Engaging Community-Based Case Management to Address Structural Trauma in Child Maltreatment Prevention Programs

Background and Purpose: Structural vulnerability contends that differential positions of power within social systems place individuals at greater risk for poor health and well-being via exposure to structural trauma. As such, professionals serving vulnerable mothers and children must understand trauma, such as child maltreatment (CM), as not only individual episodes of adversity, but as collective community and structural experiences of adversity. Structural vulnerability thus provides a useful starting point for exploring how CM prevention programs can be augmented with models that move “upstream” to address underlying social-structural conditions. SafeCare is an evidence-based CM prevention program currently implemented in Colorado with a pilot community-based case management model to address the structural vulnerabilities of families facing complex trauma. This study aimed to: (1) understand how case managers perceive and address familial experiences of structural vulnerability and the relationship with CM prevention practices; and (2) explore how community-based case management can increase CM protective factors and mitigate structural trauma to affect maternal and child outcomes.

Methods: Using a rapid cycle evaluation (RCE) framework, data were collected over a 15-month period from families participating in the SafeCare Colorado case management augmentation pilot (n =146). A pre-post study design was employed to measure changes in family stability/vulnerability and protective factors, using the validated CFSA 2.0. Pre-post test data were analyzed using the Wilcoxon matched-pairs signed rank test and the binomial test. A focus group with all case managers (n = 4) was also conducted to elicit their experiences of case management for families experiencing complex structural trauma; narratives were analyzed using inductive thematic analysis and member checking.

Results: Significant gains were observed in six domains of family stability: cash savings, childcare, food security, mental health, transportation, and physical health. The percentage of families indicating a stable situation at case closure was significantly higher in five domains: cash savings, debt management, food security, mental health, and transportation. Families also experienced significant increases in two CM protective factors: concrete support and social support. Three themes emerged from qualitative narratives: (1) Complex structural trauma as a fundamental challenge to prevention efforts; (2) Community-based case managers as aptly positioned to deliver trauma-informed care (TIC); and (3) Tension between family-centered services and program structure in delivering TIC to families experiencing structural vulnerability.

Conclusions and Implications: Findings demonstrate how case management augmentation can help to address the multiple layers of structural vulnerability and associated trauma experienced by mothers and children seeking prevention services. Moreover, results indicate that TIC guiding principles—trust, collaboration, informed choice, safety, and empowerment—can be further bolstered during CM prevention practices by using community-based case managers with shared lived experiences to participants. As such, combining TIC approaches with structural competency frameworks during social work practice is a promising pathway for interceding with structural trauma and improving maternal and child outcomes. Results also indicate areas for growth in social work practice to ensure such program augmentation does not (un)intentionally re-traumatize families, including the need to expand case management service length and balance program fidelity with emergent familial contexts.