Lessons Learned from Integrating the S.E.L.F. Intervention in an Early Head Start Program

Background:  The prevalence of children’s exposure to trauma is extremely high, particularly for children and families of color living in impoverished urban communities with multiple generations having been negatively affected by violence, abuse, and neglect. People of color and immigrant populations make up over half of Philadelphia’s population and poverty abounds. Children exposed to violence are at elevated risk for social, behavioral, emotional, and physical health issues. And, caregivers’ experiences with violence-related trauma heightens the risk that their children will be exposed to traumatic events.

In an effort to reduce the incidence and impact of children’s exposure to violence and to break the cycle of intergenerational trauma and violence transmission, the Health Federation of Philadelphia developed the Enhanced Home Visitation Program (EHVP). EHVP consists of a trauma screening and Safety, Emotional Management, Loss, and Future (SELF), a manualized, theory-based, trauma-informed, psycho-educational curriculum for groups that was integrated into an existing home based Early Head Start (EHS) program. For this project, SELF was modified and implemented in individual treatment sessions with the parent in their home. EHS families included parents with children ages 28 months or younger.

Methods:  In order to increase the likelihood of EHVP being integrated into the existing EHS system, EHS supervisors helped to design the implementation of EHVP. EHVP treatment providers were co-located with EHS staff and EHVP and EHS staff attended meetings and case conferences together. Additional steps were taken throughout the project in order to improve communication and collaboration between staff, including sharing client feedback on EHVP with EHS staff. The national SSPA evaluator monitored these start-up and implementation activities through monthly telephone calls and interviews with program staff during two site visits.

Results: EVHP staff encountered initial resistance from their EHS colleagues, who were reluctant to refer families to a new and unfamiliar program. However, integration efforts appeared to be moderately successful, as evidenced by increased referral rates, high levels of enrollment and retention in the intervention, and EHS staff requests for training on trauma informed care and the SELF model. Details on specific strategies and challenges will be discussed.

Implications: Integrating trauma specific treatment services within an existing service system is a promising practice for reaching underserved, vulnerable families who might otherwise not be able to access these services. Ongoing collaboration with our Early Head Start staff through formal and informal meetings and relationships was key to improving and maintaining our recruitment and retention numbers.