January 25, 2018

From Stephanie Sundborg, PhD, Research and Evaluation Coordinator, Trauma Informed Oregon

What are the outcomes? What will change as a result of Trauma Informed Care (TIC)? This seems to be the big question on the minds of individuals and organizations striving to adopt TIC, and one that is driving our research efforts at Trauma Informed Oregon (TIO).

As the coordinator for research and evaluation at TIO, I am grappling with this and other questions. I decided to use this blog as a way to share our thoughts about the questions that need answers and the best ways to get at this information. For many of you, research is a cool topic and you’ll enjoy geeking out as you read this. For others, this topic might take you back to a dreaded statistics or research methods class, something you’d rather avoid. For those of you who might not make it all the way through this article, I invite you to read the last section on Getting Involved because what we learn about TIC is going to depend on everyone’s involvement and input. In other words, you are a critical component to this work.

So how to think about this? As you know, this is a big topic and the research questions can go any number of directions. When considering TIC implementation, it helps me to have something concrete as a framework on which I can anchor my research questions—like the Roadmap to Trauma Informed Care. This provides some boundaries in order to keep the research focused and manageable.

With that in mind, what are some of the pressing questions in the field, and how might we get needed information?

Recognition and Awareness

I think of recognition and awareness as the stage when you are defining psychological trauma (and the need for TIC) as a social problem and researching the prevalence across fields. At this point in the history of the TIC movement, this area of inquiry has a solid amount of literature and research, thanks in part to the focus on adverse childhood experiences (ACEs) as a way to quantify people’s experience. While some fields (e.g. child welfare) have substantially more data than others do, the prevalence of trauma among those using services is pretty clear. That said, the area that still needs more research is understanding the prevalence and impact of work-related stress or trauma (e.g. vicarious trauma, secondary traumatic stress, and burnout), especially in fields that don’t tend to focus on trauma directly (e.g. education).

Although research on prevalence can be useful when creating buy-in or securing funding, to date, TIO hasn’t focused research efforts here. By the time we are working with organizations on training and implementation, the need is pretty well established.

Foundational Knowledge

This is an area of interest for me personally, but also for TIO. Training is often recommended as one of the first steps in TIC implementation. Although it seems pretty straightforward, there are many questions that need answers when researching this phase of the implementation process (see text box for examples).

Although there has been some research measuring the increase in knowledge and/or skills following a training, there are few studies investigating whether this foundational knowledge is retained and even more importantly whether it predicts the ability to implement TIC. While there does seem to be some consensus on the topic areas that are important for TIC, it is less clear how to test for this. Is it adequate to have an individual’s perception of knowledge or must they pass a factual test? How do we chose the right questions? What if they know this but not that? Should they be able to apply the information or is recognition sufficient? As you can imagine, these questions turn out to be quite challenging. Who knows, at the end of the day, maybe knowledge building is more about creating the confidence to try. Stay tuned on this.

What knowledge and skills are needed for TIC implementation?

Do individuals retain the knowledge they’ve gained from training?

How do you measure TIC competence?

Agency Readiness

Buy-in and commitment are two important components of readiness. From my own research, I have found that there are multiple factors that predict commitment to TIC including your own belief that you can do TIC (self-efficacy), your own beliefs about trauma and its impact, your belief that your coworkers and leadership support TIC, and your knowledge about trauma and TIC. There are a few studies that have considered agency readiness for TIC, and several instruments that have been created (and validated) to measure it. This is a useful area of research, and one that TIO will mostly likely continue to pursue, as it can help identify facilitating factors and barriers for implementation. When implementation stalls, it can be helpful to have some concrete ideas about what to do.

Process and Infrastructure

This stage of implementation speaks to the need for some structure in order to move the work forward. Often, there is a workgroup or internal champions that can hold the TIC efforts together. Research in this area would be in the form of a process evaluation and would pursue questions about how the work gets done? To date, there isn’t much research about process and infrastructure but as we continue to work with organizations implementing TIC we will look for opportunities to investigate what helps and what gets in the way of implementation.

Implementation or Action

The final four areas on the roadmap can be placed in a bucket called implementation or action. Understanding what changes as a result of TIC is important to folks working on implementation, yet there isn’t much empirical research to draw on. The problem so far has been that TIC doesn’t come with fidelity measures or clearly specified ingredients. This ambiguity makes investigating implementation challenging. However, I suspect in the next few years we will see more research tackling TIC implementation. It’s the $64k question. What changes as a result of implementing TIC?

What have we done in order to become trauma informed?

What difference has TIC made?

Getting Involved

OK, so I’ve given you some ideas about the types of questions we might pursue with TIC research, but how would we pursue them? This is where you come in. As I said, it is important to hear from you (ssund2@pdx.edu) and other people in the field and across the state, who are working hard to gain the knowledge and skills needed for TIC and are working within their agencies toward implementation. Your experience, expertise, and voice is essential to the learning related to TIC. It is our goal to be as inclusive and representative as we can with our research efforts. We want to pursue questions that interest you and share findings broadly as a way for all of us to learn.

In the coming months, we will be trying out some methods of gathering data from you. For instance, we may start to collect some information at trainings and forums or reach out through the website with questions needing your input. We may call on volunteers to act as citizen scientists so that we can better learn how and what things are working in real time. With today’s technology, the use of smart phones and other platforms can open the door to an inclusive and expansive approach—we are excited about the possibilities. The website will continue to be a good source of information, and we plan to carve out some space to report back on research efforts and findings.

Also, in the coming months, look for a more formal and thorough summary of these ideas—a research agenda, if you will. This will provide a rough guide for TIO’s research pursuits, and will also highlight existing studies that contribute to our knowledge base.  We are really in the infancy of researching TIC and it’s exciting to be part of that. Thank you for all the work you do—we look forward to learning together.