Advancing Trauma-Informed Care Research: The Influence of Department Affiliation and Demographics on Staff Perception

Background and purpose

Trauma is a common human experience, with higher rates often cited among recipients of mental health services than the general population (Rose, Freeman & Proudlock, 2012).  Notably, organizations have the potential to (re-)traumatize clients through traditional treatment practices and hierarchical structures (Bloom, 2006).  In response, trauma-informed care (TIC) creates an organizational culture of choice, collaboration, empowerment, safety and trust from which both service recipients and providers ought to benefit (Harris & Fallot, 2001).  Despite a dearth of rigorous research regarding TIC, national initiatives for TIC have been promoted by SAMHSA and The National Child Traumatic Stress Network.  The present study was conducted in an organization serving youth with mental illness and trauma histories  adopted TIC one year prior and explores the implications of departmental affiliation and demographics on staff perception of TIC.

Methods

As part of a larger mixed methods program evaluation, organizational members (n=100) completed a 34-item, five-subscale (α=.625-.824) online survey developed by the lead evaluator and Fallot, assessing the principles of TIC: safety, trustworthiness, choice, collaboration and empowerment (Harris & Fallot, 2006).  Data were collected between April and June, 2013.  Survey data from members of the board of directors (n=3) were collapsed with management.  Total and subscale scores were the mean score of the items for the scale.  Scores for department were compared by ANOVA and dichotomized demographics by t-tests.

Results

The total scale ANOVA was significant for department.  Management score was most positive, indicating a high presence of TIC.  Education (d=1.27), residential (d=.97) and health (d= 3.06) scores were least positive, indicating a lower presence of TIC.   Residential staff rated safety and empowerment significantly lower than management, support and community.  Educational staff rated collaboration significantly lower than management.  Staff with 15 or more years of employment were significantly more likely to rate the culture (total scale, empowerment, collaboration, and safety) more positively than those with shorter employment histories.  For total and subscale scores, effect sizes for graduate degrees, being male (excluding choice and empowerment), and for age 20-40 (excluding safety and choice) ranged from d =.21-.47.

Conclusions and implications

Findings may be partially understood as those who are male, more highly educated and have been at the organization longest may more often be in positions of authority.  Differences in training associated with one’s discipline (e.g. nursing) and the location/proximity of departments may influence perception and adoption of TIC.  Although small sample sizes and large standardized differences compromised significance testing, effect sizes provide a justification for further attention and detailed research.  This is further augmented by an awareness that the staff members providing services to clients are also deliverers and participants within TIC.  While many studies have linked trauma with poorer health outcomes and even premature death, organizations can prevent further (re-)traumatization through the successful integration of TIC. However, this study suggests that organizational efforts to become trauma-informed may require different approaches and supports to ensure consistent adoption of TIC across departments and staff.