Trauma-Informed Behavioral Parenting for Early Intervention
Agazzi, H., Adams, C., Ferron, E., Shaffer-Hudkins, E., and Salloum, A. Journal of Child and Family Studies (May 2019).
Background: Children who experience traumatic events like divorce, abuse and domestic violence (what we call Adverse Childhood Experiences, or ACEs) may have difficulty forming supportive relationships and have higher rates of poor mental health later in life. Children with disabilities experience higher rates of ACEs than their typically-developing peers, yet evidence-based practices to address social/emotional needs often left these children out. These programs also tend to be expensive and require additional training.
The program piloted in this study was created for children with disabilities who are in the child welfare system. The program was created to be low-cost, time-efficient and to build on existing skills that Early Intervention (EIs) providers already have around coaching parents on better interactions with their children.
Methods: The pilot study integrated Trauma-Informed Behavioral Parenting (TIBP) training into work providers were already doing with families. The program included 1-hour training modules, in-person training and one-on-one coaching. Five EIs were supervised as they implemented TIBP with eight parent-child pairs. Parents and EIs were asked to take a pre/post-test to evaluate the child's behavior problems, exposure to trauma, parenting stress levels and parenting skills. Afterwards, EI focus groups discussed how they felt about TIBP, and how easily they could incorporate TIBP into their programs.
Results: After the TIBP training, EIs increased their use of positive reinforcement techniques such as offering praise and reflecting back what children say. Parents also showed better behaviors when interacting with their children. This led to fewer symptoms of trauma in children with post-traumatic stress disorder and high functional impairment scores.
Conclusions: This study showed a promising path for incorporating affordable and easy evidence-based practices into community-level programs. However, the study was very small, so more research needs to be done with a larger group to see how it can work in different communities.
The combination of self-directed training modules, in-person training and practice-based coaching that this study looked at among EI providers is a training model that lends itself well to training child care providers as well. Given that many children with disabilities and children experiencing trauma are served in child care settings, it is important to think about how a similar strategy to promote trauma-informed caregiving could be implemented among child care providers.
Child care resource and referral agencies should work with partners to develop trauma-focused professional development opportunities. Pulling together child care providers, EI providers, early childhood mental health consultants, and child care health consultants for shared training could help them build more coordinated approaches to addressing trauma exposure among young children.
This study highlights the value of working within existing systems to meet the needs of children and families, particularly around trauma. Children and families interact with many different systems and service providers, from schools and child care to employers and government agencies. When those systems and service providers recognize the impact of trauma and use trauma-informed strategies in their work, children and families feel more supported and can become more resilient.
The state of Tennessee has created an exceptional model of investing in building trauma-informed communities and systems that support children and families wherever they are. The state recognized the value of creating policies and prioritizing funding to strengthen existing systems to prevent and reduce the long-term effects of trauma exposure. This meant looking at policies and funding across state agencies, including child welfare, mental health and social services to create safer, healthier and more resilient communities.