Statewide implementation of child trauma-focused practices using the community-based learning collaborative model.

Abstract

A significant number of youth in the United States experience traumatic events that substantially increase the risk of physical and behavioral health problems across the life span. This public health concern warrants concerted efforts to promote trauma-informed, evidence-based practices that facilitate recovery. Although youth-focused trauma-specific treatments exist, determining effective ways to disseminate and implement these services-so that they are available, accessible, and sustainable-poses an ongoing challenge. This paper describes a comprehensive model for such implementation, the community-based learning collaborative (CBLC), developed as part of Project BEST, a four-phase statewide initiative to promote trauma-focused practices. The CBLC augments the learning collaborative model by including clinical and nonclinical (i.e., broker) professionals from multiple service organizations within a targeted community. CBLCs aim to build capacity for sustained implementation of trauma-focused practices by promoting interprofessional collaboration among those involved in the coordination and provision of these services. This paper describes the iterative development of the CBLC by examining participant completion data across the three completed phases of Project BEST (N ϭ 13 CBLCs; 1,190 participants). Additionally, data from Project BEST's third phase (N ϭ 6 CBLCs; 639 participants) were used to evaluate changes in the frequency of specific practices, pre-to post-CBLC, and post-CBLC perceived utility of CBLC components. High participant completion rates, significant increases in reported trauma-focused practices, and positive ratings of the CBLC's utility provisionally support the feasibility and efficacy of the model's final iteration. Implications for implementation and CBLC improvements are discussed.

Nationwide efforts for trauma-informed care implementation and workforce development in healthcare and related fields: a systematic review

“…57,67,72 This 'trauma-informed systems' approach promotes shared beliefs, values, and practice approaches among organizations, some of which are multilevel interventions that provide workforce training along with policy changes, while others offer targeted services, such as child welfare screenings across multiple agencies. 72,105,110,111 In fact, with the recognition that cross-system TIC implementation may improve health, social, and educational outcomes simultaneously, numerous states have started efforts to build capacity to deliver TIC across systems serving children and their families, including child welfare, education, health and mental health systems. 103,112 States have focused their efforts in several areas: assessing whether and to what extent systems are trauma-informed, improving worker capacity through workforce training, disseminating information about traumainformed practice, and integrating systems that serve families and children.…”

“…Trauma-informed workforce initiatives within the child welfare system range from trauma education training programs in Louisiana, Tennessee, and Arkansas to multisystem approaches in South Carolina. 110,[113][114][115] Project Best, a statewide initiative in South Carolina, for example, relied on interprofessional collaboration to impact systems, resulting in improved trauma-informed practices and positive feedback about the community-based learning collaborative component. 110 In a multifaceted, statewide program spanning child welfare, mental health, and juvenile justice in New Hampshire, the Partners for Change Project implemented case planning for youth who had been screened for trauma, multisystem collaboration, and evidence-based trauma treatments across systems, resulting in improvements in case planning, trauma screening, mental health referrals, and overall system performance.…”

“…110,[113][114][115] Project Best, a statewide initiative in South Carolina, for example, relied on interprofessional collaboration to impact systems, resulting in improved trauma-informed practices and positive feedback about the community-based learning collaborative component. 110 In a multifaceted, statewide program spanning child welfare, mental health, and juvenile justice in New Hampshire, the Partners for Change Project implemented case planning for youth who had been screened for trauma, multisystem collaboration, and evidence-based trauma treatments across systems, resulting in improvements in case planning, trauma screening, mental health referrals, and overall system performance. 116 Because the child and family population in child welfare and juvenile justice system is known to have much higher healthcare needs, including physical, mental health and preventive care, implementing TIC in these systems could eventually have a significant impact on health care needs and outcomes of this vulnerable population.…”

A Causal Model of Children’s Vicarious Traumatization

“…In the case of vicarious trauma that occurs in the context of the family, family-focused interventions may be warranted (Ridings et al 2019 ). Alternatively, community-based interventions may be suitable for community-based vicarious trauma (Hanson et al 2019 ). Prevention of children’s vicarious traumatization may also be possible if children are provided clinical services to inform them about the trauma of family and friends in age-appropriate ways and to help them to cope with the trauma material.…”

Training During a Pandemic: Successes, Challenges, and Practical Guidance From a Virtual Facilitated Learning Collaborative Training Program for Written Exposure Therapy

“…A variety of implementation strategies have been used to help clinic teams build their capacity for therapy delivery, integrate the new practice into their clinical context, and foster sustainability (Nadeem et al., 2013). Two commonly used approaches are external facilitation (Harvey et al., 2002; Powell et al., 2015; Stetler et al., 2006) and learning collaboratives (e.g., Hanson et al., 2019; LoSavio et al., 2019). In external facilitation, an outside coach supports and advises a local site champion, who works with their clinic team to develop and enact implementation plans that are tailored to their particular circumstance (Ritchie et al., 2017; Stetler et al., 2006).…”