January 2021Vol. 22, No. 1Transitioning to Trauma-Informed Congregate Care
Written by the Capacity Building Center for States
Children and youth engaged with the child welfare system often experience trauma at significant rates (Dorsey et al., 2012). To address the complex challenges that arise when children and youth are exposed to trauma, the Family First Prevention Services Act (FFPSA) requires the use of trauma-informed practices along the full continuum of child welfare services, including those provided at a qualified residential treatment program (QRTP). According to the law, residential programs approved as QRTPs must use an appropriately staffed trauma-informed treatment model that meets the behavioral health-care needs of child and youth residents (Children's Bureau, 2018).
The information below is adapted from the Center for States' forthcoming publication, Congregate Care in the Age of Family First: Trauma-Informed Care. This publication can help agency leaders and managers working with residential treatment programs understand the basics of a trauma-informed approach for children and youth, including those in congregate care.
Core Principles of Trauma-Informed Care
While a trauma-informed approach to individual clinical practice is critical, it must be implemented in the context of an organizational commitment to trauma-informed care. Residential settings that treat children and youth who have been exposed to trauma must ensure that their treatment practices are rooted in the six principles listed below (Trauma-Informed Care Implementation Resource Center, 2019):
- Safety: Children and youth feel both psychologically and physically safe in their environment and during interactions.
- Trustworthiness and transparency: Families and youth have a trust-based relationship with the agency, are engaged in partnership, and are included in decisions. Expectations and accountability are clear to youth, families, staff, and leadership.
- Peer support: Opportunities for peer support are available for youth and for families, including siblings, and are considered essential practice.
- Collaboration: Youth and families are empowered to share in decision-making at all levels and are viewed as experts in their own experiences.
- Empowerment: Staff at every level of the organization believe that youth are capable and able to heal from trauma. Youth and family strengths are celebrated and validated. Resilience is clearly defined. Youth are provided with the support necessary to make and learn from mistakes.
- Cultural responsiveness: Agency staff understand and appreciate the perspectives of youth and families from all cultures. Cultural responsiveness is an organizational expectation and is reflected in policies and practices.
Planning for Trauma-Informed Care
Becoming trauma informed requires that an organization examine current practices and policies and implement a collaborative approach to organizational change. The following strategies can help organizations begin or continue the transition toward trauma-informed care (Dubay et al., 2018).
Build Awareness and Leadership Commitment
Any effort to transition to a trauma-informed approach should be rooted in a widespread organizational awareness that trauma impacts youth, staff, leadership, and the organization itself. Leadership commitment to trauma-informed care is an important part of the transition since leaders can serve as internal champions who share information and build support and buy-in among staff.
Collaborate With Families and Youth
Families and youth are the experts in their own care and needs and have substantial lived expertise that can help agencies move to a trauma-informed approach to care. Agencies and residential care facilities should work with families and youth at both case and system levels to drive the transition to trauma-informed care. Families, youth, and children (as appropriate) should be involved in all stages of the treatment process.
Ensure Organizational Support
Organizational policies, practices, and culture should reflect a commitment to the core principles of trauma-informed care, such as routinely screening children and youth in care for trauma. Trauma-informed care should also be reflected in the organization's budget, including funds to do the following:
- Train clinical and nonclinical staff
- Hire a trauma-informed workforce
- Train and coach, as necessary, to deliver a trauma-informed treatment model
Build a Trauma-Informed Workforce
Building a trauma-informed workforce starts with hiring and education practices that support trauma-informed care and treatment models, including education on topics such as adverse childhood experiences, secondary trauma, self-care, and transference. All clinical and nonclinical staff should receive training in trauma-informed care. In addition, the organization should encourage staff to engage in self-care and personal growth and should take steps to prevent secondary trauma in staff.
The Center for States' forthcoming 2021 series, Congregate Care in the Age of Family First, will offer more strategies for implementing the provisions of the FFPSA in a congregate care setting. (Visit the Center for State's website for more updates.) Agencies can also work with the Center for States to develop and implement successful approaches to trauma-informed care. Visit the Child Welfare Capacity Building Collaborative Liaisons webpage to find your state's tailored services liaison.
Children's Bureau. (2018). Information Memorandum: ACYF-CB-IM-18-02. U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. https://www.acf.hhs.gov/cb/resource/im1802
Dorsey, S. B., Burns, B. J., Southerland, D. G., Cox, J. R., Wagner, H. R., & Farmer, E. M. Z. (2012). Prior trauma exposure for youth in treatment foster care. Journal of Child and Family Studies, 21, 816-824. https://doi.org/10.1007/s10826-011-9542-4
Dubay, L., Burton, R. A., & Epstein, M. (2018). Early adopters of trauma-informed care: An implementation analysis of the advancing trauma-informed care grantees. Urban Institute. https://www.traumainformedcare.chcs.org/wp-content/uploads/early_adopters_of_trauma-informed_care-evaluation.pdf
Trauma-Informed Care Implementation Resource Center. (2019). What is trauma-informed care? https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/