Systematic review of organisation‐wide, trauma‐informed care models in out‐of‐home care (Oo HC ) settings

Abstract

Trauma in early childhood has been shown to adversely affect children's social, emotional, and physical development. Children living in out-of-home care (OoHC) have better outcomes when care providers are present for children, physically, psychologically, and emotionally. Unfortunately, the high turnover of out-of-home carers, due to vicarious trauma (frequently resulting in burnout and exhaustion) can result in a child's trauma being re-enacted during their placement in OoHC. Organisation-wide therapeutic care models (encompassing the whole organisation, from the CEO to all workers including administration staff) that are trauma-informed have been developed to respond to the complex issues of abuse and neglect experienced by children who have been placed in OoHC. These models incorporate a range of therapeutic techniques, and provide an overarching approach and common language that is employed across all levels of the organisation. The aim of this study was to investigate the current empirical evidence for organisation-wide, trauma-informed therapeutic care models in OoHC. A systematic review searching leading databases was conducted for evidence of organisation-wide, trauma-informed, out-of-home care studies, between 2002 and 2017. Seven articles were identified covering three organisational models. Three of the articles assessed the Attachment Regulation and Competency framework (ARC), one study assessed the Children and Residential Experiences programme (CARE), and three studies assessed The Sanctuary Model. Risk of bias was high in six of the seven studies. Only limited information was provided on the effectiveness of the models identified through this systematic review, although the evidence did suggest that trauma-informed care models may have significantly positive outcomes for children in OoHC. Future research should focus on evaluating components of trauma-informed care models and assessing the efficacy of the various organisational care models currently available.

An Evidence-Based Program Model for Facilitating Therapeutic Responses to Pain-Based Behavior in Residential Care

“…In sum, a growing body of evidence supports the effectiveness of the CARE program model, a fact that is acknowledged in the scientific rating of 3 (promising research evidence) for CARE in the California Evidence-Based Clearinghouse (http://www.cebc4cw.org/program/children-and-residential-experiences-care/detailed), where CARE is listed under both the Higher Levels of Placement and the Alternatives to Long-Term Residential Programs topics. In addition, a recent review of organization-wide, trauma-informed care models in out-of-home care settings found the design of the CARE evaluation, as reported in , to be the only one of seven studies that met inclusion criteria to have moderate rather than high risk of bias (Bailey et al, 2018). The CARE Evaluation also addressed nearly all of the recommendations for the measurement, analysis, design, and reporting of evaluations of trauma-informed organizational interventions in Purtle's (2018, p. 13) systematic review.…”

Trauma Informed Child Welfare Systems—A Rapid Evidence Review

“…The remaining seventy-five papers selected for data extraction contained five systematic reviews which identified definitions and components of TIC relevant to: the juvenile justice system [13]; out-of-home-care [11]; youth inpatient psychiatric and residential treatment settings [10]; inpatient mental health settings [14]; and organisation wide trauma-informed initiatives involving a training component [12]. Twenty-eight of the seventy-five papers were individual studies already included within these systematic reviews.…”

“…However, they also noted the absence of research evaluating large-scale TIC efforts, and critically, whether they produced the improved child and family outcomes or future cost savings envisaged. More recent systematic reviews on TIC implementation initiatives in varied settings [10,11,12,13,14] have also highlighted a number of methodological problems within the TIC literature. These include a developing but still relatively limited focus on child and family outcomes; the preponderance of research designs using small samples and lacking a control group; short follow-up periods; high attrition rates; and the inability to disentangle the effects of individual implementation components from broader project outcomes.…”

“…These include a developing but still relatively limited focus on child and family outcomes; the preponderance of research designs using small samples and lacking a control group; short follow-up periods; high attrition rates; and the inability to disentangle the effects of individual implementation components from broader project outcomes. Despite these limitations, the reviews concluded that: there is preliminary support for the efficacy of trauma-informed models to increase positive outcomes for children in out-of-home-care [11]; that comprehensive, theoretically grounded, and developmentally-informed trauma-informed initiatives can help to reduce the use of seclusion and restraint, and staff and patient injury rates in youth inpatient psychiatric and residential treatment settings [10], and that TIC interventions involving a training component appear to improve staff knowledge, attitudes and behaviours [12].…”

Interventions and practice models for improving health and psychosocial outcomes of children and young people in out-of-home care: protocol for a systematic review

“…Most interventions have also not been properly evaluated, and there remains a lack of rigorous research examining the impact of these interventions in improving health and/or psychosocial outcomes for children and young people in OoHC 21. Indeed, a recent systematic review investigating the empirical evidence of trauma-informed, organisation-wide models implemented in residential OoHC settings identified three models including The Sanctuary Model, Children and Residential Experiences programme and the Attachment Regulation and Competency framework, and concluded that the evidence base is limited, making it difficult to accurately evaluate outcomes of trauma-informed models 22. Recent studies have outlined the health and psychosocial needs of children and young people in OoHC and the interventions and practice models that have been designed to meet these needs; however, to date, very little research has been focused on evaluating the effectiveness of these interventions 15.…”