Trauma-informed child welfare systems and children's well-being: A longitudinal evaluation of KVC's bridging the way home initiative

•Child well-being improved with increased exposure to TST dosage over time.•Placement stability improved with increased exposure to TST dosage over time.•Results suggest no one staff member or caregiver is central to implementing TST.•Non-clinical staff and foster parents' can effectively implement TST.

This study evaluated the effectiveness of a system-wide reform effort to implement trauma-informed care (Trauma Systems Therapy [TST]) across a large, private child welfare system. The longitudinal associations among implementation of TST and four measures of children's well-being (functioning, emotional regulation, and behavioral regulation) and placement stability were examined. A description of the implementation of TST can be found in a separate article in this issue. Latent growth curve models were estimated using child-level administrative data on children's well-being, placement stability, and exposure to TST dosage for 1499 children in out-of-home placements. Results indicate that, as children's care teams implement TST, children demonstrate greater improvements in functioning, emotional regulation, and behavioral regulation and they experience increased placement stability. Moreover, results demonstrate that positive effects of implementation of TST are produced by both those who work closely with the child (caregivers, case managers, and therapists) and those who work more distally with the child (case manager supervisors and family service coordinators), suggesting that no one staff member or caregiver is central to providing trauma-informed care; rather it may be the confluence of the TST skills of the child's entire care team that produces better outcomes.