Effect of trauma-informed care on hair cortisol concentration in youth welfare staff and client physical aggression towards staff: results of a longitudinal study

Abstract

Background: Professional caregivers working in child and youth welfare institutions are frequently faced with the complex mental health issues, emotional needs and challenging coping strategies of clients with cumulated traumatic experiences, leaving them prone to developing high levels of stress, burn-out and compassion fatigue. Trauma-informed care (TIC) is a milieu-therapeutic approach that aims to promote the self-efficacy and self-care of youth welfare staff by guiding them to a better understanding of their own and their clients' stress symptoms and countertransference. Despite increasing efforts to implement TIC practices, and more widespread recognition of their value in youth welfare systems, there is a lack of studies evaluating the effectiveness of this approach. The aim of this study was to assess the effects of TIC practices in youth welfare institutions on both the physiological stress of staff members and clients' physical aggression towards their caregivers. . Methods:Data was obtained from a longitudinal study investigating the effectiveness of TIC in 14 residential youth welfare institutions. Our sample consisted of 47 youth welfare employees (66.0% female) aged from 23 to 60 years (M = 37.4, SD = 10.4 years). Hair cortisol concentration (HCC) and occurrences of client physical aggression were assessed at four annual measurement time points (T1 to T4). Results: Participants in five institutions employing TIC practices (intervention group) showed significantly lower HCC at T4 than staff members from institutions who did not receive training in TIC (control group), indicating reduced physiological stress levels. At T4, the intervention group reported significantly less physical aggression than the control group.Conclusions: TIC might be a promising approach for reducing the emotional burden of employees and institutions should invest in training their staff in TIC practices. More research is necessary, to investigate the benefits and efficacy of TIC, both to youths and staff members, and to foster a better understanding of which specific factors may contribute to stress reduction.

Shared residential placement for child welfare and juvenile justice youth: current treatment needs and risk of adult criminal conviction

“…Guiding principles of trauma informed care include: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and cultural, historical and gender issues (see also the infographic on the website of the Office of Public Health Preparedness and Response [OPHPR] of the Center for Disease and Control Prevention [CDC]: https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm ). 2 This trauma informed approach has also been examined in the more specific context of the juvenile justice system [ 70 , 71 ]. Although the combination of evidence-based trauma-therapeutic interventions in combination with trauma informed care concepts is highly promising for the treatment of, for example juvenile offenders (but also adolescents in the child welfare system), more research is warranted to examine its impact on offending behavior/recidivism as well as other adolescent/adult functional outcomes.…”

Mental Health Problems in Girls Who Committed Sexual Offenses: Similarities and Differences Compared to Girls With Non-sex Offenses and Boys With Sex Offenses

“…Given the lack of validated treatment programs for female JSOs, it could be argued that (parts of) male JSOs treatment approaches could be applied for the treatment of female JSOs, although adjusted to suit a female perspective (e.g., by including examples of female JSOs in treatment manuals). In addition, trauma-informed care, which is also receiving increasing attention within the forensic field (Branson et al, 2017;Schmid et al, 2020), could not only benefit female, but also male offenders. Nevertheless, there is a risk for a "one size fits all" approach, and despite the many similarities, the diversity of the group, however, should not be overlooked.…”

The Stress of Caring—Resilience and HPA-Axis Activity in Hair Samples of Youth Residential Caregivers

“…Nevertheless, two recent systematic reviews concluded that self-care still takes a back seat in social work, and little is known about the efficacy of specific self-care practices ( 93 , 94 ). Trauma-informed care (TIC) concepts that also focus on implementing resilience practices for caregivers might be a promising approach for reducing the emotional burden of employees and institutions and were shown to reduce hair cortisol levels of caregivers that were trained in TIC ( 95 ). However, more intervention research implementing psychophysiological assessments of stress that replicate our findings in prospective, longitudinal studies and the integration of such findings into educational programs is needed for improving resilience and maintaining empowered and healthy caregivers.…”