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Trauma-informed day services for individuals with intellectual/developmental disabilities: exploring staff understanding and perception within an innovative programme
- Author:
- KEESLER John M.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(5), 2016, pp.481-492.
- Publisher:
- Wiley
Background: Trauma-informed care (TIC) is a systems-level philosophy of service delivery which integrates choice, collaboration, empowerment, safety and trust to create an organizational culture sensitive to trauma. This study explores staff understandings and perceptions within an innovative trauma-informed day program for individuals with Intellectual/developmental disabilities. Methods: Semi-structured interviews queried staff members (n = 20) regarding trauma and TIC, the integration of the five principles of TIC, associated challenges and recommendations for improvement. Results: Inductive analyses revealed reasonable understandings of trauma and TIC, highlighting factors critical to the five principles of TIC. Differences were associated with duration of employment and the presence of specialized training. Challenges with TIC emerged at different system levels: individuals, staff, management and interorganizational. Conclusions: This study presents preliminary insight for the innovative and formative process of integrating TIC with intellectual/developmental disabilities services. (Publisher abstract)
Trauma-Informed day services: an initial conceptualization and preliminary assessment
- Authors:
- KEESLER John M., ISHAM Cory
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 14(2), 2017, pp.164-175.
- Publisher:
- Wiley
Trauma-informed care (TIC) is a systems-focused philosophy of service delivery based upon principles of choice, collaboration, empowerment, safety and trustworthiness that recognises the pervasive impact of trauma across the human experience. In a grassroots effort, one organization developed an innovative, trauma-informed day program to meet the needs of individuals with intellectual and developmental disabilities (IDD) who were recently deinstitutionalized. The present study is intended to provide an initial conceptualization and preliminary assessment of TIC within IDD services in order to understand its impact among individuals and staff. The study sought to answer the following questions: Has the program's culture been stable over time? How have individuals’ behaviours changed over time? What have been the experiences of the program's staff members with TIC? Through a mixed methods design, secondary data analysis and semi structured staff interviews were used to assess the impact of TIC. Findings revealed an initial strong presence of choice, collaboration, empowerment, safety, and trustworthiness within the program's culture, with non significant changes at follow-up. Significant reductions were noted in overall challenging behaviour, aggression, and PRN medication usage; while non significant changes were noted in physical interventions with the exception of “other” interventions (i.e., least restrictive) which significantly increased. Three major categories emerged from the qualitative data (making a difference, recognising progress and compromising factors), illuminating staff satisfaction with work experiences, individuals’ progress, and factors that challenged fidelity to TIC. The study provides a preliminary conceptualization and evidence for the efficacy of the integration of TIC into IDD services despite methodological limitations and concerns regarding the use of physical interventions. Directions for future research are presented. (Edited publisher abstract)