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• 181. [Article] What are Effective Strategies for Implementing Trauma-Informed Care in Youth Inpatient Psychiatric and Residential Treatment Settings? A Realist Systematic Review

  Background: Many young people who receive psychiatric care in inpatient or residential settings in North America have experienced various forms of emotional trauma. Moreover, these settings can exacerbate ...

  Citation × Citation Citation Abstract Copy Title: What are Effective Strategies for Implementing Trauma-Informed Care in Youth Inpatient Psychiatric and Residential Treatment Settings? A Realist Systematic Review Author: Bryson, Stephanie A., Gauvin, Emma, Jamieson, Ally, Rathgeber, Melanie, Faulkner-Gibson, Lorelei, Bell, Sarah, Russel, Jennifer, Burke, Sharlynne Year: 2017 Background: Many young people who receive psychiatric care in inpatient or residential settings in North America have experienced various forms of emotional trauma. Moreover, these settings can exacerbate trauma sequelae. Common practices, such as seclusion and restraint, put young people at risk of retraumatization, development of comorbid psychopathology, injury, and even death. In response, psychiatric and residential facilities have embraced trauma-informed care (TIC), an organizational change strategy which aligns service delivery with treatment principles and discrete interventions designed to reduce rates of retraumatization through responsive and non-coercive staff-client interactions. After more than two decades, a number of TIC frameworks and approaches have shown favorable results. Largely unexamined, however, are the features that lead to successful implementation of TIC, especially in child and adolescent inpatient psychiatric and residential settings. Methods: Using methods proposed by Pawson et al. (J Health Serv Res Policy 10:21–34, 2005), we conducted a modified five-stage realist systematic review of peer-reviewed TIC literature. We rigorously searched ten electronic databases for peer reviewed publications appearing between 2000 and 2015 linking terms “trauma-informed” and “child*” or “youth,” plus “inpatient” or “residential” plus “psych*” or “mental.” After screening 693 unique abstracts, we selected 13 articles which described TIC interventions in youth psychiatric or residential settings. We designed a theoretically-based evaluative framework using the active implementation cycles of the National Implementation Research Network (NIRN) to discern which foci were associated with effective TIC implementation. Excluded were statewide mental health initiatives and TIC implementations in outpatient mental health, child welfare, and education settings. Interventions examined included: Attachment, Self-Regulation, and Competency Framework; Six Core Strategies; Collaborative Problem Solving; Sanctuary Model; Risking Connection; and the Fairy Tale Model. Results: Five factors were instrumental in implementing trauma informed care across a spectrum of initiatives: senior leadership commitment, sufficient staff support, amplifying the voices of patients and families, aligning policy and programming with trauma informed principles, and using data to help motivate change. Conclusions: Reduction or elimination of coercive measures may be achieved by explicitly targeting specific coercive measures or by implementing broader therapeutic models. Additional research is needed to evaluate the efficacy of both approaches. Title: What are Effective Strategies for Implementing Trauma-Informed Care in Youth Inpatient Psychiatric and Residential Treatment Settings? A Realist Systematic Review Author: Bryson, Stephanie A., Gauvin, Emma, Jamieson, Ally, Rathgeber, Melanie, Faulkner-Gibson, Lorelei, Bell, Sarah, Russel, Jennifer, Burke, Sharlynne Year: 2017 Background: Many young people who receive psychiatric care in inpatient or residential settings in North America have experienced various forms of emotional trauma. Moreover, these settings can exacerbate trauma sequelae. Common practices, such as seclusion and restraint, put young people at risk of retraumatization, development of comorbid psychopathology, injury, and even death. In response, psychiatric and residential facilities have embraced trauma-informed care (TIC), an organizational change strategy which aligns service delivery with treatment principles and discrete interventions designed to reduce rates of retraumatization through responsive and non-coercive staff-client interactions. After more than two decades, a number of TIC frameworks and approaches have shown favorable results. Largely unexamined, however, are the features that lead to successful implementation of TIC, especially in child and adolescent inpatient psychiatric and residential settings. Methods: Using methods proposed by Pawson et al. (J Health Serv Res Policy 10:21–34, 2005), we conducted a modified five-stage realist systematic review of peer-reviewed TIC literature. We rigorously searched ten electronic databases for peer reviewed publications appearing between 2000 and 2015 linking terms “trauma-informed” and “child*” or “youth,” plus “inpatient” or “residential” plus “psych*” or “mental.” After screening 693 unique abstracts, we selected 13 articles which described TIC interventions in youth psychiatric or residential settings. We designed a theoretically-based evaluative framework using the active implementation cycles of the National Implementation Research Network (NIRN) to discern which foci were associated with effective TIC implementation. Excluded were statewide mental health initiatives and TIC implementations in outpatient mental health, child welfare, and education settings. Interventions examined included: Attachment, Self-Regulation, and Competency Framework; Six Core Strategies; Collaborative Problem Solving; Sanctuary Model; Risking Connection; and the Fairy Tale Model. Results: Five factors were instrumental in implementing trauma informed care across a spectrum of initiatives: senior leadership commitment, sufficient staff support, amplifying the voices of patients and families, aligning policy and programming with trauma informed principles, and using data to help motivate change. Conclusions: Reduction or elimination of coercive measures may be achieved by explicitly targeting specific coercive measures or by implementing broader therapeutic models. Additional research is needed to evaluate the efficacy of both approaches. Close

• 182. [Article] “Creative Interpretation and Fluidity in a Rights Framework”: The Intersection of Domestic Violence and Human Rights in the United States

  This study explores the manner in which leaders working in the domestic violence field in the US have or have not adopted a human rights framework and what impact this has had on domestic violence policy ...

  Citation × Citation Citation Abstract Copy Title: “Creative Interpretation and Fluidity in a Rights Framework”: The Intersection of Domestic Violence and Human Rights in the United States Author: Morgaine, Karen Lynn Year: 2007 This study explores the manner in which leaders working in the domestic violence field in the US have or have not adopted a human rights framework and what impact this has had on domestic violence policy and intervention. Participants included leaders from national domestic violence and human rights organizations. These organizations are instrumental in developing policy and in framing the issues of domestic violence and human rights, many of which also work with specific racial and ethnic populations. Some of the primary research questions included: If the human rights discourse is being put to practical use within the US, how does it meet the needs of women of color, immigrants, and other women who have been marginalized? Does bringing the issue of domestic violence into a human rights framework reinscribe hegemonic feminism in ways that are either ineffectual or oppressive and colonizing to women of color, immigrants and/or women in marginalized groups in the US and if so, in what ways? Additional research objectives include assessing whether there is active resistance to adopting a human rights framework and benefits and challenges to using the framework. This research uses the critique and experiences of women of color as a focal point. Through the use of critical ethnography and autoethnography, this study examines the manner in which the power to frame and define social problems unfolds. Findings suggest a limited dialogue to date between national domestic violence and human rights organizations with a range of thoughts regarding potential benefits and barriers to reframing domestic violence as a human rights violation. Barriers include lack of resonance/U.S. exceptionalism, power of the State to direct funding and focus, and reluctance to shift status quo based in part in white privilege. Benefits of cross-organizational dialogue include expanding focus, building coalitions, and engaging diverse communities in addressing domestic violence issues. Intersectional issues related to gender, race/ethnicity, immigration, and sovereignty are also explored. This research suggests that social workers need to continue to critically assess the application of human rights to social justice issues and the role that privilege plays in social movements and social policy formation. Title: “Creative Interpretation and Fluidity in a Rights Framework”: The Intersection of Domestic Violence and Human Rights in the United States Author: Morgaine, Karen Lynn Year: 2007 This study explores the manner in which leaders working in the domestic violence field in the US have or have not adopted a human rights framework and what impact this has had on domestic violence policy and intervention. Participants included leaders from national domestic violence and human rights organizations. These organizations are instrumental in developing policy and in framing the issues of domestic violence and human rights, many of which also work with specific racial and ethnic populations. Some of the primary research questions included: If the human rights discourse is being put to practical use within the US, how does it meet the needs of women of color, immigrants, and other women who have been marginalized? Does bringing the issue of domestic violence into a human rights framework reinscribe hegemonic feminism in ways that are either ineffectual or oppressive and colonizing to women of color, immigrants and/or women in marginalized groups in the US and if so, in what ways? Additional research objectives include assessing whether there is active resistance to adopting a human rights framework and benefits and challenges to using the framework. This research uses the critique and experiences of women of color as a focal point. Through the use of critical ethnography and autoethnography, this study examines the manner in which the power to frame and define social problems unfolds. Findings suggest a limited dialogue to date between national domestic violence and human rights organizations with a range of thoughts regarding potential benefits and barriers to reframing domestic violence as a human rights violation. Barriers include lack of resonance/U.S. exceptionalism, power of the State to direct funding and focus, and reluctance to shift status quo based in part in white privilege. Benefits of cross-organizational dialogue include expanding focus, building coalitions, and engaging diverse communities in addressing domestic violence issues. Intersectional issues related to gender, race/ethnicity, immigration, and sovereignty are also explored. This research suggests that social workers need to continue to critically assess the application of human rights to social justice issues and the role that privilege plays in social movements and social policy formation. Close