Trauma-informed care initiatives show promise for improving practice in the child welfare system

The number of American children in foster care has increased for the fourth consecutive year, from approximately 397,000 in 2012 to 438,000 in 2016. While almost all children in foster care have a history of exposure to trauma (e.g., neglect, physical abuse, domestic violence, parental substance abuse), most child welfare systems are not equipped to provide trauma-informed care (TIC) to children, families, or resource parents (foster parents and kinship caregivers). While there is little evidence about which trauma-informed approaches are most effective in child welfare systems, Child Trends recently evaluated two specific models, finding them to be promising approaches for improving outcomes.

Resource parents and child welfare staff are often insufficiently prepared to manage challenging behaviors from children who have experienced trauma, putting caregivers and staff at increased risk for burnout, secondary traumatic stress, staff turnover, and foster home closures. To address this issue, several TIC models have been adapted for use in child welfare systems. Typically, such models train staff, resource parents, and other adults in children’s lives to recognize and respond effectively to traumatic stress reactions, to integrate screening and assessment into care, and to refer children who have been exposed to trauma to evidence-based and evidence-informed treatments.

Few of these models had been evaluated until recently, when Child Trends evaluated the Trauma Systems Therapy and ARC Reflections models.*

Trauma Systems Therapy (TST) provides children’s care teams with the tools and knowledge they need to better care for children, as well as a common language for addressing trauma. TST is a flexible, research-based, therapeutic model developed by Glenn Saxe to improve the functioning of children exposed to trauma. It enables programs like KVC Kansas (KVC) to integrate TIC throughout their systems by developing and delivering customized trainings to diverse members of children’s care teams (e.g., social workers, resource parents, and therapists). In an outcome evaluation of KVC, Child Trends found that children whose care teams had been trained in TST demonstrated significant improvements in well-being (behavioral and emotional regulation, functioning) and placement stability. Child Trends’ five-year implementation evaluation indicates that the integration of TST across KVC’s system of care was complex, iterative, and demanding, but that staff and resource parents were well-trained and fidelity (or adherence to the model’s protocols for delivery) improved over time.

Child Trends also evaluated Trauma Systems Therapy-Foster Care (TST-FC), which is based on the same principles as TST but modified for public child welfare agencies. Two states used TST-FC to integrate TIC into their child welfare systems; the evaluation in these states indicated that TST-FC increased resource parents’ and staff members’ knowledge and skills related to child trauma. Resource parents learned practical concepts and tools for working with children and developed a shared language about trauma that improved collaboration and reduced their feelings of isolation. An exploratory analysis showed that, compared to resource parents without TST-FC training, those trained were more likely to keep their homes open to foster children, and that children were less likely to experience a placement disruption.

In a third example, Child Trends evaluated ARC Reflections, a manualized model that focuses on how trauma impacts youth, provides skills and tools for resource parents to manage stress related to caring for youth affected by trauma, and teaches parenting skills that enhance child well-being, stability, and permanency. ARC Reflections is based on the evidence-informed framework of Attachment, Self-Regulation, and Competency (ARC), developed by Margaret Blaustein and Kristine Kinniburgh. Five North Carolina child welfare agencies used ARC Reflections to enhance their ability to provide TIC to children and families.

An implementation evaluation of ARC Reflections showed a high level of fidelity to the model. Resource parents were positive about the training, which significantly increased their knowledge and skills about trauma and trauma-informed parenting, and conveyed the importance of tolerance toward children’s misbehavior and praise for their positive behavior. The training also increased their sense of parenting efficacy. Further, a preliminary investigation of outcomes in this study showed better resource home retention and placement stability among resource parents who were trained in ARC Reflections compared to those who were not. Training for staff was less prescriptive and its implementation varied.

These recent evaluations suggest that TST (TST and TST-FC) and ARC Reflections are promising approaches for integrating TIC into child welfare systems. Further, the results suggest that resource parents and staff benefit from practical tools and approaches and a common language of trauma, which can then lead to positive outcomes for children involved in the child welfare system.

* Information on other TIC approaches in child welfare (e.g., The Resource Parent Curriculum; Child Trauma Training Toolkit; Trauma Informed PS – MAPP) can be found on the California Evidence-Based Clearinghouse for Child Welfare and the National Child Traumatic Stress Network.