Project Mission Statement:
To research and develop materials to support the creation of a Night Care program to promote safety and support the occupations of sleep and play participation while using trauma-informed care techniques for children six months of age to six years of age.
Project Vision Statement:
For children in night care programs to feel safe and supported and for volunteers to use trauma-informed care techniques when working with children in night care programs.
Project Description
In the United States around 34 million children under the age of eighteen have faced at least one event that could possibly fit the criteria for a traumatic early childhood experience (Duffee, et al., 2021). These traumatic events, often referred to as Adverse Childhood Experiences or ACEs, have been shown to influence an individual’s physical, behavioral, and mental health for years to come (Ivey, 2020). Health care professionals often use an organizing principle called Trauma-Informed Care (TIC) in response to the knowledge that many of their patients may have at some point underwent an ACE experience . TIC in pediatric practice seeks to provide awareness related to the trauma an individual may have undergone and how it may impact their behavior, encourages practitioners to create an emotionally safe environment, and promotes the use of interventions to help reduce the long-term impacts of an ACE experience (Duffee, et al., 2021). With the understanding that almost half of children in the United States have undergone an ACE Experience, it is reasonable to expect a significant number of children who will participate in the night care program will have undergone an ACE Experience. Night-care is a term used to describe overnight services designed to facilitate the care of individuals who are unable to manage care of themselves independently, such as children. There are a multitude of professions across that require third shift work from healthcare professionals to individuals in the entertainment industry. Therefore, it is the goal of this project to research and develop materials to support the creation of a Night Care program to promote safety and support the occupations of sleep and play participation while using trauma-informed care techniques for children six months of age to six years of age.
Needs Assessment
Project Manager: Abigail Willis, OTDS
Expert Mentor: Angie Montgomery, MOT, OTR
Faculty Mentor & Capstone Coordinator: Dr. Andrew Rivera OTD, LMT, AEP, CLIPP, CEIM
- Desired Outcomes: This project will provide resources and program materials to allow for the implementation of a night-care program designed to support the occupations of rest and sleep, and play for children six months to six years of age. It will also yield a series of training videos and materials designed to educate volunteers on how the night-care program will be implemented with best-practice trauma-informed care techniques being used.
- Supporting occupations (rest and sleep, and play are explicitly referred to as occupations within the text) across the lifespan is within the Occupational Therapy scope of practice (American Occupational Therapy Association, 2020).
- Currently, there is no volunteer training program designed to train non-healthcare professionals to use trauma-informed care techniques when working with pediatric populations. Nor does a library of resources currently exist to promote the creation of a volunteer-run night-care program supporting the occupations of rest, sleep, and play.
- In the United States, around 34 million children under the age of eighteen have faced at least one event that could possibly fit the criteria for a traumatic early childhood experience (Duffee, et al., 2021).
- These traumatic events, often referred to as Adverse Childhood Experiences or ACEs, have been shown to influence an individual’s physical, behavioral, and mental health for years to come (Ivey, 2020).
Literature Review
- Adverse Childhood Experiences (ACEs) is the term used to describe experiences in childhood that cause a great amount of stress for an individual (Lornec et al., 2020).
- In a 2020 study, when physicians were surveyed on their understanding of ACEs, only about 59% responded positively, indicating they had prior knowledge regarding research on ACEs (Popp et al., 2020).
- Awareness of a patient's trauma allows for more compassionate care and is reflected in the therapeutic relationship built between practitioner and patient (Burkey et al., 2020)
- Trauma-Informed Care focuses on preventing, identifying, and treating traumatic stress on all parties, from children to parents/guardians and healthcare providers, when providing medical care (Duffee, 2022)
- To promote patient empowerment and a supportive culture, it is suggested that the entire staff be trained in Trauma-Informed Care practices, even non-healthcare professionals. (Forkey et al., 2021).
- The importance of education regarding trauma and its impact on an individual’s health cannot be stressed enough. Furthermore, by providing information regarding the physiological effects of traumatic experiences, there is more evidence to support the necessity of implementing trauma-informed care (Forkey et al., 2021).
- In Trauma-Informed Care, recognition of the cultural factors and how they impact the response and recovery to trauma is a vital component. The cultural context will influence how an individual views trauma; cultural context impacts what is considered trauma, how to respond to trauma, and what recovery methods are appropriate (Forkey et al., 2021).
Implications
With the understanding that almost half of children in the United States have undergone an ACE Experience, it is reasonable to expect a significant number of children who will participate in the night-care programs will have undergone an ACE Experience. Trauma-informed care techniques have been implemented in health-care facilities to help mitigate the impact of ACEs. Studies suggest both health-care professionals and non-healthcare professionals can benefit from the implementation of a trauma-informed approach.
DELIVERABLES
Quick Reference Guide: Document for night care program volunteers with educational materials embedded with information regarding trauma-informed care to support non-healthcare professionals working with pediatric populations.
Infographic: An informational graphic with information regarding volunteer steps in response to challenging behaviors to support volunteers in creating a safe and positive environment. This infographic helps distinguish what is causing the behavior and lists strategies for volunteers to try to mitigate the behavior.
Training Guide: Document to prepare volunteers to implement trauma-informed care addressing areas such as play, sleep, and other occupations of value
Certificate of Completion: Certificate that demonstrates Project Manager completed a Continuing Education Course on the topic of Trauma-Informed Care.
Training Videos: A series of videos that can be used to train volunteers on the fundamentals of trauma-informed care. Four six to eight minute videos were created for this project; titles and descriptions of the videos are listed below.
Understand Trauma Part 1: This video aims to educate volunteers about trauma. In order to provide trauma-informed care it is important volunteers understand what trauma is, examples of behaviors associated with trauma, and the prevalence of trauma in the United States.\
Understanding Trauma Part 2: This video begins with a brief synopsis of Understanding Trauma Part 1, before continuing to educate volunteers on trauma and trauma-informed care. This video discusses Adverse Childhood Experiences (ACEs), the prevalence and impact of ACEs, what trauma-informed care is, and the importance of implementing trauma-informed care strategies.
Understanding Boundaries: This video aims to educate volunteers on what boundaries are, the importance of boundaries, and how to set and maintain healthy boundaries with clients.
Implementing Trauma-Informed Care Strategies: This video aims to educate volunteers on practical trauma-informed care strategies that can be used while volunteering. These practical trauma-informed care strategies include promoting structure, setting expectations, and modeling consent.
A Sample Video is provided below. Please email the Project Manager. Abigail Willis, at abigail.jane.259@gmail.com to see the full videos.
Additional Artifacts
While one Continuing Education Course was planned for this capstone project, seven additional Continuing Education Courses were completed. For a full list of CEUs completed and to see additional certificates please contact the Project Manager, Abigail Willis, at abigail.j.willis.otd@gmail.com.
Because of the predicted value of the infographic on challenging behavior for volunteers, a similar pamplet was created as a parent resource for parents of participants in the night-care program.
A google account was created for the future Made Strong Night-Care program. In the account a copy of all documents and infographics for this project have been stored to allow for ease of access for the partnered organization. This includes written scripts for all four trauma-informed care training videos, so that in the future if the training videos need updated the original scripts are available.
Future Implications For OT
Occupational Therapists are impacting the lives of trauma survivors every day. Using a trauma-informed care approach, OTs are working to mitigate the impact of trauma on their patient's quality of life. Currently, the use of the trauma-informed care approach has been largely limited to healthcare professionals, despite evidence suggesting the benefits of teaching non-healthcare professionals. By continuing to spread the word about trauma-informed care, and educating our peers, especially those peers who are not healthcare workers, we can continue to promote environments that actively work to make trauma survivors feel safe and avoid retraumatizing these survivors.
Personal Implications
This project has opened my eyes to the importance of trauma-informed care and the impact implementing trauma-informed care can have on trauma survivors. I intend to add what I've learned to my OT toolbox and integrate it into my future practice setting. In the future I hope I am able to better connect with trauma survivors due to the knowledge I have gained from this experience. I've also gained skills relating to video creation, public speaking, graphic creation, non-profit creation and management. I look forward to embracing the opportunities that await me upon graduating with my doctorate in Occupational Therapy from Huntington University.
References
American Occupational Therapy Association. Occupational therapy practice framework: Domain and process (4th ed.).The American Journal of Occupational Therapy, 2020, Vol. 74v(Supplement_2), 7412410010p1–7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001
Burkey, M. D., Ali, T., Hobson, B., Despins, L., & Sze, S. (2020). Addressing adverse childhood experiences (ACEs) in BC: Practical approaches. British Columbia Medical Journal, 62(1), 14–17.
Duffee, J., Szilgyi, M., Forkey, H., & Kelly, E. T. (2021). Trauma-Informed Care in Child Health Systems. Pediatrics, 148(2), 1-12. https://doi-org./10.1542/peds.2021-052579
Duffee, J. (2022). Trauma-Informed Ethics and Relational Health. American Journal of Bioethics, 22(5), 62–65. https://doi.org/10.1080/15265161.2022.2055217
Forkey, H., Szilagyi, M., Kelly, E. T., & Duffee, J. (2021). Trauma-Informed Care. Pediatrics, 148(2), 1–26. https://doi.org./10.1542/peds.2021-052580
Ivey, J. (2020). Mental Health Screening for Children and Adolescents. Pediatric Nurse, 46(1), 27-10.
Popp, T. K., Geisthardt, C., & Bumpus, E. A. (2020). Pediatric Practitioners' Screening for Adverse Childhood Experiences: Current Practices and Future Directions. Social Work in Public Health, 35(1/2), 1–10. https://doi.org/10.1080/19371918.2020.1711839