Journal Article

Implementing a trauma-informed approach in a tiered model of pediatric population mental health care: a pilot study in primary and secondary care

Rotter, Nancy, Eschtruth, Miranda, Lee, Younga H., Malvese, Katelyn, Zhou, Yu, Blevins, Emily J., Basu, Archana, Mikesell, Caley, Wallace, Mary, Watanabe, Makiko, Allswede, Dana

2025

Overview

Background Childhood adversity and trauma are prevalent risk factors for the development of mental health conditions. This two-part paper describes the conceptual basis and pilot implementation of a tiered model of pediatric population mental health, highlighting the local socioecological context in which it was developed and the trauma-informed approach used. Methods Using retrospective record review of three datasets from the primary and secondary care pediatric clinics of a large academic medical center, which were harmonized to cover the study period from July 1, 2023 to June 30, 2024, we conducted descriptive analyses of patients across three levels: pediatric primary care ( n  = 9535), an integrated primary care program, which embeds mental health clinicians in primary care ( n  = 267), and family-centered trauma-informed psychotherapies in secondary care ( n  = 63), designed to address emotion dysregulation in pre-adolescent children. Demographics and lifetime history of trauma and adversity (assessed with a comprehensive 19-item list coded based on standardized screeners) were assessed through electronic medical records. Results Relative to the pediatric primary care population, more patients in the integrated primary care program and trauma-informed psychotherapies identified as White. Using our 19-item assessment, the lifetime prevalence of adversity or trauma was nearly universal among patients in the integrated primary care (94.4%) and trauma-informed psychotherapy (98.4%) programs. However, the lifetime prevalence of childhood adversities differed significantly across the two programs (integrated primary care: 76.8%; trauma-informed psychotherapy: 98.4%) when we assessed prevalence based only on the 10-item Adverse Childhood Experiences Questionnaire (Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS, Am J Prev Med 14:245–58, 1998). There was a higher prevalence of family and parent-related adversities in the trauma-informed psychotherapy program. Conclusions Findings support the need for trauma-informed, population mental health approaches in pediatric care. Developmentally tailored, family-centered, transdiagnostic screening and interventions are essential. Study findings, including gaps in programmatic fiscal sustainability, suggest avenues for policy reform to support and scale trauma-informed programs like ours. Programs seeking to implement trauma-informed approaches should leverage implementation and participatory research to ensure effectiveness and equitable accessibility for patients of diverse identities.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adolescent / Adverse Childhood Experiences / Adversity / Care and treatment / Child / Child psychiatric services / Child psychopathology / Child, Preschool / Female / Health Administration / Health aspects / Health Informatics / Humans / Integrated primary care / Male / Medicine / Medicine & Public Health / Mental Health Services - organization & administration / Nursing Research / Pediatric mental health care / Pediatric research / Pilot Projects / policy and research / Population mental health / Primary Health Care - organization & administration / Psychic trauma in children / Psychotherapy - methods / Public Health / Retrospective Studies / Risk factors / Secondary Care - organization & administration / Trauma / Trauma-informed approaches: Implications for practice / Trauma-informed care