowsheet and supported the learning needs of our SANEs. We recommend that clinical forensic programs that wish to develop a similar flowsheet collaborate with local professional agencies to meet the unique needs of the populations within their catchment area and use examiner feedback to maximize the usefulness of the flowsheet.

Supporting Educators and Students: A University–Community Partnership to Implement Trauma-Informed Practices in Schools

With the growing recognition of the prevalence and impact of adverse childhood experiences, building trauma-informed service systems is critical. Although there are many online resources to help school systems become more trauma informed, how much they meet the needs of educators is not well understood. To help schools implement trauma-informed practices (TIPS) to support both educators (all school-based certificated staff) and students, a partnership among a California research university, a local foundation, and three school districts was developed at the start of the COVID-19 pandemic. The partnership envisioned a three-phase study to determine the feasibility, acceptability, and outcomes of an intervention supporting TIPS. First, two local districts were engaged in a mixed method needs assessment to explore educators’ wellbeing and use of trauma-informed resources. Input from district-level advisory committees guided a needs assessment that informed the development of trainings to (1) help administrators best support their staff, and (2) teach educators how to best support themselves and their students with traumatic stress and related symptoms. Second, researchers curated freely available resources to develop a 3-module administrator training and an 8-module teacher training. Finally, university-based psychologists and teacher educators delivered the curricula in two school districts and the university’s teacher education program. Researchers implemented a pretest–posttest evaluation design and gathered in-session feedback after each module. Results indicated that participants found the sessions helpful and relevant and they had greater knowledge of TIPS. Future directions include scaling up implementation, understanding outcomes from multiple perspectives, and integrating follow-up activities to help with skill retention.

Trauma-informed care for women who are forced migrants: a qualitative study among service providers.

The aim was to explore service providers' perspectives on trauma-informed care for women who are forced migrants. Service providers (n=32) employed at one of six centres providing trauma-informed care for forced migrants were recruited by way of managers. Audio-recorded and transcribed semi-structured focus group discussions were analysed with systematic text condensation. The analysis revealed exposure to gender-based violence and abuse within patriarchal structures as the main challenges for women. Participants recognised remarkable strength and resilience among women. A range of structural, psychosocial and individual barriers to trauma-informed care were addressed. While trauma-informed care was considered to have the potential to improve the health for many women, participants articulated room for improvement in the competence of service providers and the conditions impacting women's opportunities to access support. Violence, abuse and oppression against forced migrant women severely impact their health and possibilities of accessing support. Services providing trauma-informed care for forced migrants need to empower women, and carefully consider gender-related aspects impacting women's opportunities to access and utilise trauma-informed care. To ensure that women who need support access it, trauma-informed services should work with outreach efforts, ensure competence development among providers, counteract practical barriers and coordinate with health and social services.

Exploring Public Schools as a Primary Setting for Early Prevention in Rural Areas: A Qualitative Approach to Strengthening the Trauma-Informed Elementary Schools (TIES) Program

Abstract Trauma-Informed Elementary Schools (TIES) is a pilot program designed to bring trauma-informed services to early elementary schools in a rural state. Although two sequential TIES pilot studies found significantly positive outcomes in cultivating a trauma-sensitive school climate and culture, the program has been limited to a few schools and has not yet been assessed for broader impact on primary stakeholders. The current study explored stakeholders’ input in development of a comprehensive intervention plan by identifying the benefits and challenges of implementing the program and contributing their perspectives on strengthening the program. The study also explored the challenges of implementing the TIES program during the COVID-19 pandemic to optimize the program for its unique rural environment. Fourteen semistructured interviews were conducted via Zoom or in person. Two coauthors primarily used thematic analysis to categorize findings from transcribed interviews with NVivo. The participants identified positive impact of the program on children’s socioemotional learning and support with special attention to children in need and the overall improvement of general educational tasks for all children as a whole classroom. The results highlight the importance of the program as perceived by primary stakeholders and provide specific suggestions for improvement.

Institutional Courage in the College Context: A Mixed-Methods Analysis of Campus Victim Advocate Perceptions and Experiences.

How institutions of higher education respond to campus sexual assault impacts the well-being and academic success of student survivors. Researchers at the Center for Institutional Courage developed an 11-step framework for campuses to respond to sexual assault in a manner that minimizes harm. This mixed-methods study uses the framework to understand college victim advocate perceptions of campus response to sexual assault. Results from a national survey and four focus groups found that advocates identify courageous response efforts as strong relationships across campus units, availability of trauma-informed services, and when resources were available to meet students' direct needs. The critical role of leadership throughout the framework was also identified. Implications for policy and practice are discussed.

How Advocates Use CARE to Accommodate the Needs of Domestic Violence Survivors Seeking Services With Brain Injuries and Mental Health Challenges: A Process Evaluation.

We evaluated the implementation of Connect, Acknowledge, Respond, and Evaluate (CARE), an organization-level intervention, to accommodate the health needs of survivors, including brain injury. Participants were staff or administrators at agencies serving domestic violence (DV) survivors (n = 57 advocates; n = 5 agencies). Process evaluation focus groups (n = 10 groups) were conducted. Two researchers coded/analyzed focus group transcripts using grounded theory. The use of CARE increased advocate awareness/knowledge of brain injury among survivors leading to improvements to the agencies' provision of structural and functional social support to survivors. CARE is a valuable resource to accommodate survivors, thereby improving staff's perception of their ability to provide trauma-informed service provision for DV survivors.

Field Note—Talk It Out Counseling Clinic: A Field Education Innovation

ABSTRACT The COVID-19 pandemic introduced an unforeseen challenge to social work field education and drastically changed the landscape of social work direct practice. In March 2021, University of Toronto’s Factor-Inwentash Faculty of Social Work launched the Talk It Out Counseling Clinic (the Clinic), training MSW students to provide short-term counseling and wellness workshops to residents in the Greater Toronto Area. Based on a community partnership model with an antiracism and trauma-informed service orientation, the Clinic provides services targeting those who face multiple barriers to health and equity and those who belong to Black and other racialized communities. In this paper, we introduce the Clinic, including its staffing and structure, partnership model, and training curriculum, present operation updates, and discuss future directions.

Racism-Related Experiences and Traumatic Stress Symptoms in Ethnoracially Minoritized Youth: A Systematic Review and Meta-Analysis

ABSTRACT Objective Despite growing evidence demonstrating the association between racial and ethnic discrimination and traumatic stress symptoms in adult populations, the research among youth remains sparse. Drawing upon race-based traumatic stress models, and following the PRISMA-2020 guidelines, this systematic review and meta-analysis aimed to identify the state of the empirical evidence in the association between racism-related experiences and traumatic stress symptoms in ethnoracially minoritized youth. Method Scientific databases were searched to identify articles with ethnoracially minoritized youth participants under age 18 years old that examined the association between racial and/or ethnic discrimination and traumatic stress symptoms. Results A total of 18 articles comprising 16 studies (N = 4,825 participants) met inclusion criteria. Studies were largely cross-sectional, used nonrandom sampling strategies, focused on Black and Latinx youth, and were conducted in the United States. Furthermore, most studies were theoretically grounded and operationalized racism-related experiences as frequency of direct, personal, everyday discrimination. Few studies examined other dimensions of racism-related experiences. The meta-analysis demonstrated a significant positive association with a medium effect size, rpooled = .356, 95% confidence interval [CI] = 0.27, 0.44, between racism-related experiences and traumatic stress symptoms. No evidence of moderation by age, sex/gender, race/ethnicity, country, or recruitment setting was detected. Conclusion Racism-related experiences may confer risk for traumatic stress symptoms in ethnoracially minoritized youth. Attending to racism-related experiences is critical to improve the cultural responsiveness of trauma-informed services.

Art therapy in a multidisciplinary team with young men in prison

ABSTRACT Background People in prison often present with histories of trauma that can be difficult to process in the volatile prison environment. This article seeks to advance our understanding of the benefits of art therapy within a multidisciplinary team, and how it can help young men in prison who have experienced trauma. Context A review of the art therapy-informed interventions offered for trauma stabilisation in a service for young adult men in prison with complex needs is presented. Approach This article discusses a trauma-informed service in the prison and the variety of ways in which art therapy can support people in prison with histories of complex trauma. It explores: the use of art therapy in a group focusing on improving the prison environment; the role of art therapy in supporting trauma stabilisation and the development of ‘safe place’ processing; and the use of art therapy tools to explore dissociation with service users prior to engaging in trauma therapy. Conclusions The article highlights the vital role of art therapy as a non-verbal therapy to support young men to heal their past trauma. Reflections are offered on the importance of embedding art therapy within a service’s trauma therapy pathway. Implications for research It is recommended that research into the use of art therapy within prison settings is undertaken which could explore its utility in supporting people to process their trauma. This would provide further evidence for the role that non-verbal therapies may play in healing trauma.

Trauma-Informed Primary Healthcare for Parents: Multidisciplinary Experiences in Rural Service Implementation

ABSTRACT Trauma-informed approaches to service delivery increase awareness of the pervasiveness of trauma exposure and acknowledge the lifelong effects of traumatic stress on health and wellbeing. This study explored workforce experiences of trauma-informed primary healthcare for parents. A face-to-face workshop was conducted with 14 Victorian rural professionals in 2021. Local workforce survey results (n = 63) about trauma-informed care were presented to the group (50% social workers) and they discussed strategies for system implementation. Content analysis was used to develop four categories from the transcribed workshop discussion: (1) primary healthcare understanding of complex trauma; (2) primary healthcare responses to parents; (3) trauma-informed care training; and (4) community and relational strategies to foster trauma-informed care. Our findings highlighted that structural barriers relating to resource control and restrictive program design negatively impact trauma-informed approaches. In contrast, trauma-informed service delivery is enabled by collaboration and building relationships between clients, the workforce, and organisations. In discussing these findings, we draw upon notions of power: namely, discursive, epistemic, and material power, which affect equity. To ensure the client’s voice is prioritised when planning trauma-informed care, we recommend the integration of local knowledge and the embedding of community-based strategies throughout all implementation processes. IMPLICATIONS Preparation for trauma-informed care implementation in rural primary healthcare requires strategies to identify and address structural barriers. Increased use of implementation frameworks would enhance multidisciplinary innovation in trauma-informed practice and adaptation when supporting parents. Employing a typology of discursive, epistemic, and material power to implementation processes has beneficial application in social work to challenge systemic reproduction of inequity.

Working in partnership to support trauma informed care for children, young people and their families in North Yorkshire

The Psychologically Informed Partnership Approach (PIPA) is a partnership between North Yorkshire Council (NYC) and Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). PIPA aims to provide a flexible, psychological and trauma-informed service to meet a wide range of needs of vulnerable children across Children and Families Services (C&FS) within North Yorkshire.PIPA consists of Clinical and Forensic Psychologists, and Advanced Practitioners working across NYC. The service considers the individual needs, complexities and experiences of children, young people, family members and practitioners, whilst also holding in mind broader systemic and organisational perspectives. This paper outlines how PIPA applies a range of models and frameworks to support innovative, non-blaming approaches with children, young people and their families, and the outcome of this approach thus far.A variety of measures are used to evaluate how PIPA involvement has influenced a range of outcomes for children, young people and families, as seen in theOutcomes and Feedback section. Two case studies are also included to demonstrate how this approach works in practise.The paper concludes with reflections on our learning and recommendations for similar practices to be embedded across other children and families’ services in the country.

Integrating trauma-informed services in out-of-school time programs to mitigate the impact of community gun violence on youth mental health

Community gun violence disproportionately impacts youth in low-income urban neighborhoods. Integrating trauma-informed mental health care in community-based out-of-school time (OST) programs is an innovative method of service delivery for these youth. This article provides justification for integrating evidence-based, trauma-informed services in OST programs within communities characterized by high rates of violent crime to minimize the impact of violence exposure on youth mental health. We describe the initial feasibility of a model program, the Violence Intervention and Prevention (VIP) Initiative, implemented in a small city in southeastern Pennsylvania. Within the first six months of the VIP Initiative, 95 community residents (90% under age 18; 51% Hispanic) received intervention services, primarily through single-session and short-term weekly group intervention in OST programs, and 80% of OST youth development staff participated in at least one trauma-informed professional development training. Recommendations to enhance and expand the delivery of trauma-informed services in the novel setting of OST programs are provided.

Longitudinal Evaluation of the Neurosequential Model of Therapeutics with Adoptive Families in Tennessee

ABSTRACT Purpose This study evaluated effectiveness of the Neurosequential Model of Therapeutics (NMT) with adoptive families who received post adoption services in Tennessee. Methods Researchers obtained a sample of 552 families who received post adoption services in the U.S. state of Tennessee. Most families (77%) had adopted children through public child welfare services. A quasi-experimental design examined wellbeing outcomes for an NMT group (n = 319) versus a services-as-usual (SAU) group (n = 233) in intent-to-treat analyses. Then, the SAU group was contrasted to an NMT subgroup that had high adherence to the NMT model (n = 109) in an analysis of treatment-on-the-treated. Results Intent-to-treat models indicated no differences on outcomes between the NMT and SAU groups. However, the results of treatment-on-the-treated analyses showed slightly greater reduction on the Behavior Problems Index over time for the NMT with high adherence group as compared to SAU. Discussion and Conclusion Adoptive families may face challenges that could be addressed through developmentally sensitive, trauma-informed services, such as NMT. The results of this study suggest that the NMT might benefit adoptive families if greater attention is paid to implementation adherence, or fidelity.

A Qualitative Study of Risk and Protective Factors for Resilience in Survivors of Sex Trafficking.

This study explored risk and protective factors for resilience in survivors of sex trafficking from the survivors' perspectives. In-depth interviews were conducted with 16 participants recruited from survivor-led advocacy agencies and social service agencies that provide trafficking-specific services. Two overarching themes emerged from data analysis: (a) deep connections to self and others facilitate resilience and (b) detrimental "help" threatens survivors' resilience. Our findings suggest that it may be important for service providers to assist survivors build healthy relationships with themselves and others to promote survivors' resilience. Further, our results highlight the importance of offering more inclusive, survivor-centered, and trauma-informed services.

Reexamining Modified Labeling Theory: A Sample of Incarcerated Women With Mental Illness

The current study reexamines modified labeling theory with a sample of 15 women incarcerated in two medium-security prisons and who have a diagnosable mental illness. Life history calendars (LHC) were employed to document traumatic histories and a host of risks and needs. Qualitative findings indicate that these women negotiated labels of mental illness and incarceration. The labeling process, particularly self-concept, self-esteem, and stigma, emerged as driving forces for criminal behavior, dysfunctional interpersonal relationships, and decision-making. Participants negotiated the label of mental illness, while making meaning of early and continued trauma. These findings are explained with reference to trauma-informed care (TIC), improved staff training, and the role of language. This study offers evidence that labeling concepts may serve as a language foundation for providing trauma-informed services.

Multivariate Patterns of Substance Use, Minority Stress and Environmental Violence Associated with Sexual Revictimization of Lesbian and Bisexual Emerging Adult Women

This study documented between-group differences in factors associated with sexual revictimization histories in a sample of young sexual minority women. Diverse samples of lesbian (N = 204, ageM = 23.55 years) and bisexual (N = 249, ageM = 23.35 years) women from the United States were recruited using the CloudResearch platform to assess factors associated with recent experiences of intimate partner violence (IPV). Participants were categorized into four groups based on self-reports of sexual victimization (a) during childhood and (b) during adulthood in intimate relationships. Multivariate Analysis of Variance (MANOVA) was used to model between-group differences in three variable domains: Past-year substance use involvement, minority stress, and violence in relationship and community settings. Lesbian women reporting sexual revictimization in adulthood reported significantly higher scores for measures of past-year substance use involvement and negative consequences, daily discrimination experiences, relational victimization, and criminal victimization, compared to their counterparts with no history of sexual victimization. Among bisexual women, sexual revictimization was associated with a similar pattern of between-group differences. The sexual revictimization experiences of sexual minority women appear to occur in the context of multivariate patterns of harmful substance use, minority stress, and violence in both relationship and community settings. Our findings have implications for how intervention services are provided to emerging adult sexual minority women who experience multiple episodes of sexual abuse during their lifespans. Recommendations include specialized training for counseling or intervention service providers, integrated trauma-informed services that address both substance use and sexual assault issues, and affirmative services for sexual minority women.

Sinking or swimming: perspectives of the children without placement crisis

ABSTRACT Recently, there have been reports of children without placement (CWOP) in foster care, often resulting in youth sleeping in hotels or child protective service offices. This study explored perspectives of the current crisis among child welfare practitioners who managed CWOP cases. We conducted interviews with 11 child welfare practitioners who had graduated from two universities in a Southern state. Themes aligned with the trauma-informed framework and highlighted challenges related to organizational climate, workforce development, and trauma-informed services. Implications include strategies for cross-sector collaboration, specific training, and continued research to support a healthy, trauma-informed workforce that can better meet youth needs.