Semester

Spring

Date of Graduation

2022

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Shari Steinman

Committee Member

Amy Herschell

Committee Member

Christina Duncan

Committee Member

Nicholas Turiano

Committee Member

John Campo

Abstract

Learning collaboratives (LCs) are often used in large-scale implementation initiatives to promote evidence-based practice across provider networks. Although the outcomes and stakeholder perspectives of many LCs have been documented, support for the effectiveness of LCs is equivocal, and the means by which LCs achieve long-term improvements in clinical care are not understood. The current study investigated outcomes and sustainability of a multi-agency LC for implementing trauma-informed care in 23 rural Pennsylvania counties. Changes in outcomes (i.e., trauma symptom screening, trauma-informed care training attendance, clinician confidence with using trauma informed-care, utilization of trauma-related diagnostic codes, retention in service, service unit density) were assessed in participating provider agencies (N = 22) over the course of the 15-month LC, and three years after the LC. A theoretical model of clinical training was also applied to determine the extent to which attitude- and skill-related factors were associated with sustained trauma-informed care. Rates of trauma screening, staff training, and high levels of confidence in delivering trauma-informed care increased pre- to post-LC. Rates of trauma diagnosis, density of service units received by individuals with trauma, and retention in care for individuals with trauma did not change pre- to post-LC, or during the three-year sustainment phase. Three years after the LC, trauma symptom screening and staff training improvements were sustained, while staff confidence in delivering trauma-informed care worsened across time. Sustained trauma-informed care behaviors were associated with implementation milestone completion and third-party ratings of quality improvement skills during the LC. Implications of these findings and future directions for research are discussed.

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