September 2019Vol. 20, No. 7The Massachusetts Child Trauma Project Shows Promise in Improving Well-Being Outcomes

An article in Child Abuse & Neglect discusses the findings of a statewide trauma-informed initiative in Massachusetts aimed at improving well-being, permanency, and maltreatment outcomes for children who have experienced trauma. Those outcomes are also monitored by the Child and Family Services Reviews.

The Massachusetts Child Trauma Project (MCTP), implemented from 2011 to 2016 and funded by the Children's Bureau, focused on integrating trauma-informed care into child welfare service delivery. MCTP was a partnership between child welfare agencies; the Department of Children and Families; two behavioral health agencies; and two large, urban medical centers, including a university-based medical center.

MCTP was based on the Breakthrough Series Collaborative (BSC) method and the Intensive Learning Community (ILC) workforce development training design. The BSC method focuses on improving and implementing trauma-informed casework practice by improving the identification and assessment of children exposed to trauma; supporting trauma-sensitive practices within child-serving agencies; increasing trauma training; improving referral rates to evidence-based trauma treatments; and building capacity for attachment self-regulation and competency, parent-child psychotherapy, and trauma-informed cognitive behavioral therapy. The ILC training design focuses on building sustainable change and improving clinical outcomes by implementing change in clinical practice.

The study included 91,253 children who were involved with the Massachusetts child welfare system between October 2012 and September 2013, with 55,145 children in the intervention group (participated in MCTP) and 36,108 children in the control group (children who did not participate in MCTP). Researchers used administrative data to gather information about child maltreatment, out-of-home placements, and adoption. Researchers also calculated continuous variables for each child, including the total number of maltreatment reports (regardless of substantiation), the total number of substantiated maltreatment reports of each type of maltreatment, and the total number out-of-home placements.

The following are a sampling of results of the study:

Children in the intervention group had more out-of-home placements than children in the control group.
Children in the intervention group were 21 percent more likely to be adopted than children in the control group.
Children in the intervention group were 4 percent more likely not to have a substantiated or unsubstantiated maltreatment report compared with children in the control group and had more substantiated or unsubstantiated maltreatment reports overall.
Children in the intervention group were 15 percent less likely to have a maltreatment report of any type, 12 percent less likely to experience physical abuse, and 14 percent less likely to experience neglect than children in the control group.

Implications of the study include the following:

Investment in trauma-informed programs and services is beneficial for children involved with child welfare and improves overall well-being.
Child welfare agencies should collaborate with mental health services to provide more cohesive and effective care for children affected by trauma.
Comprehensive intervention designs that include individual, organizational, and leadership drivers can help to improve maltreatment outcomes.

"The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes," by Beth Barto, Jessica Dym Bartlett, Adam Von Ende, Ruth Bodian, Carmen Rosa Noroña, Jessica Griffin, Jenifer Goldman Fraser, Kristine Kinniburgh, Joseph Spinazzola, Crystaltina Montagna, and Marybeth Todd (Child Abuse & Neglect, 81), is available at https://www.sciencedirect.com/science/article/pii/S0145213418301832.