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A statewide introduction of trauma-informed care in a child welfare system
- Authors:
- KRAMER Teresa L., et al
- Journal article citation:
- Children and Youth Services Review, 35(1), 2013, pp.19-24.
- Publisher:
- Elsevier
Most children in the care of the child welfare system have been exposed to multiple traumas in addition to the stressor of being removed from their home. Because the risk for mental health problems following exposure to trauma is high, a critical need exists to introduce trauma-informed practices into the child welfare system. The purpose of this study is to evaluate initial stages of a trauma-informed training program for the Arkansas Division of Child and Family Services (DCFS). In Phase 1, 102 (75%) of DCFS area directors and supervisors participated in 10 regional, two-day workshops modeled after the National Child and Traumatic Stress Network (NCTSN) trauma-informed training for child welfare. Pre- and post-training evaluations demonstrated significant improvements in participants' knowledge of trauma-informed practices. A three-month follow-up with directors and supervisors indicated that use of trauma-informed practices increased significantly and that such changes were correlated with pre- versus post-training improvement in knowledge. Most participants were able to partially implement action steps established at the time of training; however, a number of barriers were cited as preventing full implementation, including time constraints, heavy caseloads, lack of staff, and limited resources. Results are discussed in light of plans under way for Phase II training for all DCFS front-line staff. (Publisher abstract)
Trauma-informed care training in a child welfare system: moving it to the front line
- Authors:
- CONNERS-BURROW Nicola A., et al
- Journal article citation:
- Children and Youth Services Review, 35(11), 2013, pp.1830-1835.
- Publisher:
- Elsevier
The use of trauma-informed practices in the child welfare system is critically important to prevent system-induced trauma and encourage timely assessment, triage and referral for care when indicated. Ultimately, such measures have the potential over time to decrease the risk for mental health problems in children exposed to a trauma. This study evaluates an initiative in Arkansas to train child welfare front-line staff members in trauma-informed care practices. The impact of the training on knowledge and use of trauma-informed care practices among three types of child welfare staff (caseworkers, program assistants and other front-line staff) was evaluated. Results suggest that this training process was highly successful in improving knowledge of trauma-informed care practices, especially among staff with the least formal education and training. A significant increase in staff use of trauma-informed care practices at the three-month follow-up was also found. Barriers that may prevent staff from full implementation of training concepts are described and strategies to address barriers are proposed. (Edited publisher abstract)
Cumulative trauma and symptom complexity in children: a path analysis
- Authors:
- HODGES Monica, et al
- Journal article citation:
- Child Abuse and Neglect, 37(11), 2013, p.891–898.
- Publisher:
- Elsevier
Multiple trauma exposures during childhood are associated with a range of psychological symptoms later in life. In this study, we examined whether the total number of different types of trauma experienced by children (cumulative trauma) is associated with the complexity of their subsequent symptomatology, where complexity is defined as the number of different symptom clusters simultaneously elevated into the clinical range. Children's symptoms in six different trauma-related areas (e.g., depression, anger, posttraumatic stress) were reported both by child clients and their caretakers in a clinical sample of 318 children. Path analysis revealed that accumulated exposure to multiple different trauma types predicts symptom complexity as reported by both children and their caretakers. (Publisher abstract)
Reshaping child welfare’s response to trauma: assessment, evidence-based intervention, and new research perspectives
- Authors:
- AI Amy L., et al
- Journal article citation:
- Research on Social Work Practice, 23(6), 2013, pp.651-668.
- Publisher:
- Sage
Growing evidence has linked early trauma with severe psychiatric consequences. Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health condition found among some youth in foster care and foster care alumni. However, the current child welfare practice response has not met the demands in both assessment and intervention. This critical review aims to use the evidence to reshape the child welfare response to trauma in children and adolescents. The article begins by looking at research on the psychiatric consequences of child maltreatment and issues related to diagnostic assessment for PTSD. Next, it compares major foster care/alumni studies showing considerably higher rates of PTSD among young foster care recipients and alumni than among nationally comparable groups. To inform practice on childhood trauma, the article then summarises current evidence-based interventions showing effectiveness with PTSD. Finally, new dimensions, such as gene–environment research, posttraumatic growth, and implications for reshaping child welfare practice and foster care are explored. (Edited publisher abstract)
Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand
- Authors:
- FERGUSSON David M., McLEOD Geraldine F.H., HORWOOD L. John
- Journal article citation:
- Child Abuse and Neglect, 37(9), 2013, p.664–674.
- Publisher:
- Elsevier
Objectives: Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioural and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30. Methods: Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviours, physical health and socioeconomic outcomes to age 30. Results: After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (−0.371, 0.181, .041); and decreased life satisfaction (−0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (−0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen's d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%. Conclusions: CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial. (Publisher abstract)
Impact of dual disorders, trauma, and social support on quality of life among women in treatment for substance dependence
- Authors:
- BROWN Suzanne, et al
- Journal article citation:
- Journal of Dual Diagnosis, 9(1), 2013, pp.61-71.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: Women with dual disorders report lower levels of social support than women with substance dependence alone, and lower levels of social support have been associated with lower quality of life among individuals with substance use disorders. However, little is known about the impact of trauma symptoms and violence exposure on quality of life for women with dual disorders. The purpose of this study was to examine the impact of dual disorders, trauma, and social support related to recovery on various domains of quality of life among women in substance abuse treatment. Methods: This study utilised multiple standardised measures and hierarchical ordinary least squares regression to examine quality of life, trauma, and social support in women with dual disorders. Four domains of quality of life were measured (physical, psychological, social, and environmental domains). Participants (N = 369) were recruited from three inner-city women-only addiction treatment programmes. Institutional review board approval was obtained prior to sample recruitment. Results: Presence of dual disorders was significantly associated with lower quality of life in the physical and psychological domains. However, this difference was no longer significant when trauma symptoms were added to the model. Trauma symptoms and support for recovery significantly predicted quality of life across all four domains and friends’ support for abstinence across three domains. Conclusions: Findings suggest that the presence of dual disorders in women may indicate a history of trauma. They also support the importance of both friends’ support for abstinence and recovery support as predictors of quality of life in women with dual disorders. Interventions that focus on social support and quality of life in treatment with women with substance use disorders may potentially enhance treatment outcomes. (Publisher abstract)