Research exploring the occurrence of trauma among adults with intellectual and developmental disabilities (I/DD) has grown over the past decade. Yet there is a dearth of literature investigating the impact of organizational factors on the trauma experience despite this population's need for organizational supports. Trauma-informed care (TIC), a systems-focused model for service delivery, is a fast-developing interest among the broader field of trauma in the general population. It recognizes the prevalence and impact of trauma, and creates a culture of safety, trustworthiness, choice, collaboration, and empowerment. The author synthesized relevant literature from both the intellectual and developmental disabilities areas and integrated this with TIC and trauma literature drawn from the general population. Explored are the implications of organizations for service delivery and the potential assimilation of TIC within I/DD organizations. The effectiveness of TIC applications and their potential barriers are discussed and related to the philosophy of quality of life and organizational culture. The author notes that some individuals with I/DD comprise a vulnerable subgroup of the population that in large part relies upon the support of organizational services to foster quality of life. Given the implications of the focus on quality of life, he posits that TIC presents as a viable response for organizations, complimenting and augmenting current efforts.

Direct support professionals (DSPs) provide integral support to many individuals with intellectual and developmental disabilities (IDD). Yet, individuals' access to qualified DSPs is often compromised as organizations struggle to hire and retain DSPs. Despite a vast body of research exploring factors associated with turnover, adverse childhood experiences (ACEs) among DSPs remain absent from the literature. ACEs encompass abuse and familial dysfunction prior to the age of 18 and, in the general population, have been linked to compromised well-being and work-related challenges in adult life. An online survey was conducted to explore the prevalence of ACE categories and ACE scores (i.e., the sum of each ACE category experienced by a person) among DSPs ( n = 386) working in licensed settings. Seventy-five percent of DSPs experienced at least one ACE and 30% had an ACE score of four or more. DSPs who identified as female and those who had been in their position less than one year had significantly higher ACE scores than males and others who had been in their position longer, respectively. In comparison with other studies, the four most common ACE categories among DSPs (i.e., divorce, emotional abuse, mental illness, and substance abuse) were the same, however, DSPs in the present study had a higher average ACE score and nearly twice the percentage of persons having an ACE score of four or more. The potential implications of ACEs among DSPs, at the intersection of their work with individuals with IDD, are discussed.

This study presents preliminary insight for the innovative and formative process of integrating TIC with intellectual/developmental disabilities services.

Trauma-informed care (TIC) is a systems-focused philosophy of service delivery based upon principles of choice, collaboration, empowerment, safety and trustworthiness that recognizes the pervasive impact of trauma across the human experience. In a grassroots effort, one organization developed an innovative, trauma-informed day program to meet the needs of individuals with intellectual and developmental disabilities (IDD) who were recently deinstitutionalized. The present study is intended to provide an initial conceptualization and preliminary assessment of TIC within IDD services in order to understand its impact among individuals and staff. The study sought to answer the following questions: Has the program's culture been stable over time? How have individuals' behaviors changed over time? What have been the experiences of the program's staff members with TIC? Through a mixed methods design, secondary data analysis and semi structured staff interviews were used to assess the impact of TIC. Findings revealed an initial strong presence of choice, collaboration, empowerment, safety, and trustworthiness within the program's culture, with non significant changes at follow-up. Significant reductions were noted in overall challenging behavior, aggression, and PRN medication usage; while non significant changes were noted in physical interventions with the exception of "other" interventions (i.e., least restrictive) which significantly increased. Three major categories emerged from the qualitative data (making a difference, recognizing progress and compromising factors), illuminating staff satisfaction with work experiences, individuals' progress, and factors that challenged fidelity to TIC. The study provides a preliminary conceptualization and evidence for the efficacy of the integration of TIC into IDD services despite methodological limitations and concerns regarding the use of physical interventions. Directions for future research are presented.

Background: Individuals with intellectual and developmental disabilities (IDD) are at increased risk for adverse experiences and developing posttraumatic stress disorder (PTSD). However, trauma and PTSD in this population are frequently underdiagnosed and undertreated. Despite the availability of multiple types of trauma-specific treatments for the general population, there is a gap in understanding these collective interventions within the IDD literature. Specific Aims: The aim of this article was to conduct a review of the peer-reviewed literature on trauma-specific treatment and IDD published from 2008 to 2018. Method: A systematic search of online databases was conducted using Academic Search Premier, MEDLINE, PsycARTICLES, and Social Work Abstracts. A quality appraisal was conducted on the studies included in the review. Findings: Twelve articles described four types of trauma-specific treatments: child-parent psychotherapy, exposure therapy, trauma-focused cognitive behavior therapy, and eye movement desensitization and reprocessing therapy. All studies demonstrated that the interventions were well tolerated and associated with improvement in trauma symptoms. Eight studies demonstrated sustained improvement at follow-up, ranging from 6 weeks to 5 years. Discussion: Research on trauma-specific treatments among individuals with IDD continues to present with methodological limitations yet provides considerations for future practice and a foundation for future research.