Successes and challenges in developing trauma-informed child welfare systems: A real-world case study of exploration and initial implementation

Trauma and behavioral health problems among children in foster care are significant and prevalent, affecting their well-being and permanency. Despite the wide scope and magnitude of social and emotional problems among youth in out-of-home care, few child welfare systems have an integrated service response into their routine procedures and practices. This paper describes three federally-funded statewide demonstration sites, which represent northeast, south, and Midwest regions of the U.S., and that aimed to implement trauma and evidence-informed initiatives. Applying implementation science frameworks, we share our experiences with three key stages of implementation: exploration, installation, and initial implementation. During the exploration stage, each state engaged community stakeholders in a comprehensive data mining process to define the needs of children in care and relevant gaps in the evidence-informed service array. To respond to trauma and behavioral health needs of children, these states' initiatives established implementation plans for screening, functional assessment, data-driven case planning, ongoing progress monitoring, and service array reconfiguration. Each state's distinct installation and initial implementation experiences are described as well their shared successes and challenges. While vast differences existed within the administrative and policy context of these three states, the study demonstrates both unique and common experiences of successes and setbacks. Across the exploration, installation, and initial implementation, these analyses revealed six themes of common successes to include collaboration, building consensus, conducting trainings, teaming, optimizing opportunity, and establishing data systems. Additionally, nine themes of common challenges were workforce, turf, client voice, data sharing, coaching and support for fidelity, time, competing priorities, momentum, and policies and leadership. Implications for practice, policy, and future research are discussed.