Early stressors like trauma can lead to developmental changes that have life-long negative health consequences (Merikangas et al., 2010; Anda et al., 2006). Approximately 1 in 4 youth experience substantial trauma during their developmental years (Merikangas et al., 2010; Duke, Pettingell, McMorris, and Borowsky, 2010). Such findings suggest the need for early intervention and treatment for adolescents exposed to traumatic events and adversity. Ideally, adolescents could be treated within primary care settings where parents overwhelmingly seek services for their children. Primary care settings are sought out at a 94% to 97% rate of services as compared to only a 4% to 33% rate of parents seeking out mental health services (Guevara et al., 2001). Unfortunately, no adolescent trauma-informed interventions have yet been adapted for use in primary care (Glowa, Olson, and Johnson, 2016). This study aimed to fill this critical gap between adolescent mental health issues associated with trauma and adverse childhood experiences and the lack of treatment in integrated primary care settings. The need for trauma-informed treatment for adolescents who have experienced trauma and adverse experiences is especially salient as evidence-based treatment for adolescents in this setting is limited. A modified Delphi approach was employed to address this gap in the research. Two rounds of questionnaires and focus groups were utilized with a panel of experts and youth stakeholders to gain consensus on treatment recommendations. Ultimately, expert panelists and youth stakeholders identified 59 recommendations for adolescent trauma treatment to be delivered in integrated primary care settings. / Doctor of Philosophy / Childhood trauma can have negative health, social, and educational outcomes that extend into adulthood and over one’s lifespan (Black, Woodworth, Tremblay, & Carpenter, 2012; Merikangas et al., 2010). Approximately 1 in 4 youth today experience trauma (Duke et al., 2010). Trauma can include a variety of things such as physical, sexual, or emotional abuse; being the victim of a crime; witnessing violence in the home; living through a natural disaster or experiencing an accident (Anda et al., 2006; APA, 2017). The frequency of trauma in adolescence suggests the need for early intervention and treatment. Ideally, adolescents could be treated within primary care settings where parents and adolescents frequently seek care services. Unfortunately, no adolescent trauma interventions have been created for this setting (Glowa, Olson, & Johnson, 2016). This study was designed to improve the treatment of adolescent trauma in primary care settings. For this research study a modified Delphi technique was used. Two rounds of questionnaires and focus groups were utilized with participants that consisted of a panel of experts from the field and youth aged 14-18 years old. Ultimately, the study participants made 59 recommendations for adolescent trauma treatment to be delivered in primary care settings.

This evidence-informed doctoral project proposes the development and implementation of a digital manual, "Safe Spaces, Stronger Futures: A Digital Guide for School-Based Occupational Therapy Practitioners Working with Children Experiencing Trauma.” In order to equip occupational therapy practitioners (OTPs) with essential trauma-informed practices, this manual offers foundational knowledge on trauma symptomatology, evidence-based strategies, interactive tools, and ongoing support through a professional online community. It aims to enhance school-based OTPs (SB-OTPs) confidence and competence in addressing trauma-related behaviors, fostering environments that support healing and growth for students with trauma histories. A comprehensive literature review was completed by the program author and addressed three key questions: (1) which interventions improve occupational performance in children who have experienced trauma, (2) what design strategies maximize adult learning, and (3) what are effective sensory supports for children with trauma histories. This project aligns with the American Occupational Therapy Association (AOTA) Occupational Therapy Practice Framework (OTPF), emphasizing mental health, sensory processing, and emotional regulation (OTPF, 2020). A pilot study has been designed to measure the program's effectiveness and to identify potential areas of improvement. This study will involve SB-OTPs from various schools in the Boston area using quantitative surveys and qualitative interviews to assess changes in practitioner knowledge, confidence, and the application of trauma-informed strategies. Expected outcomes include significant improvements in SB-OTPs' ability to implement these practices, positively impacting students affected by trauma. Dissemination plans include submitting articles to journals, presenting findings at professional conferences, and leveraging social media and online platforms to reach a broader audience. A dedicated website will ensure ongoing access to the manual and related resources, providing sustained support and professional development for SB-OTPs nationwide.

Childhood trauma, often referred to as America’s hidden crisis, significantly impacts the learning and behavior of students with disabilities (SWD), in particular. SWD who experience or witness trauma face challenges related to discipline, academic achievement, absenteeism, and social and emotional well-being. According to the National Survey on Children’s Health (2021), 16.3% of children served under the Individuals with Disabilities Education Act have encountered two or more adverse childhood experiences by age 18, with over half of the states surpassing the national average. Addressing this urgent concern is difficult due to a shortage of qualified service providers, such as nurses, psychologists, and mental health specialists, and other limitations like lack of resources and funding. However, research indicates schools can implement trauma-informed practices to provide the necessary support for SWD to thrive. This research study explored how an urban school district utilized Advocacy Centers and coaches in elementary schools to support vulnerable students in overcoming trauma and achieving success in their learning environments. Specifically, this qualitative, focused ethnography case study investigated best practices in trauma-informed care provided by four advocacy coaches supporting trauma-impacted SWD in Title I elementary schools in the southeastern United States. The study incorporated participant questionnaires, classroom observations, field notes, semi-structured interviews, and examination of classroom artifacts. Two key themes emerged: (a) building strong relationships with students and (b) promising trauma-informed practices for classrooms. Results of the data analysis indicated that educators must first establish strong, authentic relationships with SWD before being able to effectively integrate trauma-informed practices into their classrooms. Recommendations and implications for future research are presented.

My study examines trauma informed practice (TIP) policies in BC, Canada. My chosen methodology, what is the problem represented to be (WPR) (Bacchi 2009), makes politics visible in policies. I am interested in the effects of trauma policies on women who experience male violence. How does discourse produce certain effects and constitute specific subjects within these texts? I extend a politicized analysis of TIP policies, specifically, an in-depth feminist post structural analysis. I advance an understanding of the effects of policy, particularly for women who have experienced male violence and who receive services under the TIP guidelines. I note the absence of an intersectional analysis and the lack of attention paid to power relations, specifically associated with the provision of care within the health care system, the construction of the traumatized female subject and the absence of a social justice lens in TIP policies. My study addresses the meanings, and resulting practices arising from the TIP policy and its impacts on women's lived experiences. My feminist post structural analysis provides a critique of TIP policies glaringly absent from the literature. I examine available literature, which evaluates TIP. My analysis deepens the understanding of the policy's inherent assumptions by revealing the problem of trauma, as represented in TIP policies. I explore the emergence of the dominant concept of trauma in the completion of a genealogy of trauma. I uncover the commonly accepted trauma ethos, a set of principles and beliefs about violence against women that has set the path for a trauma discourse in BC's guidelines, policies, and programs. I explore my interest in iv the ontology of trauma, the nature of trauma itself and the way of being when trauma has occurred. While exploring this interest through a genealogy of trauma, I identify five historical figures; the traumatized female figure, the assaulted woman figure, the wounded veteran figure, the colonized Indigenous woman figure and the emancipated woman figure. My study explores how women are obscured and invisible in policies intended to address violence against women. I demonstrate that this invisibility results in gender-neutral policies-if there is no gender-based violence- we, therefore, do not have to think of gender-based treatment. The patriarchal erasure of women from trauma policies continually repositions what the problem is represented to be. These policies constitute women as the less valued subjects, fundamentally damaged and flawed. Trauma policies shape women as people who can damage staff; assuming they are a source of trauma infection; they can infect staff with their trauma resulting in vicarious traumatization of staff. Trauma policies characterize the traumatized female subject as fundamentally different from the staff or the professional expert. Only certain kinds of women can be traumatized, the mentally ill and substance-using women. My study exposes the presupposition embedded in policies that only certain women are violated, and other women are unlike them. This trauma discourse is grounded in racism, colonialism and sexism, built on stereotypical patriarchal representations of women, resulting in the stigmatization of women who experience male violence. / Graduate / 2022-08-25