Trauma-informed care : a programme for caregivers in child and youth care centres within the South African context

Abstract

There is growing apprehension about the quality of care provided to the vulnerable children residing in child and youth care centres (CYCCs). Children in CYCCs often have unique care needs stemming from their complex trauma histories, for which the child welfare system seemingly does not adequately prepare, train, and support its workforce. The multi-level systemic difficulties inherent to caregiving in the context of CYCCs may cause strain on the caregiver-child relationship and potentially leave caregivers overburdened and children deprived of appropriate care. Research recommendations in response to this phenomenon entail the provision of trauma-informed care (TIC) and TIC-related practices that are considered mutually beneficial to caregivers and the children in their care. Though several TIC models exist for application in CYCCs, they were generally developed in high-income countries. In developing training programmes, Allsopp (2022:241) highlights the necessity of “indigenisation of child and youth care work education” and orienting such training to the South African contexts. The goal of the research was, therefore, to design and develop a TIC programme for caregivers in CYCCs within the South African context, and was guided by the research question: How can a trauma-informed programme support caregivers in their role of caring for children in CYCCs within the South African context?

The applied research study followed an intervention research design to develop a preliminary TIC programme to empower caregivers in CYCCs. The researcher used a qualitative approach to explore and describe the experiences of caregiving from the perspectives of multiple sources (20 children, 20 caregivers and 10 social workers/managers) from various contexts (four CYCCs). Guided by an interview schedule, the researcher conducted one-on-one semi-structured interviews with a purposively selected sample of 50 participants. Through thematic analysis, themes and sub-themes in the research findings supported by literature, informed the design and development of the TIC programme. A pilot test of the TIC training was conducted with 15 caregivers who attended the programme online and subsequently engaged in focus group interviews, guided by an interview guideline, to provide feedback on the TIC programme. The researcher used thematic analysis to analyse the qualitative data and present the research findings. The researcher diligently adhered to the ethical considerations throughout the research process. Developmental Systems Theory (DST) and Gestalt theory provided a conceptual and analytical structure that supported the research study and the interpretation of the findings, contributing to the credibility and validity of the research.

The findings illustrated that caregiving experiences in CYCCs are influenced by the reciprocal interaction of multiple system-level variables, consistent with a DST perspective. The system-level variables that were perceived to impact the quality of caregiving in CYCCs include: 1) children in CYCCs whose comprehensive needs in terms of care require a profound understanding of their complex trauma histories; 2) caregivers who are overwhelmed by individual-, relational- and operational-level challenges; and 3) organisation-level policies and procedures, including recruitment, preparation, training, and support of caregivers which seem inadequately implemented. The researcher concluded that the TIC training programme may be significantly relevant to address the concerns about caregiving in CYCCs and have the potential to be mutually beneficial to caregivers and the children in their care by cultivating an environment that is responsive to trauma. Gestalt theory provides a conceptual framework to understand that change in one part of the system, such as caregivers’ knowledge of trauma, may effectuate change in other parts of the system, such as the children’s experiences of care or the CYCCs’ culture of care.

The pilot test of the TIC programme indicated that caregivers perceived the TIC programme to be essential in the context of caregiving in CYCCs since it is relevant and helpful to understanding children and their behaviour in the context of their trauma histories. It was concluded that a TIC training programme may potentially empower caregivers with the knowledge and skills to provide trauma-responsive care for children in CYCCs within the South African context. Providing TIC training to caregivers who work at CYCCs is recommended as an initial step to empower caregivers for their significant role in providing quality care to children in CYCCs, consistent with Gestalt theory that accentuates awareness as the starting point for change. Since leadership in CYCCs plays an essential role in the successful implementation of organisation-wide TIC, it was recommended that leaders in policy formation and practice of child and youth care (CYC) adopt a TIC approach considering caregiving in CYCCs. Further research on the implementation of TIC is recommended.