(PS5-C69) Targeting Implementation Measurement for Trauma-informed Care Transformation: A Real-world Behavioral Health Application

Real-world implementation initiatives, whether driven by external setting (e.g., policy) or internal domain factors (e.g., organizational culture, internal characteristics, etc.), often lack valid, reliable, and pragmatic measurement to assess progress.^1,2 Measuring implementation of trauma-informed care (TIC) initiatives is especially challenging because of the dearth of trauma-specific measurement tools for capturing the multiple levels at which TIC adoption must occur - individual, programmatic, organizational.³ The current study describes a new approach to guiding a multi-level, trauma-focused organizational change process through the use of two measures – the Trauma-Informed Organizational Assessment (TIOA) and the Attitudes Related to Trauma-Informed Care (ARTIC) scale.^4,5 Both the TIOA and ARTIC scales were developed utilizing rigorous, mixed methodology for measure construction and the current study is the first to date combining these tools. The TIOA includes assessment of 9 domains of TIC practices and policies; whereas, the ARTIC scale is a measure of professional attitudes toward TIC across 7 domains (and a total score).^4,5 Given the established knowledge-attitudes-practice linkage in the research, both measures, along with staffing metrics (e.g., average leave time) and client metrics (e.g., clinical outcomes), were identified and leveraged as part of a measurement-based care plan for a multi-year TIC initiative.^6,7 It was hypothesized that TIOA and ARTIC scores would improve over the course of one year of a TIC initiative, during which all staff participated in foundational TIC training and clinicians also participated in two, trauma-focused EBP training protocols.^8,9
The participating organization was a large, children’s mental health agency in California. Participants for the current study included all staff from the organization’s residential program who completed the ARTIC (n = 85) and TIOA (n = 81). Results on the ARTIC scale demonstrated that in 80% of matched cases, staff attitudes improved from time 1 to time 2, which supported the initial hypothesis. On the TIOA, data were anonymous (matched cases could not be identified), however, 4 out of the 9 domains demonstrated improvement which supported the initial hypothesis. All improved domains included reference to screening and assessment practices specifically targeted in the TIC initiative. All staffing metrics also improved over the year (e.g., leave time, number of staff on leave per month). Notably, the TIOA domain pertaining to addressing secondary traumatic stress (STS) decreased over time (STS domain was the lowest scoring domain at time 2). Similarly, the ARTIC subscale most related to STS improved the least compared to other subscales (4 point improvement, max score = 49). The authors hypothesized that, despite other staffing metrics improving, organization turnover was significant and remaining staff were managing higher caseloads with greater potential for exposure to youth with trauma histories. Other domain comparisons will be discussed, and future research should focus on further exploration of the TIOA and ARTIC as part of a combined measurement strategy for trauma-informed organizational transformation initiatives.