TRAINING FOR TRAUMA- INFORMED SUPERVISION. Kristin Swenson, PhD Utah Department of Human Services

Transcription

1 TRAINING FOR TRAUMA- INFORMED SUPERVISION Kristin Swenson, PhD Utah Department of Human Services

2 Background Evidence-based practice Evidence based practice is the provision of services which have been shown, through available scientific evidence, to consistently improve measurable client outcomes. 1

3 Trauma-informed care The evidence-based practice that is the focus of this research is trauma-informed care: a treatment framework for understanding and responding to the effects of trauma. 2

4 Background Systemic trauma-informed approach A program, organization, or system is traumainformed when it: Realizes the widespread impact of trauma and understands potential paths for recovery; Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and Seeks to actively resist re-traumatization. 3

5 Background Trauma-Informed Supervision Trauma-informed supervision training seeks to enable supervisors to enact a trauma-informed approach by disseminating knowledge about a set of skills supervisors can implement to reduce compassion fatigue burnout vicarious trauma in supervisees.

6 Background Difference between Dissemination and Implementation Note the distinction, made by both the National Institute of Health and the Center for Disease Control and Prevention, between dissemination and implementation of evidence-based practices: Dissemination increases knowledge about practices Implementation increases use of practices

7 Background Best Practices in Professional Development Research from the field of education has identified several key training feature that effectively increase knowledge and use of practices: Form (training formats such as guided practice, mentorship and coaching often outside of the classroom in authentic environments) Durations (total training hours as well as the span of time over which training takes place) Collective participation (people who work together are trained together) Active learning (learners become actively engaged in meaningful practices and analysis) Coherence (training is aligned with real-world experiences and expectations) 7

8 The Current Research This research uses self-report data from participants engaged in a training format that adhered to those features to answer the following: To what extent had participants received prior training on trauma-informed care and trauma-informed supervision? What was the level of knowledge about trauma-informed supervision prior to training? Was the training effective in increasing knowledge about trauma-informed supervision? Were follow-up coaching sessions effective in increasing use of trauma-informed supervision?

9 Methods Participants Fifty-seven supervisors from private, state, and tribal child-serving services in Utah completed surveys before and after the training Juvenile Justice Mental Health Volunteers of America Health services Substance Abuse Child and Family Services Contracted providers System of Care Healthy transitions

10 Method Procedure Participants were invited to attend an eight hour training on trauma-informed supervision. Prior to the workshop, 28 of the supervisors were selected to participate in supplemental coaching sessions. Monthly coaching sessions were scheduled for six months after the workshop. All 57 supervisors agreed to complete follow-up questionnaires six and 12 months after the workshop. 38 supervisors (67%) completed six month questionnaires

11 Method Materials The pre- and post-event questionnaires contained a set of Knowledge Statements that respondents could agree or disagree with using a seven-point Likert scale. The post-event and follow-up questionnaire contained a set of Use Statements with the same Likert-style response options.

12 Methods Design (K) X (K)(U) c c c c c (U) (K)(U) (K) X (K)(U) (U) (K)(U) (K) =knowledge scale (U) =use scale X =8 hour training c =1 hour coaching session

13 Findings To what extent had participants received prior training on trauma-informed care and trauma-informed supervision? Results showed that 89% of participants had prior training on Trauma Informed Care and 25% of participants had prior training on Trauma Informed Supervision.

14 Figure 1. Frequencies of responses to, "Have you had previous training on Trauma Informed Care?" Findings To what extent had participants received prior training on trauma-informed care and trauma-informed supervision? Have you had previous training on Trauma Informed Care? 39% 49% 10% 1% Yes, I have had a fair amount of training Yes, I have had limited training No, I have not had formal training but I am familiar with the concept Have you had previous training on Trauma Informed Supervision? 50% No, Trauma Informed Care is new to me 20% 25% 5% Yes, I have had a fair amount of training Yes, I have had limited training No, I have not had formal training but I am familiar with the concept No, Trauma Informed Supervision is new to me

15 Findings What was the level of knowledge about trauma-informed supervision prior to training? The majority of respondents indicated that, prior to the workshop, they understood principles related to trauma informed care and did not understand principles related to trauma informed supervision.

16 Findings What was the level of knowledge about trauma-informed supervision prior to training? Statement Percent who agreed I understand the definition of trauma. 91% I understand the key elements of trauma informed care. 58% I understand the impact of secondary traumatic stress on the 46% workplace. I know how to identify secondary traumatic stress in my supervisees. 21% I know how to reduce the effects of secondary traumatic stress in my supervisees. I understand how trauma informed supervision differs from supervision-as-usual. I understand how to coach someone so that they can apply the trauma framework. 19% 13% 8%

17 Findings Was the training effective in increasing knowledge about trauma-informed supervision? All seven items on the knowledge scale showed significant mean differences between pre- and post-training administrations with higher average ratings after training than before training. On six of the seven items, the magnitude of change exceeded standards for large effects.

18 Statement Findings Was the training effective in increasing knowledge about trauma-informed supervision? Percent who agreed before training Percent who agreed after training I understand the definition of trauma. 91% 97% I understand the key elements of trauma informed care. 58% 88% I understand the impact of secondary traumatic stress on the workplace. 46% 74% I know how to identify secondary traumatic stress in my supervisees. 21% 84% I know how to reduce the effects of secondary traumatic stress in my supervisees. I understand how trauma informed supervision differs from supervisionas-usual. I understand how to coach someone so that they can apply the trauma framework. 19% 70% 13% 86% 8% 61%

19 Methods Design (K) X (K)(U) c c c c c (U) (K)(U) (K) X (K)(U) (U) (K)(U) (K) =knowledge scale (U) =use scale X =8 hour training c =1 hour coaching session

20 Findings Were follow-up coaching sessions effective in increasing use of trauma-informed supervision? Supervisors who participated in coaching sessions endorsed each of the knowledge items more strongly than did supervisors who did not participate in coaching sessions. This effect was significant for half of the items (significant at p<.05 for four items and p<.1 for one item).

21 Findings Were follow-up coaching sessions effective in increasing use of trauma-informed supervision? Statement r Coaching rno Coaching I coach supervisees in using a trauma lens to guide case conceptualization I meet with my supervisees for formal supervision on a regular schedule I employ concepts of Reflective Supervision during my supervisory time I monitor for signs of secondary trauma in my supervisees I actively intervene to reduce the effects of secondary traumatic stress in my supervisees I actively monitor and address my own secondary trauma I encourage my supervisees to share the emotional experience of doing trauma work in a safe and supportive manner I assist my supervisees in emotional re-regulation after difficult encounters I have a defined plan of how to provide support to staff after a critical trauma event

22 Discussion Summary of quantitative results The outcomes provided evidence that: Utah supervisors have not been involved in traumainformed supervision training Untrained supervisors lack understanding of traumainformed supervision principles The 8 hour workshop was effective for dissemination The coaching calls were effective for implementation

23 Summary of qualitative results (not reviewed) Themes from open-ended feedback: Appreciation for the training Appreciation for the coaching groups Disappointment in not being selected to participate in the coaching groups Desire for more trauma-informed training in general Frustration of being trauma-informed in a noninformed workspace

24 Discussion Limitations and lessons learned Data collection still taking place (i.e., this is not over) Ceiling effects limited ability to measure change on some items Needed to have a not applicable option for staff not in supervisory roles.

25 References Sogolow, E. D., Sleet, D. A., & Saul, J. (2008). Dissemination, implementation, and widespread use of injury prevention interventions. In Handbook of injury and violence prevention (pp ). Springer US. 6 Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), Guskey, T. R. (2003). What makes professional development effective?. Phi delta kappan, 84(10), 748.