Section 5 Conclusions and Limitations

5.1 Conclusion

Community Context

Racial and ethnic inequities exist across various measures of economic well-being including income, educational attainment, and home values. The primary pathway to increase economic opportunity is through educational attainment, but racial and ethnic disparities are prevalent throughout all levels of the education system.

5.2 System of Child-Serving Agencies

Staff Experiences of ACEs and Discrimination

Most staff members at child-serving agencies who responded to the survey reported experiencing at least one Adverse Childhood Experience (ACE), with almost half experiencing 1-3 ACEs. These staff experiences closely mirror those reported by residents in Forsyth County with the most common reports being emotional abuse, loss of a parent, household mental illness, substance abuse, and physical abuse. Notably, about 44% of respondents reported experiences of discrimination among Black / African American respondents, respondents not identifying as white, and middle-income respondents being the most likely to report these experiences.

Impact of COVID-19

78% of survey respondents at child-serving agencies reported being at least somewhat impacted by COVID-19, and 20% reported being “very much impacted.” Interviews with staff found that the COVID-19 pandemic not only affected how community service providers served the community, but it also added extra personal and professional stressors and trauma.

Secondary Traumatic Stress

Scores on the Secondary Traumatic Stress (STS) subscales were generally low, but some respondents at child-serving agencies did report high scores indicating that they may be experiencing symptoms of secondary traumatic stress. Executive officers and administrators reported lower scores on two of the STS subscales, Arousal and Avoidance, than other respondents. Respondents who reported being not at all impacted by COVID-19 and those with more years of experience in the field reported lower scores on the Arousal Subscale.

Trauma-Informed Practice

About 72% of respondents in child-serving agencies were not familiar with the TRC model, and an additional 26% of respondents reported familiarity with the model but no training.

Scores on the Environmental Assessment scale and Staff Practices Survey were generally high. Some respondents had lower scores, particularly on the Environmental Assessment and some subscales of the Staff Practices Survey. This suggests that environments and staff practices at many child-serving agencies in Forsyth County are at least moderately aligned with the traits and values of a trauma-informed care model, but the range of scores suggests that this is not the case across all staff members or agencies. Respondents with higher levels of training generally scored higher on the staff practices survey, indicating higher levels of alignment with trauma-informed care practice at their agencies. Organizational leaders often had higher scores than other employees on the Environmental Assessment Scale and Staff Practices Survey. While this indicates that their practices and environments are more aligned with a trauma-informed model, program planners should consider that their perspectives and experiences may be different than those of other staff members.

Racial Equity and Structural Violence

Interview participants from child-serving agencies indicated that there is a greater sense of urgency for racial equity-based work within the past few years. Several organizations have sufficient resources to engage in racial equity-based practices and policies, while others face barriers such as leadership, funding, and/or staff buy-in. Yet, respondents reported that, in general, their organization’s culture is inclusive and supportive of people from diverse backgrounds.

Multiple organizations serve members of the community who have experienced structural violence, which suggests there are many adverse experiences that community members encounter which can compound pre-existing trauma or lead to new forms of stress and trauma.

Transformational Leadership

Scores on the global transformational leadership scale were generally high, indicating that leaders in the child-serving organizations that completed the survey likely have the leadership skills necessary for institutional change.

5.3 Limitations

The limitations of this study are primarily related to survey samples. First, some demographic groups in the survey were small and the survey was non-random which affects how generalizable results are to all community organizations that serve children. Secondly, multivariate analysis could not be used with the structure of the data which limits the predictability power of the demographic differences. Additionally, both survey and interviews are cross-sectional at a fixed point in time and do not represent respondents’ attitudes, beliefs, and/or experiences over time. Despite these limitations, researchers did mitigate some of the issues with the data by computing a series of statistical tests to ensure significant differences between various demographic variables were valid at a bivariate level.

Other limitations had to do with the nature of the study topic. The survey was long and dealt with sensitive topics of abuse, trauma, and other stressors. It is possible that this affected recruitment and survey completion. Also, the wording of some survey questions could have been difficult for some respondents to understand (especially if they were not familiar with the content area). However, the survey respondent pool was skewed towards those with more educational attainment so it may not have had a significant impact.

For the qualitative analysis that examined racial equity practices at organizations, some respondents were not familiar with the TRC model or with some of the terms used, requiring clarification from the researchers, which may have affected responses. While the qualitative analyses presented in this study are rich in detail and provide important context to lived experiences, results are less generalizable to the larger population.