Abstract
Objectives: This case study aimed to explore young mothers’ perspectives of trauma-informed care (TIC) strategies developed by the employees of a community organization they frequent.
Methods: Young mothers (≤25 years old; n = 12), who were already using the organization’s services, were invited to participate in group or individual semi-structured interviews. They were asked to share their opinions on TIC strategies proposed by the employees. This qualitative case study, grounded in pragmatism, used a directed content analysis approach.
Results: The results showed that several TIC strategies were seen as helpful, particularly those offering structured guidance, improved communication, and support from both the organization and peer programs. Perspectives on strategies aiming to increase autonomy were mixed, with mothers valuing opportunities for increased agency over their service participation while emphasizing the importance of continued organizational support. Some strategies initially developed by the employees to address cultural, historical and gender considerations generated limited insights and discussions amongst service participants.
Conclusion: This study contributes to the limited literature on service participants’ perspectives of TIC. While mothers valued most strategies proposed, misalignments with employees’ ideas for TIC strategies demonstrated the relevance of including their voices during TIC implementation. The limited insights on topics related to cultural and gender considerations illustrates the importance of including participants from various social locations.
Implications: This study highlights the relevance for future studies to include service participants in the design and implementation of TIC strategies, and to adopt a collaborative approach that values trauma survivors’ experiential knowledge.
References
Abdul Rahim, K., Egglestone, N. J., Tsagareli, I. G., Usmani, W., Meherali, S., & Lassi, Z. S. (2024). Mental health outcomes beyond the post-partum period among adolescent mothers: A systematic review and meta-analysis. Health Psychology and Behavioral Medicine, 12(1), Article 2305741. https://doi.org/10.1080/21642850.2024.2305741
Ashby, B. D., Ehmer, A. C., & Scott, S. M. (2019). Trauma-informed care in a patient-centered medical home for adolescent mothers and their children. Psychological Services, 16(1), 67-74. https://doi.org/10.1037/ser0000315
Assarroudi, A., Nabavi, F. H., Armat, M. R., Ebadi, A., & Vaismoradi, M. (2018). Directed qualitative content analysis: The description and elaboration of its underpinning methods and data analysis process. Journal of Research in Nursing, 23(1), 42-55. https://doi.org/10.1177/1744987117741667
Beresford, P., & Boxall, K. (2013). Where do service users’ knowledges sit in relation to professional and academic understandings of knowledge? In P. Staddon (Ed.), Mental health service users in research: Critical sociological perspectives (pp. 69-86). Bristol University Press. https://doi.org/10.2307/j.ctt9qgmxw.10
Berkes, F., & Ross, H. (2013). Community resilience: Toward an integrated approach. Society and Natural Resources, 26(1), 5-20. https://doi.org/10.1080/08941920.2012.736605
Boxall, K., & Beresford, P. (2013). Service user research in social work and disability studies in the United Kingdom. Disability & Society, 28(5), 587-600. https://doi.org/10.1080/09687599.2012.717876
Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide. SAGE Publications.
Cabecinha-Alati, S., Langevin, R., Kern, A., & Montreuil, T. (2020). Pathways from childhood maltreatment to unsupportive emotion socialization: Implications for children’s emotional inhibition. Journal of Family Violence, 36(8), 1033-1043. https://doi.org/10.1007/s10896-020-00184-y
Creswell, J. W. (2007). Qualitative inquiry & research design : Choosing among five approaches (2nd edition). Sage Publications.
Creswell, J. W. & Poth, C. N. (2018) Pragmatism. In Qualitative inquiry & research design: Choosing among five approaches (4th edition, pp. 108-110). SAGE Publications, Inc.
Easterbrook, M. A., Katz, R. C., & Menon, M. (2019). Adolescent parenting. In M. H. Bronstein (Ed). Handbook of parenting (3rd edition, pp. 199-231). Routledge.
Faulkner, A. (2017). Survivor research and mad studies: The role and value of experiential knowledge in mental health research. Disability & Society, 32(4), 500-520. https://doi.org/10.1080/09687599.2017.1302320
Gagliardi, A. R., Berta, W., Kothari, A., Boyko, J., & Urquhart, R. (2016). Integrated knowledge translation (IKT) in health care: A scoping review. Implementation Science, 11(1), Article 38. https://doi.org/10.1186/s13012-016-0399-1
Gouvernement du Québec. (2024). Partenaires du système : Organismes communautaires. Ministère de la Santé et des services sociaux. https://www.msss.gouv.qc.ca/reseau/partenaires-du-systeme/organismes-communautaires/
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105-112. https://doi.org/10.1016/j.nedt.2003.10.001
Henretta, J. C., Grundy, E. M. D., Okell, L. C., & Wadsworth, M. E. J. (2008). Early motherhood and mental health in midlife: A study of British and American cohorts. Aging & Mental Health, 12(5), 605–614. https://doi.org/10.1080/13607860802343084
Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277-1288. https://doi.org/10.1177/1049732305276687
Hyett, N., Kenny, A., & Dickson-Swift, V. (2014). Methodology or method? A critical review of qualitative case study reports. International Journal of Qualitative Studies on Health and Well-Being, 9(1), Article 23606. https://doi.org/10.3402/qhw.v9.23606
Isobel, S., Wilson, A., Gill, K., & Howe, D. (2021). ‘What would a trauma-informed mental health service look like?’ Perspectives of people who access services. International Journal of Mental Health Nursing, 30(2), 495-505. https://doi.org/10.1111/inm.12813
Johnson, R. B., & Onwuegbuzie, A. J. (2004). Mixed methods research: A research paradigm whose time has come. Educational Researcher, 33(7), 14–26. https://doi.org/10.3102/0013189X033007014
Jull, J., Giles, A., & Graham, I. D. (2017). Community-based participatory research and integrated knowledge translation: Advancing the co-creation of knowledge. Implementation Science, 12(1), Article 150. https://doi.org/10.1186/s13012-017-0696-3
Khubchandani, J., Balls-Berry, J., Price, J. H., & Webb, F. J. (2016). Community-engaged strategies to increase diversity of participants in health education research. Health Promotion Practice, 17(3), 323–327. https://doi.org/10.1177/1524839916644713
Killian-Farrell, C., Rizo, C. F., Lombardi, B. M., Meltzer-Brody, S. & Bledsoe, S. E. (2020). Traumatic experience, polytraumatization, and perinatal depression in a diverse sample of adolescent mothers. Journal of Interpersonal Violence, 35(23-24), 6017-6040. https://doi.org/10.1177/0886260517726410
Langevin, R., Gagné, M.-E., & Collin-Vézina, D. (2023). Processus d’adaptation et d’implantation d’une approche sensible au trauma au sein d’un petit organisme communautaire en milieu urbain desservant de jeunes familles vulnérables. Travail Social, 69(1), 109-128. https://doi.org/10.7202/1112175ar
Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26(13), 1753-1760. https://doi.org/10.1177/1049732315617444
Medina, N. Y., Edwards, R. C., Zhang, Y., & Hans, S. L. (2022). A longitudinal investigation of young mothers’ prenatal attachment, depressive symptoms, and early parenting behaviour. Journal of Reproductive and Infant Psychology, 40(2), 196-211. https://doi.org/10.1080/02646838.2021.1886257
Millar, H. C., Lorber, S., Vandermorris, A., Thompson, G., Thompson, M., Allen, L., Aggarwal, A., & Spitzer, R. F. (2021). “No, you need to explain what you are doing”: Obstetric care experiences and preferences of adolescent mothers with a history of childhood trauma. Journal of Pediatric and Adolescent Gynecology, 34(4), 538-545. https://doi.org/10.1016/j.jpag.2021.01.006
Miller, E., McCauley, H. L., Decker, M. R., Levenson, R., Zelazny, S., Jones, K. A., Anderson, H., & Silverman, J. G. (2017). Implementation of a family planning clinic-based partner violence and reproductive coercion intervention: Provider and patient perspectives. Perspectives on Sexual and Reproductive Health, 49(2), 85-93. https://doi.org/10.1363/psrh.12021
Morgan, D. L. (2014). Pragmatism as a paradigm for social research. Qualitative Inquiry, 20(8), 1045-1053. https://doi.org/10.1177/1077800413513733
Muzik, M., Ads, M., Bonham, C., Lisa Rosenblum, K., Broderick, A., & Kirk, R. (2013). Perspectives on trauma-informed care from mothers with a history of childhood maltreatment: A qualitative study. Child Abuse & Neglect, 37(12), 1215–1224. https://doi.org/10.1016/j.chiabu.2013.07.014
Muzik, M., Kirk, R., Alfafara, E., Jonika, J., & Waddell, R. (2016). Teenage mothers of black and minority ethnic origin want access to a range of mental and physical health support: a participatory research approach. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 19(2), 403-415. https://doi.org/10.1111/hex.12364
Noll, J. G., Guastaferro, K., Beal, S. J., Schreier, H. M. C, Barnes, J., Reader, J. M., & Font, S. A. (2019). Is sexual abuse a unique predictor of sexual risk behaviors, pregnancy, and motherhood in adolescence? Journal of Research on Adolescence, 29(4) 967-983. https://doi.org/10.1111/jora.12436
Norris, S., Norris, M. L., Sibbald, E., Aubry, T., Harrison, M. E., Lafontaine, G., & Gandhi, J. (2016). Demographic characteristics associated with pregnant and postpartum youth referred for mental health services in a community outreach center. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 25(3), 152-158. https://cacap-acpea.org/wp-content/uploads/Demographic-Characteristics-Associated-with-Pregnant.pdf
Pottinger, A. M., Boyne, A. S., & Passard, N. N. (2023). Stigma and depression in adolescent mothers – How do types of households influence the mothers’ mental well-being? Journal of Child and Family Studies, 32(11), 3389-3400. https://doi.org/10.1007/s10826-023-02630-z
Provencher, C. & Galbraith, N. (2024). Fertility in Canada, 1921 to 2022: Demographic documents. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/91f0015m/91f0015m2024001-eng.pdf
Sarri, R., & Phillips, A. (2004). Health and social services for pregnant and parenting high risk teens. Children and Youth Services Review, 26(6), 537-560. https://doi.org/10.1016/j.childyouth.2004.02.010
Schneider, B. (2012). Participatory action research, mental health service user research, and the hearing (our) voices projects. International Journal of Qualitative Methods, 11(2), 152-165. https://doi.org/10.1177/160940691201100203
SmithBattle, L., & Freed, P. (2016). Teen mothers’ mental health. The American Journal of Maternal Child Nursing, 41(1), 31-36. https://doi.org/10.1097/NMC.0000000000000198
Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information 22(2), 63-75. https://doi.org/10.3233/EFI-2004-22201
Stargel, L. E., & Easterbrooks, M. A. (2020). Diversity of adverse childhood experiences among adolescent mothers and the intergenerational transmission of risk to children's behavior problems. Social Science & Medicine, 250, Article 112828. https://doi.org/10.1016/j.socscimed.2020.112828
Stokes, Y., Cloutier, P., Aggarwal, D., Jacob, J. D., Hambrick, E., Tricco, A. C., Ward, M. K., Kennedy, A., Greenham, S., Robb, M., Sheppard, R., Murphy, D., Boggett, J., Graham, I. D., & Lewis, K. B. (2024). Youth, caregiver and healthcare professional perspectives on planning the implementation of a trauma-informed care programme: A qualitative study. Journal of Advanced Nursing, 81(10), 6602-6624. https://doi.org/10.1111/jan.16095
Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Practical guide for implementing a trauma-informed approach. SAMHSA Publication No. PEP23-06-05-005. National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration.
Tung, I., Keenan, K., & Hipwell, A. E. (2023). Adolescent mothers’ psychological wellbeing during pregnancy and infant emotional health. Journal of Clinical Child and Adolescent Psychology, 52(5), 616-632. https://doi.org/10.1080/15374416.2021.1981339
Wathen, C. N., & MacMillan, H. L. (2018). The role of integrated knowledge translation in intervention research. Prevention Science, 19(3), 319-327. https://doi.org/10.1007/s11121-015-0564-9
Wong, S. P. W., Twynstra, J., Gilliland, J. A., Cook, J. L., & Seabrook, J. A. (2020). Risk factors and birth outcomes associated with teenage pregnancy: A Canadian sample. Journal of Pediatric and Adolescent Gynecology, 33(2), 153-159. https://doi.org/10.1016/j.jpag.2019.10.006
Yoon, Y., Cederbaum, J. A., Duan, L., & Lee, J. O. (2024). Intergenerational continuity of childhood adversity and its underlying mechanisms among teen mothers and their offspring. Child Maltreatment, 29(4), 557-573. https://doi.org/10.1177/10775595231200145