Trauma Informed Child Welfare Systems—A Rapid Evidence Review

Abstract

Trauma informed care (TIC) is a whole system organisational change process which emerged from the seminal Adverse Childhood Experiences (ACE) study, establishing a strong graded relationship between the number of childhood adversities experienced and a range of negative outcomes across multiple domains over the life course. To date, there has been no systematic review of organisation-wide implementation initiatives in the child welfare system. As part of a wider cross-system rapid evidence review of the trauma-informed implementation literature using systematic search, screening and review procedures, twenty-one papers reporting on trauma-informed implementation in the child welfare system at state/regional and organisational/agency levels were identified. This paper presents a narrative synthesis of the various implementation strategies and components used across child welfare initiatives, with associated evidence of effectiveness. Training was the TIC implementation component most frequently evaluated with all studies reporting positive impact on staff knowledge, skills and/or confidence. The development of trauma-informed screening processes, and evidence-based treatments/trauma focused services, where evaluated, all produced positive results. Whilst weaknesses in study design often limited generalisability, there was preliminary evidence for the efficacy of trauma-informed approaches in improving the mental and emotional well-being of children served by community-based child welfare services, as well as their potential for reducing caregiver stress and improving placement stability.

Impacts of child welfare worker and clientele characteristics on attitudes toward trauma informed-care

“…Training has shown to have robustly positive impacts on staff knowledge, skills, and/or confidence (Bunting et al, 2019). However, training is only one piece of the puzzle when it comes to enhancing TIC uptake and use in child welfare.…”

Trauma-focused cognitive–behavioral therapy (TF-CBT) for interpersonal trauma in transitional-aged youth.

“…The headspace model of care provides government-funded, accessible, integrated, youth-friendly, community-based mental health support services to adolescents and young adults (aged 12–25; Rickwood et al, 2015). To enhance research and clinical success, the study was implemented within a trauma-informed model of care (Bunting et al, 2019). To this extent, the study included leadership, stakeholder, and consumer engagement, including collaboration between research, leadership, and clinical teams; educating clinicians within on principles of trauma-informed care; undertaking consumer consultation and engagement in research design; offering participants and parents choice in care (e.g., involving family where appropriate); and sensitivity to cultural needs, including the creation a safe environment, that is, changes to the waiting area and consulting rooms (Bendall et al, 2020).…”

The Roadmap for Resilience: The California Surgeon General's Report on Adverse Childhood Experiences, Toxic Stress, and Health

“…Universal ACEs-aware, trauma-informed policies, trainings, and infrastructure coordination efforts within and across sectors, including first responders, healthcare, public health, social services, early childhood, education, and justice, are needed to maximally leverage existing investments, reduce retraumatization, facilitate ease of navigation for families and service providers, and advance equity. [623][624][625][626][627][628]…”