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The concept of trauma-informed care (TIC) reflects two realities: 1) exposure to trauma and childhood adversity is shockingly common and results in lifelong health consequences; and 2) organizations serving trauma survivors unintentionally use practices that at best are ineffective and at worst cause harm. In the last decade, the Traumatic Stress Institute (TSI) has become a national leader in the TIC field. We discovered in our work that theory about TIC was flourishing and there was rapid growth in implementation strategies, but there was little agreement about how to operationalize TIC and scant research supporting its efficacy. One important gap, we concluded, was the lack of tools to measure the concept. The Attitudes Related to Trauma-Informed Care (ARTIC) Scale is one of the first psychometric measures of TIC published in the peer-reviewed literature. It was developed by TSI and Courtney Baker, Ph.D., of Tulane University. The ARTIC is based on the theory that moment-to-moment staff behavior is core to TIC and staff attitudes are an important driver of that behavior. The ARTIC has three versions for human service and educational settings (a 45-item, 35-item, and 10-item short form) and seven subscales measuring different domains of staff attitudes.
TSI believes deeply in evaluating its work, yet lacked the expertise to do so. To solve this dilemma, we forged a partnership with Dr. Baker. We used our unique areas of expertise to identify this critical gap in the TIC field and fill it with a user-friendly, cost-effective, and empirically-based tool to help organizations assess the impact of their TIC interventions. Whereas previously most TIC research was based on self-designed tools with few psychometric properties, the ARTIC provided a scientifically robust measure relevant across a wide variety of organizations. TSI created a system for disseminating the ARTIC Scale that both fosters its wide use and generates income for further research. The original ARTIC has now opened the door for a revised instrument, the ARTIC-2, now in development. TSI and Dr. Baker also partnered to pilot an online dashboard to display ARTIC scores for individuals and organizations using the measure.
The 114 entities that have acquired the ARTIC are using it to evaluate their TIC implementation efforts overall, monitor how TIC is sustained, and target strategies based on ARTIC scores. For example, a low score by outreach workers on the vicarious trauma-related subscale can trigger organizational support for their self-care. On a wider level, TSI believes the groundbreaking development of the ARTIC challenges organizations to operationalize what they mean when they say, “Yes, we’re trauma-informed.” It urges them to drill down and define the staff behavior, treatment methods, and policies required to promote healing for survivors of trauma and adversity. In a funding environment that values rigorous evaluation of TIC (SAMHSA, 2014), the ARTIC can spur the TIC field to create additional measures and advance toward more evidence-based interventions. TSI is disseminating information about the ARTIC through conferences, articles, free webinars, TIC organizations, and word of mouth.
TSI has been deliberate about laying the groundwork for ARTIC sustainability. The ARTIC is copyrighted through the US National Copyright Office. TSI and Tulane have established a formal partnership to sustain and advance the ARTIC. For example, Dr. Baker, with TSI’s support, will conduct a validity study of the ARTIC in spring 2018 that will be submitted for publication in June. The study will result in a revised version of the measure, the ARTIC–2. The funds from this award will be utilized to determine how best to disseminate the ARTIC-2. The ever-increasing demand for the ARTIC demonstrates the hunger in the field for instruments to measure TIC. Our vision is that, in 10 years, there are a variety of standardized tools measuring such things as TIC staff behavior or consumer satisfaction with TIC services, all aimed at survivors receiving the highest quality care.
TSI distributes the ARTIC with scoring instructions, an Excel spreadsheet to compute scores, and ARTIC files for the Qualtrics data collection platform to make it easy for users to accurately calculate scores and use the data to drive decision making. An online dashboard to display and track scores will enhance its appeal and usability for diverse organizations, especially those lacking data expertise. The entities that have acquired the ARTIC are mostly using it in the human service and education sectors. The potential for expanded use in other sectors serving trauma survivors is vast and includes medicine, corrections, the military, religious institutions, youth development, law enforcement, government, and the courts. Future efforts could adapt the ARTIC specifically to these sectors. Finally, the ARTIC Scale is only being sold in English. There has been interest in translating the measure into other languages which could exponentially spread its use worldwide.
Since April 2016, 114 entities from more than 30 US States and 4 countries have acquired the ARTIC. There was a 43% increase in requests from 2016 to 2017. Six entities are using it at more than 10 research/evaluation sites each. Dr. Baker maintains a database with 3500 ARTIC respondents. A conservative estimate is that the 114 entities will administer it to over 25,000 professionals. Large-scale users include the Chicago and Baltimore city school systems. Both Tulane and TSI have repeatedly shown that the ARTIC can detect statistically significant increases in attitudes favorable to TIC from the beginning to the end of a multi-day training. The ARTIC also relates reliably to other metrics relevant to TIC such as staff burnout and secondary traumatic stress. Since many using the ARTIC are researchers, we anticipate numerous upcoming peer-review journal articles referencing use of the ARTIC.