Association for Public Policy Analysis & Management

Child Trends conducted a large-scale, multi-year implementation and outcome evaluation of Trauma Systems Therapy (TST). The purpose of the evaluation was two-fold: 1) to understand how effectively TST was integrated into the full continuum of care at KVC, a child welfare organization that provides out-of-home care to all children served by the Kansas Department for Children and Families’ Kansas City Metropolitan and East regions; and 2) to assess whether the introduction of TST led to improvements in outcomes (well-being, placement stability, and permanency) for the 1,500 school-age children who entered out-of-home care during the study period (2011-2014).

Methods

For the outcome evaluation, a longitudinal quasi-experimental design was conducted to assess whether child outcomes improved as a function of KVC’s implementation of TST.  Latent growth curve models and cross-lagged models were estimated to examine whether children’s well-being, placement stability, and permanency outcomes improved over time as TST was fully implemented. KVC provided administrative and assessment data on child functioning, emotional and behavioral regulation, implementation fidelity, placement stability and permanency.   

For the implementation evaluation, interviews and focus groups were conducted with foster parents, KVC leadership, supervisors, as well as staff who work directly with children, including case managers and therapists.

Results

Results indicate that implementation of TST with fidelity is associated with improvements in children’s well-being and placement stability, but not with permanency. Results also suggest that no single individual is the cornerstone for improved child well-being. KVC’s implementation of TST throughout its system of care was successful with the majority of staff and foster parents completing training in TST and fidelity measures showing progress in TST use over time.

Implications

The findings from this evaluation are notable and have important implications for public and private child welfare agency systems and others implementing trauma-informed care approaches:

• Practitioners, program developers and administrators. The findings show that KVC’s implementation of TST provided both the knowledge and the tools necessary for foster parents to better care for the children in their homes. The degree to which KVC focused on implementing and expanding TST—the iterative and complex process that was involved—is remarkable. The effort to infuse trauma-informed care into their overall system of care was not viewed as a “one-time” initiative or one that would get subsumed by new priorities.

• Policymakers and funders. For policymakers and funders, the findings represent an opportunity to better understand how trauma affects not only the children and families served by large child welfare systems, but also the staff and the foster parents who interact daily, and most closely, with the children.

• Researchers. To measure KVC’s efforts to integrate TST across its continuum of care we relied on training and fidelity data on children’s care teams. While fidelity scores are often used in implementation research, associations between fidelity and child outcomes highlight the value of using fidelity data in outcome studies as well. Finally, the findings suggest additional research on trauma-informed approaches is warranted in different settings and with different populations.