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Building a Trauma-Informed Workforce Capacity and Legacy

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Title: Building a Trauma-Informed Workforce Capacity and Legacy
Language: English
Authors: Popescu, Marciana, Strand, Virginia, Way, Ineke, Williams-Hecksel, Cheryl, Abramovitz, Robert
Source: Journal of Teaching in Social Work. 2017 37(1):36-54.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 19
Publication Date: 2017
Sponsoring Agency: Substance Abuse and Mental Health Services Administration (DHHS/PHS)
Contract Number: SU79SMO6127703
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Trauma, Social Work, Capacity Building, Caseworkers, Teaching Models, Educational Needs, Educational Practices, Educational Change, Career Readiness, Employment Potential, Labor Force Development, Qualitative Research, Narration, Career Choice, Intercollegiate Cooperation, Best Practices
DOI: 10.1080/08841233.2016.1265040
ISSN: 0884-1233
Abstract: Social workers encounter trauma in a majority of the populations they serve. It is therefore essential to train social work students to understand the impact of trauma, to assess trauma history and symptoms, and to effectively intervene with children and families. This article presents 3 qualitative research narratives that provide an in-depth analysis of factors contributing to successful implementation of an innovative trauma-informed educational model. The narratives identify common themes related to student knowledge and field readiness; personal and system context; organizational leadership; and vision, training, and partnerships/collaborations.
Abstractor: As Provided
Number of References: 31
Entry Date: 2017
Accession Number: EJ1126580
Database: ERIC
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  Value: <anid>AN0120809236;8am01jan.17;2019Feb13.14:16;v2.2.500</anid> <title id="AN0120809236-1">Building a Trauma-Informed Workforce Capacity and Legacy. </title> <p>Social workers encounter trauma in a majority of the populations they serve. It is therefore essential to train social work students to understand the impact of trauma, to assess trauma history and symptoms, and to effectively intervene with children and families. This article presents 3 qualitative research narratives that provide an in-depth analysis of factors contributing to successful implementation of an innovative trauma-informed educational model. The narratives identify common themes related to student knowledge and field readiness; personal and system context; organizational leadership; and vision, training, and partnerships/collaborations.</p> <p>Keywords: Full educational model; innovative social work education; narrative framework; trauma informed</p> <hd id="AN0120809236-2">Introduction</hd> <p>The National Child Traumatic Stress Network (NCTSN; n.d.) defined complex trauma as "children's exposure to multiple traumatic events, often of an invasive, interpersonal nature, and the wide ranging, long-term impact of this exposure." Complex trauma is cumulative, pervasive, and often exemplified in child abuse, domestic violence, and nonfamily situations by war and refugee trauma ((Cook et al., [<reflink idref="bib8" id="ref1">8</reflink>]; Courtois & Gold, [<reflink idref="bib10" id="ref2">10</reflink>]; Lieberman & Knorr, [<reflink idref="bib23" id="ref3">23</reflink>]).</p> <p>The prevalence of complex trauma in the history of clients served by social workers makes it imperative that social work education effectively prepare students for the clients they are certain to encounter. Indeed, children and their families dealing with extensive trauma histories represent the largest group of clients seen in child-serving systems (Harris, Lieberman, & Marans, [<reflink idref="bib17" id="ref4">17</reflink>]; Ko et al., [<reflink idref="bib20" id="ref5">20</reflink>]). Data on 11,000 children and adolescents served by NCTSN centers revealed that more than 80% had suffered at least one type of trauma and 77% had suffered more than one trauma exposure, with 27% experiencing three or four types of trauma exposure, and 31% experiencing five or more types (Briggs et al., [<reflink idref="bib4" id="ref6">4</reflink>]).</p> <p>Such repeated exposure results in extensive symptomatology that leads to pervasive, persistent complex dysregulation and disrupted functioning in emotional, behavioral, cognitive, physiological, and interpersonal domains (Cook et al., [<reflink idref="bib8" id="ref7">8</reflink>]). These findings have significant implications for social work education, as they complicate the diagnostic process used by social workers when such cases appear at mental health clinics and child welfare agencies. This reality often leads to traumatized children receiving behavioral disorder diagnoses such as oppositional defiant disorder and conduct disorder (attention deficit/hyperactivity disorder). Use of these diagnoses occurs because the combination of accumulated adverse events and traumatic stress symptoms significantly overlap with eight other child mental illness diagnoses (Griffin et al., [<reflink idref="bib15" id="ref8">15</reflink>]). If unrecognized and untreated, significant histories of childhood adversities can lead to negative health and behavioral health outcomes in adulthood (Felitti et al., [<reflink idref="bib12" id="ref9">12</reflink>])</p> <p>Among ethnic and racial minorities, who often compose a large proportion of social work clients, Latinos were most consistently found to have higher rates of posttraumatic stress disorder than their European American counterparts, as were African Americans and Native Americans (Pole, Gone, & Kulkarni, [<reflink idref="bib28" id="ref10">28</reflink>]). This finding has special importance for social workers because they serve large numbers of youth from varied ethnic and racial backgrounds. Preparing social work students for trauma-informed practice therefore necessitates that students receive a thorough grounding in how to recognize complex trauma exposure and how to provide evidence-based child trauma treatment.</p> <p>Layne and colleagues ([<reflink idref="bib21" id="ref11">21</reflink>]) found that participation in a case-based trauma-focused course increased students' confidence in working with traumatized children and their families. Others have found that the introduction of a trauma specific course (Breckenridge & James, [<reflink idref="bib3" id="ref12">3</reflink>]; Harner, Budescu, Gillihan, Riley, & Foa, [<reflink idref="bib16" id="ref13">16</reflink>]) and the provision of a certificate in trauma at the MSW level (Bussey, [<reflink idref="bib5" id="ref14">5</reflink>]) successfully raised students' awareness, knowledge, and skills in intervention with traumatized clients.</p> <p>This article presents three narratives reflecting on the effectiveness of a trauma-focused educational model for MSW students in their Advanced Year at seven accredited schools of social work. This model, referred to here as the <emph>full educational model</emph>, combines coursework (providing a conceptual framework for understanding trauma) with clinical training (introducing a specific evidence-based trauma treatment [EBTT] for children/adolescents) and a two-semester trauma field placement (allowing students to develop specific skills by directly implementing the specific EBTT in which they were trained). The model was implemented and evaluated by the seven schools of social work from 2010 to 2012. (The quantitative findings have been presented elsewhere; Layne et al., [<reflink idref="bib21" id="ref15">21</reflink>]). The narrative analysis was designed to construct meaning based on the individualized stories of the model's three main stakeholders: MSW students, mental health agencies (directors and field instructors), and faculty (faculty advisors and program coordinators). The three narratives offered here add an in-depth understanding of the factors that contribute to the effectiveness of this comprehensive, multilayered educational model that we believe prepares MSW students for practicing with traumatized children and adolescents upon graduation.</p> <hd id="AN0120809236-3">Literature Review</hd> <p>An outstanding feature of our full educational model is its support for both an evidence-based practice (EBP) process and training in empirically supported interventions. The need for the introduction of EBP in the MSW curriculum has been debated for a number of years. More than a decade ago, McNeece and Thyer ([<reflink idref="bib25" id="ref16">25</reflink>]) called for social work to embrace an EBP conceptual framework and reorient both BSW and MSW programs to the principles embodied in the approach. However, others have been critical of an EBP framework in social work, asserting that it is too limiting and not relevant for many social work situations (Cohen, [<reflink idref="bib6" id="ref17">6</reflink>]). A significant aspect of the debate has focused on EBP definitions: Many can endorse an EBP which is guided by an ethical obligation to seek out the best evidence for use in work with clients. Simply put, such an approach focuses on the process of identifying an answerable clinical question, searching out the best available evidence, and implementing it within the context of a client contract that allows for evaluation (Bertram, Charnin, Kerns, & Long, [<reflink idref="bib1" id="ref18">1</reflink>]; Mullen, Bellamy, Bledsoe, & Francois, [<reflink idref="bib26" id="ref19">26</reflink>]).</p> <p>Howard, Himle, Jensen, and Vaughan ([<reflink idref="bib19" id="ref20">19</reflink>]) described the benefits of a schoolwide approach to introducing an EBP framework, with an emphasis on the development of skills in researching evidence and on the exposure to empirically supported interventions in field placements. Agency–university partnerships are increasingly being developed in response as a way to address the priority for universities to teach about EBPs and the priority for agencies to develop and expand their use of EBPs (Manuel, Mullen, Fang, Bellamy, & Bledsoe, [<reflink idref="bib24" id="ref21">24</reflink>]).</p> <p>Ten years ago, Rubin and Parrish ([<reflink idref="bib31" id="ref22">31</reflink>]) found that although most social work educators (73%) endorsed EBP, their definitions and conceptualizations differed considerably. A survey of MSW programs to examine the use of university–agency partnerships for advancing EBP in social work education found many schools using one of three main strategies: individual faculty members conducting research in partnerships with agencies, schools of social work partnering with agencies that used empirically supported treatments for student training, and universities providing resources (i.e., access to the library) to partner agencies (Bledsoe-Mansori et al., [<reflink idref="bib2" id="ref23">2</reflink>]).</p> <p>In a recent survey of MSW programs, Bertram et al. ([<reflink idref="bib1" id="ref24">1</reflink>]) found that the majority of those responding stated that they were teaching EBP. However, when EBPs were defined as practices that have a clearly defined client population, a manual specifying implementation elements and phases of service delivery, and empirically supported results in a random controlled trial reflecting efficacy of use, the authors determined that only 30 of the 58 responding schools were teaching empirically supported treatments based on these criteria. Two thirds of the schools were addressing critical appraisal skills and the scientific approach, and one third (34.5%) reported that their programs addressed student development of search techniques to find and use reliable secondary sources of information about specific EBPs.</p> <hd id="AN0120809236-4">Description of the Full Educational Model</hd> <p>The model referred to in this article incorporates an evidence-based approach to practice through the use of a problem-based methodology in a trauma course, as well as training in a specific empirically supported treatment. There are three significant elements in the implementation of this educational model (Layne et al., [<reflink idref="bib21" id="ref25">21</reflink>]): First, the trauma course is designed to provide foundational trauma knowledge and is taught using a problem-based learning methodology, which has been described in the literature as one of the best methods for teaching EBP (Gambril, [<reflink idref="bib13" id="ref26">13</reflink>]; Mullen et al., [<reflink idref="bib26" id="ref27">26</reflink>]). The second element is the EBTT training, which prepares students to implement an EBTT protocol. Two EBTT models were primarily employed for three cohorts of students during the 2010–2012 period of this study: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) (Cohen, Mannarino, & Deblinger, [<reflink idref="bib7" id="ref28">7</reflink>]), and Child–Parent Psychotherapy (Lieberman & Van Horn, [<reflink idref="bib22" id="ref29">22</reflink>]). The third required element of the course was a trauma-informed field placement, during the MSW students' advanced year of study, for which they were matched with and supervised by a field instructor who had been trained in EBTT and who received support and consultation around successful implementation. A total of 169 students participated in and completed the full educational model over 3 years. Meanwhile, human subjects approval was secured from the university's Institutional Review Board.</p> <p>The quantitative evaluation of the model (Layne et al., [<reflink idref="bib21" id="ref30">21</reflink>]) was based on an educational framework that conceptualizes the learning process as three-dimensional (Rodolfa et al., [<reflink idref="bib30" id="ref31">30</reflink>]). Adapted for our study, knowledge readiness (provided through the trauma course and the didactic EBTT training), field readiness (achieved through implementation of EBTT with clients in a trauma-informed field placement), and practice preparedness (measured as employability and continuation of use of EBP upon graduation) were evaluated. Results suggest that the course and the EBTT training substantially contributed to knowledge, field, and practice readiness. Field work supervision, as well as consultation from EBTT experts, also increased students' readiness and employability upon graduation (Layne et al., [<reflink idref="bib21" id="ref32">21</reflink>]).</p> <hd id="AN0120809236-5">Methodology</hd> <p></p> <hd id="AN0120809236-6">Research Questions</hd> <p>This study examined two research questions:</p> <hd id="AN0120809236-7">RQ1:</hd> <p>What are the main factors contributing to the success of the full educational model, measured by students' field readiness and employability?</p> <hd id="AN0120809236-8">RQ2:</hd> <p>What do students, field agencies/instructors, and social work educators perceive as the model's primary contributors to a more trauma-informed social work education and workforce development?</p> <p>The study deployed a qualitative narrative analysis, examining the three main stakeholders' perspectives on successful trauma-informed social work education: students, agencies, and schools of social work. Narrative analysis contributes to the construction of meaning (Holstein & Gubrium, [<reflink idref="bib18" id="ref33">18</reflink>]; Prokkola, [<reflink idref="bib29" id="ref34">29</reflink>]) by making sense of individual stories within a given social, historic, or, in our case, organizational context. Czarniawska-Joerges ([<reflink idref="bib11" id="ref35">11</reflink>]) identified three principal ways of approaching interviews as narratives: using the interview transcript itself, using the researcher's narrative of the interview/interviewee process, or creating a narrative from the stories told by individuals interviewed. For the purpose of this study, we chose the third approach, creating three in-depth narratives of the main stakeholders (student, agency director, and school faculty coordinators). Each narrative consisted of one central theme, with additional interviews contributing to this story, identifying common elements and unique characteristics of a successful trauma-informed education (see Table 1). This framework allowed for a comprehensive analysis of views of other actors involved in each central stakeholder's story. The narratives provided a lens for understanding and interpreting the quantitative indicators of the model's effectiveness (Layne et al., [<reflink idref="bib21" id="ref36">21</reflink>]).</p> <p>Table 1. Interviews contributing to the three narratives.</p> <p> <ephtml> <table><thead><tr><td /><td>Narrative 1: Student's view on program effectiveness</td><td>Narrative 2: Agency's view on program effectiveness</td><td>Narrative 3: School's view on interschool collaboration</td></tr></thead><tbody><tr><td>Central story</td><td>Student (1)</td><td>Agency director (1)</td><td>Faculty coordinators (2)</td></tr><tr><td>Additional interviews</td><td>Field supervisor (1)</td><td>Field supervisor (1)</td><td>EBTT consultant (1)</td></tr><tr><td>Faculty liaison (1)</td><td>Clinician (1)</td><td /></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. EBTT = evidence-based trauma treatment.</p> <p>All participants were purposely chosen based on their successful participation in the full model and their complex roles in this project. As the study was built on the premise of an interconnectedness between MSW students, mental health field agencies, and schools of social work, the narratives contributed to emphasizing the roles of each of these stakeholders in promoting an effective trauma-informed social work education.</p> <hd id="AN0120809236-9">Measures</hd> <p>Key informant interview guidelines were developed for the narrative analysis, consisting of both general questions and narrative specific questions. The general questions focused on the effectiveness of the full educational model; the main factors contributing to its effective implementation; the implementation challenges encountered; and elements of impact, particularly related to employability and workforce development. The narrative specific questions aimed to identify the unique elements of success and the respective challenges, according to each narrative's central story. The students' perspectives on the effectiveness of this program, and the factors that contributed to their perceived readiness for field and practice, provided the first narrative's central story. The second narrative's core story presented the agency directors' perspectives on each agency's specific role and contribution to preparing MSW students for practice while promoting a trauma-informed practice environment. The third narrative's central story explored the contribution of collaborations between two schools of social work in implementing the full model, building upon the respective school's faculty interviews, as noted in Table 1.</p> <p>Two independent researchers, following an inductive qualitative content analysis approach, coded each interview using ATLAS.ti, and grouped codes into themes (Glaser, [<reflink idref="bib14" id="ref37">14</reflink>]). Four larger common themes were extracted from the analysis:</p> <p></p> <ulist> <item> Knowledge readiness (first common theme) or the common trauma knowledge elements all stakeholders identified as contributing to preparing students for working with traumatized children and adolescents (courses taught and EBTT training);</item> <p></p> <item> field and practice readiness (second common theme), respectively, the elements of support for increasing students' readiness for trauma-informed practice, and positively impacting their employability. This theme included field instruction in an EBTT model (and other support components), which made the difference between adequate and superior field preparedness, leading to practice readiness and increased employability. Some of the agency support elements were as follows: providing students with cases, access to continuous EBTT and related trainings, and consultation on a regular basis (peer consultation, case conferences, etc.);</item> <p></p> <item> personal context elements (third common theme) that contributed to the model's effectiveness in preparing students and agencies for trauma-informed practice (e.g., a student's and field instructor's prior experience with or exposure to working with trauma, as well as understanding of EBP and motivation to implement EBTTs); and</item> <p></p> <item> system context elements (fourth common theme) that further contributed to an impactful implementation of the model and prospectively to workforce development (e.g., infrastructure and intra/interagency interactive elements of support leading to increasing field readiness and employability for MSW graduates).</item> </ulist> <p>The meaning thus created through each story becomes a component of the larger, common narrative of field readiness, trauma-informed education, and workforce development. In addition to these four themes, individual characteristics and the field instructor–student and agency–school of social work relationships also were identified as important contributors to increased field readiness and employability for participating social work graduates.</p> <hd id="AN0120809236-10">Findings</hd> <p></p> <hd id="AN0120809236-11">A Student's View of the Trauma Program: Impact on Education and Career Choices</hd> <p>"I think it's always good to be trauma-informed. Being trauma-informed is essential to the work that we do." (Student, trauma program, graduated in 2012)</p> <p>The first narrative centers on the experience of one student—as voiced by the student and complemented by the field instructor and the faculty coordinator of the program (Table 1). The faculty coordinator identified the student as one of the school's success stories:</p> <p>The reason I recommended you interview this student is because she's very enthusiastic, and passionate! She in fact was an advanced standing student and was supposed to graduate in December 2011, but because she really wanted to be in this project she delayed her graduation a whole semester so that she could participate, which says a lot about her and her commitment to learning and growing in this area. Also ... the fact that she was Spanish-speaking and Latina had a lot to do with her work with some of the Latino families that she worked with. (Faculty Coordinator)</p> <p>This student identified two main elements that contributed to her <emph>knowledge readiness</emph> (Common Theme 1): (a) The course that helped her understand the experiences of the clients and taught her how to assist the clients' supporting systems, reactions, environments, culture, present experiences, and symptoms; and (b) the 2-day training that added specific tools and ways of addressing ethical dilemmas to the foundation provided by the course.</p> <p>The conceptual [Core Concepts of Trauma] course helped me to apply that in the real setting. And in that course we were given a lot, and I remember we had scenarios and we would role play, and take turns. One time, I was the client presenting this issue, and the other time I was the social worker or clinician, thinking about how I was going to work with this client, with that presenting issue, and so we had dialogues, role play which helped me a lot with field. (Student)</p> <p>In regard to <emph>field readiness</emph>, two of the common themes identified by the student as main contributors were (a) field supervision—by an EBTT-trained supervisor, with (b) consultation calls as added support (Common Theme 2):</p> <p>Supervision was essential in [effectively] implementing the model. It was always going back to, ok, where is the client right now, and what have I done, and do you know basically what component this might be [<emph>in the model</emph>]. ... Just to have that opportunity to process it and find things that they [<emph>clients</emph>] could benefit from. I think supervision helped me a lot to implement the trauma model. (Student)</p> <p>The student also identified <emph>her prior experience with crisis and crisis intervention</emph>—Personal Context Elements (Common Theme 3):</p> <p>Having previous experience in the field of trauma: My undergrad field placement was at a police department dealing with victims of any type of violent crime, whether it was kidnapping, aggravated robbery, sexual assault, anything that was a violent crime. So I had exposure working directly with clients and assisting them with resources, but not therapy services, so coming into this placement I knew from the very beginning it would be totally different, totally new to me, but I felt very confident. (Student)</p> <p>The field instructor validated these factors, indicating that a student coming to the agency with such skills and foundational knowledge, and building on prior experience (Personal Context; Common Theme 3) in working with crisis situations is "priceless" to the agency and for the field.</p> <p>This student came in ready to take clients. She'd had some previous experience doing a little crisis work, not so much the long-term therapy. But she was comfortable being in the room with clients and we had some great clients walk through the door that seemed perfect for the program so it all just seemed to click. (Field Instructor)</p> <p>The <emph>system context elements</emph> (Common Theme 4) of school and field placement collaboration (as well as ongoing support provided by the school) were seen by the agency as instrumental in supporting the student and building trauma treatment capacity at the agency and beyond.</p> <p>Probably the relationship that the University has with the field placements was a key. They already had good relationships with all of the four of our agencies that were the core this time, and good relationships with field instructors. I went to the University, I was familiar with them, we have a great relationship and I think that's the key. We were able to talk through any issues that came up. (Field Instructor)</p> <p>In this particular case, the effectiveness of the program was evidenced by the student's employability even before completing the program: The job offer during her trauma placement allowed her to continue working with traumatized children, adolescents, and their families. When asked how the program contributed to her employability, and the agency's hiring decision, the student responded that her participation in the trauma program was most likely the key factor in pushing the agency's decision in her favor.</p> <p>The field instructor also noted that the knowledge and skills that the students in the trauma program now would come with would surely open doors and increase their employability.</p> <p>That would be a huge bonus for anybody walking in the door who has completed this program, who has the skills that they've learned, the foundation that they have. ... It's priceless. (Field Instructor)</p> <p>The student also reported that a successful trauma program involves good collaboration between agencies and schools of social work (System Context; Common Theme 4), allowing feedback and participation in the decisions affecting students, field instructors, faculty, and agency leadership—thus continuing to inform social work education based on the reality and the needs of the field. To this, she added, the social worker's responsibility to continuously prepare and adapt to changing contexts is an ethical responsibility that involves lifelong learning.</p> <p>I'm very thankful to the school just for believing in the model and providing the students with this opportunity. I'm thankful to my agency. I got an opportunity to strengthen my skills to work with children and adolescents in the field of trauma and I was able to utilize my language skills to understand people's words, and at the same time communicate with the parents in their language. I feel that this experience gave me the opportunity to enter the field, as trauma-informed, and having the knowledge that prepares me to work with anyone who is going through a traumatic experience. (Student)</p> <hd id="AN0120809236-12">Agencies as Engines of Capacity-Building: An Agency's Story of Becoming a Trauma-Focused Cent...</hd> <p>One agency was invited to reflect on the program's impact on increasing its capacity to adopt EBTT models for child and adolescent trauma treatment. The agency director, together with a supervisor and an EBTT-trained field instructor, contributed to this narrative. Part of a much larger organization, the agency coordinated three programs—community health, schools, and foster care/mental health services—and had a small- to medium-sized staff of 20. Along with the four common themes just discussed, three other core elements were identified as contributing to the successful implementation of the trauma program, which are presented as part of this narrative: (a) Leadership—vision and understanding of trauma; (b) Training—provided to <emph>all</emph> staff with supervision; and (<reflink idref="bib3" id="ref38">3</reflink>) Agency–School Collaboration—support provided by schools to students in placement.</p> <p></p> <ulist> <item> Leadership: The agency director had extensive trauma work and EBP experience. She also understood the benefit of preparing her staff to work with trauma as a presenting problem while increasing the agency's capacity (through trauma-oriented field placements) to train the future workforce they needed. In her words,</item> <p></p> <item> The need for trauma evidence-based models and interventions came to my attention because we had a large traumatized population. So what motivated me was that I knew all these things, and I felt this was a chance for us to really bring this model into the clinics and also to provide services that have been proven to be effective in treating trauma. (Agency Director)</item> <p></p> <item> The support of the organization's leadership was the first layer of factors contributing to successful implementation of the trauma program.</item> <p></p> <item> I think what's been really helpful is the agency's support for it [the implementation of a trauma focus]. You know, a lot of times in the agency we see people for thirty minutes a week. I think [it helped that] we've had the agency's support for the TF-CBT cases. The agency purchased the manual for TF-CBT, and there's been a lot of support, with my peers, talking about our different cases. There's been a lot of agency support for the trauma-focused treatment. (Clinical Field Instructor)</item> <p></p> <item> Training/Staff Development: One important element of success was the agency's ability to continue to increase staff capacity by providing or facilitating participation in training on EBTT models. Of the 20 practitioners in the agency's three programs, six were trained in EBTT models as part of the trauma program. The agency then decided to train another 10 staff members, and with one previously trained clinician they now have 17 trained in EBTT models. By the time they participated in this interview, they also had already hired three graduates of the trauma program. As the director and a field instructor mentioned, the trauma program interns were those who other staff members turned to for a better understanding of trauma, as they came to placement with a strong foundation in trauma knowledge and ready to implement these concepts and models. This finding supports the broader theme of <emph>knowledge readiness</emph> (Common Theme 1) and affirms the contribution of the course and EBTT training to effectiveness in building agency capacity.</item> <p></p> <item> I have been very impressed with the quality of the students that we had, we have been extremely lucky, to the point that when I went to the first case conference, and [a trauma-trained student] presented, I was beside myself because she sounded like somebody that had been doing this for a while already.</item> <p></p> <item> But when I could listen to the woman who already had an LMSW [Agency Social Worker], and to this young student that we currently have that is TF-CBT-trained, they were at two different levels, and I have to tell you that the student was at a much higher clinical level.</item> <p></p> <item> So there is something to be said for what you are giving to the students in this program that may not be happening, you know, with others. For some reason, we're thinking now that, for the students trained in the TF-CBT model, there is something about them; clinically they are coming out much stronger. (Agency Director)</item> <p></p> <item> Field supervision (Field/Practice Readiness; Common Theme 2) was seen as a crucial factor in supporting the students and increasing their field and practice readiness. The agency director provides supervision to her staff and also supervises and coordinates staff and student group supervision.</item> <p></p> <item> I have individual supervision with them once a week, or every other week, and then once a month I have a meeting with all the directors and all the supervisors in the mental health program that I oversee. The other thing I have been doing this year with the students is that I go to the case conference at each one of the programs once a month; we have a clinical consultant that comes in from the outside, and I listen to the [students'] presentations, and we have discussions, and I am always interested in hearing the ones that are using the trauma models. (Agency Director)</item> <p></p> <item> Agency–School of Social Work Collaboration/Support (System Context Elements; Common Theme 4): The agency reported that the support provided by the participating schools of social work for the trauma program also was crucial to an effective adoption of the program. Agency leaders noted that the students who received training prior to starting their placement were more prepared for field. Also, the constant school–agency collaboration ensured effective matching of students placed with trained field instructors.</item> <p></p> <item> I have to say [it] has been very easy and smooth the way that we have worked it out [with the schools]. I have a direct line to the [Trauma Project Director], so she contacts me when all of you begin to prepare to place students, and she says to me, "are you interested in having students this year? How many will you need? Where do you need them? What is it you need?" And that's how we have been doing it. ... My main thing is I want people TF-CBT trained, and I want people that are bilingual in Spanish. (Agency Director)</item> <p></p> <item> Speaking to the success of the full educational model, one of the agency's MSW clinicians (who graduated in 2010), said, in reference to one of the trauma students,</item> <p></p> <item> I actually would go to him a lot for peer support, and I would say "This is what I'm doing, what do you think about that, and what are they saying in your classes?" And I would use him as a resource 'cause I really feel like he did know a lot. Our intern last year was also an intern that participated in the trauma program, and I really felt she was more qualified than I was at the time because I hadn't even been trained yet. But she was really qualified to treat children, and they really made a lot of gains, the children she worked with. (Clinician/Field Instructor)</item> <p></p> <item> When asked about students' readiness to practice in a trauma setting upon graduation, the Agency Director replied,</item> <p></p> <item> Yes, I have to tell you YES, and my premier example is that I am planning to hire two of them, two out of the four. They are ready, and when you sit with them in case conference, you hear that. They can do it. I think that is essential, and I think that this is why I probably also bought into this program.</item> <p></p> <item> Thus, from the agency's perspective, the ultimate indicator of success has been the inclusion of the trauma program as one of the few essential criteria in hiring decisions.</item> <p></p> <item> I would definitely say they [students following the full educational model] are more prepared because they have specific techniques now that they have learned and utilize, as opposed to a student who is going through the general social work program. And I think that definitely makes them more marketable. (Field Supervisor, trained in the model)</item> <p></p> <item> There is something that is being done in the school that is being given to them, which I think is making a big difference when you see them in the placement. Being in the trauma program definitely positions them better for being hired by us. (Agency Director)</item> </ulist> <hd id="AN0120809236-13">Interschool Collaboration—A Model for Effective Implementation of the Trauma Program</hd> <p>Two of the schools of social work involved in this study built a partnership for collaboration and sharing of resources. This allowed them to reach out and develop new field placements and create mechanisms for field instructor and trauma placement retention, which increased cost effectiveness while ensuring staff development. The third narrative focused on collaboration and partnerships essential to implementing the trauma program and increasing capacity for the field of practice. Three voices were included: the individual faculty coordinators from each school, and the EBTT consultant who facilitated staff and students' EBTT. Along with the four common themes, the additional elements identified as contributing to the program's success through this collaboration were leadership and vision, commitment to EBP in general and to trauma-focused evidence-based treatments (EBTs) in particular, and partnerships and collaborations (Common Theme 4): (a) strong, mutually advantageous collaboration between the two partner schools; (b) long-standing relationships between the schools and the practice community; and (c) previous collaborations with one of the NCTSN community-based treatment sites and an EBTT training consultant.</p> <p></p> <ulist> <item> Leadership and Vision</item> <p></p> <item> The two partner schools identified the following as strong contributors to successful program implementation: their universities' commitment to engaging in partnerships that will build school and field practice capacity; the schools' leadership (deans, program coordinators); and management support at the participating agencies. Both partner schools enjoyed full university support for, and their deans' commitment to, the program, and their prior work in the area of child welfare and trauma enhanced this commitment.</item> <p></p> <item> [School 2's Program Director]'s relationship with the director of [School 1] reflects a real commitment to being collaborators: we don't compete! (Faculty Coordinator 2)</item> <p></p> <item> The other way that the two schools have collaborated is that our director and [School 2's Program Director] work together anyway in statewide school of social work processes and so, as [Faculty Coordinator 2] talks with her director and I talk with my director, there's collaboration, as well. (Faculty Coordinator 1)</item> <p></p> <item> Commitment to EBP and Trauma-Focused EBTTs</item> <p></p> <item> Indicators of the schools' pledge to EBTTs included active dissemination of the trauma course—with six offerings between the two schools, and 102 students enrolled by 2012 (Knowledge Readiness; Common Theme 1); the schools' collaboration in providing EBTT training, ongoing consultation, and support around model implementation for field instructors (Field Readiness, Common Theme 2; System Context Elements, Common Theme 4); and their common support of the full educational model (Knowledge, Common Theme 1; Field/Practice Readiness, Common Theme 2). For this interschool collaboration, ongoing consultation to support the implementation of EBTT models was one of the major features of this project.</item> <p></p> <item> One school stated that there is an increased interest at the state level in EBP in general (and EBTT in particular), which in turn increases interest in participation among agencies, clinicians, and MSW students.</item> <p></p> <item> I think that TF-CBT is really increasingly recognized in our state and in this area, and evidence-based practice is being valued, so I feel really good that our students are going out with that and they're highlighting it. (Faculty Coordinator 1)</item> <p></p> <item> Investment in agency-based collaboration and the shift from a private clinician focus to an agency focus became signs of a new orientation toward building agency-level capacity for the adoption and implementation of EBTT models, strengthening existing field placements and creating new ones, to support students in their transition from knowledge readiness to field readiness and then practice readiness. The collaboration between the two schools made it possible to combine resources and provide EBTT training to additional community clinicians and agencies. The direct access to the EBTT consultant was one unique factor contributing to the success of the full model, through this collaboration.</item> <p></p> <item> I would say, absolutely, [the key to project's success] would be [EBTT Consultant]'s consultation. She makes time for calls, for the in-person consultations, and is often calling in from the side of the road. (Faculty Coordinator 1)</item> <p></p> <item> Partnerships and Collaborations</item> <p></p> <item> Aligning with the system context elements (Common Theme 4), the faculty coordinators identified <emph>strong, mutually advantageous collaboration between the two partner schools</emph>:</item> <p></p> <item> The collaboration with [School 2] began in the second year and I think it has been really positive for several reasons. We do a shared field instructor training and shared student training. We also had the opportunity to share the planning responsibility. (Faculty Coordinator 1)</item> <p></p> <item> The two schools differ in sizes and resources, one being more connected to the NCTSN site and EBTT community but the other being larger and having access to more financial resources and wider local networks. Yet they used their difference symbiotically to support this initiative.</item> <p></p> <item> Because of the size of [School 2] being a much larger institution and school than [School 1], we had the financial resources. [School 2's Program Director] committed some money. So, once [School 1] sponsored the training, we covered half of the cost. That's unique, related to just the resources that we brought. (Faculty Coordinator 2)</item> <p></p> <item> The schools' resources were used to support trauma program students, and although not advertised, students at one of the schools received a stipend once they were accepted in the program, whereas at the other school there was a small travel allowance to assist with longer commutes to placements.</item> <p></p> <item> Long-standing relationships between schools and the practice community</item> <p></p> <item> As one of the partner school's program coordinators said, being in a medium-sized state and having a large university presence (multiple schools) in a small territory lead to a small practice community. In turn, this led to a special emphasis on existing relationships, cultivating established collaborations, and shifting from an initial focus on private clinicians to a focus on large agencies. In this particular case, the vision of the program coordinators and their long-standing relationships (both with the schools and with the practice community) became a core resource for building this program.</item> <p></p> <item> The collaboration was forged in the 2nd year of the project, leading to increased effectiveness, through shared resources (costs, trainers, venues, contacts, and field placements).</item> <p></p> <item> We have very long-standing well-established relationships. We've reached out to the private agencies, which have contracts to provide child welfare services, and we've used our contacts through the state federation of private agencies. They share training resources and they do a lot of advocacy and lobbying in support of their members. [School 2's Program Director] has a strong presence, he's on their board, and through his presence and leadership in this community, specifically around child welfare, he is seen as a leader so that agencies want to partner with us. (Faculty Coordinator 2)</item> <p></p> <item> Previous collaborations with NCTSN sites and consultants</item> <p></p> <item> One of the partner schools was engaged with the project from its beginning—becoming the liaison between the second school's faculty coordinator and the training consultant, who had a previous relationship with their school and the NCTSN center.</item> <p></p> <item> Let me start with what is unique about this collaboration: Because we have an [NCTSN site], we have a trauma center here at the University, and we have an [EBTT Consultant] who is the clinical director at [NCTSN site]. (Faculty Coordinator 1)</item> <p></p> <item> The other thing is that with the [EBTT consultant] and [NCTSN site], I've been able to work really closely with her [consultant] to develop relationships with agencies, knowing who she has trained through other [NCTSN site] projects. (Faculty Coordinator 2)</item> <p></p> <item> When talking with the consultant, she described the strength and complexity of the relationships:</item> <p></p> <item> [Faculty Coordinator 1] had been involved in one of our center's earlier grants, and we worked together on a project, so there was already a collaboration between the school and our project on a variety of things that we've done; when the university got its grant, there was a conversation at one of the annual meetings at the NCTSN, and the core curriculum was coming out. All of this was unfolding when our director had a conversation with them about [Partner School 1] being a site at which the higher education project could be implemented, and we were really excited about that! (EBTT Consultant)</item> <p></p> <item> Ultimately, the main motivator for this collaboration remains the visible impact it has on the students graduating from the full educational model, and the commitment of the two schools to best prepare their students for a trauma-informed workplace.</item> <p></p> <item> Students are gaining confidence. They've learned an EBTT, they have the extra field seminars, the training. We give them a certificate at the end which they are able to put on their resume. (Faculty Coordinator 1)</item> </ulist> <hd id="AN0120809236-14">Discussion and Implications</hd> <p>This article reports on three narratives that aim to construct meaning, beyond the quantitative indicators, of the effectiveness of an educational model that prepares social work students for trauma-informed practice. The strategic supports for program implementation included a shared commitment to EBP, in general, and evidence-based trauma informed practice, in particular, by existing schools of social work and community agencies.</p> <p>The first layer builds on the four common themes just presented: knowledge readiness, field/practice readiness, personal context, and system context.</p> <p>These findings validate the quantitative findings (Layne et al., [<reflink idref="bib21" id="ref39">21</reflink>]) that similarly identify knowledge readiness (Common Theme 1), and specifically the trauma course and the EBTT training, as essential to building students' confidence in their ability to work with traumatized clients. The factors contributing to field/practice readiness (Common Theme 2) are supervision and consultation with an EBTT trainer that supports the students, field instructors, or both. Throughout each story, the narratives identify a pervasive training theme as a core element of knowledge and field readiness but also as an essential contributor to the model's sustainability.</p> <p>The training component also links personal context elements for students, field supervisors, agency directors, and faculty coordinators (Common Theme 3), providing social work educators with a profile of the successful student for this program being committed to EBP and having some prior exposure to either trauma work or crisis intervention. Field instructors contributing to the narratives identify these elements as directly contributing to both the students' employability and the field instructors' own growth and professional development within the agency.</p> <p>Finally, the narratives clearly point to the contribution of the system context elements (Common Theme 4) to both the effective implementation of trauma-informed social work education and a sustainable workforce development for trauma-informed EBP.</p> <p>The second layer of contributing factors is revealed by the unique characteristics of each narrative and has major implications for social work education and practice.</p> <p>Leadership and vision at the administrative level emerged as core facilitating factors for effective full-model implementation for all contributing actors in these networks. Agency leaders agreed that existing resources also play an important role in the effectiveness of this model. Leadership and vision also support the schools' and agencies' engagement with and commitment to EBP in general and to trauma-informed EBP in particular. Quoting Ziad K. Abdelbour, one student mentioned, "True leaders do not create followers; they create new leaders".</p> <p>The agency narrative identifies agency leadership's commitment to best practices: The director used agency resources to train the entire staff to become trauma-informed practitioners who can prepare trauma-informed social workers.</p> <p>Both through coursework and field work, training is identified as one of the crucial factors in increasing students' readiness for the field and contributing to their employability. The relevance of training as a core factor extends beyond students, becoming the main contributor to increasing organizational readiness for trauma informed practice as well as staff commitment to this model. The interschool collaboration narrative shows how training can be a resource and can contribute to developing learning communities within agencies that will both formally and informally contribute to promoting EBTTs. Based on these findings, training becomes the overarching sustainability factor that addresses specific social work competencies (Council on Social Work Education, [<reflink idref="bib9" id="ref40">9</reflink>], EPAS 2.1.6) while preparing social work graduates to effectively assess and address trauma in the client populations they will serve (EPAS 2.1.10).</p> <p>Partnership and collaboration, of course, are intrinsic elements in all three narratives, yet it is the third narrative that clearly presents a model of ethical commitment to social work education and to EBP. If field is the signature pedagogy of social work education, partnership is its main tool. The two social work schools' decision to partner, share resources, and promote a trauma-informed evidence-based education model had an impact on <emph>all</emph> the agencies with which they worked. The vignettes show that such partnerships contribute not only to maximizing existing resources but to creating new ones, as well. The initial partnership snowballed into a generation of wider networks, with a far greater reach. At the state level, the collaborative model provided had an added impact because it generated a focus on trauma knowledge, and we believe significantly contributed to workforce development. Smaller communities and agencies were able to tap into the resources of larger universities and NCTSN sites. The human and social capital generated we trust will ensure sustainability and offer a model that may become a best practice, marking the beginning of a legacy in social work education.</p> <hd id="AN0120809236-15">An Epilogue</hd> <p>The three participating sites (including five partner schools and the field agencies they work with) have continued to promote the full education model over the past 4 years (2013–2016). Since conducting the interviews for these narratives, the trauma course has been offered 36 times at the five schools represented in this study; 679 students have taken the trauma course, and 221 students have graduated after participating in the full model. Further, an additional 76 students will graduate from the full model at these sites this year.</p> <hd id="AN0120809236-16">Funding</hd> <p>This study was partially supported by a grant from the U. S. 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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Trauma%22">Trauma</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Work%22">Social Work</searchLink><br /><searchLink fieldCode="DE" term="%22Capacity+Building%22">Capacity Building</searchLink><br /><searchLink fieldCode="DE" term="%22Caseworkers%22">Caseworkers</searchLink><br /><searchLink fieldCode="DE" term="%22Teaching+Models%22">Teaching Models</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Needs%22">Educational Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Practices%22">Educational Practices</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Change%22">Educational Change</searchLink><br /><searchLink fieldCode="DE" term="%22Career+Readiness%22">Career Readiness</searchLink><br /><searchLink fieldCode="DE" term="%22Employment+Potential%22">Employment Potential</searchLink><br /><searchLink fieldCode="DE" term="%22Labor+Force+Development%22">Labor Force Development</searchLink><br /><searchLink fieldCode="DE" term="%22Qualitative+Research%22">Qualitative Research</searchLink><br /><searchLink fieldCode="DE" term="%22Narration%22">Narration</searchLink><br /><searchLink fieldCode="DE" term="%22Career+Choice%22">Career Choice</searchLink><br /><searchLink fieldCode="DE" term="%22Intercollegiate+Cooperation%22">Intercollegiate Cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22Best+Practices%22">Best Practices</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/08841233.2016.1265040
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0884-1233
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Social workers encounter trauma in a majority of the populations they serve. It is therefore essential to train social work students to understand the impact of trauma, to assess trauma history and symptoms, and to effectively intervene with children and families. This article presents 3 qualitative research narratives that provide an in-depth analysis of factors contributing to successful implementation of an innovative trauma-informed educational model. The narratives identify common themes related to student knowledge and field readiness; personal and system context; organizational leadership; and vision, training, and partnerships/collaborations.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 31
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2017
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1126580
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1126580
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/08841233.2016.1265040
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 19
        StartPage: 36
    Subjects:
      – SubjectFull: Trauma
        Type: general
      – SubjectFull: Social Work
        Type: general
      – SubjectFull: Capacity Building
        Type: general
      – SubjectFull: Caseworkers
        Type: general
      – SubjectFull: Teaching Models
        Type: general
      – SubjectFull: Educational Needs
        Type: general
      – SubjectFull: Educational Practices
        Type: general
      – SubjectFull: Educational Change
        Type: general
      – SubjectFull: Career Readiness
        Type: general
      – SubjectFull: Employment Potential
        Type: general
      – SubjectFull: Labor Force Development
        Type: general
      – SubjectFull: Qualitative Research
        Type: general
      – SubjectFull: Narration
        Type: general
      – SubjectFull: Career Choice
        Type: general
      – SubjectFull: Intercollegiate Cooperation
        Type: general
      – SubjectFull: Best Practices
        Type: general
    Titles:
      – TitleFull: Building a Trauma-Informed Workforce Capacity and Legacy
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Popescu, Marciana
      – PersonEntity:
          Name:
            NameFull: Strand, Virginia
      – PersonEntity:
          Name:
            NameFull: Way, Ineke
      – PersonEntity:
          Name:
            NameFull: Williams-Hecksel, Cheryl
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          Name:
            NameFull: Abramovitz, Robert
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            – D: 01
              M: 01
              Type: published
              Y: 2017
          Identifiers:
            – Type: issn-print
              Value: 0884-1233
          Numbering:
            – Type: volume
              Value: 37
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of Teaching in Social Work
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