Graduation Date

Spring 5-9-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Health Services Research, Administration, and Policy

First Advisor

Jungyoon Kim, Ph.D.

Second Advisor

Dana Verhoeven, Ph.D.

Third Advisor

Hongmei Wang, Ph.D.

Fourth Advisor

Isak Kim, Ph.D.

Abstract

Trauma-informed care (TIC) research is gradually rising and has been recognized as a supportive and beneficial organizational approach for clients/patients and employees dealing with mental and emotional symptoms due to trauma. The overarching goal of this dissertation is to advance understanding of how trauma-informed care is implemented within child-serving organizations (CSOs) and how different stages of implementation relate to employee well-being. The objectives of the three studies include capturing the gap of current TIC implementation approaches, regarding the stage of trauma-informed implementation and if employee health outcomes were incorporated in the outcomes (study 1), uncovering the stage of TIC implementation of Nebraska CSOs though primary data collection, and agency perspectives on vicarious trauma and burnout experiences while utilizing TIC (study 2), and evaluating the role of TIC by stage within the job demands-resources model for burnout among Nebraska CSO employees (study 3). Study 1 systemically provides a review of existing studies on how CSOs implement and sustain trauma-informed approaches within their organizations. Findings indicate that most CSOs stayed within the early initial implementation phase, implying a possible barrier for agencies to fully integrate a TIC approach system-wide. Furthermore, less than 15% of articles discussed observing or measuring employee health outcomes during or after implementation. iv Study 2 identifies the range of TIC readiness and implementation stage of Nebraska’s CSOs through surveys and semi-structured interviews with organizational leaders. Findings indicate most NE CSOs were at beginner (exploration, 32%) or early implementation (initial implementation, 28%) in the stages of TIC implementation. This may indicate that additional training, organizational resources, or further awareness of vicarious trauma could support CSOs’ progress toward full TIC implementation. Study 3 examines the association between TIC Stages of Implementation as an organizational level resource, and job strain using the job demands–resources (JD–R) model among Nebraska CSO employees. Findings indicate that though TIC Stages were not an adequate predictor of employee job-strain, due to a coefficient change, there is a high plausibility of TIC Stages being related to one or more of the JD-R predictors. All three studies could provide a multifaceted view of how TIC implementation may vary in NE CSOs, and how this level of implementation, along with other organizational factors, could be associated with employee well-being.

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