Implementing Trauma-Informed Care Through a Learning Collaborative: A Theory-Driven Analysis of Sustainability

Area of Science:

• Public Health
• Behavioral Health Services
• Organizational Psychology

Background:

• Implementing trauma-informed care (TIC) in rural behavioral health settings presents unique sustainability challenges.
• A 15-month multi-agency Learning Collaborative (LC) was designed to foster TIC implementation across 23 rural Pennsylvania counties.

Purpose of the Study:

• To evaluate the sustainability of trauma-informed practices three years after the completion of a Learning Collaborative.
• To identify factors associated with sustained trauma-informed care implementation in provider agencies.

Main Methods:

• A longitudinal assessment of 22 provider agencies participating in the LC.
• Evaluation criteria included organizational achievement as a trauma-informed care center and sustained trauma symptom screening rates.
• A theoretical model of clinical training was used to examine training- and skill-related factors.

Main Results:

• Trauma symptom screening rates and staff training improvements were sustained three years post-LC.
• Staff confidence in delivering trauma-informed care showed a decline over time.
• Sustained trauma-informed care was linked to completing implementation milestones and positive third-party quality improvement ratings during the LC.

Conclusions:

• Building organizational capacity for change through training and skill development is crucial for sustaining trauma-informed care.
• Ongoing support and reinforcement are necessary to maintain staff confidence and ensure long-term fidelity of trauma-informed practices.
• Implementation milestone completion and external quality assessments during active phases predict sustained trauma-informed care in behavioral health services.