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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.

Family homelessness has become a growing public health problem over the last 3 decades. Despite this trend, few studies have explored the effectiveness of housing interventions and housing and service interventions. The purpose of this systematic review is to appraise and synthesize evidence on effective interventions addressing family homelessness. We searched 10 major electronic databases from 2007 to 2013. Empirical studies investigating effectiveness of housing interventions and housing and service interventions for American homeless families regardless of publication status were eligible for inclusion. Outcomes included housing status, employment, parental trauma and mental health and substance use, children's behavioral and academic status, and family reunification. Study quality was appraised using the Effective Public Health Practice Project tool. Six studies were included in this review. Overall, there was some postintervention improvement in housing and employment, but ongoing residential and work stability were not achieved. Methodological limitations, poor reporting quality, and inconsistent definitions across outcomes hindered between-study comparisons. Substantial limitations in research underscore the insufficiency of our current knowledge base for ending homelessness. Although many families were no longer literally homeless, long-term residential stability and employment at a livable wage were not ensured. Developing and implementing evidence-based approaches for addressing homelessness are long overdue.

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.