Foster care children tend to have greater physical and mental health needs compared
to those of their peers who are not in foster care due to many challenges that threaten
their well-being. Yet, owing to frequent placement changes, their treatment may be
fragmented. Moreover, if foster children are unable to provide important information
about their own health status, and the same cannot be obtained from their families
of origin, the resulting incomplete and/or inconsistent health history puts them at
risk for unrecognized problems and conflicting diagnoses. Paradoxically, foster parents
and resource providers often request psychotropic medications for children and youth
in their care as a means of managing their behaviors. The phenomenon of inappropriate
polypharmacy arises due in part to the difficulties related to integrating trauma-informed
principles into the care process. 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. In this second paper,
we report on the same intervention as that discussed in the first paper, focusing
on the effectiveness of the live 2-hour face-to-face training for child welfare staff
and the 3-month web-based curriculum for leadership personnel in improving the participants'
1. What are the child welfare staff’s perceptions of their own knowledge, attitudes,
and communication behaviors associated with medications used to treat mental health
symptoms and monitoring for side-effects of psychotropic medication use in children?
2. What is the level of trauma responsiveness among child welfare staff?
Methodology and Participants
The ABC Medication Scale was employed to measure staff knowledge, attitudes, and behaviors
associated with medications used to treat mental health symptoms before and after
the intervention to determine if the training resulted in any improvements. Individual-
and organizational-level trauma responsiveness was rated on a continuum of the Missouri
Model: A Developmental Framework for Trauma-Informed Approaches. Artifacts of the
web-based curriculum and qualitative interview data were analyzed by applying grounded
There was a significant increase in The ABC Medication Scale scores following the
training. The qualitative findings further revealed that majority of the participants
rated themselves as “trauma aware” or “trauma responsive” on the Missouri Model, while
indicating that their agencies could work harder to become more fully trauma-informed.
As trauma-informed child welfare workforce that understands the complexity and advocacy
requirements of psychotropic medication management is needed, further longitudinal
research is required is to assess the training effects over time. In particular, the
aim should be to establish (a) how knowledge and attitude shifts correlate with greater
degrees of trauma responsiveness, and (b) if and how such trainings translate into
improved systems of support.