Background: Disadvantaged social, economic, and environmental factors create Adverse Childhood Experiences (ACEs), which can harm a child’s developing brain and have lasting effects on health. These experiences range from physical, emotional, or sexual abuse to parental divorce or substance abuse. Afflicted children have a significantly increased risk of behavioral and health issues later in childhood, as well as adult onset chronic health problems. We hypothesize that primary care ACEs screening, intervention by a primary care-behavior health care integrated care team, and referrals for parenting support and resources will be feasible, acceptable, and beneficial from parent and provider perspectives. Methods: Parents with an ACE score of four or higher at the one-month checkup will be offered The Incredible Years interactive video intervention during checkups through 9 months of age. Parents or children with an ACE score of four or higher at the 1-4 year well child visits will be referred to participate in Nurturing Parenting group visits provided by a partnering community agency. Both programs are evidence-based, family-centered trauma-informed programs supporting positive child rearing practices. Process and outcome variables will be assessed using surveys administered after patient screening and following each program session, and primary care providers will be surveyed at the end of the project period. Process and outcome measures include; number of families screened for ACEs, number referred to parenting programs, the number of program sessions completed and attendance and changes in selfassessed parenting competence. This study will demonstrate the feasibility of integrating traumainformed practices into primary pediatric care, document an increase in referrals to community support services and document an increase in self assessed parenting competence among parents who have suffered 4 or more ACEs. Results: Preliminary survey results show that families evaluate the process of undergoing ACEs screening and follow up discussion with providers in a favorable manner. Additionally, families with elevated ACEs scores that meet criteria for additional interventions, received the corresponding program in as acceptable and appropriate. Provider surveys are forthcoming, however the additional screening, intervention provided by the Behavioral Health Team, and feasibility survey collection has not affected the clinic’s productivity or delayed patient care. Upon initially starting screening and survey administration at clinic, an error was noted in the reporting of ACEs screening results in the EMR. Data collection was delayed while the EMR function was edited by IT administrator. Conclusions: Our multidisciplinary team will continue to collect data and continue to evaluate and streamline all aspects of the project in order to enhance the care of our patients and families. Additionally, will evaluate concerns and recommendations noted with provider administration survey at conclusion of data collection.

The purpose of this study is to evaluate the effectiveness of an intervention model designed to enhance practitioners’ biological lens when using a biopsychosocial-spiritual model of holistic assessment and planning. The specific intervention utilized is a course curriculum developed to broaden human service professionals’ (including clinical social work professionals) understanding of attachment theory, neuroscience and trauma informed methods of practice. The course teaches professionals how to apply this knowledge to clinical assessment and intervention planning with youth who have experienced significant trauma in their lives and exhibit problems of conduct. Using an experimental design, participants from a large private mental health organization were asked to evaluate the impact of curriculum on their 1) knowledge of attachment theory, trauma informed practice and neurobiology; 2) attitudes concerning the relevance of trauma-informed practice, the biological perspective and consequence focused models of intervention; and 3) assessment and intervention planning strategies. The curriculum focused its application on youth who have experienced significant levels of trauma and display conduct related behavior problems. Group differences for the workshop intervention group and waitlist control group are discussed. Additionally, a preliminary evaluation of differences between two different intervention groups (participants in the Distance Learning version of the course and the Workshop Seminar version of the course) was conducted.

Trauma is a substantial threat to public health. As such, significant effort has been exerted into developing interventions which mitigate the consequences of trauma. Trauma-informed practice (TIP) aims to alleviate the effects of trauma by building policies and practices focused on safety, trust, transparency, support, collaboration, and empowerment. This study investigated how individual-level factors, including readiness for organizational change, perceived benefit of TIP training, and personal trauma history affect one’s ability to apply a TIP lens in a sample (n =100) of members of a graduate-level college. Further, it explored if one’s perceptions of and response to trauma-informed practice training predict changes in well-being, stress, and burnout. Results indicated that perceived benefit and readiness for organizational change are important predictors of post-training outcomes. Participants with a history of trauma performed more poorly on post-training trauma-informed knowledge questions. Results provided initial utility for use of objective measurement of trauma-informed application abilities.

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

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In this dissertation, I sought to understand foster parents’ perceptions of giftedness, how foster children’s strengths, gifts, and talents affect their experiences and those of their foster parents, and what resources and information foster parents have for supporting their foster children’s education and gifts. To understand these beliefs, I analyzed quantitative and qualitative survey data from 53 foster parents throughout the United States and analyzed interviews from 14 of those foster parents. Most foster parents surveyed perceived their foster children as a little or very different academically and in other ways than their peers not in foster care, and perceived they had different educational experiences than their peers, largely attributed to their lived experiences prior to entering and during foster care. Most participants felt their foster children’s abilities, strengths, and talents affected foster parents a little or very much. Interviewed and surveyed foster parents defined giftedness as including the following attributes: academic achievement, natural ability or innate talent, intelligence, domain-specific capabilities, performance or skills above average for their age or above their peers, unique approaches to learning, and motivation for learning. Interviewees also addressed non-academic forms of giftedness, socioemotional characteristics of children with gifts and talents, and noted that these students may have some difficulties in school. Foster parents explained the adaptations they have made to their parenting because of their foster children’s strengths, talents, and abilities, and highlighted the unique life experiences of foster children, which were not only hinderances but also could help them succeed academically and in life. Participants also expressed why they think foster children are not identified for gifted education programming. Foster parents had many needs related to their foster children’s education and strengths, talents, and abilities. They made recommendations to those who train new foster parents and provide ongoing training to current foster parents; to schools and teachers of foster children; and to new foster parents about how to best meet the needs of foster children and encourage their gifts and talents.