Using a Cross-System, Multi-Informant Approach to Develop a Trauma-Informed, Data-Driven Child Welfare System

Background/Purpose:  Growing evidence has linked early exposure to traumatic events with long-lasting consequences on child development (Conradi et al., 2014). Children in foster care have an increased vulnerability to multiple traumatic events, which in turn may impact their well-being and permanency. Existing literature corroborates the need for early identification and evidence-based, trauma-informed services in order to improve child welfare outcomes (Ai et al., 2013). The U.S. Children’s Bureau has responded with an initiative that funds approximately 20 grantees nationally. As part of this national initiative and following models of implementation science along with a cross-system approach, this study sought to examine child-, family-, and system-level factors related to the problem and target population. In addition to enhancing the literature on the behavioral health needs of children in foster care, this study builds knowledge about a systematic and rigorous approach to bring trauma-informed and evidence-based practices into child welfare daily practices.   

Methods: This study used a mixed-methods design. Both quantitative and qualitative data were collected, including 59 semi-structured interviews (22 adoptive parents and 37 professionals), two focus groups (16 foster care alumni), 325 web-based surveys, and child welfare administrative data (N= 16,220). Participants were recruited statewide, from multiple systems (child welfare, mental health, and courts), urban and rural communities, and private and public organizations. For qualitative data, transcripts were analyzed using theoretical thematic analysis, member checking, and data triangulation. Bivariate and multivariate statistics were used to analyze the quantitative data, such as survival analysis and logistic regression.

Results: Using an ecological framework, findings from quantitative and qualitative data were organized into four major themes. At the child level, this study showed significant and widespread trauma-related, social, emotional, and behavioral problems among youth in foster care, most pressingly under-identified and untreated trauma-related needs among young children. Among all ages of children, disability (mainly emotional/behavioral problems) predicted a lower likelihood of reunification and a higher likelihood of adoption. At the family level, we found that adoptive parents need strong preparation on youth trauma and behavioral health needs, effective communication, lifelong learning, and extraordinary commitment. At the system level, we identified that improvements are needed in cross-system collaboration and the system’s understanding and response to trauma and behavioral health needs. Service gaps identified included insufficient or absent trauma framework, and very few trauma-informed treatments for young children across the state. 

Conclusion:  Findings substantiate the need for trauma-informed evidence-based interventions that promote well-being, prepare and engage parents, and enhance cross-system collaboration. Findings also corroborate the importance of diverse perspectives on problem definition; the need for strong collaboration underlying the exploration work; and the need to consider the system’s readiness, capacity, and fit when aligning strategies with feasible solutions that are more likely to succeed in real-world settings. In this study, defining the problem and target population using multi-informant views, a cross-system perspective, and information on the system’s readiness, capacity, and fit was possible through a strong university-agency partnership.