Yehudis Stokes was awarded the 2023 Research Impact Canada Engaged Scholarship Award for her project, Identifying, Measuring, Implementing, and Evaluating Trauma-Informed Care in Practice.
About project
Decades of evidence has demonstrated the enduring impact of trauma on individuals, families, and communities. “Trauma-informed care” (TIC) is a philosophy that involves addressing the needs of individuals with histories of trauma, whether they are the ones seeking care, or providing care. Generally agreed upon principles of TIC include four “R”s: 1) Realizing the prevalence of trauma, 2) Recognizing manifestations of trauma, 3) Responding appropriately to trauma, and 4) Resisting re-traumatization, as well as the six principles of 1) physical and psychological safety, 2) trustworthiness and transparency, 3) support, 4) collaboration, 5) empowerment, and 6) cultural and gender considerations.
When CHEO (Children’s Hospital of Eastern Ontario) identified TIC as a priority and sought to proceed in selecting and implementing a program of TIC, I committed to designing my doctoral thesis in a manner to support their goal. In partnership with a CHEO multidisciplinary TIC Advisory Committee, we identified shared research aims:
- To systematically identify TIC interventions used in pediatric inpatient and residential treatment mental health settings, the implementation strategies used, the measures used to evaluate, and the effectiveness of these interventions, through scoping and systematic reviews of the literature and an environmental scan.
- To facilitate the selection of a TIC intervention for the inpatient mental health unit through triangulation of the results from the reviews and through discussions with the TIC advisory committee.
- To facilitate the tailoring of the TIC intervention to the inpatient mental health unit setting, through focus groups with youth, caregivers and staff and through discussions with the TIC advisory committee.
In reviewing the literature and conducting our environmental scan we identified a broad interest in TIC with many emerging interventions. While the TIC interventions demonstrated overlap with common aims and core elements, there were also many differences, pointing to the need for CHEO to clarify their goals in implementing TIC and the pertinent audiences to target with the intervention (youth, caregivers, staff). We also found that although educational trainings were a common implementation strategy across TIC interventions, that most authors recommended a tailored and multi-pronged approach to TIC implementation that goes well beyond educational trainings. Based on CHEO’s identified priorities, the TIC Advisory Committee narrowed down the options and selected one TIC intervention. We then sought feedback from youth, caregivers, and staff to assist in customizing the intervention to the CHEO context and to identify factors for its successful implementation.
We asked these participants about 1) their vision of TIC in this setting and 2) what would be needed for a TIC program to be successfully implemented within the setting and what may hinder the process. What emerged from these findings were four key elements to consider and address within TIC implementation: 1) the centrality of relational engagement in TIC and in implementation of TIC, 2) TIC core program components 3) factors that may support or limit success in implementing TIC within the mental health unit and hospital wide, and 4) the importance of intersectoral collaboration. At present, we are drawing on these findings to tailor the TIC program to the CHEO context and to develop a customized implementation plan before field testing and launching the program.
Partnering with CHEO throughout this process has been an enriching experience for myself as a trainee. Three lessons learned through this process are: 1) The importance of leadership involvement and support, which was critical to progression of this work, 2) The importance of CHEO leadership taking responsibility for the decision-making and flow of the project, while I became a facilitator of the shared research aims, and 3) The importance of organizational enthusiasm and perseverance to continue to prioritize this project was and will continue to be essential in implementing and sustaining this initiative.
About award recipient
Yehudis Stokes is currently completing her PhD in Nursing at the University of Ottawa, with a thesis research focus on planning the implementation of a trauma-informed care program in a pediatric mental health setting. She practices clinically as a Registered Nurse at the Children’s Hospital of Eastern Ontario (CHEO) and as a Clinical Nurse Specialist with the Psychosocial Oncology team at Princess Margaret Cancer Centre. She is also trained as an art therapist and a psychotherapist. Yehudis speaks and advocates on topics relating to trauma-informed care.