Lessons Learned Implementing a Trauma-informed System of Care in Rural Communities.

BACKGROUND: The negative impact of trauma on health is devastating. Providers, especially those in rural areas, require support to implement trauma-informed care (TIC) on a systems level. OBJECTIVES: This paper describes a partnership of county behavioral health administrators, service providers, and a behavioral health managed care organization and steps taken over a 5-year initiative to enhance capacity and quality of community services to meet the needs of individuals in a rural setting to receive TIC. METHODS: The initiative included trainings in evidence-based and best practices in TIC, improved trauma screening, development of TIC centers, and development of community-based networks for ongoing support. Lessons learned were summarized through discussions between partnership members. LESSONS LEARNED: Shared ownership, opportunity to build networks, and continuous assessment of organizational strengths resulted in successful implementation and sustained practice. Challenges included turnover among staff and organizations. CONCLUSIONS: Building a TIC network across a rural health care system can be successful with long-term support and investment from multiple stakeholders.

Implementing a trauma-informed system of care: An analysis of learning collaborative outcomes.

Trauma exposure can negatively impact health. Trauma-informed care implementation within health care systems may improve the identification and treatment of trauma-related illness on a population health level. The current study investigated outcomes of a multiagency implementation of trauma-informed care for Medicaid-enrolled adults and children in 23 rural Pennsylvania (United States) counties. Changes in trauma symptom screening, the number of staff trained in trauma-informed care, and clinician confidence in using trauma-informed care were assessed in participating treatment agencies (N = 22) over the course of a 15-month trauma-informed care learning collaborative (TLC). Data included monthly agency-reported screening, training, and confidence outcomes, which were analyzed using repeated-measures analyses of variance. Trauma symptom screening rates improved from 41.1% (SD = 43.0%) to 93.3% (SD = 12.0), p < .001; ηp 2 = .30. The average number of cumulative staff members trained in trauma-informed care per agency increased from 24.43 (SD = 42.22) to 140.00 (SD = 150.87), p < .001, Kendall's W = .09. The percentage of agencies that reported high confidence in delivering trauma-informed care increased from 15.8% (SD = 15.5%) to 80.5% (SD = 17.7%), p < .001; ηp 2 = .45. Pairwise comparisons revealed both screening rates and confidence ratings reached significant improvement in Month 11 of the TLC, suggesting that these processes may be related. A total of 2,935 staff members were trained during the TLC. The immediate impact of system-level implementation of trauma-informed care was evident for agency processes and staff confidence, with support provided by multiple stakeholders.