Evaluation of Interventions
Similarities and Differences in Addressing Early Childhood Trauma
TS and LC overlap in several key ways, and both use evidence-based practices to work with children and their families mainly through ECE programs. Both TS and LC include and prioritize caregiver well-being and support all while taking a contextual approach to trauma. Sustainability is prioritized in both programs, as they both follow the training of the local facilitator model. Importantly, they both include ongoing consultation, evaluation, and support of local organizations to ensure a smooth and informed implementation process and customize trainings for each organization's unique needs. TS and LC were both designed to address gaps in current intervention programs and skillfully integrate known protective factors and buffer against risk factors. For example, both capitalize on the importance of using stable, supportive relationships with caregivers and increased caregiver knowledge and skills as ways to improve child well-being. Both programs foster feelings of safety at both home and school and focus on promoting supportive family environments and structure, especially LC. Additionally, both take a two-generation approach and prioritize children, family, and staff well-being. In terms of addressing risk factors, both address the issue of secondary trauma of caregivers and staff and familial stress to buffer against negative effects of traumatic experiences.
However, TS and LC differ in many ways, as each of them bring unique and much-needed facets of trauma-informed care. LC mainly focuses on caregiver interventions, while TS extends its work to the entire community with a special focus on ECE teachers and staff. In this way, LC could be implemented in any organization that works with children in any capacity, while TS is focused specifically on ECE centers. Additionally, LC is less trauma-specific, making it more applicable to a wider audience. TS offers several protective factors, including peer mentoring, which is important to combat social isolation, works directly on cognitive and language functioning, which predicts better outcomes in children who have experienced trauma, and integrates safety, collaboration, voice & choice, trustworthiness, and peer support in accessible ways. Finally, TS is a more established intervention, while LC is a promising up-and-coming program. While overall cost of TS couldn't be locked down, it is more expensive than LC, which reflects the breadth of the training TS provides to many different stakeholders.
Possible Gaps in Interventions
Starfish Family Services noticed several gaps in the TS intervention that they supplement within the organization. One major gap is in addressing cultural and racial dynamics in the intervention. More specific to Starfish, there is a lack of consideration of immigration issues, many of which can cause trauma. Starfish serves a large immigrant population and supplements discussions of these dynamics into the training for both staff and families. In terms of evaluation, TS doesn't provide validated tools for every measure, making some parts of evaluation more difficult for the organization. TS also doesn't address issues of mandated reporting and involvement with Child Protective Services, so internal training supplements this gap. Another gap Starfish noted is surrounding the language used to talk about caregiver well-being. Starfish is trying to move away from using the term "self care" and instead replacing it with "well-being." Well-being describes a more holistic approach to wellness that includes things like setting boundaries, whereas self care connotes images of simply doing yoga or burning a candle. Because TS focuses on self-care instead of well-being, it doesn't fit as well into the culture at Starfish. Additionally, staff who didn't work directly in classrooms and those who worked with infants and toddlers at Starfish noted difficulties in translation of principles and skills for preschoolers to younger children or in environments outside of the classroom. Therefore, it may be helpful if TS made more specific recommendations on the translation outside of preschool classrooms.¹
A gap in LC is that it doesn't integrate a common language and skill basis across a child's environment, but rather primarily focuses on caregivers. However, classroom management has been found to be extremely important for the well-being of both students and staff in ECE environments, so if an organization were to just implement LC, they may be missing parts that limit the integrative nature of the intervention. However, this may make it easier to be more widely implemented, as it can be used to compliment other trauma-informed practices at an ECE organization. LC also doesn't purposefully extend to the wider community in terms of training, limiting the breadth of its scope. Additionally, LC noted that they want to adjust their website to provide resources directly to families instead of just to facilitators.²
Although both programs may have gaps, they are both evidence-based and fill urgent needs to improve trauma-informed practices in ECE environments.
Barriers to Implementation
If we know that these and other evidence-based trauma-informed interventions are effective, then why aren't they being universally implemented?
Cost
Both of these interventions are expensive for the organization, as they include comprehensive training, skill-building, and continued consultation and support. The amount of training and practice necessary to implement trauma-informed practices with fidelity comes at a cost for an organization, which presents a barrier to implementation. This barrier is inextricably linked to matters of access and inequity, as organizations who have less resources, which often serve marginalized communities, are less able to implement these practices, even if those are the places they are most urgently needed. However, grant programs can help offset costs of implementation.
Time
Both models include at least 16-20 hours worth of training for staff. If teachers and staff are overloaded as it is, they may not have time to undergo such extensive training or may not have as much time to practice their skills, making it harder to implement these strategies. Additionally, caregivers who work several jobs or who have other responsibilities may not be able to devote enough time for their individual training, which also makes implementation difficult and is linked to systemic inequities and levels of poverty.
Lack of Investment at All Levels
Starfish Family Services emphasized the importance of buy-in and excitement at every level of the organization. Integrating trauma-informed practices is a long and expensive journey, and neither of these programs provide just a quick overview on trauma-informed work. If staff, teachers, and administrators don't value the importance of trauma-informed work and are not prepared to embark on such a long journey, implementation will be difficult.
Lack of Mental Health Professionals
An abundance of mental health professionals are needed to implement such programs to support students, their families, and staff. Shortage of such professionals is especially prevalent in rural communities, creating a barrier to implementation.
Stigma Around Trauma and Treatment
Many families may not feel comfortable talking about trauma with others because of the large stigma attached to talking about and receiving treatment for mental health issues, especially in communities that regard such matters as private and/or have been or continue to be mistreated by the healthcare and education systems. As cultural norms for seeking help and feelings of mistrust vary across communities, it is often those who have been discriminated against the most who are therefore not getting the support they need. This is why the relationship and trust building processes of both interventions are integral in ensuring equitable access to services.³
Therefore, it will take a combined effort on the part of local organizations, state legislators, and policy-makers at the federal level to prioritize and expand access to ECE trauma-informed programs. Drawing from the research on early childhood trauma and the first-hand experiences of program designers and implementors in the community, it comes down to a shift in how we as communities and as a nation see and prioritize mental health and address its systemic causes and consequences. This shift must be accompanied by a more equitable distribution of education and social program funding to ensure all communities have equitable access to the great work that is being done in the fields of both psychology and education to support and empower children and families.