Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York.
JAMA Netw Open. 2019 Apr 5;2(4):e193193. doi: 10.1001/jamanetworkopen.2019.3193.
Adverse childhood experiences are common and are associated with changes in early development and learning, but training early childhood educators in trauma-informed approaches to care has not been evaluated with randomized clinical trials.
To determine whether a 6-session (12-week) professional development course, "Enhancing Trauma Awareness," improved the quality of teachers' relationships with the children in their classrooms.
DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial conducted from September 2017 to May 2018 allocated classrooms by a computer-generated random sequence to intervention (attend Enhancing Trauma Awareness course) and control (no course) groups. Outcomes were reported by participants via survey and analyzed by group allocation. Classrooms under the auspice of the School District of Philadelphia, Pennsylvania, serving 3- and 4-year-old children living in low-income households were invited to participate. Lead and/or assistant teachers from 63 of 348 eligible classrooms (18.1%) agreed to participate, and none were excluded. Of 96 enrolled teachers, 93 (96.9%) were assessed at follow-up (61 of 63 classrooms [96.8%]).
In September 2017, 32 classrooms (48 teachers) were assigned to receive a professional development course that taught about the effects of trauma using a group-based relational process, and 31 classrooms (48 teachers) received no intervention. Teachers completed online surveys immediately before and after the course. Exploratory focus groups with intervention teachers (n = 15) were conducted 5 months after the course ended.
The primary outcome was teacher-children relationship quality, with a hypothesized decrease in teacher-children conflict scores. Secondary outcomes included relational capacities (eg, empathy, emotion regulation, and dispositional mindfulness). Focus group themes described teachers' experience of the course.
Of 96 teachers enrolled, 93 (96.9%) were women, and 58 (60.4%) were 40 years and older. Follow-up surveys were completed by 46 teachers (95.8%) in the control group and 47 (97.9%) in the intervention group, of whom 38 (79.2%) attended 4 or more course sessions. Adjusting for baseline values, mean (SE) conflict scores after the course were not significantly different between course participants (15.8 [0.6]) and controls (15.0 [0.6]) (effect size = 0.16; 95% CI, -0.19 to 0.52). There were no significant between-group differences in secondary outcomes. However, in focus groups, the teachers reported improvements in teacher-children relationship quality and several related relational capacities.
A course to enhance trauma awareness among preschool teachers did not reduce teacher-children conflict scores, yet qualitative assessments suggested the potential for improved teacher-children relationship quality.
ClinicalTrials.gov identifier: NCT03303482.
不良的儿童经历很常见，并且与早期发展和学习的变化有关，但针对创伤的儿童教育工作者培训方法在随机临床试验中尚未得到评估。
确定为期 6 节（12 周）的专业发展课程“增强创伤意识”是否可以提高教师与课堂上儿童关系的质量。
设计、设置和参与者：这项群组随机临床试验于 2017 年 9 月至 2018 年 5 月进行，通过计算机生成的随机序列将教室分配给干预（参加增强创伤意识课程）和对照组（无课程）。通过调查，由参与者报告结果，并按组分配进行分析。宾夕法尼亚州费城市学区邀请了为居住在低收入家庭的 3 至 4 岁儿童服务的教室参加。来自 348 个合格教室中的 63 个（18.1%）的首席和/或助理教师同意参加，但没有被排除在外。在 96 名入组教师中，有 93 名（96.9%）在随访时进行了评估（61 个教室[96.8%]）。
2017 年 9 月，32 个教室（48 名教师）被分配接受专业发展课程，该课程使用基于小组的关系过程来教授创伤的影响，而 31 个教室（48 名教师）则没有接受干预。教师在课程开始前和结束后立即完成在线调查。在课程结束后 5 个月，对干预教师进行了 15 人的探索性焦点小组讨论。
主要结果是教师与儿童的关系质量，预计教师与儿童的冲突分数会降低。次要结果包括关系能力（例如，同理心，情绪调节和内在正念）。焦点小组主题描述了教师对课程的体验。
在 96 名入组教师中，有 93 名（96.9%）为女性，58 名（60.4%）年龄在 40 岁及以上。对照组中完成随访调查的有 46 名教师（95.8%），干预组中完成随访调查的有 47 名教师（97.9%），其中 38 名教师（79.2%）参加了 4 次或更多课程。调整基线值后，课程参与者（15.8 [0.6]）和对照组（15.0 [0.6]）的课程结束后冲突得分没有显著差异（效果量=0.16；95%CI，-0.19 至 0.52）。次要结果没有显示出组间差异。但是，在焦点小组中，教师报告说，教师与儿童的关系质量以及其他一些相关的关系能力得到了改善。
针对学前教师增强创伤意识的课程并未降低教师与儿童的冲突分数，但定性评估表明，教师与儿童的关系质量可能会有所改善。
ClinicalTrials.gov 标识符：NCT03303482。
