Improving Well-Being in Racially Disadvantaged Children and Families with an Adapted Trauma-Informed Home-Based Intervention

Background-Purpose: Assuring healthy development of children is essential for societal achievement of their full health, social, and economic potential (Metzler et al. 2017). Adverse childhood experiences including trauma have negative effects on education, employment, and income in adulthood (Hughes et al., 2017). Research on racial disparities shows black-Americans experience more and earlier exposure to trauma than white-Americans (Umberson, 2017). Nationally, more than 46% of youth have had at least one adverse experience, 22%, two or more (Chandler, 2017). When living in urban Washington-DC, 47% of youth experience traumatic events, including parental incarceration or death, witnessing or being victims of violence, or living with suicidal, drug-addicted, maltreating family-member (National Survey of Children's Health, 2016). Untreated traumas lead to negative long-term health and mental health outcomes for children/adolescents and their families (Finkelhor, 2015). To mitigate trauma in an integrated approach (Myers et al., 2015), a non-profit mental health agency has partnered with multiple schools and community agencies, implementing an evidence-based mental health intervention for youth within schools in Washington-DC.  Subsequently, some children/adolescents reduced their trauma symptoms, while others struggled, as their parental-caregivers did not engage with schools or community-based services, often due to their own traumas known to compromise parenting efforts intergenerationally (Voncina et al., 2017; Widom & Wilson, 2015). To strengthen the trauma-informed support to these urban youth (6-17 years) and families, in 2016 this community agency implemented, a home-based mental health program, adapting an evidence-based, Trauma Adapted Family Connections (TA-FC) intervention-model (Collins et al., 2011; Collins, 2012; Collins et al., 2015). Pearlin’s (1981, 2005) theoretical stress model for reducing cumulative racially-patterned social disadvantages justifies the application of home-based TA-FC. This study hypothesizes that participation in the home-based program will improve well-being outcomes in District children and their families, and investigates change in domain-outcome data for past two years of this 5-year federally-funded (SAMHSA/NCTSN) intervention.

Methods: The Institutional Review Board of the university-partner approved the external program-evaluation of the TA-FC implementation with predominantly African American and Latino families (N=68 to date) with low SES in the District. The study-design uses pre-post evaluation with parametric and nonparametric statistical methods for analysis. Well-being outcome-domains include PTSD, depression, child behavior, parent-child communication, and family resources. Additional presentation includes intervention logic-model, enrollment-protocol, sample-characteristics, data collection, and reliability of standardized outcome-measures.

Results: Forty-five youth and families completed a full-dose of home-based intervention to date. Parental-caregivers were exposed to around 10 stressful life events (using PCL-5, criterion A). Significant (p<0.05) improvements are seen on child-PTSD symptoms (with CPSS), and behavioral strengths and difficulties (with SDQ), and parental-depression (with MFQ), parental-PTSD (with PCL-5), parental-communication with child (with PACS), and selected family needs (with FRS-R). Less improvement is seen on child-depression (with MFQ) and child-communication with parent (with PACS). Additional discussion includes implications for therapeutic practice, current study limitations, and further directions in research evaluation strategies.

Conclusions: Providing a home-based, trauma-informed, effective mental health support to racially and economically disadvantaged families increases the likelihood that the negative impact of trauma on children/adolescents is identified and their well-being-needs are addressed.