Applying Principles of Trauma-Informed Care to Adolescent and Young Adult Foster Youths' Experiences of Placement Change, Permanency Planning, and Mental Health Services

Background: Early exposure to chronic or repetitive traumatic experiences in childhood has been linked to adverse physical, social, emotional, and behavioral outcomes across the life course. To address the prevalence and significant impact of trauma on youth developmental trajectories and outcomes, researchers have argued the need for trauma-informed systems of care. Trauma-informed care is a framework rooted in the awareness of, and responsiveness to, the impacts of trauma on physical, psychological and emotional safety for clients and providers. It embeds within systems opportunities for clients to rebuild their sense of control and individual empowerment. The majority of the research on trauma-informed care within the child welfare systems focuses on descriptive studies of trauma-informed programs, or on evaluation studies of worker training to increased trauma knowledge and screening. However, significant gaps remain in our understanding of effective implementation of trauma-informed care. The current study takes a novel approach to identifying potential methods to implementing trauma-informed care practices for adolescents in child welfare agencies by examining the lived experience of older youth with current or past foster care system involvement.

Methods: Using a qualitative, phenomenological approach, six semi-structured focus groups were conducted with nine current (aged 15-17) and twelve former (aged 18-24) foster care youth. Participants were recruited through the Rhode Island Department of Children and Family Services in partnership with a local social service organization, Foster Forward. Participants identified as female (N=12), male (n=8) and other (n=1). 40% of the youth identified as LGBTQ. Youth self-identified as Latino/Hispanic (N=8), mixed race (N=4), White (N=4), African American/Black (N=3), or Native American (N=1). Two professors of social work with professional experiences with foster care populations participated in the data analysis. The themes presented were unexpected and emerged inductively in the analytic process. We used thematic content analysis to code and analyze the interview data. In this process the researchers identified codes to represent concepts and themes, specifically, SAMHSA’s six fundamental principles of trauma-informed care were applied to the emerging themes during the analytic process.

Results: Findings produced two overarching themes: 1) Humanizing Practice and 2) Physical and Psychological safety. Theme one has three distinct, yet interrelated, categories. Being Heard, aligns with the trauma-informed principle of Empowerment, Voice and Choice; Caring & Mattering, relates to the principle of Collaboration & Mutuality; and Trust and Transparency, corresponds to the similarly named principle. Within a trauma-informed framework, Physical and Psychological Safety (theme 2) is recognized as the foundation of healing. This theme has six distinct categories: Helpers Awareness of Trauma; Common Ground; Restriction; Control; Multiple Traumas and Losses; and Baggage from Being a Foster Youth.

Conclusions and Implications: We use these findings to identify recommendations for implementing trauma-informed care within child welfare agencies across four key areas: 1) increased transparency and shared decision-making with youth; 2) trauma-informed training for caregivers, including foster/adoptive parents and staff in group home or institutional settings; 3) the need for trauma-informed evidence-based services and supports; and 4) infusing the concept of “normalcy” in the care of adolescents.