Overarching abstract
The phenomenon of inappropriate polypharmacy among the foster care population arises
in part due to the challenges related to integrating trauma-informed principles into
service delivery. It is further exacerbated by the complexity of intersecting systems
in which child welfare case workers need to communicate, including foster and biological
parents, social service agencies, and advocates. Yet, there is limited research about
trauma-informed psychotropic medication management interventions for child welfare
staff. This pilot study was conducted to evaluate a trauma-informed psychotropic medication
management intervention and is reported in two manuscripts, pertaining respectively
to the facilitators and barriers to learning, and perceived individual and institutional
trauma responsiveness. The intervention comprised of a 2-hour-long training session
for child welfare staff and a 3-month web-based curriculum for leadership personnel,
aiming to increase their understanding of trauma-informed psychotropic medication
management. In the first paper, we report on the facilitators and barriers to learning,
grouped into three categories: teacher attributes, learner attributes, and situational
factors. In the second paper, in addition to trauma responsiveness ratings, we also
provide a detailed account of one participant's life experience and perceptions of
the intervention provided, as an exemplar of the psychosocial facets of resilience.
The ABC Medication Scale scores that measured staff knowledge, attitudes, and behaviors
associated with medications used to treat mental health symptoms showed a significant
change in scores following training. Based on these findings, we provide practical
solutions to address situational factors that are worth considering when providing
training for child welfare staff.
Paper 1 abstract: the facilitators and barriers to learning about trauma-informed medication management
Given that foster care children experience many challenges that threaten their well-being,
their physical and mental health needs tend to be greater than those of their peers
who are not in foster care. However, owing to the transient nature of the foster care
placements, as well as continuous changes in medical providers and counselors, the
screenings, supportive interventions, and treatments they receive may be fragmented.
This is particularly problematic when considering that many of these children are
medicated as a means of managing their behavior. Moreover, children in foster care
are also more vulnerable to having the medications and diagnoses accumulate due to
frequent placement changes and lack of treatment continuity. Our research was guided
by the question “What are the facilitators and barriers to learning about trauma-informed
psychotropic medication management?” We developed an intervention to address the issue
of inappropriate polypharmacy and examined the facilitators and barriers to learning
using a mixed methods design. The facilitators to learning were instructor-specific
(e.g., reputation, teaching style, capacity for selecting and implementing relevant
resources), learner-specific (altruism, capacity to see personal relevance in the
learning situation, desire for knowledge/competence, career advancement/recognition-seeking),
and situational (immediacy/on-demand resources, reinforcement of pleasant learning
experience). Barriers were largely situational (workload and family demands). Based
on these findings, we provide practical strategies for addressing situational factors
that are worth considering when designing training curricula aimed at child welfare
staff.
Keywords
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Article info
Publication history
Published online: July 19, 2022
Accepted:
July 2,
2022
Received in revised form:
June 24,
2022
Received:
February 9,
2022
Footnotes
☆In Child Welfare, the concept of psychotropic medication management is used to reflect all of the actions that adults implement to ensure safe utilization of medicines. These actions include understanding the purpose of the medicine, the intended response, ensuring that monitoring for outcomes and side effects is guided by best practices, and is documented; that the person who provides consent is informed of the risks, benefits, and alternatives for the proposed treatment. The coordination of medication management within foster homes or congregated care settings requires an organized process for accessing medicine prescriptions and the medicine itself, storing, administering, and safe disposal. The documentation practices record patterns of response and/or side effects, and provides a report of the care that was delivered. The communication that occurs to critically evaluate the medications effects and targeted outcomes is a shared responsibility of the Child Welfare team.
☆Inappropriate polypharmacy is distinguished by unnecessary or excessive use of medications and is distinct from legitimate use of more than one psychotropic medication for specific purposes that are then closely monitored within a comprehensive treatment approach.
Identification
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