title: Application of a Framework to Implement Trauma-Informed Care Throughout a Pediatric Health Care Network.
abstract: To evaluate the initial application of a recently published three-step framework for implementing trauma-informed care (TIC) in a pediatric health care network by applying Framework for Spread.
  
  
  
  In steps 1 and 2 of the framework, we established commitment from the health care network leadership and initial interest in TIC among clinical providers (step 1), set evidence-based training goals and created the associated TIC training content (step 2). In step 3, 440 health care professionals (from 27 health care teams) participated in single-session, 1-hour training that covered the psychological impact of injury- and illness-related trauma, identification of traumatic stress symptoms, and how to respond to children exposed to potentially traumatic events. A concomitant quality improvement project allowed us to assess potential changes in training participants' favorable attitudes toward the integration of TIC and confidence in delivering TIC.
  
  
  
  Compared with pretraining, participants demonstrated increases in attitude toward TIC, t(293) = 5.8, P < .001, Cohen's d = 0.32, and confidence in delivering TIC, t(293) = 20.9, P < .001, Cohen's d = 1.09.
  
  
  
  Trainings were effective in achieving proximal goals targeting attitudes and confidence, thereby demonstrating the feasibility and clinical relevance of TIC training when implemented according to the three-step framework. Future research should examine methods of training to reach wide audiences to promote systematic change and evaluate changes in patient outcomes associated with providers' implementation of TIC.
authors.affiliation: Ms. Weiss: Research Assistant, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Kassam-Adams: Research Associate Professor of Clinical Psychology in Pediatrics, Perelman School of Medicine, University of Pennsylvania, Associate Director for Behavioral Research, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, and Director of the Center for Pediatric Traumatic Stress; Past President, International Society for Traumatic Stress Studies. Ms. Murray: Training Manager, Violence Prevention Initiative, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. Ms. Kohser: Research Coordinator, Center for Injury Research and Prevention; Project Coordinator, Center for Pediatric Traumatic Stress, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Fein: Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Director, Violence Prevention Initiative, The Children's Hospital of Philadelphia, and Director of Advocacy & Health Policy, The Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Winston: Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Attending Physician, Founder and Scientific Director, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, and Director of the National Science Foundation Industry, University Cooperative Research Center, the Center for Child Injury Prevention Studies. Dr. Marsac: Assistant Professor of Pediatrics, College of Medicine, Kentucky University, and Kentucky Children's Hospital, Lexington, KY.
authors.forename: Danielle
authors.initials: D
authors.lastname: Weiss
authors.forename: Nancy
authors.initials: N
authors.lastname: Kassam-Adams
authors.forename: Carol
authors.initials: C
authors.lastname: Murray
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Kohser
authors.forename: Joel A
authors.initials: JA
authors.lastname: Fein
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.forename: Meghan L
authors.initials: ML
authors.lastname: Marsac
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000639:trends*; D004496:Education, Continuing / Q000379:methods; D005260:Female; D006282:Health Personnel / Q000193:education* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013663:Teaching / Q000592:standards*; D014193:Trauma Centers / Q000458:organization & administration* / Q000639:trends