(PS5-D76) Overcoming Barriers to Access for Children in Need of Trauma Therapy: a Process Mapping Approach

In the United States, more than 60% of children experience a trauma before the age of 18 with 50% developing at least one symptom of PTSD and 20% meeting full criteria (Alisic et al., 2014; McLaughlin et al., 2013). Although efficacious treatments exist, such as Trauma-Focused Cognitive-Behavioral Therapy (Cohen et al., 2015), barriers to accessing evidence-based interventions (EBIs) exist at the macro (e.g., systemic) and micro levels (e.g., therapist, client) (e.g., Gervasio & Herren, 2020). Before addressing barriers, it is crucial to understand the process for identifying youth in need of trauma services. Process mapping is a data-driven approach to creating detailed visualizations of the steps in complex systems (Frank et al., 2022; Kim et al., 2019). Process mapping allows for the assessment and identification of barriers and gaps in the process (e.g., connecting to services). This study uses process mapping to capture data from qualitative interviews conducted with community leaders on available resources, needs, and barriers for traumatized youth.

Qualitative data were drawn from an ongoing national training grant focused on disseminating EBIs for traumatized youth. Interventions are delivered through school-community-mental health partnerships in Nevada, South Dakota, North Dakota, Michigan, Maryland, and South Carolina. Each site created a trauma team consisting of rights holders, including school personnel, mental health providers, parents, and youth. Qualitative data were collected through individual SWOT (Strengths, Weaknesses, Opportunities, Threats) interviews (N = 68) with each rights holder.  Questions addressed: the site’s current response when trauma is experienced/reported, strengths in the response, gaps, opportunities to make it more effective, and barriers to making changes. To guide content analysis of the qualitative data, an iterative team approach was used to develop a codebook of common themes (Fonteyn et al., 2008). A preliminary process map of steps from exhibiting trauma symptoms to being identified for trauma services was then created. The map then underwent a content expert review by grant leadership and team members.

The process map includes four potential steps: identification of trauma symptoms, referral to an evaluator, trauma-informed assessment, and connection to a trauma therapist. Based on preliminary coding of interviews, challenges exist at each step. Community leaders reported lack of site and community resources, time, and material needs obstruct every step. Community leaders reported that youth exhibiting trauma symptoms may not be referred for mental health services; instead, symptoms are often interpreted as behavioral problems. Barriers to trauma-informed assessment include a dearth of evaluators in schools and lack of integrated mental health services. Referrals to trauma therapists are limited by clinician capacity and burnout, lack of professional training in trauma interventions, and staff resistance to change. Recommended solutions include education and training in trauma for caregivers and professionals and use of evidence-based engagement strategies with families. We will discuss process mapping methodology in the context of trauma-informed care.