Incubator members are developing, delivering and evaluating training and education on Trauma- and Violence-Informed Care (TVIC) to organizations and individuals across a range of health and social services, including public health, child welfare, policing, hospitals, primary health care, education and more.
A core dimension of the EQUIP Healthcare intervention, TVIC provides a series of low-cost, high impact strategies to provide safe and effective care, while addressing the needs of individual providers for safety and well-being at work, and of organizations to foster cultures of safety for everyone in their settings.
Watch Dr. Colleen Varcoe talk about TVIC, and why the “V” is so important.
Visit the main study page here – including links to products and presentations.
The COVID-19 pandemic, and our response to it, has laid bare social and health inequities, especially as they affect women and children experiencing violence in the home. Our research team is helping address these issues by working with local violence against women services in SW Ontario, and across the province, to understand the impact of “stay at home” orders, and physical distancing mandates on women’s experiences of safety, and on how services deliver care.
A team from our Gender, Trauma & Violence Knowledge Incubator @ Western received a Western Catalyst Grant to study the effects of pandemic-related changes in service experiences on those using and delivering anti-violence services. I’m honoured to co-lead this inter-related set of studies with Jessie Rodger, Executive Director of Anova, London’s women’s shelter and sexual assault service. We’re also partnering with violence against women services in Strathroy, Stratford, Sarnia and Thunder Bay. The Western research team includes Tara Mantler (Health Studies), Susan Rodger (Education), and Marilyn Ford-Gilboe & Vicki Smye (Nursing), and staff and trainees Jen MacGregor, Eugenia Canas, Jill Veenendaal and Caitlin Burd (all from FIMS) and Isobel McLean (University of Toronto). A study summary is available here.
In October 2020 our team was awarded a SSHRC Connections Grant to hold two events to develop and share knowledge within and beyond the VAW sector. For more information, click here.
Wathen, N., (2020). “Not all find comfort while ‘safe at home’”. Western News, https://news.westernu.ca/2020/03/not-all-find-comfort-while-safe-at-home/
Wathen, N. (2020). Impossible Choices: Serving Women Experiencing Violence During Covid-19. (Invited). Royal Society of Canada COVID-19 Series | Publication #18. https://rsc-src.ca/en/voices/impossible-choices-serving-women-experiencing-violence-during-covid-19
Incubator members have been delivering educational sessions and workshops on TVIC since 2015, with hundreds of participants in various parts of Canada, and from numerous health and social service contexts. However, we do not yet know whether these sessions have impact beyond providing initial new knowledge, nor is there existing research on this topic.
This study examined the impact, if any, that Trauma- and Violence-informed Care (TVIC) education workshops have on health and social service providers’ individual-level knowledge and practice and on organizational-level policies and strategies. To date, little research on TVIC education has been conducted.
Participants in this study were health and social service professionals who had attended a TVIC workshop presented by a member of the GTV Incubator. Two methods of data collection were used:
- an online survey asking about the impact of the workshop on participants’ thinking, actions and their perceptions of their organization’s practice and policies.
- at the end of the survey, participants were asked if they could be contacted for a follow-up interview to discuss in more detail the impact of the workshop, and related topics.
The study was approved by Western University’s Research Ethics Board.
Take away messages:
1) Educating health professionals and others (e.g., educators) about trauma, violence, and discrimination is not easy.
2) TVIC education can help shift potentially stigmatizing attitudes which can then precipitate practice change.
3) These approaches are emerging as an important way to improve health and quality of life.
Nadine Wathen, Jen MacGregor, Sandy Beyrem (Masters student) and members of the Incubator who have delivered workshops (M. Ford-Gilboe, S. Jack, S. Macphail, M. Macpherson, C. Varcoe).
Trauma and violence are pervasive public health issues. Social and systemic barriers such as poverty and discrimination can intensity the effects of such experiences and negatively impact one’s ability to access health and social services. Equity-oriented care practices combat these challenges, supporting healthcare settings to attend to and reduce the poor health outcomes associated with these experiences. Trauma- and violence-informed care (TVIC) is a key element of equity-oriented care, promoting the emotional, physical, and cultural safety of those accessing services – TVIC can be thought of as a “universal precaution” to minimize harms in the care process. Ongoing work is being done to incorporate TVIC principles into organizational policies and practices, but little has been done to translate this knowledge into information that can inform the general public. This is important because social norms and structures can perpetuate the trauma, violence, and inequities experienced by vulnerable and marginalized groups – and inequities affect individuals, communities and society.
There is little to no evidence that directly informs how to develop public education material using the emerging principles of TVIC. This suggests an important gap in the research and understanding of the benefits and uses of this information. Local organizations, including the Canadian Mental Health Association (CMHA) Middlesex, are actively adopting a TVIC approach for service provision. Therefore, this project seeks to extend such efforts by examining how to use TVIC principles to frame and share TVIC information with the public. This project would be a critical first step in externally focused efforts to support broader community awareness and action regarding trauma, violence, equity and cultural safety.
Our project, in partnership with CMHA Middlesex, will explore the following questions:
- How can the principles and practices of TVIC be integrated into public education material?
- What barriers and facilitators (structural, cultural, and practical) exist that may impact the success of implementing this kind of educational programming and material for the community?
- What is the ideal citizen engagement strategy to use in order to successfully engage the public in the design of TVIC content for public education programming?
We are exploring CMHA’s priorities and current practices to understand how TVIC information can be translated into a useful format for the general community. Linked to existing TVIC efforts at CMHA, surveys, interviews, and/or focus groups with CMHA staff and key community partners will help determine priorities for a citizen engagement strategy, and other relevant, equity-promoting considerations.
We are also reviewing CMHA’s current policies, procedures, and practices regarding public education and any TVIC-related practices, allowing us to co-create with CMHA relevant and effective recommendations for action at the community level.
The results of this study will inform our understanding of:
- providing mental health promotion and psycho-education in a trauma- and violence-informed way;
- educating clients and the public about TVIC.
Ultimately, this research may help to increase the chances of such endeavors leading to improved educational interventions with clients and the public about trauma, violence and mental health.
Data collection: Summer/Fall 2019
Final report: Spring/Summer 2020
MHIS Student Jessica Carswell, Nadine Wathen, Susan Macphail, Vicki Smye
Health and social inequities are increasing, especially for those already marginalized by systemic barriers, such as poverty, discrimination and racism. Many people, across the socio-economic spectrum, have experienced various forms of trauma and violence; for those facing structural barriers and marginalization, these exposures, and their consequences, are often worse, making it even more difficult to access health and social services. To address these challenges, there is a call to explicitly integrate equity-oriented care to address barriers and improve outcomes by addressing both individual and social/structural determinants of health. A core aspect of equity-oriented care is attention to trauma and violence, and their effects, and a commitment to minimizing harm by adopting what we call trauma- and violence-informed care (TVIC). TVIC, and its related concepts of contextually tailored, culturally safe care, and harm reduction, act both as “universal precautions” to reduce harm, and as an approach to tailoring care to improve the fit between people’s needs and provided services.
Very little is known about how to actually integrate TVIC into community-based services – this is an important research gap. A number of organizations in London, Ontario, have recently come together to discuss how to make our community trauma- and violence-informed. This means individual organizations are integrating common, but tailored, TVIC strategies into their services, so that clients experience this care across the system. This provides an important opportunity to evaluate the implementation and integration of TVIC into community-based health and social services. We are looking to partner with organizations that are in different stages of implementation of TVIC, including those already shifting their organizational culture toward TVIC and those in the planning stages of TVIC uptake and implementation. This multiple case study will explore:
- How organizations come to understand the concept of TVIC for their service context.
- What structural, cultural and practical changes are required to implement TVIC, and what factors enable or impede uptake.
- How TVIC implementation impacts organizations.
This is a multistage, multiple case study design. In the first stage, we will approach organizations who participated in a meeting in November 2017, convened by the Centre for Research on Health Equity and Social Inclusion, on “Making London a TVIC Community”. Interviews with those who attended the meeting will help us understand organizations’ initial and subsequent interest and actions specific to TVIC. Three to five organizations from the initial sample will be selected based on their stage in the TVIC planning and implementation process: those who have initiated or are in the latter planning stages will be invited to participate as “cases” in the multiple case study. Data will be collected from interviews with key leaders and staff, document analysis, and observation of relevant meetings to understand TVIC planning and implementation.
The results of this study will inform the development of approaches to better integrate, and assess the uptake and impact of, TVIC into a range of health and social service settings.
Underway, anticipated completion late 2020.
Tanaz Javan, PhD Candidate, Nadine Wathen, Marilyn Ford-Gilboe, Lorie Donelle.
Study summary (pdf) – here.
Links have been established between exposure to trauma and violence and both the development of mental health concerns and the impact on learning success and other educational outcomes for students as well as workplace wellness for teachers. Contemporary teacher education and teacher professional development must meet the needs of teachers in today’s classrooms and communities, where exposure to both interpersonal and systemic forms of violence is the experience of many students, family members, and staff.
Taking a social justice and equity oriented approach to education allows the connections between health care are education to be explicitly aligned in their shared mission to serve the needs of all. Through finding the ‘common ground’ we build on the important work of EQUIP and their health care initiatives, and the language of ‘universal precautions’ becomes one of ‘universal design’ for learning, safety and connections in schools.
The evidence is clear: teachers want to know more about how to care for the emotional, safety and learning needs of their students and both students and teachers must be well, in order to teach and learn well. This project seeks to bring the work in the health care sector that has demonstrated the efficacy of TVIC to the education sector, beginning with education experiences for both pre-service (student) teachers through mandatory course material, and for practicing teachers, through professional development workshops.
These projects, in partnership with local school districts and teacher education colleagues, will explore the following questions:
- How can professional development on TVIC influence the knowledge, attitudes and behavioural intentions of pre-service and in-service teachers?
- What are the immediate and longer term effects of a mandatory online mental health literacy curriculum that includes TVIC?
Project One: 2020-21: Pre-service teachers. Through a program evaluation of a mandatory, completely online course on the topic of mental health literacy with 20% of the curriculum devoted to TVIC principles, we will explore the impact of the learning through both pre-post testing and online discussion forum responses to questions. A one-year follow up is planned. Measures include: the Mental Health Literacy Questionnaire (Rodger, Johnson, Weston & Hatcher, in preparation), the ARTIC-35 questionnaire for educators, and items developed for the project that more directly measure attitudes toward systemic forms of violence.
Project Two: 2020-21: TVIC workshops for teachers. These 3 hour workshops will be held through the 2019-20 school year and focus on Associate Teachers (those teachers who supervise student teachers in their classrooms as part of pre-service teacher education) from 4 local school boards. The same pre-post design will be used, with the same measures.
The results of Project One 2019-20 version (which did not include a one-year follow up) were clear in the impact of TVIC education on the knowledge, attitudes and behavioural intentions of 236 teacher candidates who participated in the study:
The multivariate effect of time was significant for the group of variables that included the 5 subscales of the Attitudes Related to Trauma Informed Care (ARTIC-35; Underlying Causes, Reponses to Problem Behaviour and Symptoms, On the Job Behaviour, Self-Efficacy at Work, and Reactions to Work), 3 subscales of the Teacher Efficacy for Inclusive Practice (TEIP; Inclusive Instruction, Collaboration, and Managing Behaviour) and the four subscales of the MHLQ (Teaching and Leading in a Mentally Healthy Classroom, Role Clarity, Expectations, and Professional Relational Skills): F(13) = 55.6, P<001, η2= .77. Univariate tests revealed significant effects for each of the Time 1-Time 2 comparisons, indicating that the course material and experience impacted the knowledge, attitudes and behavioural intentions of pre-service teachers as measured by the TEIP, ARTIC-35, EHoCS scale, and MHLQ.
Data collection: Fall/Winter 2020-21
Final report: Spring 2020 (for Inservice Teacher Workshops) and Spring 2021 ( for one year follow up for Pre-Service Teacher Education students)
Susan Rodger1, Nadine Wathen2, Matthew Sereda3, Jacqueline Specht1, Kathryn Hibbert1
1Faculty of Education, Western University
2Faculty of Information and Media Studies, Lead, Gender and Violence Incubator
3Thames Valley District School Board
Policing is on the front-line of today’s toughest social challenges. Increasing poverty, the opioid crisis, homelessness and family violence create complex conditions that require police officers to understand trauma and violence informed responses so that they are better prepared to address each unique situation and so that they can mitigate the impact of these situations on their own lives. The research is clear that untreated trauma, whether direct or vicarious, has a cascade effect that destroys lives.
Working with the London and Woodstock, Ontario Police Services, this project will develop and evaluate evidence based, police specific policies, procedures, training and resources.
The project will:
- Establish an organizational TVI implementation model, including a police service TVI accountability team, training and support for existing psychological and peer support programs and community partnerships to advance TVI practices.
- Develop and provide customized training about TVI practice for police services. This will involve breaking the negative stigma commonly associated with acknowledging and seeking help for vicarious trauma.
- Collaborate with mental health professionals and researchers working on TVIC on the development and implementation of the model.
- Pilot and evaluate the model with a mid-sized urban police force and a small urban/rural police force.
An end of project forum for representatives of police services from across Ontario will be held to encourage a broader discussion about the rationale and value of becoming a trauma and violence informed police service. Our police partners are committed to providing train-the-trainer sessions to other police services interested in adapting and implementing the work for their workplaces.
Barb MacQuarrie, Margaret MacPherson and members of the GTV Incubator’s Evaluation Working Group
For more detail, see the project summary.
Our evaluation group is actively involved developing methods and tools for understanding the effectiveness and impact of our TVIC educational approaches.
The curriculum group is evolving both our training methods (off- and online, synchronous and asynchronous) and supporting resources.
Knowledge Mobilization Group
The KMb group strategizes effective communications to key audiences, including ways to assess impact of our work in broader systems and communities.