School Mental Health

, Volume 8, Issue 1, pp 61–76 | Cite as

Development and Psychometric Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) Scale

  • Courtney N. Baker
  • Steven M. Brown
  • Patricia D. Wilcox
  • Stacy Overstreet
  • Prerna Arora
Original Paper


Due to its high prevalence and associated risk of poor academic and health outcomes, adverse childhood experiences and trauma are considered a public health epidemic. In response, there has been a surge of initiatives aimed at helping institutions and individuals serving people with histories of trauma to adopt a trauma-informed care (TIC) approach. However, significant roadblocks to TIC research and practice include an unclear operational definition of TIC and the shortage of psychometrically robust instruments to evaluate TIC. To close these gaps, we used a partnership-based approach to develop a direct, efficient, and cost-effective measure of TIC focused on evaluating the TIC-relevant attitudes of staff working in schools, human service systems, and other settings serving individuals with histories of trauma. We then conducted a psychometric evaluation of the resultant measure, the Attitudes Related to Trauma-Informed Care (ARTIC) Scale, with a sample of 760 staff employed in education, human services, and health care. Study findings established support for the psychometric properties of the measure. Specifically, confirmatory factor analysis indicated that the seven-factor structure fit the data well. Scores on the ARTIC demonstrated strong internal consistency and test–retest reliability over 6 months for the 45-item and 35-item composites, the seven subscales, and the 10-item short form. Construct and criterion-related validity were supported by correlations with indicators of familiarity with TIC and staff- and system-level indicators of TIC implementation. The current study has implications for accelerating research on TIC and facilitating data-based decision making related to the adoption and implementation of TIC.


Trauma Adverse childhood experiences Trauma-informed care Instrument development 



We are grateful to Tulane University and A Studio in the Woods/Tulane-Xavier Center for Bioenvironmental Research for their support of this project. We would like to acknowledge Laurie Pearlman, Kay Saakvitne, Steve Girelli, Christine Farber, Beth Hudnall-Stamm, Michael Hoerger, Johanna Kester, and Andrew Finnegan for their assistance with this project. Finally, we would also like to thank the educators, service providers, and staff who participated in this study. Risking Connection® is a registered trademark of the Sidran Institute.


  1. Adams, E. J. (2010). Healing invisible wounds: Why investing in trauma-informed care for children makes sense. Washington, DC: Justice Policy Institute.Google Scholar
  2. Adams, M. E. (2015). Lawsuit says schools are legally required to address student trauma. EdSource: Highlighting strategies for student success.
  3. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. doi: 10.1016/0749-5978(91)90020-T.CrossRefGoogle Scholar
  4. Alim, T. N., Graves, E., Mellman, T. A., Aigbogun, N., Gray, E., Lawson, W., & Charney, D. S. (2006). Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population. Journal of the National Medical Association, 98(10), 1630.PubMedCentralPubMedGoogle Scholar
  5. Azeem, M. W., Aujla, A., Rammerth, M., Binsfeld, G., & Jones, R. B. (2011). Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. Journal of Child and Adolescent Psychiatric Nursing, 24(1), 11–15. doi: 10.1111/j.1744-6171.2010.00262.x.CrossRefGoogle Scholar
  6. Baker, C. N., Kupersmidt, J. B., Voegler-Lee, M. E., Arnold, D. H., & Willoughby, M. T. (2010). Predicting teacher participation in a classroom-based, integrated preventive intervention for preschoolers. Early Childhood Research Quarterly, 25(3), 270–283.PubMedCentralCrossRefPubMedGoogle Scholar
  7. Bloom, S. L., & Farragher, B. (2010). Destroying sanctuary: The crisis in human service delivery systems. New York: Oxford University Press.CrossRefGoogle Scholar
  8. Bloom, S. L., & Farragher, B. (2013). Restoring sanctuary: A new operating system for trauma-informed systems of care. New York: Oxford University Press.CrossRefGoogle Scholar
  9. Brown, S. M., Baker, C. N., & Wilcox, P. (2012). Risking Connection trauma training: A pathway toward trauma-informed care in child congregate care settings. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 507–514. doi: 10.1037/a0025269.CrossRefGoogle Scholar
  10. Burch, B., Naser, S., & Overstreet, S. (2010). Children and disasters: Lessons from Hurricane Katrina. Whittier Journal of Child and Family Advocacy, 10, 3.Google Scholar
  11. Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse and Neglect, 35(6), 408–413.PubMedCentralCrossRefPubMedGoogle Scholar
  12. Capezza, N. M., & Najavits, L. M. (2012). Rates of trauma-informed counseling at substance abuse treatment facilities: Reports from over 10,000 programs. Psychiatric Services, 63(4), 390–394.Google Scholar
  13. Center for Disease Control and Prevention. (2010). Adverse childhood experiences reported by adults—Five states, 2009. Morbidity and Mortality Weekly Report, 59(49), 1609.Google Scholar
  14. Chandler, G. (2008). From traditional inpatient to trauma-informed treatment: Transferring control from staff to patient. Journal of the American Psychiatric Nurses Association, 14(5), 363–371. doi: 10.1177/1078390308326625.CrossRefPubMedGoogle Scholar
  15. Cohen, J. A., Berliner, L., & Mannarino, A. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse and Neglect, 34(4), 215–224. doi: 10.1016/j.chiabu.2009.12.003.CrossRefPubMedGoogle Scholar
  16. Cole, S. F., Eisner, A., Gregory, M., & Ristuccia, J. (2013). Helping traumatized children learn: Safe, supportive learning environments that benefit all children. Boston, MA: Massachusetts Advocates for Children Trauma and Learning Policy Initiative.Google Scholar
  17. Cole, S. F., O’Brien, J. G., Gadd, M. G., Ristuccia, J., Wallace, D. L., & Gregory, M. (2005). Helping traumatized children learn: Supportive school environments for children traumatized by family violence. Boston, MA: Massachusetts Advocates for Children Trauma and Learning Policy Initiative.Google Scholar
  18. Colton, D., & Xiong, H. (2010). Reducing seclusion and restraint: Questionnaire for organizational assessment. Journal of Psychiatric Practice, 16(5), 358–362. doi: 10.1097/01.pra.0000388632.74899.86.CrossRefPubMedGoogle Scholar
  19. Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584. doi: 10.1001/archpsyc.64.5.577.CrossRefPubMedGoogle Scholar
  20. DeVellis, R. F. (2012). Scale development: Theory and applications (3rd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  21. Donnellan, M. B., Oswald, F. L., Baird, B. M., & Lucas, R. E. (2006). The mini-IPIP scales: Tiny-yet-effective measures of the Big Five factors of personality. Psychological Assessment, 18(2), 192–203. doi: 10.1037/1040-3590.18.2.192.CrossRefPubMedGoogle Scholar
  22. Downey, L. (2007). Calmer classrooms: A guide to working with traumatised children. Melbourne: Child Safety Commissioner.Google Scholar
  23. Drury, S. S., Theall, K., Gleason, M. M., Smyke, A. T., De Vivo, I., Wong, J. Y. Y., et al. (2012). Telomere length and early severe social deprivation: Linking early adversity and cellular aging. Molecular Psychiatry, 17(7), 719–727. doi: 10.1038/mp.2011.53.PubMedCentralCrossRefPubMedGoogle Scholar
  24. Felitti, M. D., Vincent, J., Anda, M. D., Robert, F., Nordenberg, M. D., Williamson, M. S., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.CrossRefPubMedGoogle Scholar
  25. Fixsen, D. L., Blase, K. A., Naoom, S. F., & Wallace, F. (2009). Core implementation components. Research on Social Work Practice, 19(5), 531–540.CrossRefGoogle Scholar
  26. Giaconia, R., Reinherz, H., Silverman, A., Bilge, P., Frost, A., & Cohen, E. (1995). Traumas and posttraumatic stress disorder in a community population of older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1369–1380. doi: 10.1097/00004583-199510000-00023.CrossRefPubMedGoogle Scholar
  27. Green, B. L., Saunders, P. A., Power, E., Dass-Brailsford, P., Schelbert, K. B., Giller, E., et al. (2015). Trauma-informed medical care: A CME communication training for primary care providers. Family Medicine, 47(1), 7.PubMedCentralPubMedGoogle Scholar
  28. Greenwald, R., Siradas, L., Schmitt, T. A., Reslan, S., Fierle, J., & Sande, B. (2012). Implementing trauma-informed treatment for youth in a residential facility: First-year outcomes. Residential Treatment for Children & Youth, 29(2), 141–153. doi: 10.1080/0886571X.2012.676525.CrossRefGoogle Scholar
  29. Hammer, J. H., Springer, J., Beck, N. C., Menditto, A., & Coleman, J. (2011). The relationship between seclusion and restraint use and childhood abuse among psychiatric inpatients. Journal of interpersonal violence, 26(3), 567–579. doi: 10.1177/0886260510363419.CrossRefPubMedGoogle Scholar
  30. Harris, M., & Fallot, R. (Eds.). (2001). Using trauma theory to design service systems. New directions for mental health services. San Francisco, CA: Jossey-Bass.Google Scholar
  31. Hausman, A. J., Baker, C. N., Komaroff, E., Thomas, N., Guerra, T., Hohl, B. C., & Leff, S. S. (2013). Developing measures of community-relevant outcomes for violence prevention programs: A community-based participatory research approach to measurement. American Journal of Community Psychology, 52(3–4), 249–262.CrossRefPubMedGoogle Scholar
  32. Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28(7), 679–692. doi: 10.1007/s10896-013-9531-z.CrossRefGoogle Scholar
  33. Hoerger, M. (2010). Participant dropout as a function of survey length in Internet-mediated university studies: Implications for study design and voluntary participation in psychological research. Cyberpsychology, Behavior, and Social Networking, 13(6), 697–700. doi: 10.1089/cyber.2009.0445.CrossRefGoogle Scholar
  34. Hooper, D., Coughlan, J. & Mullen, M. R. (2008). Structural equation modelling: Guidelines for determining model fit. The Electronic Journal of Business Research Methods, 6(1), 53–60.
  35. Hummer, V. L., Dollard, N., Robst, J., & Armstrong, M. I. (2010). Innovations in implementation of trauma-informed care practices in youth residential treatment: A curriculum for organizational change. Child Welfare, 89, 79–95.PubMedGoogle Scholar
  36. Jennings, A. (2007). Blueprint for action: Building trauma-informed mental health service systems. Retrieved August 4, 2010, from the Anna Institute Web site:
  37. Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28(1), 36–47. doi: 10.1016/j.cpr.2007.01.017.CrossRefPubMedGoogle Scholar
  38. Kirkpatrick, D. I. (1967). Evaluation of training. In R. Craig & I. Bittel (Eds.), Training and development handbook (pp. 87–112). New York: McGraw-Hill.Google Scholar
  39. Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., et al. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396. doi: 10.1037/0735-7028.39.4.396.CrossRefGoogle Scholar
  40. Lebel, J. (2011). The business case for preventing and reducing restraint and seclusion use. HHS Publication No. (SMA), 11-4632.Google Scholar
  41. Lipschitz, D. S., Winegar, R. K., Hartnick, E., Foote, B., & Southwick, S. M. (1999). Posttraumatic stress disorder in hospitalized adolescents: Psychiatric comorbidity and clinical correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 38(4), 385–392. doi: 10.1097/00004583-199904000-00010.CrossRefPubMedGoogle Scholar
  42. Metz, A. J., Blase, K., & Bowie, L. (2007). Implementing evidence-based practices: Six “drivers” of success. Child trends: Research-to-results brief. Washington, DC: The Atlantic Philanthropies.Google Scholar
  43. Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. Quality and safety in health care, 14(1), 26–33.PubMedCentralCrossRefPubMedGoogle Scholar
  44. Morgan, E., Salomon, N., Plotkin, M., & Cohen, R. (2014). The School discipline consensus report: Strategies from the field to keep students engaged in school and out of the juvenile justice system. New York: The Council of State Governments Justice Center.Google Scholar
  45. Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. M. (2005). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56(10), 1213–1222.Google Scholar
  46. Moses, D. J., Reed, B. G., Mazelis, R., & D’Ambrosio, B. (2003). Creating trauma services for women with co-occurring disorders: Experiences from the Substance Abuse and Mental Health Services Administration women with alcohol, drug abuse and mental health disorders who have histories of violence study. Delmar, NY: Policy Research Associates. Retrieved from
  47. Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide: Statistical analysis with latent variables: User’s guide. Los Angeles: Muthén & Muthén.Google Scholar
  48. Overstreet, S., & Mathews, T. (2011). Challenges associated with exposure to chronic trauma: Using a public health framework to foster resilient outcomes among youth. Psychology in the Schools, 48(7), 738–754.CrossRefGoogle Scholar
  49. Porche, M. V., Fortuna, L. R., Lin, J., & Alegria, M. (2011). Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults. Child Development, 82(3), 982–998.PubMedCentralCrossRefPubMedGoogle Scholar
  50. Rivard, J. C., Bloom, S. L., McCorkle, D., & Abramovitz, R. (2005). Preliminary results of a study examining the implementation and effects of a trauma recovery framework for youths in residential treatment. Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations, 26(1), 83–96.Google Scholar
  51. Rossen, E., & Hull, R. V. (Eds.). (2013). Supporting and educating traumatized students: A guide for school-based professionals. New York: Oxford University Press.Google Scholar
  52. Saakvitne, K. W., Gamble, S., Pearlman, L. A., & Tabor Lev, B. (2001). Risking connection: A training curriculum for working with survivors of childhood abuse. Baltimore, MD: Sidran Press.Google Scholar
  53. Sochting, I., Corrado, R., Cohen, I. M., Ley, R. G., & Brasfield, C. (2007). Traumatic pasts in Canadian Aboriginal people: Further support for a complex trauma conceptualization? British Columbia Medical Journal, 49(6), 320–326.Google Scholar
  54. Sprague, C. (2008). Informing judges about child trauma: Findings from the National Child Traumatic Stress Network/National council for Juvenile and Family Court Judges Focus Groups. NCTSN Service System Briefs, 2(2). Los Angeles: National Center for Child Traumatic Stress.Google Scholar
  55. Stevens, J. E. (2012). “Lincoln High School in Walla Walla, WA tries new approach to school discipline—Suspensions drop 85%.” ACEs too high. Retrieved from
  56. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  57. Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navalta, C. P., & Kim, D. M. (2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience and Biobehavioral Reviews, 27(1), 33–44. doi: 10.1016/S0149-7634(03)00007-1.CrossRefPubMedGoogle Scholar
  58. Van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389–399. doi: 10.1002/jts.20047.CrossRefPubMedGoogle Scholar
  59. Weiner, B. J. (2009). A theory of organizational readiness for change. Implement Sci, 4(1), 67. doi: 10.2286/2748-5908-4-67.PubMedCentralCrossRefPubMedGoogle Scholar
  60. Women and Trauma Federal Partners Committee, & United States of America. (2013). Trauma-informed approaches: Federal activities and initiatives-Federal Partners Committee on Women and Trauma. A working document/second report.
  61. Woods, S. A., & Hampson, S. E. (2005). Measuring the Big Five with single items using a bipolar response scale. European Journal of Personality, 19(5), 373–390.CrossRefGoogle Scholar
  62. Zelechoski, A. D., Sharma, R., Beserra, K., Miguel, J. L., DeMarco, M., & Spinazzola, J. (2013). Traumatized youth in residential treatment settings: Prevalence, clinical presentation, treatment, and policy implications. Journal of Family Violence, 28(7), 639–652.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Courtney N. Baker
    • 1
  • Steven M. Brown
    • 2
  • Patricia D. Wilcox
    • 2
  • Stacy Overstreet
    • 1
  • Prerna Arora
    • 3
  1. 1.Department of PsychologyTulane UniversityNew OrleansUSA
  2. 2.Traumatic Stress Institute of Klingberg Family Centers and Risking Connection Training ProgramNew BritainUSA
  3. 3.Department of PsychologyPace UniversityNew YorkUSA

Personalised recommendations