Community-University Partnership Intervention: Do Attitudes about Trauma-Informed Care Change Among Mental Health Providers after Training?

Background: Through a community-university partnership, a 3-day trauma-informed intervention workshop was delivered to the mental health professionals in a rural Native/White community where historical and current day trauma related to racism and rurality are high. A 45-item Attitudes Related to Trauma-informed Care (ARTIC) scale, one of the first theoretically driven and psychometrically validated survey tools, was delivered to assess attitudes related to trauma-informed care (TIC) and organizational readiness to implement TIC across seven subscales. The subscales emphasize: 1) the underlying causes of problem behaviors as fixed-versus-malleable; 2) responses to problem behaviors as rule-versus-safety focus; ) on-the- job behaviors that exhibit control-versus empathy; 4) feelings of self-efficacy (unable-versus-able) to work with a traumatized population; 5) reaction to the work, as underappreciate-versus-appreciate the effects of vicarious traumatization and coping skills; 6) concern-versus optimism about implementing TIC; and 7) feeling supported-versus-unsupported system-wide to implement TIC.

Methods: The workshop attendees were Native and White social workers and therapists in schools, mental health and behavioral health clinics. The anonymous ARTIC survey link was emailed to workshop attendees at three time-points (pre-, post-, and six month following the workshop). Thirty attendees participated in all three days of the workshop but responses across time points varied, pre (n=23); post (n=30); and 6 month follow up (n=18). The ARTIC scores were summarized as mean and standard deviation with inter-group comparison that used unequal independent t-test of the mean scores for the seven subscales between the time points. Not all variables were normally distributed, therefore the analysis included t-test with unequal variances.

Results:

The pre/post mean comparison across all of the subscales showed a statistically significant improvement. The post/6month mean comparison found a positive statistically significant difference between the post and 6-month follow up mean scores for four of the seven subscales (#1, 2, 3, 5). The mean scores of the pre/6 month follow up found that none of the subscales were significantly different, with the exception of the seventh subscale that showed an increase in positive attitudes about system wide support: pre (M=4.31, SD=1.89); 6 month (M=5.37, SD= 1.24); Satterthwaite’s t (38.01) = -2.15, p= .05. The bootstrapped difference in the subscales’ mean scores before and 6 months after the seminar intervention is moderately large and differs by approximately -0.63 standard deviation with 95% confidence intervals r(d)(-1.21, -0.802) and r(g) (-1.18, -0.79).

Implications: System-wide support for TIC implementation was evident six months following the three-day training, however findings suggest the three-day workshop intervention was not enough to shift and maintain positive TIC attitudes among the attendees. These result may be due to the fact that attendees did not receive ongoing monthly TIC support following the workshop. Future research is needed to develop robust sustainable TIC training models that address historical and current day trauma while also assisting social workers and mental health providers to better understand their own attitudes and biases.