Lessons Learned Integrating Universal Trauma Screening and Attachment Interventions (COS and ARC) in a Head Start Program

Background:  Spokane, Washington has higher than expected rates of children’s exposure to violence and has disproportionately high rates of poverty. Recent reductions in the flexibility and levels of funding in the public social service and community safety systems in Spokane has resulted in decreased community capacity to respond to the needs of children at risk. Because of these capacity deficits, many community partners, schools and early learning programs have had to rely increasingly on their internal response capacity.

In order to reduce risks for young children exposed to violence (CEV), prevention and early intervention practices need to be integrated into the universal systems that serve children and families. In an effort to improve the quality of response to children’s exposure to violence, Washington State University (WSU) integrated evidence-informed strategies for the identification and treatment of CEV into the Spokane Head Start program for children ages 3 to 5 years old. This universal response strategy included trauma-informed professional development for Head Start staff, implementation of universal trauma screening within Head Start, and delivery of two evidence-informed therapy models: the Circle of Security (COS) and the Attachment, Self-Regulation, and Competence (ARC) Model. COS is a structured group intervention using attachment principles developed specifically for high-risk toddlers, preschoolers and their caregivers. ARC is a structured, manualized individual psychotherapeutic treatment that addresses trauma in children using an attachment framework.

Methods: To facilitate service integration, WSU provided universal training to Head Start staff and parents in the areas of early learning social emotional learning, instructional practice, trauma awareness and management in early learning settings, assessment, and crisis response. Head Start staff administered a modified Adverse Childhood Experiences (ACE) screening tool with all consenting Head Start families to identify those at risk. Additionally, both the COS and ARC therapy models were offered to families in the study by Head Start staff. Licensed mental health staff at WSU trained in COS and ARC provided supervisory support as needed as well as the developers of these models. 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: Head Start encountered some logistical challenges related to integration of training, screening, and the interventions, including locating space and developing procedures for each component. In addition, some Head Start staff expressed uncertainty about the benefits of some aspects of the program, resulting in fewer than expected referrals to the interventions. Due to a long-standing history of positive collaboration, WSU and Head Start leadership were able to quickly overcome these early challenges. Ultimately, 233 staff received 133 hours of training and 1066 paired caregiver/child ACE screenings were completed with the Head Start population.

Implications: Implementation of a universal response strategy for children exposed to violence through integration of social emotional learning including professional development, trauma screening, and evidence-informed interventions enhanced capacity and improved access to care for Head Start families. While there were some challenges, positive, trusting relationships between collaborators and staff buy-in helped address these issues.