Paper 2 abstract: levels of trauma responsiveness among child welfare staff
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' trauma responsiveness.
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 theory methods.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Psychiatric Nursing
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Patient-centered psychiatric care for youth in foster care: A systematic and critical review.Journal of Public Child Welfare. 2019; 13: 462-489
- Children in out-of-home placement.in: Yearwood E.L. Pearson G.S. Newland J.A. Child and adolescent behavioral health. Wiley-Blackwell, 2021: 444-457
- Implementing a novel self-care clock strategy as part of a trauma awareness intervention in a university setting.Perspectives in Psychiatric Care. 2022; : 1-10https://doi.org/10.1111/ppc.13101
- Improving cardiometabolic monitoring of children on antipsychotics.Journal of Child and Adolescent Psychopharmacology. 2017; 27: 916-919
- Rapid growth of antipsychotic prescriptions for children who are publicly insured has ceased, but concerns remain.Health Affairs. 2016; 35: 974-982
- High-level psychotropic polypharmacy: A retrospective comparison of children in foster care to their peers on Medicaid.BMC Psychiatry. 2021; 21: 1-11
- Communication patterns between foster parents and case managers.Children and Youth Services Review. 2018; 89: 329-339
- Are children and adolescents in foster care at greater risk of mental health problems than their counterparts? A meta-analysis.Children and Youth Services Review. 2021; 127: 1-11https://doi.org/10.1016/j.childyouth.2021.106100
- Developmental service referrals and utilization among young children in protective custody.The Journal of Pediatrics. 2021; 234: 260-264
- Outcomes of children who grew up in foster care: Systematic-review.Children and Youth Services Review. 2017; 76: 74-83
- Effects of child maltreatment, cumulative victimization experiences, and proximal life stress on adult crime and antisocial behavior.
- Experiences of child welfare workers regarding psychotropic medications: Results from a mixed-method evaluation of a critical medication curriculum.Children and Youth Services Review. 2020; 116: 1-9https://doi.org/10.1016/j.childyouth.2020.105193
- Evidence use in mental health policy making for children in foster care.Administration and Policy in Mental Health and Mental Health Services Research. 2016; 43: 52-66
- Psychosocial facets of resilience: Implications for preventing posttrauma psychopathology, treating trauma survivors, and enhancing community resilience.European Journal of Psychotraumatology. 2014; 5: 1-10https://doi.org/10.3402/ejpt.v5.23970
- Characterization of chronic multiclass psychotropic polypharmacy and psychotherapy in foster care youth in a state Medicaid population.Journal of Managed Care & Specialty Pharmacy. 2019; 25: 1340-1348https://doi.org/10.18553/jmcp.2019.25.12.1340
- A comparison study of primary care utilization and mental health disorder diagnoses among children in and out of foster care on Medicaid.Clinical Pediatrics. 2020; 59: 252-258
- Policy and practice innovations to improve prescribing of psychoactive medications for children.Psychiatric Services. 2020; 71: 706-712
- Fostering psychotropic medication oversight for children in foster care: A national examination of states’ monitoring mechanisms.Administration and Policy in Mental Health and Mental Health Services Research. 2017; 44: 243-257
- Systematic review: System-wide interventions to monitor pediatric antipsychotic prescribing and promote best practice.Journal of the American Academy of Child & Adolescent Psychiatry. 2021; 60: 76-104https://doi.org/10.1016/j.jaac.2020.08.441
- Implications of foster care on attachment: A literature review.The Family Journal. 2019; 27: 394-403
- Missouri model: A developmental framework for trauma informed approaches.https://dmh.mo.gov/Date: 2014
- “No one acknowledged my loss and hurt”: Non-death loss, grief, and trauma in foster care.Child and Adolescent Social Work Journal. 2018; 35: 1-9
- Psychotropic medication monitoring checklists: Use and utility for children in residential care.Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2014; 23: 38-47
- Children prenatally exposed to alcohol and other drugs: What the literature tells us about child welfare information sources, policies, and practices to identify and care for children.Journal of Public Child Welfare. 2022; 16: 71-94
- Challenges and strategies in foster care.The Psychiatric Times. 2020; 37: 30-31
- Basics of qualitative research: Techniques and procedures for developing grounded theory.2nd ed. Sage, 1998
- A Medicaid quality improvement collaborative on psychotropic medication prescribing for children.Psychiatric Services. 2018; 69: 501-504
- Closing the research to practice gap in therapeutic residential care: Service provider university partnerships focused on evidence-based practice.Journal of Emotional and Behavioral Disorders. 2017; 25: 46-56
- Nutritional status of foster children in the US: Implications for cognitive and behavioral development.Children and Youth Services Review. 2016; 70: 369-374
- Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey.Child Abuse & Neglect. 2017; 64: 117-129
- Racial/ethnic disparities in mental health service use for older foster youth and foster care alumni.Child and Adolescent Social Work Journal. 2017; 34: 419-429https://doi.org/10.1007/s10560-016-0479-8
- Fostering the initiation of discretionary psychotropic medication reviews by child welfare caseworkers.Child Welfare. 2018; 96: 23-45
- Universal design for learning guidelines version 2.2.http://udlguidelines.cast.orgDate: 2018
Published online: July 18, 2022
Published by Elsevier Inc.