Children and adolescents who enter the foster care system have typically been previously exposed to more adverse experiences than children in the general population. That’s because foster care is designed to protect children who have experienced trauma such as abuse, neglect or other family challenges. While no fault of their own, youth who have experienced trauma often have difficulty regulating their emotions and managing their behavior. This inability to cope with challenging emotions and situations can postpone the child’s safe reunification with his or her family, affect foster home stability and delay adoption.

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The issue of childhood trauma affects many of the 428,000 children in the child welfare system nationally. As part of the solution, KVC Health Systems along with The Annie E. Casey Foundation, Child Trends and Dr. Glenn Saxe of New York University, launched one of the largest longitudinal studies on the impact of trauma-informed and focused care in the country. KVC knows children grow best in families and aims to ensure all children in foster care are able to reach their potential in safe, loving homes until they can be safely reunified with their families or a permanent home can be found.

In the five-year research study called Bridging the Way Home, KVC Health Systems, The Child Study Center at New York University, Child Trends, and the Annie E. Casey Foundation partnered to evaluate the implementation of Trauma Systems Therapy (TST), a trauma-informed intervention model for youth and families experiencing traumatic stress. KVC implemented TST throughout KVC Kansas, an organization that provides in-home and out-of-home care to children served by the Kansas Department for Children and Families in the Kansas City Metropolitan and East Kansas regions. This was the largest study ever conducted to implement a research-informed therapeutic model across an organization’s full continuum of care.

McCauley

“This study validates what we have long believed, which is that, with the right interventions applied at the right time, children with significant challenges can and do get better. KVC’s staff have clearly demonstrated that implementing and sustaining trauma-informed and focused care changes lives,” said Kelly McCauley, Associate Director for the KVC Institute for Health Systems Innovation and project lead for TST implementation and evaluation.

Trauma Systems Therapy

Dr. Glenn Saxe, M.D., of the New York University School of Medicine developed the Trauma Systems Therapy model, which has previously been used in clinical settings. TST is a research-based approach that identifies trauma in youth and helps to create a community surrounding the child for continued treatment and support. With Dr. Saxe’s support, KVC adapted the TST model to help children and families involved in the child welfare system.

In essence, trauma-informed care replaces the question of, “What’s wrong with you?” with “What happened to you?” By addressing a child’s trauma, more often than not, KVC’s clinical teams, staff, foster parents and parents are able to get to the heart of why that child is having challenges.

Bridging the Way Home Study

This study was comprised of two separate evaluations; an outcome evaluation which addressed the question, “Did the implementation of TST improve placement stability, permanency and emotional and behavioral child well-being?” and an implementation evaluation that addressed the question, “How was TST implemented across KVC Kansas to fidelity?”

1,500 children and adolescents ages 6 and up who entered foster care through KVC Kansas between 2011 and 2014 were evaluated for the study. Evaluations included their exposure to TST and the outcomes.

Study Results

The study found that the implementation of TST throughout the entire agency was successful and created positive results for children. Children exposed to TST showed measurable improvements in functioning, behavior regulation and placement stability (which means not moving from foster family to foster family). Within the first three months of exposure to trauma-informed care, children also showed improvements in emotional regulation. Finally, staff reported higher levels of effectiveness with children based on concerted care using an integrated, multi-disciplinary approach grounded in a common language and shared interventions.

Outcome results for permanency were unclear because many factors beyond the child’s behavior play a role in finding a permanent home.

Implementation of TST across an entire agency is no small task, so KVC Kansas provided a variety of training mediums such as in-person, web-based, consultations and coaching for staff, foster parents, and community providers. Over 90 percent of KVC Kansas staff was trained on trauma-informed care and 70 percent of its foster parents. The study found that no one person is the key to improving a child’s well being, rather it is the integration of the child’s team that creates a better outcome.

Impacting Child Welfare

KVC has implemented the TST model in many of its subsidiaries including KVC Hospitals, KVC Nebraska, Niles, KVC West Virginia and KVC Kentucky. Recently, McCauley and Saxe have developed a Trauma Systems Therapy curriculum to give relative caregivers, foster families and communities hands-on tools for helping children who have experienced trauma. The curriculum will be available as a free download this summer.

KVC wishes to thank its wonderful partners at the Annie E. Casey Foundation, Child Trends and especially Dr. Saxe and his team for their incredible dedication and collaboration on this project.

The findings of the Bridging the Way Home study have implications for the child welfare system as a whole and should positively influence policy, programs and future research projects. Learn more about the KVC Bridging the Way Home Study in these articles published in the Children and Youth Services Review:

• KVC’s Bridging the Way Home: An innovative approach to the application of trauma systems therapy in child welfare
• Trauma-informed child welfare systems and children’s well-being: A longitudinal evaluation of KVC’s Bridging the Way Home Initiative

See articles from our research partners here:

• When Child Welfare Systems Embrace Trauma-Informed Care, Kids Do Better (Annie E. Casey Foundation)

• Trauma-informed child welfare systems and children’s wellbeing: A longitudinal evaluation of KVC’s Bridging the Way Home initiative (Children and Youth Services Review, a peer-reviewed academic journal)