This article describes the development and psychometric properties of the Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA), a 40-item instrument designed to evaluate the degree to which an organization is STS-informed and able to respond to the impact of secondary traumatic stress in the workplace. A sample of 629 respondents representing multiple systems of care, job roles, and functions completed the STSI-OA. Analyses revealed a 5 factor structure that explained a large proportion of variance, excellent internal consistency, good test-retest reliability, and concurrent criterion validity with the Trauma System Readiness Tool Vicarious Trauma domain. Quartile scores and means were calculated to allow for comparisons. Based on the results of this analysis, it appears the STSI-OA total and domain scores can be used to create a blueprint for organizational learning, and to reliably track progress toward desired change over time.
Background: Trauma Focused-Cognitive Behavioural Therapy (TF-CBT) has been established as an evidence-based treatment for youth with traumatic stress symptoms. The versatility of TF-CBT in conjunction with its established effectiveness has led to its widespread dissemination. However, dissemination efforts have not always translated into sustainability, which has prompted a more thorough investigation into those factors that impact implementation and encouraged the development of strategies that promote sustainability. Toward this end, the aims of this study were to: (1) determine which components of TF-CBT clinicians found the most difficult to implement; (2) explore clinicians' perceptions as to why these components were challenging; and (3) examine whether the use of formalized problem-solving approaches (FPSAs) or training format was associated with implementation outcomes. Methods: A mixed methods design was utilized to analyse survey data from mental health professionals (N = 85) who received TF-CBT training. Thematic analysis explored responses to questions concerning those TF-CBT components respondents found most difficult to implement, while bivariate analyses helped determine whether training format or the use of FPSAs was associated with training engagement, confidence in delivering TF-CBT, fidelity or sustainability. Results: Clinicians perceived the same three components of TF-CBT as most difficult regardless of the type of training they received, and provider, youth, caregiver, and organizational-related themes emerged from thematic analysis. Bivariate analyses indicated more extended training formats and the use of FPSAs were associated with greater implementation success. Conclusion: Findings suggest that perceived difficulty of TF-CBT components did not vary by training format, but more extended formats and the use of FPSAs were associated with more favourable implementation outcomes. Implementers should consider ways to utilize FPSAs within training programs, as well as focus on content identified by clinicians as difficult, as this may assist clinicians in developing skills and managing implementation barriers.
Objective: Gender differences in the development and severity of PTSD have long been observed, but much less is known about gender differences within the context of trauma-focused treatment. This study investigated gender differences in the PTSD symptoms of polytraumatized youth during Traumafocused Cognitive Behavioral Therapy (TF-CBT). Method: The sample included child welfare-involved youth ages 7-18 (N = 138) who experienced a mean of 4.78 types of trauma and received TF-CBT at a trauma treatment clinic. Mixed ANOVA analyses assessed gender differences in PTSD symptoms from baseline to termination of treatment. PTSD symptoms were then mapped according to the phase of treatment, and factorial ANOVAs examined gender differences during isolated phases of TF-CBT. Potential interactions with sexual violence history were considered. Results: Significant reductions in overall PTSD, intrusive, avoidance and arousal symptoms were found from baseline to termination of TF-CBT for the entire sample, although females reported higher symptom levels across all PTSD symptom domains. Significant gender differences were also revealed during some, but not all, phases of treatment, with variations among PTSD symptom domains noted. Conclusions: Findings suggest TF-CBT is effective in reducing PTSD in youth with poly-trauma exposure, irrespective of gender. Gender differences in symptom severity were revealed, however, and indicate the need to attend to gender within the context of treatment. Findings also suggest the use of measurement-based care, and specifically attending to symptom fluctuation in PTSD symptom domains during treatment, can help inform clinical decision making and individualize treatment. Clinical Impact StatementThis study investigated gender differences in the PTSD symptoms of child welfare-involved and polytraumatized youth ages 7-18 from baseline to termination of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), as well as during isolated phases of treatment. Findings revealed significant reductions across all PTSD symptom domains for both males and females from the beginning to the end of treatment, although females exhibited higher levels of symptoms. Gender differences were also observed during some phases of treatment. Results can help guide clinical decision making, and reinforce the importance of attending to gender, individual PTSD symptom domains and symptom fluctuation during treatment.
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