School of Social Sciences, Education and Social Work, Queen's University Belfast, 6 College Park, Belfast BT7 1LP, Ireland.
Int J Environ Res Public Health. 2019 Jul 3;16(13):2365. doi: 10.3390/ijerph16132365.
Trauma informed care (TIC) is a whole system organisational change process which emerged from the seminal Adverse Childhood Experiences (ACE) study, establishing a strong graded relationship between the number of childhood adversities experienced and a range of negative outcomes across multiple domains over the life course. To date, there has been no systematic review of organisation-wide implementation initiatives in the child welfare system. As part of a wider cross-system rapid evidence review of the trauma-informed implementation literature using systematic search, screening and review procedures, twenty-one papers reporting on trauma-informed implementation in the child welfare system at state/regional and organisational/agency levels were identified. This paper presents a narrative synthesis of the various implementation strategies and components used across child welfare initiatives, with associated evidence of effectiveness. Training was the TIC implementation component most frequently evaluated with all studies reporting positive impact on staff knowledge, skills and/or confidence. The development of trauma-informed screening processes, and evidence-based treatments/trauma focused services, where evaluated, all produced positive results. Whilst weaknesses in study design often limited generalisability, there was preliminary evidence for the efficacy of trauma-informed approaches in improving the mental and emotional well-being of children served by community-based child welfare services, as well as their potential for reducing caregiver stress and improving placement stability.
创伤知情关怀（TIC）是一种全系统组织变革过程，源自开创性的不良童年经历（ACE）研究，在整个生命过程中，在经历的童年逆境数量和一系列负面结果之间建立了强有力的分级关系。迄今为止，儿童福利系统中还没有对全系统实施举措进行系统审查。作为使用系统搜索、筛选和审查程序对创伤知情实施文献进行更广泛跨系统快速证据审查的一部分，确定了 21 篇报告在州/地区和组织/机构层面的儿童福利系统中实施创伤知情的论文。本文对儿童福利举措中使用的各种实施策略和组成部分进行了叙述性综合，并附有相关有效性证据。培训是 TIC 实施中评估最多的部分，所有研究都报告对员工知识、技能和/或信心产生了积极影响。评估了创伤知情筛选流程和基于证据的治疗/创伤为重点的服务的发展，所有这些都取得了积极的结果。尽管研究设计的弱点常常限制了推广性，但有初步证据表明，创伤知情方法在改善社区儿童福利服务所服务儿童的心理和情绪健康方面具有功效，以及它们在减轻照顾者压力和提高安置稳定性方面的潜力。
