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The Provision of Trauma Awareness Training in the Early Childhood Education & Care Profession: A Systematic Review

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Title: The Provision of Trauma Awareness Training in the Early Childhood Education & Care Profession: A Systematic Review
Language: English
Authors: Catherine Sheehan (ORCID 0000-0002-8741-119X), Judith Butler, Cian O' Neill
Source: Early Childhood Education Journal. 2025 53(2):373-391.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 19
Publication Date: 2025
Document Type: Journal Articles
Information Analyses
Education Level: Early Childhood Education
Descriptors: Trauma, Trauma Informed Approach, Training, Early Childhood Education, Early Childhood Teachers, Meta Analysis, Educational Research, Global Approach, Standardized Tests, Program Evaluation, Intervention
DOI: 10.1007/s10643-023-01565-w
ISSN: 1082-3301
1573-1707
Abstract: Advances in the field of Early Childhood Education & Care (ECEC) are catalysing an important paradigm shift in the understanding of childhood trauma throughout the life course. While there is little dispute regarding the unique role of ECEC practitioners in providing critical support to children who experience trauma, international provisions of trauma-related education for this cohort require further interrogation. A systematic literature review was performed to examine the delivery of trauma awareness training in the ECEC profession. Relatedly, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were implemented to facilitate the review process, which yielded a total of 10 papers across five electronic databases to be appraised. Findings consolidated that, presently, there appears to be (i) a paucity of international research pertaining to trauma awareness training in ECEC, (ii) a lack of a standardised measurement tools to evaluate trauma-focused interventions in an ECEC context, and (iii) an absence of practitioner well-being components in current training interventions. Due to the practical and theoretical importance of ECEC practitioners receiving trauma awareness training, this review serves to highlight the urgent need for increased, and context-specific, training provisions for ECEC practitioners worldwide.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1460497
Database: ERIC
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  Value: <anid>AN0182844395;5mx01feb.25;2025Feb10.02:59;v2.2.500</anid> <title id="AN0182844395-1">The Provision of Trauma Awareness Training in the Early Childhood Education & Care Profession: A Systematic Review </title> <p>Advances in the field of Early Childhood Education & Care (ECEC) are catalysing an important paradigm shift in the understanding of childhood trauma throughout the life course. While there is little dispute regarding the unique role of ECEC practitioners in providing critical support to children who experience trauma, international provisions of trauma-related education for this cohort require further interrogation. A systematic literature review was performed to examine the delivery of trauma awareness training in the ECEC profession. Relatedly, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were implemented to facilitate the review process, which yielded a total of 10 papers across five electronic databases to be appraised. Findings consolidated that, presently, there appears to be (i) a paucity of international research pertaining to trauma awareness training in ECEC, (ii) a lack of a standardised measurement tools to evaluate trauma-focused interventions in an ECEC context, and (iii) an absence of practitioner well-being components in current training interventions. Due to the practical and theoretical importance of ECEC practitioners receiving trauma awareness training, this review serves to highlight the urgent need for increased, and context-specific, training provisions for ECEC practitioners worldwide.</p> <p>Keywords: Childhood trauma; Trauma awareness training; Early childhood education & care; Trauma sensitive; Early childhood education & care practitioner</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <hd id="AN0182844395-2">Introduction</hd> <p>An expanding body of empirical literature has enhanced the existing understanding of childhood trauma, and consequently, the implications of the same for Early Childhood Education & Care (ECEC) practitioners (Bilbrey et al., [<reflink idref="bib12" id="ref1">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref2">22</reflink>]; McClain, [<reflink idref="bib41" id="ref3">41</reflink>]). Trauma is defined as 'an experience, or pattern of experiences, that impair the proper functioning of the person's stress response system, making it more reactive or sensitive' (Perry cited in Supin, [<reflink idref="bib58" id="ref4">58</reflink>], p.5), and has been conceptualised as a spectrum between biological and social interactions (van der Kolk, [<reflink idref="bib61" id="ref5">61</reflink>]). Within the breadth of traumatic experiences, Felitti et al. ([<reflink idref="bib25" id="ref6">25</reflink>]) coined the term Adverse Childhood Experiences (ACEs) related to 10 specific stress-inducing experiences that occur before the age of 18 that may have the potential to alter brain-body functioning (Shantone & Nunan, [<reflink idref="bib55" id="ref7">55</reflink>]). More broadly, substantial evidence has demonstrated the potential negative impact of trauma/ACE exposure on emotional regulation (Adkins et al., [<reflink idref="bib2" id="ref8">2</reflink>]), building relationships (Nicholson et al., [<reflink idref="bib46" id="ref9">46</reflink>]), and school attendance (Krasnoff, [<reflink idref="bib37" id="ref10">37</reflink>]).</p> <p>This discourse catalysed Harris and Fallot ([<reflink idref="bib30" id="ref11">30</reflink>]) to establish a specialised framework, namely 'Trauma Informed Care', which serves to support understanding of the impact of trauma and to respond to this by integrating knowledge into organisational systems (Substance Abuse and Mental Health Association, [<reflink idref="bib57" id="ref12">57</reflink>]). To initiate change, the framework constitutes six universal principles; (i) Safety, (ii) Choice, (iii) Trustworthiness, (iv) Collaboration, (v) Empowerment, and (vi) Cultural, Historical, and Gender Issues (Substance Abuse and Mental Health Association, [<reflink idref="bib57" id="ref13">57</reflink>]), which can be adapted to discipline-specific environments (NovaScotia, [<reflink idref="bib47" id="ref14">47</reflink>]). An ubiquitous trend in trauma-related research indicates that when children are exposed to household chaos, that same dysfunction can be reproduced in the child's Microsystem (Brunzell et al., [<reflink idref="bib17" id="ref15">17</reflink>]; Shamblin et al., [<reflink idref="bib54" id="ref16">54</reflink>]; Shantone & Nunan, [<reflink idref="bib55" id="ref17">55</reflink>]), which consolidates Bronfenbrenner's ([<reflink idref="bib13" id="ref18">13</reflink>]) emphasis on the proximal relationship between context and individuals (Ashiabi & O'Neal, [<reflink idref="bib4" id="ref19">4</reflink>]). Thus, professional practice that is contextually appropriate and grounded in the six framework pillars can achieve a sector-wide paradigm shift in educating and caring for children exposed to trauma through new methods.</p> <p>In 2014, the Missouri Department of Mental Health and Partners devised a multi-tiered developmental framework comprising four progressive layers; (i) trauma aware, (ii) trauma sensitive, (iii) trauma responsive, and (iv) trauma informed, to assist in the implementation of trauma-focused organisational change. The features of each identifiable layer consist of <emph>"knowledge, perspective, attitudes and skills that continue to deepen and unfold over time"</emph> (Missouri Department of Mental Development, [<reflink idref="bib43" id="ref20">43</reflink>], p.1). While the model supports the developmental continuum from trauma aware to trauma informed, the current review purposefully focused on trauma awareness training and trauma sensitive approaches as a realistic and attainable component for ECEC settings. Internationally, researchers have taken the initiative to explore trauma awareness training among the ECEC cohort (Kim et al., [<reflink idref="bib36" id="ref21">36</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref22">62</reflink>]), revealing a host of complexities pertaining to attitudes and burnout (Kim et al., [<reflink idref="bib36" id="ref23">36</reflink>]; Stein et al., [<reflink idref="bib56" id="ref24">56</reflink>]), perceptions of conflict (Whitaker et al., [<reflink idref="bib62" id="ref25">62</reflink>]), and knowledge, skills, and confidence (Bilbrey et al., [<reflink idref="bib12" id="ref26">12</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref27">40</reflink>]). Moreover, research in the United States (Loomis & Felt, [<reflink idref="bib40" id="ref28">40</reflink>]; McClain, [<reflink idref="bib41" id="ref29">41</reflink>]; Miller & Stipp, [<reflink idref="bib42" id="ref30">42</reflink>]) consolidates the lack of practitioner trauma awareness training as a concerning issue in the ECEC sector, calling for increased trauma-related education during Initial Practitioner Education (IPE) (Brown et al., [<reflink idref="bib15" id="ref31">15</reflink>]; McClain, [<reflink idref="bib41" id="ref32">41</reflink>]; Miller & Stipp, [<reflink idref="bib42" id="ref33">42</reflink>]) and Continuous Professional Development (CPD) (Bilbrey et al., [<reflink idref="bib12" id="ref34">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref35">22</reflink>]; Kim et al., [<reflink idref="bib36" id="ref36">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref37">40</reflink>]), respectively.</p> <p>Internationally, many countries (e.g., United States, Australia, South Africa, Scotland, Wales, and Canada) have implemented trauma-focused training interventions in ECEC environments, with preliminary findings indicating a decrease in negative attributes of the preschool learning environment (Shamblin et al., [<reflink idref="bib54" id="ref38">54</reflink>]), exhibitions of lower practitioner stress (Loomis & Felt, [<reflink idref="bib40" id="ref39">40</reflink>]), and authentic relationships (Morgan et al., [<reflink idref="bib44" id="ref40">44</reflink>]). However, while enthusiasm exists for the benefits of training interventions in educational contexts (Kim et al., [<reflink idref="bib36" id="ref41">36</reflink>]), in a study examining 15 USA-based, female (<emph>n</emph> = 13) and male (<emph>n</emph> = 2) Early Childhood Teacher Candidates, 53% did not receive trauma awareness training during Initial Practitioner Education (IPE) (McClain, [<reflink idref="bib41" id="ref42">41</reflink>]). In addition, recent research (Butler et al., [<reflink idref="bib19" id="ref43">19</reflink>]; Butler, [<reflink idref="bib18" id="ref44">18</reflink>]) investigating trauma sensitive approaches in ECEC environments highlight the potentiality that over 60% of those working in the ECEC profession have no trauma-related education. Therefore, this systematic review examined literature related to trauma awareness training and explored the current provisions and conditions under which ECEC practitioners receive adequate training (if any).</p> <hd id="AN0182844395-3">Methods</hd> <p></p> <hd id="AN0182844395-4">Search Strategy</hd> <p>To facilitate a comprehensive examination of extant trauma-related literature in the field of Early Childhood Education & Care (ECEC), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Liberati et al., [<reflink idref="bib39" id="ref45">39</reflink>]) guidelines were implemented to facilitate the review process. This method of evaluation ensured that an accurate and transparent screening process was conducted (Page et al., [<reflink idref="bib50" id="ref46">50</reflink>]), resulting in the inclusion of high quality, suitable papers to frame the topic under investigation. Five electronic databases (ERIC, PsychINFO, EBSCO, Springer, SAGE Journals) were searched with terms 'Trauma-Aware' OR 'Trauma-Sensitive' OR 'Trauma-Responsive' OR 'Trauma-Informed' AND 'Training' OR 'Development' AND 'Early Childhood Education and Care' OR 'Early Childhood Education' OR 'Early Childhood Program*' OR 'Early Learning and Care' OR 'Kindergarten' OR 'Pre-k' OR 'Nursery' OR 'Pre-school' OR 'Pre-primary' OR 'Early Years Settings' OR 'Crèche' OR 'Day care' OR 'Childcare' OR 'Early Learning Cent*' OR 'Early Childhood Cent*' in the title.</p> <p>Considering diverse language and spelling-based differences across countries, Boolean modifiers include the asterisk (*) to append the root words 'Program' and 'Cent' to match alternative forms of these words (i.e., programs, programme, programmes, centre, center).</p> <hd id="AN0182844395-5">Inclusion Criteria</hd> <p>Papers pertaining to the provision of trauma awareness training in the ECEC profession were included in this review. The parameters for this review included journal articles where (i) participants were required to have a qualification in ECEC, (ii) papers were published over the last ten years (i.e., 2012–2022), (iii) papers were peer-reviewed, (iv) papers had educational perspectives at the epicentre, and (v) papers combined and appraised both national and international publications of effective trauma education, with an emphasis on professional practice and training. Papers were excluded if: (i) they were not published in English, (ii) they were in the format of book chapters, case papers, dissertations, conference abstracts, systematic reviews, review articles, meta-analyses, protocol papers or editorials, or (iii) the full text was not available.</p> <hd id="AN0182844395-6">Screening</hd> <p>The paper titles and abstracts retrieved from the initial search were concomitantly screened by two reviewers. In the initial search, 202 unique results were identified across the five electronic databases. Following the removal of duplications, the records of 180 (89%) titles and abstracts were screened, with 46 (23%) full-text papers deemed eligible for inclusion. After reviewing the full-text of potentially eligible papers, 36 papers were excluded due to either the incorrect publication type (i.e., systematic review, case study, or special issue article, <emph>n</emph> = 14), incorrect population cohort (<emph>n</emph> = 11), invalid research design (i.e., not focused on professional practice, <emph>n</emph> = 7), or inapplicable setting type (<emph>n</emph> = 4), resulting in 10 papers (5%) selected for inclusion (Fig. 1).</p> <p>Graph: Fig. 1 PRISMA 2009 flow diagram</p> <hd id="AN0182844395-7">Risk of Bias</hd> <p>The risk of bias in each included paper was independently assessed by two reviewers (CS and JB) using Cochrane's Quality Assessment Tool (Higgins et al., [<reflink idref="bib31" id="ref47">31</reflink>]), which includes six domains of bias: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other bias (Higgins et al., [<reflink idref="bib31" id="ref48">31</reflink>]), with two items to be evaluated within the 'selection bias' domain, yielding a total of seven items for quality consideration. Inter-rater reliability between reviewers was found to be > 90% across all seven domains. Procedural methods assigned a score of '0' if a paper was deemed to have no risk of bias, a score of '1' if a risk of bias was considered to be present, or 'NR' if the respective bias domain was not reported within the paper. A total score was calculated for each included paper by summing the scores assigned across the seven criteria. Papers with a risk of bias total score of ≤ 3 were classified as 'low risk of bias', those with a score between four and five inclusive were classified as a 'medium risk of bias', while those with a total score of ≥ 6 were classified as a 'high risk of bias' (maximum score = 7). Of the 10 papers selected for preliminary inclusion, all papers were classified as 'low risk of bias' and were included in the final review (Table 1).</p> <p>Table 1 Risk of bias assessment of included papers using Cochrane's quality assessment tool</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Papers</p></th><th align="left"><p>Random sequence generation</p></th><th align="left"><p>Allocation concealment</p></th><th align="left"><p>Blinding of participants and personnel</p></th><th align="left"><p>Blinding of outcome assessment</p></th><th align="left"><p>Incomplete outcome data</p></th><th align="left"><p>Selective reporting</p></th><th align="left"><p>Other bias</p></th><th align="left"><p>Total score</p></th><th align="left"><p>Bias classification</p></th></tr></thead><tbody><tr><td align="left"><p>Bilbrey et al., (<xref ref-type="bibr" rid="bibr12">2022</xref>)</p></td><td align="left"><p>1</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>3</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Conners Edge et al., (<xref ref-type="bibr" rid="bibr22">2022</xref>)</p></td><td align="left"><p>1</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>2</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>McClain, (<xref ref-type="bibr" rid="bibr41">2021</xref>)</p></td><td align="left"><p>1</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>3</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Loomis & Felt, (<xref ref-type="bibr" rid="bibr40">2020</xref>)</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>2</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Whitaker et al., (<xref ref-type="bibr" rid="bibr62">2019</xref>)</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Kanine et al., (<xref ref-type="bibr" rid="bibr35">2018</xref>)</p></td><td align="left"><p>1</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>3</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Stein et al., (<xref ref-type="bibr" rid="bibr56">2022</xref>)</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>3</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Kim et al., (<xref ref-type="bibr" rid="bibr36">2021</xref>)</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>3</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Pölkki & Vornanen, (<xref ref-type="bibr" rid="bibr51">2016</xref>)</p></td><td align="left"><p>1</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>3</p></td><td align="left"><p>Low</p></td></tr><tr><td align="left"><p>Hunter-Dehn, (<xref ref-type="bibr" rid="bibr33">2021</xref>)</p></td><td align="left"><p>1</p></td><td align="left"><p>1</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>1</p></td><td align="left"><p>0</p></td><td align="left"><p>0</p></td><td align="left"><p>3</p></td><td align="left"><p>Low</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>NR</emph> Not reported; <emph>0</emph> No risk of bias; <emph>1</emph> Risk of bias</p> <hd id="AN0182844395-8">Results</hd> <p></p> <hd id="AN0182844395-9">Study Characteristics</hd> <p>Table 2 presents the characteristics and associated intervention details of the 10 papers selected for inclusion in this review. While the search strategy screened papers within the previous 10 years (i.e., 2012–2022), the selected papers were conducted between 2016 and 2022 inclusive. Across all 10 papers, the sample size ranged from six (Hunter-Dehn, [<reflink idref="bib33" id="ref49">33</reflink>]) to 1,419 participants (Stein et al., [<reflink idref="bib56" id="ref50">56</reflink>]). Of these participants, eight papers included both males and females (i.e., Bilbrey et al., [<reflink idref="bib12" id="ref51">12</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref52">35</reflink>]; Kim et al., [<reflink idref="bib36" id="ref53">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref54">40</reflink>]; McClain, [<reflink idref="bib41" id="ref55">41</reflink>]; Pölkki & Vornanen, [<reflink idref="bib51" id="ref56">51</reflink>]; Stein et al., [<reflink idref="bib56" id="ref57">56</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref58">62</reflink>]), one study comprised of a female-only sample (Conners Edge et al., [<reflink idref="bib22" id="ref59">22</reflink>]), while one study did not disclose the gender of the study sample (Hunter-Dehn, [<reflink idref="bib33" id="ref60">33</reflink>]). Moreover, the study design varied from cross-sectional papers (<emph>n</emph> = 8), a control trial (<emph>n</emph> = 1), and a cluster randomised control trial (<emph>n</emph> = 1), with the methodological approaches comprising qualitative (<emph>n</emph> = 2) (Hunter-Dehn, [<reflink idref="bib33" id="ref61">33</reflink>]; McClain, [<reflink idref="bib41" id="ref62">41</reflink>]), quantitative (<emph>n</emph> = 5) (Bilbrey et al., [<reflink idref="bib12" id="ref63">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref64">22</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref65">35</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref66">40</reflink>]; Stein et al., [<reflink idref="bib56" id="ref67">56</reflink>]), and mixed-methods research designs (<emph>n</emph> = 3) (Kim et al., [<reflink idref="bib36" id="ref68">36</reflink>]; Pölkki & Vornanen, [<reflink idref="bib51" id="ref69">51</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref70">62</reflink>]).</p> <p>Table 2 Characteristics of included papers</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Author(s)</p></th><th align="left" rowspan="2"><p>Year</p></th><th align="left" rowspan="2"><p>Country</p></th><th align="left" rowspan="2"><p>Sample (<italic>N</italic>; M/F; Age[y])</p></th><th align="left" rowspan="2"><p>Target cohort</p></th><th align="left" rowspan="2"><p>Study design</p></th><th align="left" colspan="4"><p>Intervention information</p></th></tr><tr><th align="left"><p>Intervention</p></th><th align="left"><p>Recruitment</p></th><th align="left"><p>Retention</p></th><th align="left"><p>Duration</p></th></tr></thead><tbody><tr><td align="left"><p>Bilbrey et al.,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr12">2022</xref>)</p></td><td align="left"><p>USA</p></td><td align="left"><p><italic>N </italic>= 218;</p><p>M = 18;</p><p>F = 200;</p><p>Age = 30-40 years (27%), 41-50 years (25%), 51-60 years (24%)</p></td><td align="left"><p>Primary early education educators</p></td><td align="left"><p>Quantitative: cross-sectional study</p></td><td align="left"><p>NA</p></td><td align="left"><p>Invitation to superintendents</p></td><td align="left"><p>Survey responses: <italic>n</italic> = 256</p><p>Data cleaning: <italic>n </italic>= 218</p><p>Retention: = 85%</p></td><td align="left"><p>NA</p></td></tr><tr><td align="left"><p>Conners Edge et al.,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr22">2022</xref>)</p></td><td align="left"><p>USA</p></td><td align="left"><p><italic>N </italic>= 91;</p><p>M = 0;</p><p>F = 91;</p><p>Age = 18-25</p></td><td align="left"><p>Pre-K teachers</p></td><td align="left"><p>Quantitative: cross-sectional study</p></td><td align="left"><p>FIRST:ECE</p></td><td align="left"><p>State quality rating improvement system</p></td><td align="left"><p>Participants recruited:</p><p><italic>n</italic> = 91</p><p>Dropout: <italic>n</italic> = 3</p><p>Retention: = 96.5%</p></td><td align="left"><p>Two years</p></td></tr><tr><td align="left"><p>McClain,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr41">2021</xref>)</p></td><td align="left"><p>USA</p></td><td align="left"><p><italic>N </italic>= 15;</p><p>M = 2;</p><p>F = 108;</p><p>Age = 18-25</p></td><td align="left"><p>Early childhood teacher candidates (Pre-Service)</p></td><td align="left"><p>Quantitative: cross-sectional study</p></td><td align="left"><p>NA</p></td><td align="left"><p>In person recruitment via a junior-level seminar course</p></td><td align="left"><p>Participants recruited:</p><p><italic>n </italic>= 15</p><p>Survey responses: <italic>n</italic> = 14</p><p>Retention: = 93%</p></td><td align="left"><p>NA</p></td></tr><tr><td align="left"><p>Loomis & Felt,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr40">2020</xref>)</p></td><td align="left"><p>USA</p></td><td align="left"><p><italic>N </italic>= 111;</p><p>M = 3;</p><p>F = 108;</p><p>Age = 19-35</p></td><td align="left"><p>Preschool staff</p></td><td align="left"><p>Quantitative: cross-sectional study</p></td><td align="left"><p>Trauma informed training (RE-AIM Framework)</p></td><td align="left"><p>Email to all Head Start Programs</p><p>Flyer</p><p>On site recruitment</p></td><td align="left"><p>Survey responses: <italic>n </italic>= 149</p><p>Data cleaning: <italic>n</italic> = 38</p><p>Retention: = 74.5%</p></td><td align="left"><p>NR</p></td></tr><tr><td align="left"><p>Whitaker et al.,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr62">2019</xref>)</p></td><td align="left"><p>USA</p></td><td align="left"><p><italic>N </italic>= 96</p><p>(INT = 48,</p><p>CON = 48);</p><p>M = 3;</p><p>F = 93;</p><p>Age = ≥ 40 years</p></td><td align="left"><p>Preschool teachers</p></td><td align="left"><p>Mixed methods: cluster randomised control trial</p></td><td align="left"><p>Enhancing trauma awareness course</p></td><td align="left"><p>NR</p></td><td align="left"><p>(INT) Participants recruited: <italic>n </italic>= 48</p><p>Dropout:<italic> n</italic> = 1</p><p>Retention: = 97.9%</p><p>(CON) Participants recruited: <italic>n </italic>= 48</p><p>Dropout: <italic>n </italic>= 2</p><p>Retention: = 95.8%</p></td><td align="left"><p>12 weeks</p></td></tr><tr><td align="left"><p>Kanine et al.,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr35">2018</xref>)</p></td><td align="left"><p>USA</p></td><td align="left"><p><italic>N </italic>= 16</p><p>(INT = 8,</p><p>CON = 8);</p><p>M = 3;</p><p>F = 5;</p><p>Age = (Mean 40.38 years)</p></td><td align="left"><p>Preschool teachers</p></td><td align="left"><p>Quantitative: quasi-experimental/non-randomised study</p></td><td align="left"><p>Teacher-child interaction training (TCIT)</p></td><td align="left"><p>NR</p></td><td align="left"><p>Participants recruited:</p><p><italic>n</italic> = 8</p><p>Dropout: <italic>n </italic>= 1</p><p>Retention: = 87.5%</p></td><td align="left"><p>12 weeks</p></td></tr><tr><td align="left"><p>Stein et al.,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr56">2022</xref>)</p></td><td align="left"><p>USA</p></td><td align="left"><p><italic>N</italic> = 1419;</p><p>F = 1355</p><p>M = 47</p><p>Other = 17</p><p>Age = NR</p></td><td align="left"><p>Early Childhood Educators</p></td><td align="left"><p>Quantitative</p></td><td align="left"><p>NA</p></td><td align="left"><p>Email to all registrants of the Professional Development Information System (PDIS) database</p></td><td align="left"><p>NR</p></td><td align="left"><p>NA</p></td></tr><tr><td align="left"><p>Kim et al.,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr36">2021</xref>)</p></td><td align="left"><p>Canada</p></td><td align="left"><p><italic>N </italic>= 112;</p><p>(INT = 71,</p><p>CON = 41);</p><p>M = 7;</p><p>F = 105;</p><p>Age = NR</p></td><td align="left"><p>Educators</p></td><td align="left"><p>Mixed methods: control trial</p></td><td align="left"><p>Trauma Informed Training</p><p>· MindUP</p></td><td align="left"><p>NR</p></td><td align="left"><p>Participants recruited:</p><p><italic>n </italic>= 112</p><p>Participants lost to school transfer: <italic>n </italic>= 9</p><p>· Retention: = 92%</p></td><td align="left"><p>Three years</p></td></tr><tr><td align="left"><p>Pölkki & Vornanen,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr51">2016</xref>)</p></td><td align="left"><p>Finland</p></td><td align="left"><p><italic>N </italic>= 70;</p><p>ECEC: <italic>N </italic>= 26</p><p>M = 2;</p><p>F = 24;</p><p>Age = NR</p><p>Children:</p><p><italic>N</italic> = 103</p><p>M = 53</p><p>F = 50</p><p>Age = 1-6 years</p></td><td align="left"><p>Early Childhood Education & Care staff</p><p>Children in Child Welfare</p></td><td align="left"><p>Mixed methods</p></td><td align="left"><p>NA</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>NA</p></td></tr><tr><td align="left"><p>Hunter-Dehn,</p></td><td align="left"><p>(<xref ref-type="bibr" rid="bibr33">2021</xref>)</p></td><td align="left"><p>New Zealand</p></td><td align="left"><p><italic>N </italic>= 6;</p><p>Children: <italic>N </italic>= 6</p><p>Age = 5-7 years</p><p>Riroriro Teachers:</p><p><italic>N</italic> = NR</p><p>Gender = NR</p><p>Age = NR</p></td><td align="left"><p>Teachers</p><p>Preschool Children</p></td><td align="left"><p>Qualitative</p></td><td align="left"><p>Trauma-informed transition model: Riroriro</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>One year</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>N</emph> Number; <emph>M</emph> Male; <emph>F</emph> Female; <emph>y</emph> Year; <emph>NR</emph> Not Reported; <emph>NA</emph> Not Applicable; <emph>INT</emph> Intervention Group; <emph>CON</emph> Control Group</p> <hd id="AN0182844395-10">Trauma Awareness Training: International Context</hd> <p>Based on the extensive database search that yielded limited empirical data from a mere four countries across three continents, the evidence suggests that trauma awareness training across the ECEC sector internationally is low. Ten papers, emerging from four countries, housed on three continents (i.e., North America, Europe, and Oceania), conformed to the inclusion criteria and reported on the current provisions of trauma awareness in ECEC environments. From an international standpoint, seven of the included papers were conducted in the United States (Bilbrey et al., [<reflink idref="bib12" id="ref71">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref72">22</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref73">35</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref74">40</reflink>]; McClain, [<reflink idref="bib41" id="ref75">41</reflink>]; Stein et al., [<reflink idref="bib56" id="ref76">56</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref77">62</reflink>]), while the remaining papers were conducted in Canada (Kim et al., [<reflink idref="bib36" id="ref78">36</reflink>]), Finland (Pölkki & Vornanen, [<reflink idref="bib51" id="ref79">51</reflink>]), and New Zealand (Hunter-Dehn, [<reflink idref="bib33" id="ref80">33</reflink>]). It warrants a mention that this review of the extant literature in this domain was purposely confined to papers written in English; therefore, it is plausible that there may be some relevant papers from non-English speaking countries that were not selected as part of the review process. That being said, if this was the case, such papers were also not noted in the reference list of the 10 papers selected for inclusion in this review.</p> <hd id="AN0182844395-11">Intervention Information</hd> <p>Although an intervention was not deemed integral to the eligibility criteria, nor was it specified as a critical feature in the scope of this review, six of the 10 included papers evaluated a trauma-related intervention with ECEC practitioners (Conners Edge et al., [<reflink idref="bib22" id="ref81">22</reflink>]; Hunter-Dehn, [<reflink idref="bib33" id="ref82">33</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref83">35</reflink>]; Kim et al., [<reflink idref="bib36" id="ref84">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref85">40</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref86">62</reflink>]), two papers explored the existing trauma-related knowledge and skills of ECEC practitioners (i.e., Bilbrey et al., [<reflink idref="bib12" id="ref87">12</reflink>]; McClain, [<reflink idref="bib41" id="ref88">41</reflink>]), one paper investigated early childhood mental health, educator stress, and burnout (Stein et al., [<reflink idref="bib56" id="ref89">56</reflink>]) while one paper examined if children in welfare's needs are fulfilled in day care services (Pölkki & Vornanen, [<reflink idref="bib51" id="ref90">51</reflink>]). The breadth of interventions reported are extensive, and include the Enhancing Trauma Awareness (ETA) course (Whitaker et al., [<reflink idref="bib62" id="ref91">62</reflink>]), MindUp delivery (Kim et al., [<reflink idref="bib36" id="ref92">36</reflink>]), the Trauma-Informed Transition Model: Riroriro (Hunter-Dehn, [<reflink idref="bib33" id="ref93">33</reflink>]), Trauma Informed Training (RE-AIM Framework) (Loomis & Felt, [<reflink idref="bib40" id="ref94">40</reflink>]), Teacher-Child Interaction Training (TCIT) (Kanine et al., [<reflink idref="bib35" id="ref95">35</reflink>]), and the Fostering Informed and Responsive Systems for Trauma in Early Care and Education (FIRST:ECE) (Conners Edge et al., [<reflink idref="bib22" id="ref96">22</reflink>]). Moreover, the interventions varied in duration, with two papers providing training over a 12-week period (Kanine et al., [<reflink idref="bib35" id="ref97">35</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref98">62</reflink>]), three papers implementing training ≥ 1 year (Conners Edge et al., [<reflink idref="bib22" id="ref99">22</reflink>]; Hunter-Dehn, [<reflink idref="bib33" id="ref100">33</reflink>]; Kim et al., [<reflink idref="bib36" id="ref101">36</reflink>]), while one paper did not report the duration of the intervention (Loomis & Felt, [<reflink idref="bib40" id="ref102">40</reflink>]) (Table 2).</p> <hd id="AN0182844395-12">Evaluation Method/Assessment Tool</hd> <p>Participant data were measured through a varied profile of assessment tools, comprising both validated (Bilbrey et al., [<reflink idref="bib12" id="ref103">12</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref104">35</reflink>]; Kim et al., [<reflink idref="bib36" id="ref105">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref106">40</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref107">62</reflink>]) and original (Conners Edge et al., [<reflink idref="bib22" id="ref108">22</reflink>]; McClain, [<reflink idref="bib41" id="ref109">41</reflink>]; Pölkki & Vornanen, [<reflink idref="bib51" id="ref110">51</reflink>]; Stein et al., [<reflink idref="bib56" id="ref111">56</reflink>]) evaluation measures. In total, 14 diverse and area-specific assessment methods were embedded across the 10 papers, which evaluated a range of pedagogical, theoretical, and practical outcomes (i.e., attitudes, knowledge, skills, confidence, self-reflection, and stress). Table 3 presents the outcomes and results of the selected papers in this review, with a comprehensive outline of each (i) instrument, (ii) area of assessment, (iii) scale variables, and (v) sub-scale domain information. A common methodological approach was shared by the three mixed-methods papers (Kim et al., [<reflink idref="bib36" id="ref112">36</reflink>]; Pölkki & Vornanen, [<reflink idref="bib51" id="ref113">51</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref114">62</reflink>]) in that focus groups and surveys were conducted, utilising the Student-Teacher Relationship Scale (Whitaker et al., [<reflink idref="bib62" id="ref115">62</reflink>]), as well as the Attitudes Related to Trauma Informed Care (ARTIC) Scale and the Maslach Burnout Inventory (MBI) scale (Kim et al., [<reflink idref="bib36" id="ref116">36</reflink>]). Those papers that adopted a quantitative design (i.e., Bilbrey et al., [<reflink idref="bib12" id="ref117">12</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref118">35</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref119">40</reflink>]; Stein et al., [<reflink idref="bib56" id="ref120">56</reflink>]) used a similar line of assessment scales, such as the ARTIC Scale, the Single-Item Stress Questionnaire (SISQ), the Preschool Expulsion Risk Measure (PERM) Scale (Loomis & Felt, [<reflink idref="bib40" id="ref121">40</reflink>]), the Devereux Early Childhood Assessment-Clinical Form (DECA) Scale, the Total Protective Factors (TPF) Scale, the Behavioral Concerns (BC) Scale, the Dyadic Parent-Child Interaction Coding System (DPICS-IV) (Kanine et al., [<reflink idref="bib35" id="ref122">35</reflink>]), and the Primary Early Childhood Educators-Trauma Informed Care Knowledge Confidence Relationship Building (PECE-TICKCR) (Bilbrey et al., [<reflink idref="bib12" id="ref123">12</reflink>]) assessment tool.</p> <p>Table 3 Outcome and results of included papers</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Author(s) & Year</p></th><th align="left"><p>Aspect within trauma variable</p></th><th align="left"><p>Instrument</p></th><th align="left"><p>Area of assessment</p></th><th align="left"><p>Scale variables</p></th><th align="left"><p>Sub-scale domain</p></th><th align="left"><p>Pre-intervention (Mean)</p></th><th align="left"><p>Post-intervention (Mean)</p></th><th align="left"><p>Findings</p></th></tr></thead><tbody><tr><td align="left" colspan="9"><p>Trauma training and experience</p></td></tr><tr><td align="left"><p> Whitaker et al., (<xref ref-type="bibr" rid="bibr62">2019</xref>)</p></td><td align="left"><p>Trauma Awareness Training: Perceptions of conflict</p></td><td align="left"><p>Student-Teacher Relationship Scale</p><p>Focus groups</p><p>(<italic>n</italic> = 3)</p></td><td align="left"><p>Teacher-child conflict</p></td><td align="left"><p>8 item scale:</p></td><td align="left"><p>NA</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>CPD training did not decrease teacher's perceptions of conflict with children (<italic>p </italic>=.36)</p><p>No statistically significant quantitative findings</p></td></tr><tr><td align="left"><p> Stein et al., (<xref ref-type="bibr" rid="bibr56">2022</xref>)</p></td><td align="left"><p>Childhood Mental Health, Stress, and Burnout</p></td><td align="left"><p>Survey</p></td><td align="left"><p>Educator stress and burnout: factors and Implications</p></td><td align="left"><p>15 items</p></td><td align="left"><p>Training & experience</p><p>preparedness</p><p>ECE mental health</p><p>ECEC mental health, stress & burnout</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>ECE's with childhood mental health training during IPE were statistically more confident in recognising the signs of child mental health (<italic>p</italic> <.001)</p><p>66% of educators (<italic>n </italic>= 936) had experience working with children with trauma</p></td></tr><tr><td align="left" colspan="9"><p>Trauma-informed knowledge</p></td></tr><tr><td align="left"><p> Bilbrey et al., (<xref ref-type="bibr" rid="bibr12">2022</xref>)</p></td><td align="left"><p>Knowledge and training</p></td><td align="left"><p>PECE-TICKR scale</p></td><td align="left"><p>Knowledge, self-efficacy, awareness & training</p></td><td align="left"><p>24 items: likert scale</p></td><td align="left"><p>NA</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>Teachers require further knowledge about community resources</p></td></tr><tr><td align="left"><p> Conners Edge et al., (<xref ref-type="bibr" rid="bibr22">2022</xref>)</p></td><td align="left"><p>Knowledge</p></td><td align="left"><p>Original to respective study (Survey 1, α = 0.92; Survey 2, α = 0.87)</p></td><td align="left"><p>Knowledge gain</p></td><td align="left"><p>6 items</p></td><td align="left"><p>NA</p></td><td align="left"><p>2.37</p><p>2.23</p></td><td align="left"><p>3.69</p><p>3.67</p></td><td align="left"><p>*↑in General Trauma Knowledge (<italic>p</italic> <.001)</p><p>*↑in Knowledge of TI Schools (<italic>p</italic> <.001)</p></td></tr><tr><td align="left"><p> Loomis & Felt, (<xref ref-type="bibr" rid="bibr40">2020</xref>)</p></td><td align="left"><p>Knowledge, Skills and Self-reflection</p></td><td align="left"><p>ARTIC scale</p><p>PERM scale</p><p>SISQ</p></td><td align="left"><p>TI attitudes</p></td><td align="left"><p>35 items: 5 sub-scales</p><p>12 items: 4 sub-scales</p><p>Statements - Likert scale</p></td><td align="left"><p>Stated above</p><p>Classroom disruption, Fear of accountability, Hopelessness, and Teacher stress</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>*↑in TI attitudes with TI Self-only training</p><p>(<italic>p</italic> =.014) and Self+Skill training (p =.001)</p><p>Significant correlation between children's stress and teacher's trauma knowledge</p><p>(<italic>p</italic> <.05)</p><p>Teachers with higher TI attitudes reported lower child-related stress (<italic>p</italic> <.001)</p></td></tr><tr><td align="left" colspan="9"><p>Therapeutic training</p></td></tr><tr><td align="left"><p> Kanine et al., (<xref ref-type="bibr" rid="bibr35">2018</xref>)</p></td><td align="left"><p>Teacher-Child Interaction Training</p></td><td align="left"><p>DECA-C</p><p>TPF scale</p><p>Behavioural concerns scale</p></td><td align="left"><p>Child behaviour</p><p>Social-emotional competence</p></td><td align="left"><p>62 items</p><p>3 domains</p><p>3 domains</p></td><td align="left"><p>NA</p><p>Initiative, self-control, attachment</p><p>Withdrawal, emotional control problems, aggression</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>*↑in children's social-emotional skills</p><p>(<italic>p</italic> <.001)</p><p>*↓in overall behavioural concerns (<italic>p</italic> =.02)</p></td></tr><tr><td align="left"><p> Hunter-Dehn, (<xref ref-type="bibr" rid="bibr33">2021</xref>)</p></td><td align="left"><p>Trauma-Informed Transition Model: Riroriro</p></td><td align="left"><p>Semi-structured interviews</p></td><td align="left"><p>Emotional regulation skills</p><p>Social/interpersonal skills</p><p>Academic achievement.</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>↑in children's ability to verbalise emotions</p><p>↑in children's use of calming tools and techniques post intervention</p><p>↑in children's interpersonal skills; recognising fault and displaying empathy post intervention</p></td></tr><tr><td align="left" colspan="9"><p>Stress and burnout</p></td></tr><tr><td align="left"><p> Kim et al., (<xref ref-type="bibr" rid="bibr36">2021</xref>)</p></td><td align="left"><p>Burnout</p></td><td align="left"><p>MBI scale</p></td><td align="left"><p>Educators burnout levels</p></td><td align="left"><p>18 item Likert scale: 2 sub-scales</p></td><td align="left"><p>Emotional exhaustion</p><p>Personal accomplishment</p></td><td align="left"><p>6.8</p></td><td align="left"><p>7.6</p></td><td align="left"><p>*↓in emotional exhaustion rates among the <italic>involved-once</italic> group only (<italic>p</italic> =.021), with no change among the comparison and <italic>involved twice</italic> group</p></td></tr><tr><td align="left"><p> Whitaker et al., (<xref ref-type="bibr" rid="bibr62">2019</xref>)</p></td><td align="left"><p>Emotional exhaustion, Sleep quality, Secondary traumatic stress</p></td><td align="left"><p>Survey</p></td><td align="left"><p>NR</p></td><td align="left"><p>3 outcome domains</p></td><td align="left"><p>Relational capacities, health & well-being, and Relationship quality</p></td><td align="left"><p>1.8</p><p>2.9</p><p>51.2</p></td><td align="left"><p>1.7</p><p>2.8</p><p>52.1</p></td><td align="left"><p>No significant decrease in emotional exhaustion (<italic>p</italic> =.93)</p><p>No significant increase in sleep quality</p><p>(<italic>p </italic>=.78)</p><p>No significant decrease in secondary traumatic stress (<italic>p</italic> =.07)</p></td></tr><tr><td align="left"><p> Stein et al., (<xref ref-type="bibr" rid="bibr56">2022</xref>)</p></td><td align="left"><p>Stress and Burnout</p></td><td align="left"><p>Survey</p></td><td align="left"><p>Educator stress and burnout</p></td><td align="left"><p>15 items</p></td><td align="left"><p>Stated above</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>Factors to prevent burnout were (i) relational connections and mental health supports and (ii) the need for systemic change</p></td></tr><tr><td align="left"><p> Pölkki & Vornanen, (<xref ref-type="bibr" rid="bibr51">2016</xref>)</p></td><td align="left"><p>Childrens' behaviour</p></td><td align="left"><p>Interview</p></td><td align="left"><p>Child welfare childrens' needs and behaviours</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>Day care staff felt stressed when discussing child welfare notifications and parenting skills with parents</p><p>The ratio of day care staff-child welfare children caused stress among the staff</p></td></tr><tr><td align="left" colspan="9"><p>Behaviours</p></td></tr><tr><td align="left"><p> Kim et al., (<xref ref-type="bibr" rid="bibr36">2021</xref>)</p></td><td align="left"><p>Attitudes</p></td><td align="left"><p>ARTIC scale</p></td><td align="left"><p>TI attitudes</p></td><td align="left"><p>35 items: 5 sub-scales</p></td><td align="left"><p>Causes, responses, behaviour, self-efficacy, & reactions</p></td><td align="left"><p>5.67</p><p>5.34</p><p>5.49</p></td><td align="left"><p>5.82</p><p>5.48</p><p>5.61</p></td><td align="left"><p>*↑in Self-efficacy (<italic>p</italic> <.05), Overall (<italic>p</italic> <.05), and Reactions (<italic>p</italic> <.05) after 2 years of MindUp training</p></td></tr><tr><td align="left"><p> Loomis & Felt, (<xref ref-type="bibr" rid="bibr40">2020</xref>)</p></td><td align="left"><p>Attitudes</p></td><td align="left"><p>ARTIC scale</p></td><td align="left"><p>TI attitudes</p></td><td align="left"><p>35 items: 5 sub-scales</p></td><td align="left"><p>Stated above</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>*↑in TI attitudes from the Skill+Self (<italic>p</italic> =.001) group compared to Skill only (<italic>p</italic> =.003)</p></td></tr><tr><td align="left"><p> Kanine et al., (<xref ref-type="bibr" rid="bibr35">2018</xref>)</p></td><td align="left"><p>Positive teacher behaviours</p></td><td align="left"><p>DPICS-IV</p></td><td align="left"><p>Behavioural coding system</p></td><td align="left"><p>25-minute videotaping: 5 coding categories</p></td><td align="left"><p>Behavioural descriptions, reflections, labelled praise, negative talk, questions</p></td><td align="left"><p>NR</p><p>0.31</p><p>1.44</p></td><td align="left"><p>NR</p><p>5.82</p><p>5.27</p></td><td align="left"><p>↓in Avoid skills (Questions & Negative talk) by a range of 22% to 81%</p><p>↑in labelled praise from the intervention group</p><p>↑in Reflections from the intervention group</p></td></tr><tr><td align="left"><p> Pölkki & Vornanen, (<xref ref-type="bibr" rid="bibr51">2016</xref>)</p></td><td align="left"><p>Childrens' behaviour</p></td><td align="left"><p>Interview</p></td><td align="left"><p>Child welfare childrens' needs and behaviours</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>Day care staff recognised psycho-social behaviours including; aggression, lack of trust, withdrawn, and joyless among child welfare children in ECEC</p></td></tr><tr><td align="left" colspan="9"><p>Readiness</p></td></tr><tr><td align="left"><p> McClain, (<xref ref-type="bibr" rid="bibr41">2021</xref>)</p></td><td align="left"><p>Preparedness</p></td><td align="left"><p>Qualitative survey</p></td><td align="left"><p>Teachers preparedness</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>Teachers feel "some- what" prepared to support children who experience trauma</p><p>Only 13% (<italic>n </italic>= 2) reported being knowledgeable about targeted strategies and tools when teaching students who have experienced trauma</p></td></tr><tr><td align="left"><p> Stein et al., (<xref ref-type="bibr" rid="bibr56">2022</xref>)</p></td><td align="left"><p>Preparedness</p></td><td align="left"><p>Survey</p></td><td align="left"><p>Childhood mental health</p></td><td align="left"><p>15 items</p></td><td align="left"><p>Stated above</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>42.8% (<italic>n</italic> = 607) of early childhood educators felt confident in recognising mental health needs in young children</p></td></tr><tr><td align="left"><p> Bilbrey et al., (<xref ref-type="bibr" rid="bibr12">2022</xref>)</p></td><td align="left"><p>Confidence</p></td><td align="left"><p>PECE-TICKR Scale</p></td><td align="left"><p>Stated above</p></td><td align="left"><p>24 items: Likert scale</p></td><td align="left"><p>NA</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>Teachers confident in providing Supportive relationships (<italic>p</italic> <.01)</p></td></tr><tr><td align="left" colspan="9"><p>Relationships</p></td></tr><tr><td align="left"><p> Kanine et al., (<xref ref-type="bibr" rid="bibr35">2018</xref>)</p></td><td align="left"><p>Relationships (PRIDE skills)</p></td><td align="left"><p>DPICS-IV</p></td><td align="left"><p>Teacher behaviour</p></td><td align="left"><p>62-item: Likert scale</p></td><td align="left"><p>NA</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>Correlation between the confidence in providing TI strategies and confidence in providing supportive relationships (<italic>p</italic> =.01)</p></td></tr><tr><td align="left"><p> Bilbrey et al., (<xref ref-type="bibr" rid="bibr12">2022</xref>)</p></td><td align="left"><p>Supportive relationships</p></td><td align="left"><p>PECE-TICKR Scale</p></td><td align="left"><p>Stated above</p></td><td align="left"><p>24 items: Likert scale</p></td><td align="left"><p>NA</p></td><td align="left"><p>NR</p></td><td align="left"><p>NR</p></td><td align="left"><p>*↑Teachers confident in providing supportive relationships (<italic>p</italic> <.01)</p></td></tr><tr><td align="left"><p> Conners Edge et al., (<xref ref-type="bibr" rid="bibr24">2022</xref>)</p></td><td align="left"><p>Relationship building strategies</p></td><td align="left"><p>Original to respective study (Survey 1, α=0.92; Survey 2, α=0.87)</p></td><td align="left"><p>Frequency of TI strategies</p></td><td align="left"><p>4 outcome domains</p></td><td align="left"><p>Building relationships, Feelings identification, Self-regulation, Crisis plan</p></td><td align="left"><p>2.52</p><p>2.73</p><p>2.76</p><p>2.28</p></td><td align="left"><p>3.20</p><p>3.29</p><p>3.49</p><p>2.93</p></td><td align="left"><p>*↑ in use of relationship-building strategies</p><p>(<italic>p</italic> <.001)</p><p>*↑ in supporting feelings identification</p><p>(<italic>p</italic> <.001)</p><p>*↑ in practicing self-regulation (<italic>p</italic> <.001)</p><p>*↑ in utilizing a crisis plan (<italic>p</italic> <.001)</p></td></tr><tr><td align="left"><p> Whitaker et al., (<xref ref-type="bibr" rid="bibr62">2019</xref>)</p></td><td align="left"><p>Relational quality</p><p>→relational trust</p><p>Relational capacity</p><p>→increased compassion satisfaction</p></td><td align="left"><p>Survey</p><p>Focus groups</p></td><td align="left"><p>Effect of the intervention</p></td><td align="left"><p>3 outcome domains</p></td><td align="left"><p>Stated above</p></td><td align="left"><p>NR</p><p>NR</p></td><td align="left"><p>NR</p><p>NR</p></td><td align="left"><p>No statistically significant effect of ETA training on relational trust (<italic>p</italic> =.97)</p><p>No statistically significant effect of ETA training on increased compassion satisfaction (<italic>p</italic> =.56)</p><p>Qualitative findings suggest the potential for improved teacher-child relationship quality</p></td></tr><tr><td align="left"><p> Hunter-Dehn, (<xref ref-type="bibr" rid="bibr33">2021</xref>)</p></td><td align="left"><p>Trauma-Informed Transition Model: Riroriro</p></td><td align="left"><p>Semi-structured Interviews</p></td><td align="left"><p>Stated above</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>NA</p></td><td align="left"><p>↑ in children's ability to build relationships with peers, post intervention</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>NA</emph> Not Applicable; <emph>NR</emph> Not Reported *↑statistically significant increase; *↓statistically significant decrease; ↑increase; ↓decrease</p> <hd id="AN0182844395-13">Study Themes</hd> <p>The papers selected for inclusion were grouped into three overarching categories; (i) Initial Practitioner Education (IPE) (McClain, [<reflink idref="bib41" id="ref124">41</reflink>]; Stein et al., [<reflink idref="bib56" id="ref125">56</reflink>]), (ii) Continuous Professional Development (CPD) programmes (Bilbrey et al., [<reflink idref="bib12" id="ref126">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref127">22</reflink>]; Hunter-Dehn, [<reflink idref="bib33" id="ref128">33</reflink>]; Kim et al., [<reflink idref="bib36" id="ref129">36</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref130">62</reflink>]), and (iii) professional practice (Bilbrey et al., [<reflink idref="bib12" id="ref131">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref132">22</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref133">35</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref134">40</reflink>]; McClain, [<reflink idref="bib41" id="ref135">41</reflink>]; Pölkki & Vornanen, [<reflink idref="bib51" id="ref136">51</reflink>]; Stein et al., [<reflink idref="bib56" id="ref137">56</reflink>]). Precisely, the review further catagorised the results into three emerging themes, namely (i) training, (ii) vicarious trauma, and (iii) relationships (Table 4). The convergence of these lines of inquiry are evident across the selected papers. Specifically, all 10 papers heavily feature practitioner training as an avenue for increased trauma awareness trajectories in ECEC settings, thus generating the first theme of this review. In addition, a common thread was identified between the intersectionality of trauma experienced by children and vicarious trauma in ECEC practitioners. This strand was evident among four of the training-based papers (i.e., Kim et al., [<reflink idref="bib36" id="ref138">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref139">40</reflink>]; Stein et al., [<reflink idref="bib56" id="ref140">56</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref141">62</reflink>]), with a concurrent pattern emanating/presenting between practitioner training, or lack thereof, and the associative nature with vicarious trauma causing practitioner burnout. Given that some papers within this review address the graded relationship between trauma and elevated stress levels among practitioners (Kim et al., [<reflink idref="bib36" id="ref142">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref143">40</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref144">62</reflink>]), vicarious trauma emerged as the second emergent theme. Finally, the conceptualisation that responsive relationships are instrumental in mitigating against trauma is a narrative that connected five of the papers (Bilbrey et al., [<reflink idref="bib12" id="ref145">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref146">22</reflink>]; Hunter-Dehn, [<reflink idref="bib33" id="ref147">33</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref148">35</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref149">62</reflink>]), thus emerging as the third and final theme within this review. The selected papers are thematically presented with cross examination of commonalities and contrasts.</p> <p>Table 4 Cross-examination of categories and themes of included papers</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Author</p></th><th align="left"><p>Overarching category: IPE</p></th><th align="left"><p>Overarching category: CPD</p></th><th align="left"><p>Overarching category: practice</p></th><th align="left"><p>Theme: relationships</p></th><th align="left"><p>Theme: vicarious trauma</p></th><th align="left"><p>Theme: training</p></th></tr></thead><tbody><tr><td align="left"><p>Bilbrey et al., (<xref ref-type="bibr" rid="bibr12">2022</xref>)</p></td><td align="left" /><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td char="." align="left" /><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Conners Edge et al., (<xref ref-type="bibr" rid="bibr22">2022</xref>)</p></td><td char="." align="left" /><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td align="left" /><td align="left"><p>X</p></td></tr><tr><td align="left"><p>McClain, (<xref ref-type="bibr" rid="bibr41">2021</xref>)</p></td><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td char="." align="left" /><td char="." align="left" /><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Loomis & Felt, (<xref ref-type="bibr" rid="bibr40">2020</xref>)</p></td><td char="." align="left" /><td char="." align="left" /><td align="left"><p>X</p></td><td char="." align="left" /><td align="left"><p>X</p></td><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Whitaker et al., (<xref ref-type="bibr" rid="bibr62">2019</xref>)</p></td><td char="." align="left" /><td align="left"><p>X</p></td><td char="." align="left" /><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Kanine et al., (<xref ref-type="bibr" rid="bibr35">2018</xref>)</p></td><td align="left" /><td char="." align="left" /><td align="left"><p>X</p></td><td align="left"><p>X</p></td><td align="left" /><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Stein et al., (<xref ref-type="bibr" rid="bibr56">2022</xref>)</p></td><td align="left"><p>X</p></td><td align="left" /><td align="left"><p>X</p></td><td align="left" /><td align="left"><p>X</p></td><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Kim et al., (<xref ref-type="bibr" rid="bibr36">2021</xref>)</p></td><td align="left" /><td align="left"><p>X</p></td><td align="left" /><td align="left" /><td align="left"><p>X</p></td><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Pölkki & Vornanen, (<xref ref-type="bibr" rid="bibr51">2016</xref>)</p></td><td char="." align="left" /><td char="." align="left" /><td align="left"><p>X</p></td><td char="." align="left" /><td char="." align="left" /><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Hunter-Dehn, (<xref ref-type="bibr" rid="bibr33">2021</xref>)</p></td><td char="." align="left" /><td align="left"><p>X</p></td><td char="." align="left" /><td align="left"><p>X</p></td><td align="left" /><td align="left"><p>X</p></td></tr><tr><td align="left"><p>Total</p></td><td align="left"><p>2/10</p></td><td align="left"><p>6/10</p></td><td align="left"><p>7/10</p></td><td align="left"><p>5/10</p></td><td align="left"><p>4/10</p></td><td align="left"><p>10/10</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0182844395-14">Discussion</hd> <p>This scoping review addresses research on the provision of trauma awareness training in the Early Childhood Education and Care (ECEC) profession, globally. Within the literature base, the efficacy and impact of trauma-focused interventions is well established (Bilbrey et al., [<reflink idref="bib12" id="ref150">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref151">22</reflink>]; Hender-Dehn, [<reflink idref="bib33" id="ref152">33</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref153">35</reflink>]; Kim et al., [<reflink idref="bib36" id="ref154">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref155">40</reflink>]). However, this review found that, to date, there appears to be (i) a paucity of ECEC trauma awareness training on an international scale, (ii) a lack of a universal measure to evaluate trauma-focused interventions in an ECEC context, and (iii) a lack of clarity about the most effective and impactful intervention design (i.e., duration, content, and assessment tool) to ensure positive, and meaningful trauma-related outcomes.</p> <hd id="AN0182844395-15">International Context</hd> <p>The span of papers selected for inclusion within this review were geographically myopic. Following the PRISMA screening process (Liberati et al., [<reflink idref="bib39" id="ref156">39</reflink>]) and pre-determined eligibility criteria, all included papers (<emph>N</emph> = 10) were limited to research conducted in four countries only: the USA (Bilbrey et al., [<reflink idref="bib12" id="ref157">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref158">22</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref159">35</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref160">40</reflink>]; McClain, [<reflink idref="bib41" id="ref161">41</reflink>]; Stein et al., [<reflink idref="bib56" id="ref162">56</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref163">62</reflink>]), Canada (Kim et al., [<reflink idref="bib36" id="ref164">36</reflink>]), Finland (Pölkki & Vornanen, [<reflink idref="bib51" id="ref165">51</reflink>]), and New Zealand (Hunter-Dehn, [<reflink idref="bib33" id="ref166">33</reflink>]). While it is important that some countries have recognised the interconnectedness between childhood trauma and ECEC environments, this review highlights that efforts to address this discourse on an international scale are critically scarce. Explanations as to what may contribute to the relative paucity of international trauma provisions are currently unknown, which is particularly surprising given that researchers around the globe have concurrently documented the reverberations of childhood trauma (Hughes et al., [<reflink idref="bib32" id="ref167">32</reflink>]; UNICEF, [<reflink idref="bib59" id="ref168">59</reflink>]). However, there are ample demonstrations globally of trauma-related research that did not meet the scope and selection criteria of this review, which offer contextual and relational aspects that broaden the current international findings. For example, although $748 billion of annual government expenditure is directly attributed to ACEs in North America (Bellis et al., [<reflink idref="bib10" id="ref169">10</reflink>]), one study that examined the impact of child abuse and violence in East Asia and Pacific countries found that the cost of childhood maltreatment was $209 billion (UNICEF, [<reflink idref="bib59" id="ref170">59</reflink>]), similar to reports on the total ACE-attributable cost across 28 European countries, which ranged from $1 billion (Montenegro) to $129.4 billion (Germany) (Hughes et al., [<reflink idref="bib32" id="ref171">32</reflink>]). Moreover, in a global context, aggregate data from cross-cultural studies examining the prevalence of childhood trauma revealed that 41% (<emph>N</emph> = 6,500,000) of Australian adults experience at least one traumatic event in early childhood (Barrett, [<reflink idref="bib7" id="ref172">7</reflink>]), 52% (<emph>N</emph> = 1,396,545) of children in Denmark experience at least one ACE (Bager et al., [<reflink idref="bib5" id="ref173">5</reflink>]), 58% (<emph>N</emph> = 2,122) of children in Latin America and the Caribbean experience some form of abuse annually (Devries et al., [<reflink idref="bib24" id="ref174">24</reflink>]), while a college-student cohort study in China found that 64.7% (<emph>N</emph> = 6,820) experienced childhood maltreatment (Fu et al., [<reflink idref="bib26" id="ref175">26</reflink>]).</p> <p>Given the empirical evidence on the prevalence and financial burden of trauma in Australia (Barrett, [<reflink idref="bib7" id="ref176">7</reflink>]), Latin America and the Caribbean (Devries et al., [<reflink idref="bib24" id="ref177">24</reflink>]; UNICEF, [<reflink idref="bib60" id="ref178">60</reflink>]), Europe (Hughes et al., [<reflink idref="bib32" id="ref179">32</reflink>]) Asia-Pacific (UNICEF, [<reflink idref="bib59" id="ref180">59</reflink>]), China (Fu et al., [<reflink idref="bib26" id="ref181">26</reflink>]), and Denmark (Bager et al., [<reflink idref="bib5" id="ref182">5</reflink>]), it is astounding that the current review identified no indication of trauma-based interventions to combat this trajectory. Interestingly, the Economist Intelligence Unit ([<reflink idref="bib21" id="ref183">21</reflink>]) claim that the Nordic Countries and Europe are ranked the highest on the Starting Well Index which evaluates State provisions in offering quality, inclusive early learning environments. Furthermore, a 2017 report evaluating government expenditure and investment in ECEC as a percentage of Gross Domestic Product (GDP) found that Nordic countries held four of the top five positions (Samuels, [<reflink idref="bib53" id="ref184">53</reflink>]). Although one of the 10 papers investigated the role and success of Finnish ECEC in supporting children in welfare, the researchers highlighted the need for in-service training on the needs of children who have experienced trauma (Pölkki & Vornanen, [<reflink idref="bib51" id="ref185">51</reflink>]). Given the notable discrepancy between classified world leaders in ECEC, and the dearth of trauma education offered to ECEC practitioners, there is major scope to investigate the variables affecting the provisions of trauma awareness training in the ECEC profession globally. Expectedly, further research to expound the inconsistencies across the trauma training landscape is imperative.</p> <hd id="AN0182844395-16">Intervention Design</hd> <p>Despite the lack of international diversity among the included papers, analysis of trauma-focused interventions has yielded mixed results. Interestingly, the intervention-based papers reported at least one statistically significant increase to (i) practitioners' general trauma knowledge (<emph>p</emph> <.001) (Conners Edge et al., [<reflink idref="bib22" id="ref186">22</reflink>]), (ii) practitioners' trauma informed attitudes (<emph>p</emph> =.001) (Loomis & Felt, [<reflink idref="bib40" id="ref187">40</reflink>]), and (iii) childrens' social-emotional skills (<emph>p</emph> <.001) (Kanine et al., [<reflink idref="bib35" id="ref188">35</reflink>]), with a significant decreased in (iv) practitioners' emotional exhaustion rates (<emph>p</emph> =.021) (Kim et al., [<reflink idref="bib36" id="ref189">36</reflink>]), and (v) practitioners overall behavioural concerns (<emph>p</emph> =.020) (Kanine et al., [<reflink idref="bib35" id="ref190">35</reflink>]). However, conclusions pointing to the most viable pathway to implement widespread delivery of trauma education is less acknowledged (i.e., during Initial Practitioner Education (IPE) or Continuous Professional Development (CPD).</p> <p>The selected papers within the scope of this review convey a heavy sense of overwhelm attached to the ECEC practitioner role (Kim et al., [<reflink idref="bib36" id="ref191">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref192">40</reflink>]; Stein et al., [<reflink idref="bib56" id="ref193">56</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref194">62</reflink>]), validating the need to incorporate core strands of trauma theory into the provision of ECEC training. Four of the six CPD-intervention papers reported promising preliminary results in decreased emotional exhaustion rates (<emph>p</emph> =.021) (Kim et al., [<reflink idref="bib36" id="ref195">36</reflink>]), decrease in behavioral concerns (<emph>p</emph> =.02) (Kanine et al., [<reflink idref="bib35" id="ref196">35</reflink>]), increase in trauma informed attitudes (<emph>p</emph> =.014) (Loomis & Felt, [<reflink idref="bib40" id="ref197">40</reflink>]), and increase in practitioners confidence to provide supportive relationships (<emph>p</emph> <.01) (Bilbrey et al., [<reflink idref="bib12" id="ref198">12</reflink>]). While this thread of outcomes is favourable in ECEC environments, it remains concerning that in McClain's ([<reflink idref="bib41" id="ref199">41</reflink>]) findings, a mere 13% (<emph>n</emph> = 2) of Early Childhood Teacher Candidates (Pre-Service) reported knowledge of trauma-related concepts, indicating a lack of trauma awareness content during IPE. Commonalities are also evident in Stein et al.'s ([<reflink idref="bib56" id="ref200">56</reflink>]) work whereby it was reported that 30.5% (<emph>n</emph> = 433) of ECEC practitioners in a USA-based study received no training in young children's mental health, despite 66% of participants (<emph>n</emph> = 936) having experience of working with children impacted by trauma. These collective findings substantiate the work of Nicholson et al. ([<reflink idref="bib46" id="ref201">46</reflink>]) who reported that early childhood professionals did not have the requisite skills, knowledge and competence to work effectively with children who had experienced trauma; a damning verdict that is echoed in several papers in the current review (Bilbrey et al., [<reflink idref="bib12" id="ref202">12</reflink>]; McClain, [<reflink idref="bib41" id="ref203">41</reflink>]; Pölkki & Vornanen, [<reflink idref="bib51" id="ref204">51</reflink>]). This discourse is compounded by the fact that existing Trauma Informed Practice (TIP) frameworks are targeted at specific disciplines (e.g., clinicians), making it challenging to transfer strategies directly to ECEC settings (Nicholson et al., [<reflink idref="bib46" id="ref205">46</reflink>]). Therefore, addressing the fragmented training structure within IPE programmes is a pressing matter, which requires (i) the integration of trauma-related education as a critical component of IPE globally, and (ii) context-specific training that combines TIP principles with ECEC professional practice, which would maximise trauma-related outputs.</p> <hd id="AN0182844395-17">Trauma Awareness Training</hd> <p>Given that trauma sensitive practice is experiencing an ever expanding trajectory in the field of ECEC (Bartlett & Smith, [<reflink idref="bib8" id="ref206">8</reflink>]; Butler et al., [<reflink idref="bib19" id="ref207">19</reflink>]), it is likely that practitioners will be subject to increased exposure to trauma-related concepts, lending the conversation to focus on what 'type' of trauma training should be rolled out (Loomis & Felt, [<reflink idref="bib40" id="ref208">40</reflink>]). Many papers implementing and evaluating trauma awareness training found that practitioners with (i) elevated stress levels (Miller & Stipp, [<reflink idref="bib42" id="ref209">42</reflink>]; Kim et al., [<reflink idref="bib36" id="ref210">36</reflink>]), and (ii) a poverty of trauma-related knowledge and confidence (Shamblin et al., [<reflink idref="bib54" id="ref211">54</reflink>]) are more likely to enforce punitive, zero-tolerance approaches in guiding children's behaviour. The process of psychologically ingesting the trauma of others is conceptualised by various researchers as vicarious trauma, secondary traumatic stress, compassion fatigue, and empathy fatigue (Alber, [<reflink idref="bib3" id="ref212">3</reflink>]; Hupe & Stevenson, [<reflink idref="bib34" id="ref213">34</reflink>]; Ormiston et al., [<reflink idref="bib49" id="ref214">49</reflink>]). When practitioners internalise the existential pain of the children, particularly those who can harness high levels of empathy (Adams et al., [<reflink idref="bib1" id="ref215">1</reflink>]), or those dealing with personal trauma themselves (Ollison, [<reflink idref="bib48" id="ref216">48</reflink>]), the likelihood of experiencing compassionate fatigue can be increased (Levkovich & Gada, [<reflink idref="bib38" id="ref217">38</reflink>]). While it is important that researchers have finally commenced the process of addressing the theoretical connection between vicarious trauma on the enforcement of punitive behavioral strategies, the practical application of this knowledge remains insufficient, and even misunderstood. Within the current review, the intensity of burnout, catalysed by vicarious trauma, is communicated by those in an education and care role, with four of the 10 papers consolidating the fact that children's adverse histories can threaten practitioner's emotional exhaustion rates (Kim et al., [<reflink idref="bib36" id="ref218">36</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref219">62</reflink>]), mental health (Stein et al., [<reflink idref="bib56" id="ref220">56</reflink>]), attitudes (Loomis & Felt, [<reflink idref="bib40" id="ref221">40</reflink>]), sleep quality (Whitaker et al., [<reflink idref="bib62" id="ref222">62</reflink>]), and general stress (Loomis & Felt, [<reflink idref="bib40" id="ref223">40</reflink>]), which could be considered problematic. If children are already disadvantaged by maltreatment, it adds another layer of complexity if the adults in an education and care role are suffering from psychological wear and tear. One study (Loomis & Felt, [<reflink idref="bib40" id="ref224">40</reflink>]) noted that teacher's work-related stress can manifest in difficulties maintaining teacher-child relationships, which is somewhat unsurprising given that what teachers think, believe, and feel can influence professional practice (Miller et al., 2017). In fact, Berardi and Mortion ([<reflink idref="bib11" id="ref225">11</reflink>]) believe that children's complex needs due to neglect, abuse, and/or household dysfunction compound the challenges faced in an educational context.</p> <p>Naturally, barriers that threaten the establishment of positive relationships among the educator-child dyad are concerning. Although the centrality of relationships in ECEC environments is not a new discovery, and is well document in curriculum frameworks (European Commission, [<reflink idref="bib23" id="ref226">23</reflink>]; National Council for Curriculum and Assessment, [<reflink idref="bib45" id="ref227">45</reflink>]) and the European Early Childhood Strategy (Bartolo et al., [<reflink idref="bib9" id="ref228">9</reflink>]), researchers are striving to frame relationships as a wider, trauma-informed phenomenon (Adkins et al., [<reflink idref="bib2" id="ref229">2</reflink>]; Bartlett & Smith, [<reflink idref="bib8" id="ref230">8</reflink>]; Brooks, [<reflink idref="bib14" id="ref231">14</reflink>]). Interestingly, while four of the six interventions in the current review feature a relationship-centric approach (Bilbrey et al., [<reflink idref="bib12" id="ref232">12</reflink>]; Conners Edge et al., [<reflink idref="bib22" id="ref233">22</reflink>]; Kanine et al., [<reflink idref="bib35" id="ref234">35</reflink>]; Whitaker et al., [<reflink idref="bib62" id="ref235">62</reflink>]), which is a leading trauma sensitive response in guiding children's behaviour (Butler et al., [<reflink idref="bib19" id="ref236">19</reflink>]; Buyse et al., ([<reflink idref="bib20" id="ref237">20</reflink>]); Hamre and Pianta, [<reflink idref="bib29" id="ref238">29</reflink>]), it can be argued that research on the implications of harsh disciplinary action is not communicated to practitioners, nor is it identified as a breach of the Trauma-Informed Care (TIC) principles. Worryingly, punitive strategies for children impacted by trauma can replicate prior chaotic and harmful experiences, which can reaffirm the belief that the world is unsafe, and implicitly cause re-traumatisation (Furnivall & Grant, [<reflink idref="bib27" id="ref239">27</reflink>]). Thus, the theoretical intricacies that underpin relationship-based approaches should be integral to the design and implementation of training interventions to explain the factors that drive maladaptive practice. In a pilot study designed to evaluate the Trauma-Informed Transition Model: Riroriro for new ECEC entrants with dysregulated behaviour (<emph>N</emph> = 6) (Hunter-Dehn, [<reflink idref="bib33" id="ref240">33</reflink>]), children were found to show improved emotional regulation abilities, more frequent verbalisation of emotions, and greater use of calming techniques post intervention. Evidently, trauma informed, behaviour-based strategies inherent in the Riroriro programme, and subsequently nurtured by ECEC practitioners, support children to arrive at a regulated state through evidence-based techniques. However, based on other related findings in the current review, the entanglement between practitioner burnout and punitive approaches does not appear to be given the platform and exposure that it imminently requires, for the wellbeing of both children 'and' practitioners. The idea that burnout is commensurate with trauma education is an important discovery, given Kim et al., ([<reflink idref="bib36" id="ref241">36</reflink>]) findings that when educators are exposed to elevated levels of work-related stress, there is a greater likelihood of punitive approaches used to dominate distressing behaviour.</p> <p>Considering the juxtaposition of TIC with punitive approaches, if this limitation is not addressed in the current training intervention landscape, it is highly probable that these sub-optimal practices will continue, adversely affecting the establishment, and indeed progression, of trauma sensitive ECEC environments. However, it is interesting that the most plausible solution of integrating practitioner wellness components to reduce burnout in the first instance appear to be uncommon within (i) Initial Practitioner Education (IPE) (Brown et al., [<reflink idref="bib15" id="ref242">15</reflink>]; McClain, [<reflink idref="bib41" id="ref243">41</reflink>]) and (ii) Continuous Professional Development (CPD) training interventions (Bannister, [<reflink idref="bib6" id="ref244">6</reflink>]). Notable findings from one paper, which investigated stress and burnout conditions among 1419 early childhood educators in the USA, revealed that buffering factors to prevent burnout included (i) relational connections and mental health supports and (ii) the need for systemic change (Stein et al., [<reflink idref="bib56" id="ref245">56</reflink>]). To reconcile this discourse and underpinned by the findings from four of the papers in this review (Kim et al., [<reflink idref="bib36" id="ref246">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref247">40</reflink>]; McClain, [<reflink idref="bib41" id="ref248">41</reflink>]; Stein et al., [<reflink idref="bib56" id="ref249">56</reflink>]), it is suggested that self-care and practitioner well-being content should not only be integrated into practitioner education, but prioritised. Even so, to erode the ties between child punishment and highly stressed practitioners (Shamblin et al., [<reflink idref="bib54" id="ref250">54</reflink>]; Miller & Stipp, [<reflink idref="bib42" id="ref251">42</reflink>]), the allocation of targeted self-care training should be mandatory during IPE to decrease the likelihood of vicarious trauma. Moreover, participant data from two of the included papers (i.e., Kim et al., [<reflink idref="bib36" id="ref252">36</reflink>]; McClain, [<reflink idref="bib41" id="ref253">41</reflink>]) align with the notion that ECEC roles are inherently relational, which places the educator-child dyad in an optimum space for indirect trauma to occur and prevail. Herein lies educators' vulnerability to the proximal and distal effects of educating and caring for individuals disadvantaged by trauma (Brunzell et al., [<reflink idref="bib16" id="ref254">16</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref255">40</reflink>]), justifying Miller and Stipp's ([<reflink idref="bib42" id="ref256">42</reflink>]) position to advocate for IPE training to understand and curtail vicarious trauma. Here, a comprehensive training programme that harmonises 'all' aspects of trauma, to centre on both the child 'and' the practitioner, could be a gateway to establishing a more compassionate and restorative approach in guiding children's behavior, and supporting practitioner wellness.</p> <p>However, it must be noted that one of the 10 included papers produced less conclusive results in the evaluation of the Enhancing Trauma Awareness Course (ETA) (Whitaker et al., [<reflink idref="bib62" id="ref257">62</reflink>]), which is an intervention centered on validating trauma-induced emotions, behaviour, and biology. The effect of the ETA intervention was measured by three inter-related variables including (i) Relationship Quality, (ii) Relational Capacities, and (iii) Health and Wellbeing. Despite the implementation of a 12-week training intervention with 96 preschool teachers in the United States, it is concerning that there was no significant decrease in emotional exhaustion (<emph>p</emph> =.93), sleep quality (<emph>p</emph> =.78), or secondary traumatic stress (<emph>p</emph> =.07) among the intervention group (<emph>n</emph> = 48). A certain degree of perplexity arises from the fact that no statistically significant outcomes were evident on any of the three sub-scale domains, nor were there any compelling quantitative evidence of change within the pre- and post-intervention scores (Whitaker et al., [<reflink idref="bib62" id="ref258">62</reflink>]). A potential causation for the paucity of empirical evidence could rest in either the ETA course itself, or by virtue of the Student-Teacher Relationship Scale used to evaluate the intervention. Interestingly, researchers' (Brown et al., [<reflink idref="bib15" id="ref259">15</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref260">40</reflink>]) have noted a stark and common discovery whereby during the appraisal of each respective trauma-based intervention, it emerged that there was no standardised measure to evaluate trauma awareness training, specifically in an ECEC context (Loomis & Felt, [<reflink idref="bib40" id="ref261">40</reflink>]). This may lend itself to inconsistencies within the field as to what constitutes adequate and effective training standards, and further, how methods of evaluation can be assessed. Consequently, with no universal, trauma-specific measurement tool, it is difficult to benchmark training courses in terms of efficacy, impact, and transformative prospects. Addressing this gap within the CPD domain could stimulate a wave of generalised understanding about trauma-sensitive approaches, which could produce more conclusive and meaningful outcomes for children and practitioners.</p> <p>While a great deal has been written on Trauma Informed Practice (TIP) (Brown et al., [<reflink idref="bib15" id="ref262">15</reflink>]; Brunzell et al., [<reflink idref="bib17" id="ref263">17</reflink>]; Kim et al., [<reflink idref="bib36" id="ref264">36</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref265">40</reflink>]; Shamblin et al., [<reflink idref="bib54" id="ref266">54</reflink>]), contemporary research has drawn little attention to the far-reaching, and arguably unattainable, nature of TIP in terms of practicality and sustainability. Further, trauma sensitive practice, a preceding layer on the progressive ladder seldom appears in the literature as a more suitable line of pursuit to complement the ECEC practitioner role. Within ECEC environments, there is ample research combining practitioner wellbeing and relational-based approaches as hallmarks of trauma-sensitive practice (Butler, [<reflink idref="bib18" id="ref267">18</reflink>]; Butler et al., [<reflink idref="bib19" id="ref268">19</reflink>]; Nicholson et al., [<reflink idref="bib46" id="ref269">46</reflink>]). Notably, this connection may suggest that the focus should be (re)adjusted to target trauma sensitive practice as an achievable and realistic goal in ECEC services, which would serve to (i) address the shortcomings surrounding practitioner wellness, and (ii) aim to target the reduction of punitive and control-focused behavioural guiding techniques. Researchers should move towards identifying viable avenues to streamline trauma theory and relational pedagogy into the ECEC sphere to enable informed, evidence-based practice.</p> <hd id="AN0182844395-18">Strengths and Limitations</hd> <p>This is a pioneering systematic review that specifically investigates the provision of trauma awareness training in the Early Childhood Education & Care (ECEC) profession. Notably, the PRISMA guidelines were used to extract trauma-specific literature from five electronic databases, to create an unprecedented academic output in the Early Childhood Education & Care literature base. However, various limitations have been identified and considered. Ample effort was made in the initial search to capture international provisions of trauma awareness training through the utilisation of 15 widely utilised, ECEC-related terms across five international databases. However, historically, the respective field has a proliferation of changeable and inconsistent terminology (Government of Ireland, [<reflink idref="bib28" id="ref270">28</reflink>]), yielding technical and cultural variables that limit the possibility of screening all potentially relevant papers. Moreover, in order to combine and appraise international research, the current review included papers written in the English language only, to ensure that papers could be accurately reviewed and critiqued, eliminating any language-based misinterpretations. Although this review concludes that the provision of trauma awareness in ECEC environments is low, internationally, it is possible that papers describing this apparently concerning trend exist in the literature base, albeit in a different language. In addition, given the reflexive nature of a qualitative synthesis, caution is warranted when interpreting the assumptions and conclusion drawn from the papers included. By the same logic, due to the subjectivity of a narrative style review, other researchers may not have derived the same themes as the current review.</p> <hd id="AN0182844395-19">Conclusion</hd> <p>This systematic review synthesised core elements and commonalities of the trauma awareness training provision in the ECEC profession. Although data on the unique position of ECEC practitioners in providing essential support for children who experience trauma is incontrovertible (Bilbrey et al., [<reflink idref="bib12" id="ref271">12</reflink>]; Brown et al., [<reflink idref="bib15" id="ref272">15</reflink>]; Loomis & Felt, [<reflink idref="bib40" id="ref273">40</reflink>]), this review found an overall dearth of research relating to the provision of trauma awareness training offered to ECEC practitioners (Miller & Stipp, [<reflink idref="bib42" id="ref274">42</reflink>]). Of concern, leading trauma training interventions in ECEC settings were geographically limited to North America, Canada, Finland, and New Zealand, with a paucity of trauma awareness training provisions outside the scope of these countries. Cumulative findings further suggest that the impact of trauma is so concerning, that no country can afford to ignore its devastating effects. Essentially, the justification for adequate and appropriate training rests on the fact that trauma awareness is a necessity (Rahimi et al., [<reflink idref="bib52" id="ref275">52</reflink>]), and still, a universal, sector-wide consensus regarding the most viable pathway to roll out trauma-related education remains unclear and is yet to be determined. Finally, developing a context-specific, comprehensive framework that would reconcile all areas of trauma concepts that are lacking in current interventions could act as a blueprint for a renewed trauma-sensitive culture within ECEC services.</p> <hd id="AN0182844395-20">Author Contribution</hd> <p>All authors contributed to the study preparation and co-constructed the idea to conduct a systematic literature review. The initial literature search was performed by CS and was reviewed by JB following the PRISMA screening process. All authors contributed to the data analysis of the paper. While the first draft of the manuscript was written by CS, subsequent work and iterations were critically revised by JB and CON, with all authors commenting on previous versions of the manuscript. All authors contributed and approved the final manuscript.</p> <hd id="AN0182844395-21">Funding</hd> <p>No funding was received for conducting this study.</p> <hd id="AN0182844395-22">Declarations</hd> <p></p> <hd id="AN0182844395-23">Competing Interests</hd> <p>The authors have no competing interests to declare that are relevant to the content of this article.</p> <hd id="AN0182844395-24">Ethical Approval</hd> <p>This is a review article. The Munster Technological University Research Ethics Committee has confirmed that no ethical approval is required.</p> <hd id="AN0182844395-25">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0182844395-26"> <title> References </title> <blist> <bibl id="bib1" idref="ref215" type="bt">1</bibl> <bibtext> Adams RE, Boscarino JA, Figley CR. Compassion fatigue and psychological distress among social workers: A validation study. 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  Data: The Provision of Trauma Awareness Training in the Early Childhood Education & Care Profession: A Systematic Review
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22Catherine+Sheehan%22">Catherine Sheehan</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-8741-119X">0000-0002-8741-119X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Judith+Butler%22">Judith Butler</searchLink><br /><searchLink fieldCode="AR" term="%22Cian+O'+Neill%22">Cian O' Neill</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Early+Childhood+Education+Journal%22"><i>Early Childhood Education Journal</i></searchLink>. 2025 53(2):373-391.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
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  Data: 19
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  Data: 2025
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  Label: Document Type
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  Data: Journal Articles<br />Information Analyses
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  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink>
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  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Trauma%22">Trauma</searchLink><br /><searchLink fieldCode="DE" term="%22Trauma+Informed+Approach%22">Trauma Informed Approach</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Childhood+Teachers%22">Early Childhood Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22Meta+Analysis%22">Meta Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Research%22">Educational Research</searchLink><br /><searchLink fieldCode="DE" term="%22Global+Approach%22">Global Approach</searchLink><br /><searchLink fieldCode="DE" term="%22Standardized+Tests%22">Standardized Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Evaluation%22">Program Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink>
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  Data: 10.1007/s10643-023-01565-w
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  Data: 1082-3301<br />1573-1707
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Advances in the field of Early Childhood Education & Care (ECEC) are catalysing an important paradigm shift in the understanding of childhood trauma throughout the life course. While there is little dispute regarding the unique role of ECEC practitioners in providing critical support to children who experience trauma, international provisions of trauma-related education for this cohort require further interrogation. A systematic literature review was performed to examine the delivery of trauma awareness training in the ECEC profession. Relatedly, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were implemented to facilitate the review process, which yielded a total of 10 papers across five electronic databases to be appraised. Findings consolidated that, presently, there appears to be (i) a paucity of international research pertaining to trauma awareness training in ECEC, (ii) a lack of a standardised measurement tools to evaluate trauma-focused interventions in an ECEC context, and (iii) an absence of practitioner well-being components in current training interventions. Due to the practical and theoretical importance of ECEC practitioners receiving trauma awareness training, this review serves to highlight the urgent need for increased, and context-specific, training provisions for ECEC practitioners worldwide.
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