Societal Impact through Trauma Informed Organizational Change: Preliminary Outcomes of a Collaborative Intervention

Background: People living with HIV PLWHA) experience high rates of trauma, posing a significant barrier to successful progression through the HIV care continuum, negatively affecting well-being of individuals and public health. Most trauma-informed interventions have been implemented on an individual level, however research increasingly points to the role of an organizations’ culture and climate in shaping staff and client outcomes (Goering, 2018). Trauma-informed organizational change (TIOC) interventions aim to enhance safety, collaboration, empowerment, and healing among service users and organizational staff through alterations to organizations’ climate, culture. In collaboration with PLWH, the SUSTAIN Center (Stanton et al., 2023) developed a justice-centered TIOC intervention for Southern HIV Service Organizations. The TIOC Intervention consisted of in-depth group training on TIOC and implementation coaching to support participating organizations’ TIOC project plans.This study examined evaluation outcomes of a TIOC intervention implemented with HIV service organizations in the U.S. South.

Methods: To measure individuals’ pre/post TIOC-related knowledge, attitudes, and skills, the authors developed a highly reliable (ɑ=.956) 29-item, 10-point Likert scale survey based on TIC principles (n=14 participants). To measure organizational-level TIOC, authors used the TICOMETER, a reliable measure (ɑ=.920) consisting of 35-items across five domains (N=7 organizations). Authors conducted paired samples t-tests for subscales/domains and individual items of both measures (one sided p<.05)

Results: Paired samples t-tests revealed statistically significant increases for the TICOC knowledge (Cohort 1: MD=3.2, p=.003; Cohort 2: MD=3.3, p<.001), attitudes (Cohort 1: MD=1.2, p<.05; Cohort 2: MD =1.1, p<.05), and skills (Cohort 1: MD=2.8, p<.05; Cohort 2: MD=1.8, p<.05) subscales. 25 of 29 individual items were statistically significant. Paired samples t-tests also revealed statistically significant increases for the TICOMETER across domain 1 (Cohort 1: MD=5.83, p<.05; Cohort 2: MD=1.43, p<.05), domain 2 (Cohort 1: MD=6.0, p<.01; Cohort 2: MD=1.39, p<.001), domain 3 (Cohort 1: MD=1.83, p=.224; Cohort 2: MD=2.39, p<.01), domain 4 (Cohort 1: MD=7.67, p<.05; Cohort 2: MD=1.18, p=.096), and domain 5 (Cohort 1: MD=5, p<.05; Cohort 2: 1.28, p<.05). 25 of 35 individual items were statistically significant.

Conclusions: Despite limitations of small sample sizes, our exploratory pilot results indicate change in the expected direction, i.e. increases in knowledge, skills, attitudes, and evidence of organizational change related to TIOC. The SUSTAIN Center’s approach is rooted in a) collaborating with People living with HIV and organizational staff; b) being intentional about power and equity in intervention development, implementation and evaluation. Given the collaborative nature of the intervention, the SUSTAIN team was able to stay rooted in community need, such as the need to address anti-Blackness and stigma directly in the intervention. Such processes are essential in developing interventions for a greater social impact.