Beyond the Buzzword: Exploring Factors Associated with Implementation Levels of Trauma-Informed Care

Background & Purpose: Trauma-informed care (TIC) is a developing approach and philosophy to providing care that is sensitive to clients’ previous experiences with traumatic events, recognizes how trauma symptomatology manifests in present behaviors and relationships, and actively avoids causing additional harm as clients seek care. Presently, TIC is largely theoretical and lacks concrete operationalization which makes it difficult to understand and assess if mental health providers are adequately providing TIC or if agencies and systems are offering the necessary supports to mental health providers engaged in providing TIC. As the breadth of what is considered TIC is not well-understood, the purpose of this study was to examine the implementation of trauma-informed policies and practices at a large, urban behavioral health system. The study aimed to assess the level of implementation of trauma-informed policies and practices and explore individual- and agency-level factors related to the implementation of TIC.

Methods: The present, exploratory study used survey methodology. Participants were recruited from a large, urban behavioral health system and all provided direct services to clients within the past 6 months. Implementation levels were measured using a modified version of the Trauma-Informed Systems Change Instrument (TISCI; Richardson et al., 2012), which measures four dimensions of trauma-informed implementation: agency policy, agency practice, integration, and openness, using a 1-5 Likert-type scale. Additionally, participants were asked questions about their professional experiences, educational background, and personal demographics. All statistics were calculated using Stata version 17.0.

Results: Of the eligible participants (n=13), mean scores for the dimensions of agency policy (M=3.2, SD=.83), agency practice (M=3.94, SD=.54), integration (M=4.28, SD=.94), and openness (M=4.18, SD=.26) were calculated. A two-independent samples t-test [t(9)=3.63, p<.01] found that providers that worked with children reported higher levels of trauma-informed policy implementation in their clinics (M=3.49, SD=.18) as compared to providers that worked with adults (M=1.90, SD=.50). Additionally, a two-independent samples t-test [t(10)-2.40, p<.05] found that providers who worked with children integrated TIC into their own practices (M=4.59, SD=.14) at higher levels than their adult-serving counterparts (M=3.33, SD=.88). Finally, a linear regression analysis [R²=.43, F(1,8)=6.08, p<.05] found that the number of years a behavioral health provider had been practicing was positively related to the clinic’s level of trauma-informed practice implementation. As no dimension of TIC was correlated with multiple study factors, multivariate analysis was not conducted.

Conclusions & Implications: While study results are limited by sample size, they may provide insights on future directions for scholarship. Presently, much of the literature and resources on TIC are focused on child-serving providers, which may account for higher levels of trauma-informed policy implementation and integration levels in child-serving providers as compared to adult-serving providers. This finding may indicate that more trauma-informed research is necessary for providers that serve adults. Additionally, the mechanism for how length of practice experience increases implementation of trauma-informed practices may merit further exploration. Overall, exploring factors related to trauma-informed implementation levels shows promise as potential targets to improve the provision of TIC in mental health services.