The Implementation of a Trauma-Informed Intervention in Child Welfare: A Case of Diffused Responsibility?

Background

Child maltreatment is considered a significant public health concern and is closely linked with an array of biopsychosocial consequences. Multiagency collaborative evidence-based intervention (EBI) implementations within child welfare service contexts have successfully treated these consequences. However, there remain many barriers and challenges to these successful collaborative EBI implementations, and especially in low- or under-resourced service environments and on organizational leadership levels. Few studies have examined the occurrence of diffusion of responsibility within multiagency EBI implementation contexts, though in some, it has illuminated salient implementation barriers and challenges. This study examined a multiagency partnership of child welfare and mental health service agencies that collaboratively implemented an EBI, Trauma Systems Therapy (TST), to treat the negative emotional sequalae of child maltreatment within its community context.

Methods

This qualitative case study leveraged implementation science theoretical frameworks to examine how the multiagency Tuscaloosa County Trauma Systems Therapy Project implemented TST, and the contextual factors that characterized TST implementation and sustainment outcomes. Access to recruit participants was gained through archived Project documents containing contact information of former Project members, and participants were recruited via phone calls and emails. Data were collected from various Project documents and through 34 in-depth, semi-structured interviews with 12 recruited participants (N=12). Data analysis involved primarily inductive open coding, followed by use of a priori codes based on key implementation science concepts.

Results

Eight main themes and 19 sub themes generated from analysis described how Project members implemented TST amid various challenges and resource constraints. All participants with agency administrative leadership roles on the Project (n=9) described the significance of the low- or under-resourced community service environment as a salient implementation challenge. Ultimately, several aspects of the Project’s multiagency structure hindered its long-term capacity to address the demands of implementing and sustaining TST in this environment. Several themes explained how Project members widely acknowledged these barriers yet did not address them through sufficient implementation role and responsibility allocation, mirroring a diffusion of responsibility phenomenon throughout implementation.

Conclusions and Implications

Study findings demonstrate this Project’s contextual difficulties with organizational responsibility allocation and reflect how diffusion of responsibility can occur in multiagency EBI implementations in child welfare service contexts. These effects may be even more salient in low- or under-resourced service environments such as the one under examination in this study. Study findings hold implications for social work scholars and practitioners to leverage implementation science in child welfare service contexts to both equip collaborating agencies for EBI implementation and to collectively engage in policy advocacy for equitable community resource allocation. Study findings thus also hold vital implications for improving implementation outcomes and for ameliorating implementation disparities disproportionately affecting socially and economically marginalized populations of child welfare system-involved children and families.