Trauma-Informed Workshop: Rural & Tribal Communities

Journal of Child & Adolescent Trauma | 2024, Vol. 17, p. 187-196

A Trauma‑Informed Workshop Targeting the Attitudes of Mental Health Providers in a Rural, Racially Diverse Community Bordering Tribal lands

Tasha Seneca Keyes;  Department of Social Work, ELB 632, California State University, San Marcos 333 S. Twin Oaks Valley Rd, San Marcos, CA 92096, USA

Kara Patin; College of Social Work, University of Utah, Salt Lake, UT, USA

Jeremiah W. Jaggers; College of Social Work, University of Utah, Salt Lake, UT, USA

Purpose: This study examines a three-day trauma informed workshop with 32 mental health providers in a rural community that borders an American Indian reservation to determine if there is an association with positive trauma-informed care (TIC) attitudes.

Methods: Thirty-two workshop participants were invited to take the Attitudes Related to Trauma Informed Care (ARTIC-45) scale pre-workshop, post-, and six months- after the workshop. Results were analyzed at the group-level using t-tests and Wilcoxon signed-rank tests for subscales that were not normally distributed.

Results: Pre- to Post- (Time 1) findings reveal statistically significant positive changes in all ARTIC subscales. However, post-workshop to six months follow-up (Time 2) four subscales showed statistically significant decreases. This seems to be an indication that these trauma-informed attitudes, knowledge, and beliefs had gotten worse with time. There were three subscales without significant change.

Conclusion: The findings should be interpreted with caution but point to plausible implications related to the decline in trauma-informed attitudes such as, lack of ongoing training following the workshop, limitations in workforce and resources within the rural community, unaddressed implicit bias, and needing more organizational leadership buy-in and resources.

Trauma-informed training; ARTIC scale; rural Native/White community

“Approximately 53% of children living in small rural communities’ report having at least one ACE compared to 47% of children living in urban areas Racial minorities living in rural communities, particularly rural American Indian and rural African Americans are at greater risk of experiencing adversity, frequent mental distress, and negative mental health outcomes when compared with rural non-Hispanic Whites… One way to address trauma in rural communities is to provide specialty trauma-informed training among rural mental health providers through a community-university partnership. Research on implementing a Trauma Informed Approach (TIA) systematically in organizations suggests the process begins with developing organizational cultures in human service, health, education, and related sectors that understand the prevalence and impact of trauma, can identify the signs and symptoms of trauma in the service users and staff, and behave in ways that alleviate rather than exacerbate the potential effects of ACEs and trauma” (p. 188).

“This is the second phase of a community-university partnership to assist a rural community to become trauma informed. The first phase occurred in 2017 and included basic trauma-informed education with frontline Native and White health care providers, educators, and community businesspeople. The second phase focused on providing a three- day trauma-informed approach workshop for all mental health providers within the community, which included the community mental health clinic, the school district, and the tribal behavioral health clinic. This study assesses the change in trauma informed attitudes among the rural mental health providers following a three-day trauma-informed workshop" (p. 189).

“Prior to the consecutive three-day interactive lecture-style in-person workshop, 32 participants were emailed a link to take the pre-Attitudes Related to Trauma-Informed Care survey, then immediately following the workshop, participants completed the post-ARTIC survey, and researchers emailed participants 6 months following the workshop with a 6 month follow up ARTIC survey. The workshop educated participants about the basics of trauma and the Trauma-Informed Approach (TIA)… Independent sample t-tests were conducted for the variables that passed the Shapiro Wilk test (p ≥ 0.05); the Wilcoxon signed-rank test was used for subscales that did not pass the Shapiro–Wilk test” (p. 191).

“Our findings indicate that generally the training was most successful in the association with improving participants' level of confidence to meet the needs of their clients with trauma backgrounds and the belief that the administration within their organizations were supportive of participants’ trauma informed efforts. However, our findings do not show there were meaningful shifts in participant’s attitudes about trauma which could be signal that the organization is not primed for the paradigm shift that is needed to become a trauma informed organization. Research finds that a change in providers’ attitudes and beliefs is a potential indicator signaling an organization’s readiness to change and integrate a TIA system-wide” (p. 193).

“This study shows that a three-day trauma workshop among rural mental health providers with White and Native racial backgrounds may be an appropriate starting point but should not stop there. It is recommended that along with an introductory trauma-informed workshop the leadership within the organization needs to take the initiative to become a trauma informed organization and determine the level of trauma informed care and how widespread the approach will be” (p. 193).

“It is documented that to become trauma-informed is a dynamic process which requires an understanding of the ongoing and interconnected nature of trauma and its effects.This study provides a glimpse into the ways attitudes and beliefs can change with a three-day trauma workshop with rural mental health providers near tribal border lands and much more work remains to fully understand the role of trauma informed workshop have in advancing organizations and communities to be trauma informed. Inferences are made about why trauma attitudes and beliefs were not sustained over time in this study and include a lack of ongoing trauma-informed support and guidance by those with trauma expertise, providing time within the organization to debrief with workshop participants, and conducting conversations about ways to sustain the momentum from the three-day workshop across the organization. These aspects were not part of the three-day workshop, and it is unknow if workshop participants were supported within their organizations to engaged in them. In addition, the historical context between the two racial groups in this rural community could also be an important factor to consider when engaging with trauma around issues of discrimination, implicit bias, and finding ways to mitigate re-traumatization. For many participants, being a trauma-informed leader and trainer within their organization was an additional responsibility to their regular job duties. For TIA to be sustainable it is important to be aware of the responsibilities and the overall capacity of those placed in trauma-informed leadership roles. Organization or community leadership can consider removing some responsibilities from the expected duties of those who are specifically working to shift the paradigm towards TIC. Lastly, creating a TIA confidential network of other mental health providers to consult with about individual cases or organizational policies and structures may be a useful way for providers to integrate TIA into their daily practices” (p. 194).

“Certain limitations of this study could be addressed in future research. For instance, the small sample size (≤ 30) limited the statistical power; in small samples the effect size tends to be inflated (Schäfer & Schwarz, 2019). Therefore, the reported effect sizes should be closely considered in future research. Next, the data collection procedure limited the researchers’ ability to pair the data across time points and to conduct more advanced repeated measures analyses. The small sample likely contributes to the distributional characteristics seen in the data. This resulted in two separate analytic approaches – independent samples t-test and the Wilcoxon signed-rank test. As such, direct comparisons could not be made between time points except when the same test was used for each comparison. Strengths of the study include having a previously established relationship with the community, having access to administer pre and post-test evaluations, and having a group size that allowed for meaningful engagement and responsive facilitation rooted in cultural sensitivity. Another potential benefit of the study is both facilitators being people of color. Anecdotally, one participant said, “you’re not Native, but you get it” (p. 194).