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儿童福利系统中创伤知情护理的能力建设:全州实施的初步结果

Building Capacity for Trauma-Informed Care in the Child Welfare System: Initial Results of a Statewide Implementation.

作者信息

Lang Jason M, Campbell Kimberly, Shanley Paul, Crusto Cindy A, Connell Christian M

机构信息

Child Health and Development Institute, Farmington, CT, USA Department of Psychiatry, UCONN Health, Farmington, CT, USA Child Study Center, Yale School of Medicine, New Haven, CT, USA

Child Health and Development Institute, Farmington, CT, USA.

出版信息

Child Maltreat. 2016 May;21(2):113-24. doi: 10.1177/1077559516635273. Epub 2016 Feb 28.

Abstract

Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to (N = 223) and 2 years following implementation (N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed.

摘要

童年创伤暴露是一个重大的公共卫生问题,在儿童福利系统(CWS)中的儿童中尤为普遍。州和部落的儿童福利系统越来越多地将工作重点放在通过创建创伤知情系统来识别和服务遭受创伤的儿童上。这项对康涅狄格州一项全州范围倡议的评估描述了用于创建创伤知情儿童福利系统的策略,包括劳动力发展、创伤筛查、政策变革以及在最初的两年实施期内改善获得循证创伤聚焦治疗的机会。使用分层随机样本对儿童福利工作人员进行评估,以衡量系统在提供创伤知情护理方面的准备情况和能力变化。这些工作人员在实施前(N = 223)和实施两年后(N = 231)完成了一项综合评估。结果表明,在几乎所有评估的儿童福利领域,创伤知情知识、实践和协作都有显著改善,这表明全系统在提供创伤知情护理的准备情况和能力方面都有提高。各领域存在差异,一线工作人员在某些领域报告的改善比主管/经理更大。文中讨论了在儿童福利和其他儿童服务系统中实施和评估创伤知情护理的经验教训及建议。

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