Trauma Smart
What is Trauma Smart?
Trauma Smart (TS) is a holistic trauma-informed intervention that applies evidence-based principles at every level of care a child receives in order to sustainably promote resilience. Its integrative framework based on the ARC model (attachment, self-regulation, and competency) prepares children academically and socially, includes caregivers in the education experience, improves workplace conditions for teachers and staff, and creates lasting change for children, families, and communities. TS was developed by Crittenton Children’s Center at St. Luke’s Hospital of Kansas City, and was deemed effective in addressing trauma and violence by both the US Department of Health and Human Services and the National Child Traumatic Stress Network.¹
Starfish Family Services of Southeast Michigan provides ECE at 12 centers,² and was the first organization in Michigan to integrate Trauma Smart in 2017.³ TS has 4 components:
Training of Caregivers and Staff
TS training is administered across multiple caregivers, including all ECE staff in all positions including bus drivers and administrative staff, the child's parents, neighbors, grandparents, etc. The goal is to train all caregivers who interact with the child in tools and skills to promote resilience and buffer against the effects of trauma in developmentally appropriate and hands-on ways in all aspects of the child's life.
Individual Intensive Therapy
Children can be referred to receive individual trauma-based therapy by staff or families through TS. This therapy is specialized for children ages 3-5 and is targeted toward children who are experiencing poverty. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is often used, which utilizes psychoeducation, parenting and relaxation skills, effective coping and adjustment skills, processing the trauma narrative, in vivo exposure, joint caregiver-child sessions, and promoting feelings of safety. Therapy usually includes 12-24 sessions that last about 30-45 minutes each and parental involvement is highly encouraged. Additionally, it is a priority to keep caregivers involved, so therapists call caregivers weekly and discuss the sessions with them so caregivers can reinforce the skills learned in therapy in the home setting.
Classroom Consultations
Coaches who are trained in TS interventions provide classroom consultations for teachers in order to help them integrate evidence-based practices into the classroom environment and support teachers through the process of implementation. ARC and TF-CBT principles are integrated into the classroom setting, and consultants often help redesign physical classroom spaces and/or procedures.
Peer-Based Mentoring
Staff create mentorship relationships among themselves so they can discuss techniques and implementation. Additionally, there are peer-mentor opportunities for parents, especially facilitated through group trainings and workshops.⁴
Trauma Smart Model - Graphic From http://traumasmart.org/the-model
Through this process, TS's goals are to identify and reduce chronic trauma, support children's cognitive and social development, promote a trauma-informed culture for children, parents, and staff,⁵ and overall help children and caregivers succeed through the integration of coping skills in all aspects of the child's life. TS uses full community integration of trauma-informed practices as a lever to promote children's and ECE staff's resilience and well-being.⁶
Implementation/Cost
TS is implemented through various training processes. When an organization contracts with TS, a facilitator from Kansas City comes to the organization and trains all the staff and oversees classroom consultations for at least the first year.⁷ The training of teachers and staff from the CEO down happens across 20 hours with an annual booster.⁸ In subsequent years, an organization can send internal members to the coaching and/or facilitation academy in Kansas City so that they can provide TS training internally to the staff in the coming years. Those who are trained facilitators in TS and specifically in the caregiver curriculum called Smart Connections (an adaptation of the teacher/staff training specifically designed for parents) then train caregivers in TS principles, often in group settings. Although caregiver training is extremely flexible, it usually entails 10 meetings lasting 1-2 hours each.⁹ Finally in terms of the individual therapy component, TS will help the organization find another organization in the community to refer children to for individual therapy. Starfish Family Services is unique in this regard, as they have an internal infant mental health clinic that was able to accommodate individual therapy for those who were referred.
Throughout the implementation of TS, Starfish Family Services learned:
- Early childhood mental health consultants were extremely important for consistent implementation of advanced trauma-informed skills.
-It was not enough to say they were recognizing and responding to secondary traumatic stress and the wellness of their staff. Instead, they needed to give staff concrete tools, time, and resources to prioritize the implementation of trauma-informed care.
-When caregiver training fell outside already existing events and meetings, there was low turnout. TS training should be integrated into existing engagement opportunities to encourage higher turnout of caregivers.¹⁰
Cost: The cost of TS training and implementation varies greatly by amount of people, how often they are trained, and whether or not an organization utilizes internal trainers after the first year. Cost usually is not solidified until further into the contracting process and is determined on an individual basis. Therefore, a general cost cannot be determined. The program does become more sustainable over time, as there may not be a need to have training and consultation directly from TS once internal members are trained in facilitation and coaching. However, there is no cost for individual families outside the possible copays for the individual therapy sessions.¹¹
Design Process
TS was built as an integrated model to address gaps in trauma-informed services families receive. By training everyone in a consistent, specific plan of action, a child does not need to wait to receive therapy to get trauma-informed support. Caregiver training is used to protect community members from secondary traumatic experiences, as they are now also equipped with coping strategies. Additionally, when the general community acquires trauma-informed skills, they can help build a culture of resilience based on a common understanding and language of trauma across stakeholders.¹²
Evaluation
Starfish Family Services has conducted 3 years of evaluation on the implementation of TS. Through this evaluation process, they measured levels of childhood adverse experiences, TS training engagement of employees and caregivers, teacher levels of trauma-informed skills and behaviors, the trauma-informed culture at Starfish Family Services, and the overall implementation process of TS.
These aspects were studied using the following instruments/methods:
1. ACE-Q - This instrument asks caregivers about numbers of adverse childhood experiences their children have encountered. This assessment was moved from the beginning of the year to later in the year because caregivers may feel uncomfortable sharing this information without a solid relationship with Starfish Family Services first.
2. Attendance, Learning, and Likeliness to Use Feedback - While not a validated instrument, a learning check was given after all modules of TS training to gauge usefulness and understanding.
3. Trauma-Informed Skills Checklist for Teachers - While also not a validated tool, this assessment is based on the ARC model and consists of a retro-pre-test and a post-test on levels of comfort and use of trauma-informed practices in the classroom.
4. Attitudes Related to Trauma-Informed Care (ARTIC) - This is a validated tool used to measure organizational culture and attitude shifts in response to the introduction/training on trauma-informed practices. The ARTIC is given as a pre- and post-test for all staff who go through TS training.
5. Focus Groups - Targeted focus groups were used throughout the implementation process to collect rich data on implementation processes from parents, staff, teachers, administration, consultants etc.¹³
Starfish Family Services is currently in the process of evaluating children-centered outcomes, but over the first 3 years mainly focused on implementation outcomes for staff and caregivers with the idea in mind that improvements at the caregiver and teacher level would cascade down and impact students.
On the ARTIC assessment, teacher and staff attitudes and beliefs about the trauma-informed work consistently increased after training and were maintained after 1-2 years.
Teachers' increase in using trauma-informed skills in the classroom was found via the Trauma Informed Skills Checklist.
Additionally, Starfish Family Services' internal coaches observed teachers, which showed an overall increase in trauma-informed skill development.¹⁴
In terms of more widespread findings on the effectiveness of TS, research suggests that there was significant improvements in children's attention and externalizing behaviors in the classroom as reported by teachers and a reduction in internalizing and externalizing behaviors as well as inattention and hyperactivity at home as reported by caregivers.¹⁵ Additionally, parents, administrators, and teachers in Head Start programs that implemented TS reported satisfaction with the program.¹⁶
Outcomes
¹ http://traumasmart.org/the-model
² Starfish Family Services About Us
⁷ Meeting with Brianne Twombly, LMSW and Manager of Trauma-Informed Care at Starfish Family Services
⁸ TS Presentation at Zero to Three Family Conference
⁹ Meeting with Brianne Twombly, LMSW and Manager of Trauma-Informed Care at Starfish Family Services
¹⁰ TS Presentation at Zero to Three Family Conference
¹¹ Meeting with Brianne Twombly, LMSW and Manager of Trauma-Informed Care at Starfish Family Services
¹³ TS Presentation at Zero to Three Family Conference
¹⁴ Meeting with Brianne Twombly, LMSW and Manager of Trauma-Informed Care at Starfish Family Services