Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Education

Supervisor

Stewart, Shannon L.

Abstract

Interpersonal trauma can have a detrimental impact on child development. Consequently, there is continued need in the literature to better understand how trauma impacts children, including behavioural presentation and communicative ability. Moreover, increasing awareness of these outcomes indicates that an organized strategy is needed in children’s mental health agencies, such that of trauma-informed care education and training. The current research investigated factors related to externalizing behaviour outcomes in a sample of preschoolers in receipt of outpatient care, as well as factors associated with communication outcomes in a sample of children in receipt of mental health service. This research then explores clinician perspectives around a trauma-informed care training program that was designed and implemented to increase knowledge and awareness of trauma on a variety of developmental outcomes and associated care planning needs for children, youth, and parents exposed to trauma. The first study found that exposure to traumatic life events (compared to children with no exposure to traumatic life events) was related to higher externalizing behaviours in a sample of at-risk preschoolers, however, this relationship was attenuated and no longer significant when caregiver distress (compared to no caregiver distress) was added to the model. Results from the second paper extended upon this, by determining that the number of traumas a child is exposed to (polyvictimization), the number of disruptions in care, parenting strengths, sex, and age were relevant factors in understanding communication concerns within a sample of children and youth in receipt of mental health service. Such findings indicated the importance of early identification and intervention in improving outcomes for children. Findings from the third study examined the impact of a trauma-informed care training program designed for children, youth, and parents in receipt of mental health service, including the facilitators and barriers associated with its implementation. Childhood adversity remains a crucial area of investigation for researchers, as are efforts that seek to target, address, and improve such outcomes on an organizational scale.

Summary for Lay Audience

There is a remaining need for research to examine outcomes for children at risk due to adversity, especially in the context of behaviour and communication. Parental factors, such that of distress and parenting strengths, are important to consider as caregivers play a crucial role in the range of outcomes for children. In turn, attentiveness to these outcomes indicates that a wide-reaching intervention is essential to apply in children’s mental health agencies. The current research thus investigated key factors as it related to the following outcomes for at-risk children and youth: 1) externalizing behaviours in a sample of preschoolers in receipt of outpatient care, 2) communication outcomes in a sample of children in receipt of mental health service, and 3) features of a trauma-informed care training program that was designed to increase awareness and care for trauma exposed children, youth, and parents. The initial research study substantiated that exposure to traumatic life events (compared to no exposure of traumatic life events) was related to higher externalizing behaviours in a sample of at-risk preschoolers, however, this relationship was weakened and no longer significant with the addition of caregiver distress (compared to no caregiver distress). Consequently, behaviour is an avenue by which young children communicate their needs, especially with the presence of relevant stressors. Results from the second paper extended that the number of traumas a child is exposed to (polyvictimization), the number of disruptions in care, parenting strengths, sex, and age were prominent factors related to communication concerns in a sample of children and youth in receipt of mental health service. These findings further indicated the importance of early identification, effective care planning, and intervention for at-risk children. Findings from the final study extended on this work through an organized intervention (i.e., an interRAI trauma-informed care training program) which encompassed both facilitators and barriers of care for children, youth, and parents in receipt of trauma-informed mental health service. Exposure to adversity must continue to be closely examined by researchers and should be addressed in direct service provision, as such efforts work to improve the lives of at-risk and vulnerable children and youth.

Available for download on Thursday, April 30, 2026

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