title: Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia.
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.
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA. Electronic address: rbeidas@upenn.edu.
authors: Rinad S
authors: RS
authors: Beidas
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
authors: Danielle R
authors: DR
authors: Adams
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
authors: Hilary E
authors: HE
authors: Kratz
authors: Community Behavioral Health, 801 Market Street, Philadelphia, PA 19107, USA, USA.
authors: Kamilah
authors: K
authors: Jackson
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
authors: Steven
authors: S
authors: Berkowitz
authors: Community Behavioral Health, 801 Market Street, Philadelphia, PA 19107, USA, USA.
authors: Arturo
authors: A
authors: Zinny
authors: Hall Mercer, Community Mental Health Center, 245 South 8th Street, Philadelphia, PA 19106, USA.
authors: Lauren Pilar
authors: LP
authors: Cliggitt
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
authors: Kathryn L
authors: KL
authors: DeWitt
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, USA.
authors: Laura
authors: L
authors: Skriner
authors: 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.
authors: Arthur
authors: A
authors: Evans
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health; D001291:Attitude of Health Personnel; D002648:Child; D000067576:Child Health; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007318:Inservice Training; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D019982:Organizational Case Studies; D015143:Philadelphia; D016730:Program Development / Q000379:methods*; D015397:Program Evaluation / Q000379:methods; D000067073:Psychological Trauma / Q000628:therapy; D011594:Psychometrics; D011634:Public Health; D014481:United States
keywords: Evidence-based practices; Implementation science; Trauma-informed system