Objective: To describe the development of a new measure, the TICOMETER, a brief assessment tool that can measure trauma-informed care (TIC) in health and human service organizations at a single point in time or repeatedly as well as determine training needs. Methods: With the input of an expert panel we selected relevant items and domains. Initially we organized the instrument into 5 domains consisting of 189 items that were then scored by 424 service providers representing 68 organizations. Using an iterative approach, we selected the 35 psychometrically strongest items across 5 domains. Within each domain a set of rating scale models (RSM), confirmatory factor analytic models (CFA), internal consistency and test-retest reliability statistics, and receiver operating curves were used to assesse the item fit, reliability, and face and construct validity of the TICOMETER. Results: The 5 TICOMETER domains had high reliability along with good item and CFA fit. Strong associations between domain scores and a priori rankings demonstrated validity of the domains. Conclusion: The TICOMETER has strong psychometric properties, creating new possibilities for assessing the level of TIC offered by an organization, monitoring progress in service delivery over time, determining training needs, and developing trauma-informed policies.
In response to the growing awareness of the high rates of potentially traumatic experiences and their potential adverse impacts, health and human service providers have increasingly focused on implementing trauma-informed care (TIC). However, studies focusing on effective implementation have been limited. In this study, we explored the relationship of individual and agency characteristics to the level of organizational TIC. With data collected from a sample of 345 providers from 67 agencies, we used the TICOMETER, a brief measure of organizational TIC with strong psychometric properties, to determine these associations. We found weak relationships between individual factors and TICOMETER scores and stronger associations for agency-level factors. These included agency type, time since last trauma training, and involvement of service users. These findings highlight the importance of robust cultural changes, service user involvement at all levels of the organization, flattening power differentials, and providing ongoing experiential training. This analysis fills an important gap in our knowledge of how best to ensure agency-wide provision of TIC.
This overview of parenting and homelessness includes the characteristics and needs of families who are homeless, with a focus on the unique challenges faced by mothers, fathers, and children. In addition, the authors discuss how homeless families are narrowly defined based on the family members who present at shelters and other service programs. In order to fully support parents and their children as they exit homelessness, homeless service programs should consider the broader context of the nontraditional family system and support networks. The overview also includes common challenges to parenting while homeless, a summary of the articles in the Special Section, and recommendations for research, practice, and policy.
Housing options for people exiting homelessness and seeking recovery from substance use disorders are limited. Policies tend to favor low-demand models such as housing first and permanent supportive housing that do not require abstinence, but offer immediate housing placement based on consumer choice and separate housing from clinical services. While these models have proven effective in promoting housing retention, especially among individuals with a primary diagnosis of mental illness, evidence to support positive outcomes related to people with a primary or co-occurring substance use disorder are mixed. Recovery housing models provide abstinence-focused environments and integrated peer support embedded within a recovery framework. Various models exist along a continuum from fully peer-run to clinically staffed residences. However, this continuum is typically separate from the homeless services system, and many barriers to integration persist. Recent national dialogues have begun to explore opportunities to integrate housing and substance use recovery approaches to meet the needs of people who need both types of support. This perspective paper argues that recovery housing is essential for supporting some homeless individuals and families. Within a comprehensive continuum based on choice, both recovery housing and low-demand models can support housing retention, reduce homelessness, promote recovery, and foster self-determination.
Although recovery housing is limited and has not been integrated into many housing and treatment continuums, there is growing consensus about its importance for various subpopulations. Developing consistent definitions, program models, funding streams, networks of recovery housing providers, and collaborations among recovery-oriented systems of care will reduce misperceptions and enhance the likelihood that recovery housing will be expanded.
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