Trauma‐Informed Day Services: An Initial Conceptualization and Preliminary Assessment

Abstract

Trauma-informed care (TIC) is a systems-focused philosophy of service delivery based upon principles of choice, collaboration, empowerment, safety and trustworthiness that recognizes the pervasive impact of trauma across the human experience. In a grassroots effort, one organization developed an innovative, trauma-informed day program to meet the needs of individuals with intellectual and developmental disabilities (IDD) who were recently deinstitutionalized. The present study is intended to provide an initial conceptualization and preliminary assessment of TIC within IDD services in order to understand its impact among individuals and staff. The study sought to answer the following questions: Has the program's culture been stable over time? How have individuals' behaviors changed over time? What have been the experiences of the program's staff members with TIC? Through a mixed methods design, secondary data analysis and semi structured staff interviews were used to assess the impact of TIC. Findings revealed an initial strong presence of choice, collaboration, empowerment, safety, and trustworthiness within the program's culture, with non significant changes at follow-up. Significant reductions were noted in overall challenging behavior, aggression, and PRN medication usage; while non significant changes were noted in physical interventions with the exception of "other" interventions (i.e., least restrictive) which significantly increased. Three major categories emerged from the qualitative data (making a difference, recognizing progress and compromising factors), illuminating staff satisfaction with work experiences, individuals' progress, and factors that challenged fidelity to TIC. The study provides a preliminary conceptualization and evidence for the efficacy of the integration of TIC into IDD services despite methodological limitations and concerns regarding the use of physical interventions. Directions for future research are presented.

Trauma‐informed Day Services for Individuals with Intellectual/Developmental Disabilities: Exploring Staff Understanding and Perception within an Innovative Programme

“…This was part of a larger research project that utilized a mixed‐methods approach to obtain a preliminary understanding of the impact of TIC within intellectual/developmental disabilities services. Additional details of the study can be found elsewhere (Keesler & Isham In press ). The present findings are an analysis of staff perspectives, understandings and experiences with TIC.…”

“…familial abandonment, restrictive interventions and lengthy institutionalization) and complex behavioural needs. A brief overview of the programme is presented here yet described in greater detail elsewhere (Keesler & Isham In press ).…”

Use of Trauma‐Informed Care With Incarcerated Offenders

“…Trauma‐informed care can be implemented with both correctional staff and counselors. According to Keesler and Isham (), it can take a while for trauma‐informed care to become a part of the culture within a setting. However, when a facility adapts a trauma‐informed care approach, the whole facility may be working to help offenders address their trauma through these five principles, which can create a more holistic approach to help offenders and to reduce trauma‐provoked incidents.…”

Creating a Trauma-Informed Community Through University-Community Partnerships:An Institute Agenda

“…Higher education and higher ranked personnel (e.g., administration) were associated with more favorable ratings of TIC. Keesler and Isham (2017) identified the feasibility of integrating TIC within the context of services for individuals with intellectual and developmental disabilities. Findings suggested a positive association between TIC and staff satisfaction, restraint reduction, and behavioral improvement among individuals with disabilities.…”