Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Rinad S Beidas; Danielle R Adams; Hilary E Kratz; Kamilah Jackson; Steven Berkowitz; Arturo Zinny; Lauren Pilar Cliggitt; Kathryn L DeWitt; Laura Skriner; Arthur Evans Jr

doi:10.1016/j.evalprogplan.2016.07.004

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Eval Program Plann. 2016 Dec:59:21-32. doi: 10.1016/j.evalprogplan.2016.07.004. Epub 2016 Jul 27.

Affiliations

¹ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA. Electronic address: rbeidas@upenn.edu.
² Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
³ Community Behavioral Health, 801 Market Street, Philadelphia, PA 19107, USA, USA.
⁴ Hall Mercer, Community Mental Health Center, 245 South 8th Street, Philadelphia, PA 19106, USA.
⁵ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA; Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Philadelphia, PA 19107, USA.

Abstract

Exposure to traumatic experiences among youth is a serious public health concern. A trauma-informed public behavioral health system that emphasizes core principles such as understanding trauma, promoting safety, supporting consumer autonomy, sharing power, and ensuring cultural competence, is needed to support traumatized youth and the providers who work with them. This article describes a case study of the creation and evaluation of a trauma-informed publicly funded behavioral health system for children and adolescents in the City of Philadelphia (the Philadelphia Alliance for Child Trauma Services; PACTS) using the Exploration, Preparation, Implementation, and Sustainment (EPIS) as a guiding framework. We describe our evaluation of this effort with an emphasis on implementation determinants and outcomes. Implementation determinants include inner context factors, specifically therapist knowledge and attitudes (N=114) towards evidence-based practices. Implementation outcomes include rate of PTSD diagnoses in agencies over time, number of youth receiving TF-CBT over time, and penetration (i.e., number of youth receiving TF-CBT divided by the number of youth screening positive on trauma screening). We describe lessons learned from our experiences building a trauma-informed public behavioral health system in the hopes that this case study can guide other similar efforts.

Keywords: Evidence-based practices; Implementation science; Trauma-informed system.

MeSH terms

Adolescent
Adolescent Health
Attitude of Health Personnel
Child
Child Health
Cognitive Behavioral Therapy / methods*
Female
Humans
Inservice Training
Insurance Claim Review
Male
Medicaid / statistics & numerical data
Mental Disorders / therapy*
Mental Health Services / organization & administration*
Organizational Case Studies
Philadelphia
Program Development / methods*
Program Evaluation / methods
Psychological Trauma / therapy
Psychometrics
Public Health
United States

Grants and funding

K23 MH099179/MH/NIMH NIH HHS/United States