School of Public Health and Preventive Medicine, Monash Centre for Health Research and Implementation, Monash University, Melbourne, Vic., Australia.
School of Psychology, Deakin University, Geelong, Vic., Australia.
Health Soc Care Community. 2019 May;27(3):e10-e22. doi: 10.1111/hsc.12621. Epub 2018 Jul 23.
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.
儿童早期创伤已被证明会对儿童的社会、情感和身体发育产生不利影响。当照顾者在身体、心理和情感上陪伴儿童时，生活在家庭外照料（OoHC）中的儿童会有更好的结果。不幸的是，由于替代性创伤（经常导致倦怠和精疲力竭），家庭外照顾者的高离职率可能导致儿童在 OoHC 中的创伤再次发生。已经开发了全组织治疗护理模式（涵盖整个组织，从首席执行官到所有工人，包括行政人员），这些模式具有创伤意识，可以应对遭受虐待和忽视的儿童所面临的复杂问题。这些模型结合了一系列治疗技术，并提供了一种全面的方法和共同的语言，适用于组织的所有层面。本研究旨在调查目前关于 OoHC 中全组织、具有创伤意识的治疗性护理模式的实证证据。对 2002 年至 2017 年间具有全组织、具有创伤意识、家庭外护理研究的主要数据库进行了系统检索，以寻找证据。确定了七篇涵盖三个组织模型的文章。其中三篇文章评估了依恋调节和能力框架（ARC），一项研究评估了儿童和住宅体验计划（CARE），三项研究评估了避难所模式。这七项研究中有六项的偏倚风险较高。虽然证据表明，具有创伤意识的护理模式可能对 OoHC 中的儿童有显著的积极影响，但通过这次系统评价确定的模式的有效性只提供了有限的信息。未来的研究应集中于评估具有创伤意识的护理模式的组成部分，并评估当前可用的各种组织护理模式的效果。
