Trauma-informed climate scale-10 and attitudes related to trauma-informed care-10: An examination of scale psychometrics using data from disability service providers.

BACKGROUND: Assessment is fundamental to the implementation of trauma-informed care. As trauma-informed care advances among organizations supporting people with intellectual and developmental disabilities (IDD), it is critical that they have access to validated assessment tools. OBJECTIVE: This is the first study to examine the psychometric properties of two brief measures associated with trauma-informed care, Trauma-Informed Climate Scale (TICS-10) and Attitudes Related to Trauma-Informed Care (ARTIC-10), using data from the IDD service industry. METHODS: We employed structural equation modeling to examine the factor structure, reliability of TICS-10 and ARTIC-10, and construct validity with the ProQOL using secondary data from 374 service providers. RESULTS: We confirmed the factorial validity of TICS-10 and ARTIC-10 with single factor solutions; however, modifications were necessary to achieve adequate model fit. CONCLUSIONS: The current study provides initial evidence of the validity and reliability of TICS-10 and ARTIC-10 when used within organizations supporting people with IDD. Recommendations for subsequent improvements and future research of the scales are provided.

Advancing trauma-informed care in intellectual and developmental disability services: A pilot study of a digital training with direct service providers.

BACKGROUND: As trauma-informed care advances in the service delivery system for people with intellectual and developmental disabilities, additional resources are needed to foster staff development. This article describes the development and pilot evaluation of a digital training on trauma-informed care among direct service providers (DSPs) in the disability service industry. METHOD: Following an AB design, a mixed methods approach was used to analyse the responses of 24 DSPs to an online survey at baseline and at follow-up. RESULTS: The training was associated with increased staff knowledge in some domains and greater alignment with trauma-informed care. Staff expressed a strong likelihood of using trauma-informed care in practice and identified organisational assets and barriers to implementation. CONCLUSIONS: Digital trainings can facilitate staff development and the advancement of trauma-informed care. Although additional efforts are warranted, this study fills a gap in the literature regarding staff training and trauma-informed care.

Assessing Alignment Between Intellectual and Developmental Disability Service Providers and Trauma-Informed Care: An Exploratory Study.

People with intellectual and developmental disabilities (IDD) are disproportionately impacted by potentially traumatic experiences; however, organizations serving this population have lagged in their integration of trauma-informed care (TIC). Trauma-informed care is a systemwide response to the pervasiveness of trauma that frequently requires an organizational shift rooted in staff training. Using an online statewide survey, the present study examined beliefs and training among IDD service providers. Responses from 288 service providers suggested some alignment among beliefs and staff training content with TIC principles. Although the findings indicate a foundation for TIC, intentional efforts are needed for IDD agencies to fully embrace TIC.

Exploring maternal adversity and childhood outcomes among low-income rural families.

BACKGROUND: Research has linked adversity among mothers to poorer outcomes among their offspring. However, additional inquiry is warranted particularly in rural communities where risk factors for adversity are prevalent. OBJECTIVE: This study had two objectives: (1) to describe and compare relationships between individual and cumulative maternal adversity with childhood outcomes; and, (2) to determine if mother-child attachment mediated the relationship between maternal adversity and childhood outcomes. PARTICIPANTS AND SETTING: A convenient sample of 140 women with low socio-economic status (SES) were recruited through Head Start programs in the rural Midwest. METHODS: Data was gathered using a survey comprised of multiple measures to assess maternal adversity and childhood outcomes (i.e. behavior and attachment). Data were analyzed in SPSS using bivariate and multivariate analyses, including stepwise regression. RESULTS: Nearly 80 % of respondents experienced at least one adverse childhood experience (ACE) and 48 % reported having one or more traumatic experiences. Higher levels of adversity were associated with increased attention problems, increased emotional reactivity, and decreased harmonious attachment (p < .05, d = 0.37-0.38). Maternal experiences of childhood physical abuse and sexual abuse, as well as witnessing trauma, significantly predicted childhood outcomes, however, the variance accounted for by each type of adversity was small (4%-6%). Maternal adversity was unrelated to mother-child attachment. CONCLUSIONS: Low-SES mothers in rural communities have significant histories of adversity. It is important to consider individual and cumulative adverse experiences, as well as the mother's perception of events as traumatic. Factors associated with rural communities and Head Start programming, as well as implications for research and practice surrounding maternal adversity and childhood outcomes, are discussed.

From the DSP Perspective: Exploring the Use of Practices That Align With Trauma-Informed Care in Organizations Serving People With Intellectual and Developmental Disabilities.

Trauma-informed care (TIC) is a systemwide approach that emphasizes organizational practices based upon principles of safety, choice, collaboration, empowerment, and trustworthiness. It is intended to influence an entire organization, with implications for clients and the workforce. The present study explored the extent to which IDD organizations utilize practices that align with TIC with their DSP workforce. Through an online survey, 380 DSPs (84% women; 82% white) responded to a trauma-informed organizational culture measure. Results demonstrated variability across items and significant differences between TIC principles with safety most strongly scored, and collaboration least strongly scored. Perception of organizational practices differed by ethnicity, with non-white DSPs having more favorable responses. Current practices with DSPs align with TIC, however, increased attention through explicit trauma-informed initiatives is warranted.

They Care for Others, But What About Themselves? Understanding Self-Care Among DSPs' and Its Relationship to Professional Quality of Life.

Direct support professionals (DSPs) are instrumental to the daily operations of organizations that support people with intellectual and developmental disabilities (IDD). With extensive responsibilities, DSPs often experience high levels of stress and burnout that can result in turnover and vacant positions. Self-care is the practice of behaviors that promote well-being, counter work-related stress, and foster resilience. The current study explored self-care and resilience, and their relationship with professional quality of life (i.e., satisfaction, burnout, and secondary traumatic stress) among DSPs. Using a convenient sample, 153 DSPs (71% female) completed an online survey comprised of multiple measures. Results indicated that DSPs often engaged in self-care behaviors across physical, psychological, emotional, spiritual, relational, and workplace domains, however, less than 40% engaged in self-care behaviors directly related to work. On average, DSPs reported high levels of resilience. Collectively, self-care and resilience accounted for 12% to 28% of variance in DSPs' professional quality of life. Given the contribution of self-care to resilience and professional quality of life, an active approach by IDD organizations to foster self-care among DSPs may help promote their longevity and retention.

Promoting satisfaction and reducing fatigue: Understanding the impact of trauma-informed organizational culture on psychological wellness among Direct Service Providers.

BACKGROUND: Organizations supporting individuals with intellectual and developmental disabilities (IDD) are challenged with maintaining a viable workforce of direct support professionals (DSPs). Amid multiple factors, organizational culture based on trauma-informed care may promote DSP retention through increased satisfaction and decreased fatigue. METHOD: An online survey was used to gather data from DSPs (n = 380) across seven agencies and two online social media groups. Data were analysed using stepwise regression to identify the relationship between trauma-informed organizational culture and professional quality of life (i.e., satisfaction, burnout and secondary traumatic stress). RESULTS: Trauma-informed organizational culture was associated with increased DSP psychological wellness. Regression models explained 7.3%-40.5% of the variance in professional quality of life. CONCLUSIONS: Although trauma-informed initiatives have lagged in IDD services, this study provides preliminary evidence to bolster its justification, highlighting it as a possible partial response to the current workforce challenges.

Adverse Childhood Experiences Among Direct Support Professionals.

Direct support professionals (DSPs) provide integral support to many individuals with intellectual and developmental disabilities (IDD). Yet, individuals' access to qualified DSPs is often compromised as organizations struggle to hire and retain DSPs. Despite a vast body of research exploring factors associated with turnover, adverse childhood experiences (ACEs) among DSPs remain absent from the literature. ACEs encompass abuse and familial dysfunction prior to the age of 18 and, in the general population, have been linked to compromised well-being and work-related challenges in adult life. An online survey was conducted to explore the prevalence of ACE categories and ACE scores (i.e., the sum of each ACE category experienced by a person) among DSPs ( n = 386) working in licensed settings. Seventy-five percent of DSPs experienced at least one ACE and 30% had an ACE score of four or more. DSPs who identified as female and those who had been in their position less than one year had significantly higher ACE scores than males and others who had been in their position longer, respectively. In comparison with other studies, the four most common ACE categories among DSPs (i.e., divorce, emotional abuse, mental illness, and substance abuse) were the same, however, DSPs in the present study had a higher average ACE score and nearly twice the percentage of persons having an ACE score of four or more. The potential implications of ACEs among DSPs, at the intersection of their work with individuals with IDD, are discussed.

Trauma-informed Day Services for Individuals with Intellectual/Developmental Disabilities: Exploring Staff Understanding and Perception within an Innovative Programme.

BACKGROUND: Trauma-informed care (TIC) is a systems-level philosophy of service delivery which integrates choice, collaboration, empowerment, safety and trust to create an organizational culture sensitive to trauma. This study explores staff understandings and perceptions within an innovative trauma-informed day program for individuals with Intellectual/developmental disabilities. METHODS: Semi-structured interviews queried staff members (n = 20) regarding trauma and TIC, the integration of the five principles of TIC, associated challenges and recommendations for improvement. RESULTS: Inductive analyses revealed reasonable understandings of trauma and TIC, highlighting factors critical to the five principles of TIC. Differences were associated with duration of employment and the presence of specialized training. Challenges with TIC emerged at different system levels: individuals, staff, management and interorganizational. CONCLUSIONS: This study presents preliminary insight for the innovative and formative process of integrating TIC with intellectual/developmental disabilities services.

Applying for supplemental security income (SSI) for individuals with intellectual and developmental disabilities: family and service coordinator experiences.

In the United States, the Social Security Administration (SSA) provides financial benefits through Supplemental Security Income (SSI) to many individuals with intellectual and developmental disabilities (IDD). Family members and service coordinators (SCs) provide a critical role in applying for SSI on behalf of individuals with IDD. The present study uses a street-level lens to understand the implementation of SSI policy from the perspective of family respondents and SCs based upon their experiences with the application process. Using surveys developed from focus groups and interviews with family members and SCs, the study explores parts of the application process that facilitated success and barriers that hindered the procurement of benefits, and also elicited suggestions for improvement of the process. Survey respondents included 122 family members and 122 SCs in the western region of New York State. Findings reflect experiences at the various steps of the application process including initial applications, interviews and assessments, as well as experiences with SSA workers. Despite several significant differences, a general congruence between family respondents and SCs suggests considerable opportunities for improvement. This study provides a preliminary evaluation of a complex process from two different perspectives, with implications for policy, practice and future research.