Skip to main content

Advertisement

SpringerLink
Log in

Development and Psychometric Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) Scale

  • Original Paper
  • Published:
School Mental Health Aims and scope Submit manuscript

Abstract

Due to its high prevalence and associated risk of poor academic and health outcomes, adverse childhood experiences and trauma are considered a public health epidemic. In response, there has been a surge of initiatives aimed at helping institutions and individuals serving people with histories of trauma to adopt a trauma-informed care (TIC) approach. However, significant roadblocks to TIC research and practice include an unclear operational definition of TIC and the shortage of psychometrically robust instruments to evaluate TIC. To close these gaps, we used a partnership-based approach to develop a direct, efficient, and cost-effective measure of TIC focused on evaluating the TIC-relevant attitudes of staff working in schools, human service systems, and other settings serving individuals with histories of trauma. We then conducted a psychometric evaluation of the resultant measure, the Attitudes Related to Trauma-Informed Care (ARTIC) Scale, with a sample of 760 staff employed in education, human services, and health care. Study findings established support for the psychometric properties of the measure. Specifically, confirmatory factor analysis indicated that the seven-factor structure fit the data well. Scores on the ARTIC demonstrated strong internal consistency and test–retest reliability over 6 months for the 45-item and 35-item composites, the seven subscales, and the 10-item short form. Construct and criterion-related validity were supported by correlations with indicators of familiarity with TIC and staff- and system-level indicators of TIC implementation. The current study has implications for accelerating research on TIC and facilitating data-based decision making related to the adoption and implementation of TIC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Adams, E. J. (2010). Healing invisible wounds: Why investing in trauma-informed care for children makes sense. Washington, DC: Justice Policy Institute.

    Google Scholar 

  • Adams, M. E. (2015). Lawsuit says schools are legally required to address student trauma. EdSource: Highlighting strategies for student success. http://www.edsource.org

  • Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. doi:10.1016/0749-5978(91)90020-T.

    Article  Google Scholar 

  • Alim, T. N., Graves, E., Mellman, T. A., Aigbogun, N., Gray, E., Lawson, W., & Charney, D. S. (2006). Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population. Journal of the National Medical Association, 98(10), 1630.

    PubMed Central  PubMed  Google Scholar 

  • Azeem, M. W., Aujla, A., Rammerth, M., Binsfeld, G., & Jones, R. B. (2011). Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. Journal of Child and Adolescent Psychiatric Nursing, 24(1), 11–15. doi:10.1111/j.1744-6171.2010.00262.x.

    Article  Google Scholar 

  • Baker, C. N., Kupersmidt, J. B., Voegler-Lee, M. E., Arnold, D. H., & Willoughby, M. T. (2010). Predicting teacher participation in a classroom-based, integrated preventive intervention for preschoolers. Early Childhood Research Quarterly, 25(3), 270–283.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bloom, S. L., & Farragher, B. (2010). Destroying sanctuary: The crisis in human service delivery systems. New York: Oxford University Press.

    Book  Google Scholar 

  • Bloom, S. L., & Farragher, B. (2013). Restoring sanctuary: A new operating system for trauma-informed systems of care. New York: Oxford University Press.

    Book  Google Scholar 

  • Brown, S. M., Baker, C. N., & Wilcox, P. (2012). Risking Connection trauma training: A pathway toward trauma-informed care in child congregate care settings. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 507–514. doi:10.1037/a0025269.

    Article  Google Scholar 

  • Burch, B., Naser, S., & Overstreet, S. (2010). Children and disasters: Lessons from Hurricane Katrina. Whittier Journal of Child and Family Advocacy, 10, 3.

    Google Scholar 

  • Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse and Neglect, 35(6), 408–413.

    Article  PubMed Central  PubMed  Google Scholar 

  • Capezza, N. M., & Najavits, L. M. (2012). Rates of trauma-informed counseling at substance abuse treatment facilities: Reports from over 10,000 programs. Psychiatric Services, 63(4), 390–394.

  • Center for Disease Control and Prevention. (2010). Adverse childhood experiences reported by adults—Five states, 2009. Morbidity and Mortality Weekly Report, 59(49), 1609.

    Google Scholar 

  • Chandler, G. (2008). From traditional inpatient to trauma-informed treatment: Transferring control from staff to patient. Journal of the American Psychiatric Nurses Association, 14(5), 363–371. doi:10.1177/1078390308326625.

    Article  PubMed  Google Scholar 

  • Cohen, J. A., Berliner, L., & Mannarino, A. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse and Neglect, 34(4), 215–224. doi:10.1016/j.chiabu.2009.12.003.

    Article  PubMed  Google Scholar 

  • Cole, S. F., Eisner, A., Gregory, M., & Ristuccia, J. (2013). Helping traumatized children learn: Safe, supportive learning environments that benefit all children. Boston, MA: Massachusetts Advocates for Children Trauma and Learning Policy Initiative.

    Google Scholar 

  • Cole, S. F., O’Brien, J. G., Gadd, M. G., Ristuccia, J., Wallace, D. L., & Gregory, M. (2005). Helping traumatized children learn: Supportive school environments for children traumatized by family violence. Boston, MA: Massachusetts Advocates for Children Trauma and Learning Policy Initiative.

    Google Scholar 

  • Colton, D., & Xiong, H. (2010). Reducing seclusion and restraint: Questionnaire for organizational assessment. Journal of Psychiatric Practice, 16(5), 358–362. doi:10.1097/01.pra.0000388632.74899.86.

    Article  PubMed  Google Scholar 

  • Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584. doi:10.1001/archpsyc.64.5.577.

    Article  PubMed  Google Scholar 

  • DeVellis, R. F. (2012). Scale development: Theory and applications (3rd ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Donnellan, M. B., Oswald, F. L., Baird, B. M., & Lucas, R. E. (2006). The mini-IPIP scales: Tiny-yet-effective measures of the Big Five factors of personality. Psychological Assessment, 18(2), 192–203. doi:10.1037/1040-3590.18.2.192.

    Article  PubMed  Google Scholar 

  • Downey, L. (2007). Calmer classrooms: A guide to working with traumatised children. Melbourne: Child Safety Commissioner.

  • Drury, S. S., Theall, K., Gleason, M. M., Smyke, A. T., De Vivo, I., Wong, J. Y. Y., et al. (2012). Telomere length and early severe social deprivation: Linking early adversity and cellular aging. Molecular Psychiatry, 17(7), 719–727. doi:10.1038/mp.2011.53.

    Article  PubMed Central  PubMed  Google Scholar 

  • Felitti, M. D., Vincent, J., Anda, M. D., Robert, F., Nordenberg, M. D., Williamson, M. S., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.

    Article  PubMed  Google Scholar 

  • Fixsen, D. L., Blase, K. A., Naoom, S. F., & Wallace, F. (2009). Core implementation components. Research on Social Work Practice, 19(5), 531–540.

    Article  Google Scholar 

  • Giaconia, R., Reinherz, H., Silverman, A., Bilge, P., Frost, A., & Cohen, E. (1995). Traumas and posttraumatic stress disorder in a community population of older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1369–1380. doi:10.1097/00004583-199510000-00023.

    Article  PubMed  Google Scholar 

  • Green, B. L., Saunders, P. A., Power, E., Dass-Brailsford, P., Schelbert, K. B., Giller, E., et al. (2015). Trauma-informed medical care: A CME communication training for primary care providers. Family Medicine, 47(1), 7.

    PubMed Central  PubMed  Google Scholar 

  • Greenwald, R., Siradas, L., Schmitt, T. A., Reslan, S., Fierle, J., & Sande, B. (2012). Implementing trauma-informed treatment for youth in a residential facility: First-year outcomes. Residential Treatment for Children & Youth, 29(2), 141–153. doi:10.1080/0886571X.2012.676525.

    Article  Google Scholar 

  • Hammer, J. H., Springer, J., Beck, N. C., Menditto, A., & Coleman, J. (2011). The relationship between seclusion and restraint use and childhood abuse among psychiatric inpatients. Journal of interpersonal violence, 26(3), 567–579. doi:10.1177/0886260510363419.

    Article  PubMed  Google Scholar 

  • Harris, M., & Fallot, R. (Eds.). (2001). Using trauma theory to design service systems. New directions for mental health services. San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Hausman, A. J., Baker, C. N., Komaroff, E., Thomas, N., Guerra, T., Hohl, B. C., & Leff, S. S. (2013). Developing measures of community-relevant outcomes for violence prevention programs: A community-based participatory research approach to measurement. American Journal of Community Psychology, 52(3–4), 249–262.

    Article  PubMed  Google Scholar 

  • Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28(7), 679–692. doi:10.1007/s10896-013-9531-z.

    Article  Google Scholar 

  • Hoerger, M. (2010). Participant dropout as a function of survey length in Internet-mediated university studies: Implications for study design and voluntary participation in psychological research. Cyberpsychology, Behavior, and Social Networking, 13(6), 697–700. doi:10.1089/cyber.2009.0445.

    Article  Google Scholar 

  • Hooper, D., Coughlan, J. & Mullen, M. R. (2008). Structural equation modelling: Guidelines for determining model fit. The Electronic Journal of Business Research Methods, 6(1), 53–60. www.ejbrm.com

  • Hummer, V. L., Dollard, N., Robst, J., & Armstrong, M. I. (2010). Innovations in implementation of trauma-informed care practices in youth residential treatment: A curriculum for organizational change. Child Welfare, 89, 79–95.

    PubMed  Google Scholar 

  • Jennings, A. (2007). Blueprint for action: Building trauma-informed mental health service systems. Retrieved August 4, 2010, from the Anna Institute Web site: http://www.theannainstitute.org/2007%202008%20Blueprint%20By%20States02.08.pdf

  • Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28(1), 36–47. doi:10.1016/j.cpr.2007.01.017.

    Article  PubMed  Google Scholar 

  • Kirkpatrick, D. I. (1967). Evaluation of training. In R. Craig & I. Bittel (Eds.), Training and development handbook (pp. 87–112). New York: McGraw-Hill.

    Google Scholar 

  • Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., et al. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396. doi:10.1037/0735-7028.39.4.396.

    Article  Google Scholar 

  • Lebel, J. (2011). The business case for preventing and reducing restraint and seclusion use. HHS Publication No. (SMA), 11-4632.

  • Lipschitz, D. S., Winegar, R. K., Hartnick, E., Foote, B., & Southwick, S. M. (1999). Posttraumatic stress disorder in hospitalized adolescents: Psychiatric comorbidity and clinical correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 38(4), 385–392. doi:10.1097/00004583-199904000-00010.

    Article  PubMed  Google Scholar 

  • Metz, A. J., Blase, K., & Bowie, L. (2007). Implementing evidence-based practices: Six “drivers” of success. Child trends: Research-to-results brief. Washington, DC: The Atlantic Philanthropies.

  • Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. Quality and safety in health care, 14(1), 26–33.

    Article  PubMed Central  PubMed  Google Scholar 

  • Morgan, E., Salomon, N., Plotkin, M., & Cohen, R. (2014). The School discipline consensus report: Strategies from the field to keep students engaged in school and out of the juvenile justice system. New York: The Council of State Governments Justice Center.

    Google Scholar 

  • Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. M. (2005). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56(10), 1213–1222.

  • Moses, D. J., Reed, B. G., Mazelis, R., & D’Ambrosio, B. (2003). Creating trauma services for women with co-occurring disorders: Experiences from the Substance Abuse and Mental Health Services Administration women with alcohol, drug abuse and mental health disorders who have histories of violence study. Delmar, NY: Policy Research Associates. Retrieved from http://www.praine.com/wedvs/pdfs/CreatingTraumaServices.pdf

  • Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide: Statistical analysis with latent variables: User’s guide. Los Angeles: Muthén & Muthén.

    Google Scholar 

  • Overstreet, S., & Mathews, T. (2011). Challenges associated with exposure to chronic trauma: Using a public health framework to foster resilient outcomes among youth. Psychology in the Schools, 48(7), 738–754.

    Article  Google Scholar 

  • Porche, M. V., Fortuna, L. R., Lin, J., & Alegria, M. (2011). Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults. Child Development, 82(3), 982–998.

    Article  PubMed Central  PubMed  Google Scholar 

  • Rivard, J. C., Bloom, S. L., McCorkle, D., & Abramovitz, R. (2005). Preliminary results of a study examining the implementation and effects of a trauma recovery framework for youths in residential treatment. Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations, 26(1), 83–96.

    Google Scholar 

  • Rossen, E., & Hull, R. V. (Eds.). (2013). Supporting and educating traumatized students: A guide for school-based professionals. New York: Oxford University Press.

    Google Scholar 

  • Saakvitne, K. W., Gamble, S., Pearlman, L. A., & Tabor Lev, B. (2001). Risking connection: A training curriculum for working with survivors of childhood abuse. Baltimore, MD: Sidran Press.

    Google Scholar 

  • Sochting, I., Corrado, R., Cohen, I. M., Ley, R. G., & Brasfield, C. (2007). Traumatic pasts in Canadian Aboriginal people: Further support for a complex trauma conceptualization? British Columbia Medical Journal, 49(6), 320–326.

    Google Scholar 

  • Sprague, C. (2008). Informing judges about child trauma: Findings from the National Child Traumatic Stress Network/National council for Juvenile and Family Court Judges Focus Groups. NCTSN Service System Briefs, 2(2). Los Angeles: National Center for Child Traumatic Stress.

  • Stevens, J. E. (2012). “Lincoln High School in Walla Walla, WA tries new approach to school discipline—Suspensions drop 85%.” ACEs too high. Retrieved from http://ACEstoohigh.com/2012/04/23/Iincoln-high-schooI-in-waIla-walia-wa-tries-new-approach-to-school-discipline-expulsions-drop-85/

  • Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  • Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navalta, C. P., & Kim, D. M. (2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience and Biobehavioral Reviews, 27(1), 33–44. doi:10.1016/S0149-7634(03)00007-1.

    Article  PubMed  Google Scholar 

  • Van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389–399. doi:10.1002/jts.20047.

    Article  PubMed  Google Scholar 

  • Weiner, B. J. (2009). A theory of organizational readiness for change. Implement Sci, 4(1), 67. doi:10.2286/2748-5908-4-67.

    Article  PubMed Central  PubMed  Google Scholar 

  • Women and Trauma Federal Partners Committee, & United States of America. (2013). Trauma-informed approaches: Federal activities and initiatives-Federal Partners Committee on Women and Trauma. A working document/second report. http://static.nicic.gov/Library/027657.pdf.

  • Woods, S. A., & Hampson, S. E. (2005). Measuring the Big Five with single items using a bipolar response scale. European Journal of Personality, 19(5), 373–390.

    Article  Google Scholar 

  • Zelechoski, A. D., Sharma, R., Beserra, K., Miguel, J. L., DeMarco, M., & Spinazzola, J. (2013). Traumatized youth in residential treatment settings: Prevalence, clinical presentation, treatment, and policy implications. Journal of Family Violence, 28(7), 639–652.

    Article  Google Scholar 

Download references

Acknowledgments

We are grateful to Tulane University and A Studio in the Woods/Tulane-Xavier Center for Bioenvironmental Research for their support of this project. We would like to acknowledge Laurie Pearlman, Kay Saakvitne, Steve Girelli, Christine Farber, Beth Hudnall-Stamm, Michael Hoerger, Johanna Kester, and Andrew Finnegan for their assistance with this project. Finally, we would also like to thank the educators, service providers, and staff who participated in this study. Risking Connection® is a registered trademark of the Sidran Institute.

Author information

Authors and Affiliations

  1. Department of Psychology, Tulane University, 6400 Freret Street, Percival Stern Hall, New Orleans, LA, 70118, USA

    Courtney N. Baker & Stacy Overstreet

  2. Traumatic Stress Institute of Klingberg Family Centers and Risking Connection Training Program, New Britain, CT, USA

    Steven M. Brown & Patricia D. Wilcox

  3. Department of Psychology, Pace University, New York, NY, USA

    Prerna Arora

Authors
  1. Courtney N. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia D. Wilcox
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stacy Overstreet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Prerna Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Courtney N. Baker.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baker, C.N., Brown, S.M., Wilcox, P.D. et al. Development and Psychometric Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) Scale. School Mental Health 8, 61–76 (2016). https://doi.org/10.1007/s12310-015-9161-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12310-015-9161-0

Keywords

Search

Navigation