A Pilot Study of a Trauma-Informed Skills Parenting Group

Abstract

Intergenerational trauma transmission, or trauma responses transmitted from parent to child through relational mechanisms, can be detrimental to both parents and children. The present study details a trauma-informed parenting intervention group. The curriculum for the group was created using research on trauma treatment, the neuroscience of parenting, and nervous system regulation. During the modules, parents reflected on their own experiences of being parented and connected those patterns to how they now interact with their own children. This pilot intervention study ran for eight weeks with a total of 7 participants (n = 7), including two couples. Using both quantitative and qualitative methods, researchers aimed to better understand both the outcomes of participation and the participants’ experiences. Results indicated reduced symptoms of anxiety and stress, with improvement in couples’ satisfaction and family resilience levels. These findings show promise for the delivery of trauma-informed group interventions for parents and the possible systemic benefits.

The prevalence of adverse childhood experiences (ACEs) continues to demand focus on how to treat adults with traumatic exposure. Within a sample of 144,000 adults, 61% had experienced at least one ACE, and 16% of that 61% experienced 4 or more ACEs (National Conference of State Legislatures, 2022). The effects of ACEs, if not treated, can last well into adulthood and impact individual, relational, and familial functioning (Daines et al., 2021; Hambrick et al., 2019; Herzog & Schmahl, 2018). These experiences alter the behaviors, emotional regulation abilities, and attachment schemas of each person differently and can be passed down to future generations (i.e., grandparents to parents and then from parents to children), which is referred to as intergenerational trauma transmission (Fredland et al., 2015; Montalvo-Liendo et al., 2015). Intergenerational trauma transmission has been linked to childhood maltreatment for parents who experienced traumatic experiences during their childhood (Bryce & Collier, 2022; Keeshin & Monson, 2022). Interventions are needed to interrupt this transmission process. Previous literature found that parenting groups can help support parents with ACEs (Burke et al., 2021). While there is a growing body of research on parenting interventions, there is less focus on trauma-informed parenting groups and how they may support parents who have experienced trauma.

Literature Review

Treatment

Childhood adversity can impair parents’ capacity to be supportive caregivers, leading to behaviors ranging from insensitivity to abuse (Lindstrom Johnson et al., 2018; Rowell & Neal-Barnett, 2022). This impairment likely stems from past adverse experiences impacting parents’ psychological, cognitive, and behavioral functioning (Cooke et al., 2019). Moreover, children whose parents have experienced traumatic events are more prone to experiencing similar hardship and accompanying negative consequences (Shaw & Starr, 2019). Specifically, parents who have faced greater adversity tend to exhibit more severe parenting behaviors, report heightened stress levels, and struggle with self-regulation, impacting their ability to manage both their own stress and that of their children (Carreras et al., 2019; Pereira et al., 2018). This process highlights the challenges and importance of addressing the intergenerational transmission of trauma.

Challenges in parents’ emotional regulation often impact the development of emotional and behavioral issues in children (Choe et al., 2013). Effective stress management by parents, which is closely tied to their ability to regulate difficult emotions, is crucial for promoting positive outcomes in children (Shaw & Starr, 2019; Verreault et al., 2014). Secure parent-child attachment bonds can mitigate these challenges, as parents employ adaptive coping strategies that children then learn and internalize (Brumariu, 2015; Steele & McKinney, 2019). Interventions that foster such adaptive relationships among parents have shown efficacy; meta-analytic studies indicate that the benefits can endure for up to two decades post-intervention (Sandler et al., 2011). Children must rely on their parents to meet their physical and emotional needs – specifically in early childhood, such as ages five to ten, which was the age of focus of the current study. Children cannot meet these needs alone as they develop cognitive and physical abilities. Therefore, they turn to their parents for food, safety, emotional regulation, and physiological and safety needs, as described in Maslow’s hierarchy of needs (Maslow, 1943). When a parent cannot attune to their child’s needs, their child’s behaviors tend to be heightened, which can make it difficult for the parent to regulate themselves and respond to their child appropriately (Carrère & Bowie, 2012; Choe et al., 2013; Lunkenheimer et al., 2021). If the parent does not have the knowledge and skills to calm their nervous system, they will become and stay dysregulated. In this state of overwhelm, the dysregulation transfers to the child and creates further disconnection (Alen et al., 2022). This age range was selected as this is typically when children that are in elementary school and developmentally benefit from modeling behaviors, co-regulation, and the process of building their executive functioning skills (Taylor et al., 2005; Siegel & Bryson, 2012).

Resource Parenting Curriculum (RPC) has shown effectiveness in educating caregivers on trauma-informed practices and resources to improve parenting skills, but targets children through their caregivers rather than the parents directly (Gigengack et al., 2019; Murray et al., 2019; Strolin-Goltzman et al., 2018; Sullivan et al., 2016). Most trauma-informed parenting studies differ from the current intervention, as they tend to view the child as the identified patient or they use caregiver-child dyads as the primary treatment group (Dozier et al., 2002; Lindstrom Johnson et al., 2018; Purvis et al., 2015). In contrast, our group, Trauma Informed Parenting Skills (TIPS For Parents), specifically targets parents’ experiences and dominant messages around parenting using a trauma-informed lens. Further, our curriculum not only focuses on providing psychoeducation regarding children’s behaviors but also invites parents to turn inward and consider how their own experiences impact the family system. For example, we highlight the connection between parents’ awareness of their childhood experiences and their ability to practice and model self-regulation for their children. Additionally, TIPS for Parents prioritizes maintaining an environment where the parents can find social support, which previous literature suggests can mitigate the impact of childhood maltreatment (O’Shields et al., 2024). Using a family systems theory lens (Bowen, 1966), our study aims to not only help parenting directly but also impact their children via the ripple effects of the intervention in challenging the family’s homeostasis, while addressing the gap in the literature of trauma-informed parenting groups.

TIPS for Parents is a trauma-informed parenting skills group that includes a multifaceted relational intervention to help parents better understand themselves and their children. Trauma-informed literature underscores the importance of addressing parental trauma and fostering robust parent-child attachments (Isobel et al., 2019; Kiser et al., 2020). It also highlights the significance of behavior management strategies and equipping parents with skills to effectively navigate their child’s developmental behaviors (Steele & McKinney, 2019). A group setting provides a safe physical and emotional environment where trauma survivors can restore social connections and address the negative impact of interpersonal trauma on self-perception and relationships (Jackson & Jewell, 2021). All these considerations were incorporated into the development and execution of the group.

Moreover, the program prioritizes cultural humility to foster an inclusive healing environment that honors the intersectionality of participants’ identities and experiences. Research indicates that culturally humble approaches in trauma-informed care improve therapeutic outcomes, enhance participant engagement, and support sustainable healing processes (Ranjbar et al., 2020). By cultivating safety and trust, cultural humility allows participants to share their experiences without fear of cultural misunderstanding or judgment (Kibakaya & Oyeku, 2022). TIPS for Parents encourages continuous self-reflection and learning among participants, ensuring a dynamic and responsive approach to the diverse needs of trauma survivors.

The program addresses multifaceted pathways through which past trauma may impact parenting, with each module focusing on different topics. The closing session celebrated the participants’ growth over the eight weeks and reviewed ways to continue implementing the skills into their daily lives. It also provided feedback reinforcing their sense of being valued and supported. Each module’s topics are supported by rational and relevant research backing the interventions provided (see Table 1).

Table 1.

Intervention topics who have adverse childhood experiences

Intervention Topic:	Purpose/Goal	Previous Research Support
Module 1: Introduction & Welcome	Joining, Rapport Building, Safety Building, Expectations	Phase-1 Safety and Stability of the Triphasic Model (Herman, 1992)
Module 2: We Are the Family History Holders	Attachment and Intergenerational Trauma Transmission through Parents	Adult Attachment Interview (AAI; George et al., 1985) Social Learning Theory (Bandura & Walters, 1977) Attachment theory (Bowlby et al., 1992)
Module 3: Understanding Our Body Signals	Nervous System Mapping	Polyvagal Theory (Porges, 2009)
Module 4: How to Understand My Child’s Response System	Identify Emotions, Model Self-regulation, Enact Co-regulation, Notice Child’s Nervous System	The Developing Mind (Siegel, 2020) The Whole-Brain Child (Siegel & Bryson, 2012)
Module 5: What on Earth Is My Child Trying to Tell Me?	Developmentally Appropriate Communication, Building Executive Functioning Skills through Choices for Decision Making Techniques, Grounding technique	The Whole-Brain Child (Siegel & Bryson, 2012) Social Learning Theory (Bandura & Walters, 1977)
Module 6: My Child Can Do It	Fostering Children’s Independence through Trust and Relationship Building and Employing Parenting Styles that Encourage Independence	Parenting Styles (Baumrind, 2013) Self-determination Theory (Ryan & Deci, 2022) The Incredible Years (Webster-Stratton et al., 2005)
Module 7: Strategies for When Your Child Makes Poor Choices	Understanding the Difference between Punishment and Discipline, Noticing Child’s Needs through Behaviors, and Strategies for Managing Children’s Undesired Behaviors	Attachment Theory (Bowlby et al., 1992) Social Learning Theory (Bandura & Walters, 1977) The Incredible Years (Webster-Stratton et al., 2005)
Module 8: Closing & Graduation	Review and Celebrate Progress	Phase 3 (Reconnection and Integration) of the Triphasic Model (Herman, 1992)

Module Topics from Empirical Research

Module 1: Introduction & Welcome

The first module was dedicated to establishing safety and stability by creating a secure therapeutic environment and setting clear expectations. Previous research has demonstrated that creating safety provides a mechanism for change through connection and honesty (Podolan & Gelo, 2023). Trauma survivors require a secure environment to reduce hyperarousal and reactivity, enabling more effective engagement in therapeutic work (Herman, 1992; van der Kolk, 2014). Without this stability, attempts to introduce new skills or process traumatic memories may be overwhelming and counterproductive (Murray et al., 2020). The program adhered to the triphasic model of trauma, which emphasizes a phased approach to trauma recovery to ensure parents receive adequate support (Herman, 1992). In sum, participants were introduced to the facilitators, curriculum, and the ground rules of the group.

Module 2: We Are the Family History Holders

The second module focused on helping parents explore and connect with their own experiences of being parented. This approach aimed to help participants with complex trauma histories identify and understand feelings of insecurity and confusion arising from relational or attachment trauma with their own caregivers. Unresolved trauma and loss in parents’ histories can affect their attachment styles and be passed on to their children as early as infancy (Granqvist et al., 2017). These early attachment issues can lead to severe problems such as dissociation, stress reactivity, disruptive behavior, and emotion dysregulation in childhood, adolescence, and adulthood (Bosquet Enlow et al., 2014; Lyons-Ruth et al., 2016).

Parents were asked to recall autobiographical attachment-related memories during early childhood through a reflection activity based on existing attachment research (George et al., 1985). The reflection activity alternates between eliciting general descriptions of relationships, specific memories that support or contradict these descriptions, and current relationship dynamics with parents. The facilitators reminded participants that they could choose what and how much of these details to share with the group. This trauma-informed care recognizes participants’ autonomy and prioritizes giving them the ability to make choices, small and large (Marks et al., 2022). By fostering self-compassion and a realistic perspective on current caregiving and personal relationships, parents can understand how their reflexive parenting behaviors are often learned from their own caregivers, as explained by social learning theory (Bandura & Walters, 1977). This self-awareness enables parents to consciously select alternative parenting strategies, leading to positive change and more effective engagement with their children.

Module 3: Understanding Our Body Signals

Module Three was focused on enhancing body awareness and supporting parents in developing their emotional regulation skills via psychoeducation guided by Polyvagal Theory (Porges, 2009). Research indicates that early life adversity impacts the stress response system, significantly impairing emotion regulation (Hostinar et al., 2014; Schnyder et al., 2015). Given that children develop their ability to express and manage emotions through interactions with their parents (Luthar & Eisenberg, 2017), it is essential for parents to be well-prepared to guide their children in regulating their emotions. Research consistently highlights the intricate relationship between parental psychological symptoms, parenting behaviors, and child psychosocial issues (Snyder et al., 2016).

Polyvagal Theory was integrated with the previous module’s exploration of attachment history through the impact of parents’ emotional regulation experiences in caregiving. Polyvagal Theory elucidates how the autonomic nervous system affects emotional responses and social engagement (Porges, 2009). Siegel (2020) emphasizes that emotion regulation is linked to a coherent self-relationship, highlighting the importance of noticing and interpreting bodily cues. Emotional regulation involves detecting and evaluating physiological reactions to various situations and applying appropriate regulation strategies. By fostering these skills, parents can better support not only their own but also their children’s emotional development and overall nervous system responses (Hajal & Paley, 2020).

Module 4: How to Understand My Child’s Response System

In Module four, we transitioned from focusing on parental physiological cues to those of their children. The emphasis was on understanding and supporting children’s regulation of bodily states and emotions, aligned with the principles from The Whole-Brain Child (Siegel & Bryson, 2012). Key strategies included helping children become aware of their physiological sensations to manage emotions effectively (Blaustein & Kinniburgh, 2018), teaching techniques to inhibit impulsive reactions such as deep breathing or counting (Pozuelos et al., 2019) and maintaining bodily arousal within the window of tolerance using mindfulness and structured routines (Singh et al., 2021). Additionally, enacting co-regulation by modeling and responding empathetically supports children in developing self-regulation skills. Applying these strategies can help children to understand better and manage their emotional and physical states, which can in turn improve emotional resilience and overall well-being.

Module 5: What on Earth Is My Child Trying to Tell Me?

The focus in Module Five was on helping parents support their children in developing essential executive functioning skills (i.e., planning, problem-solving, and self-regulation) while also emphasizing age-appropriate communication. Recognizing that children’s communication abilities evolve with age, activities were designed to help parents model clear, developmentally suitable language. These skills are crucial for overall cognitive development and emotional well-being (Zelazo & Carlson, 2012). This module also highlights the significance of recognizing how cultural background and parenting styles influence communication between parents and children (Chen et al., 2019). The lesson emphasized that parents’ cultural contexts and individual parenting approaches shape their methods of interaction and communication with their offspring. By increasing awareness of these factors, the intervention aimed to help parents appreciate how their cultural values and parenting practices can affect their child’s development and behavior.

Module 6: My Child Can Do It

Building on the focus from previous modules, this module underscores the importance of establishing trust as a cornerstone for promoting children’s independence (Xie, 2024). Attachment theory emphasizes that secure attachments, where children feel safe and supported, are crucial for exploring their surroundings confidently and independently (Bretherton, 2013). Research indicates that children who view their parents as trustworthy are more inclined to embrace challenges and engage with their environment assertively (Castelo et al., 2022). Furthermore, enhancing executive functioning, which includes skills such as working memory, inhibitory control, and cognitive flexibility, is essential for supporting children’s brain development and self-regulation (Moriguchi, 2014), which are necessary for fostering independence. In Module Six, the goal was to enhance children’s independence by helping parents build trust, promote executive functioning for brain development, and enact parenting practices that foster independence (Baumrind, 2013). These practices are vital for developing secure attachments, which are necessary for fostering autonomy in children (Miller, 2023).

Module 7: Strategies for When Your Child Makes Poor Choices

In Module Seven, parents were provided psychoeducation on the difference between discipline and punishment. The emphasis was on the importance of using reinforcement to set effective boundaries, which helps create a nurturing environment for children (Seay et al., 2014). Parents were reminded that maintaining positive forms of discipline can be especially challenging under stress. This difficulty is often exacerbated for parents who have experienced adverse childhood events, as they may unconsciously link discipline with punishment and control. Such parents might be more prone to inconsistent or aggressive disciplinary practices (Zubizarreta et al., 2019). Additionally, this module included guidance on making effective choices and turning “no’s” into conditional “yes’s,” helping parents adopt a more flexible, supportive approach to discipline as well as a sense of autonomy – which is critical for those parents who have experienced trauma (Marks et al., 2022). This strategy encourages parents to explore alternative solutions that establish clear boundaries while accommodating their children’s needs. Research suggests that such approaches can lead to increased cooperation and decreased defiance in children (Peng et al., 2021). The content from Module Seven called back to Module Three and learning about parents’ nervous system responses in times of dysregulation and how to use tools to reintegrate.

Module 8: Graduation

In the final session, a graduation was held for participants to receive diplomas and personal letters highlighting the participants’ strengths and growth. In alignment with the final phase of the Triphasic model (Herman, 1992), the purpose of the last module was to promote empowerment and self-worth through reflection on progress, celebration of achievements, and the development of strategies and resources to navigate future challenges. This is also a critical part of trauma-informed work in celebrating the completion and journey of the parents.

Present Study

The purpose of this pilot study was to test a family therapist-developed trauma-informed parenting intervention group for parents of elementary school-aged children. The intervention was intentionally designed to provide psychoeducation and tools for parents with diverse backgrounds to better understand themselves and connect with their children. Specifically, the group’s location was chosen in the center of several city bus routes at a location with free parking, and parents did not pay for any materials for participation in the group. Cultural humility and sensitivity guided the intervention through multicultural perspectives in group development to diverse examples and research throughout the curriculum. We tracked clinical changes across multiple individual and relational outcomes quantitatively and qualitatively.

Methods

Study Participants

Participants included eight parents from the Southeastern region of the United States who have a child between 5 and 10 years old. Participants were eligible if they: (a) were 18 or older, (b) spoke English fluently, and (c) had a child between the ages of 5–10. Both mothers and fathers were invited to participate in the intervention. Our sample mainly included mothers (n = 5), and two fathers who were partners of the mothers (n = 2). Parents’ age ranged from 24 to 44 years (M = 33.4, SD = 8.5). Parents reported that their highest educational attainment was a bachelor’s degree (n = 3), a graduate or professional degree (n = 1), some college (n = 1) and an associate or technical degree (n = 2). Parents self-identified as White/Caucasian (n = 4), Black/African American (n = 2), and as Black/African American, Native, and Asian (n = 1). Household income was split into five categories: less than $25,000 (n = 3), $25,000 to $49,999 (n = 1), $75,000 to $99,999 (n = 2), and $150,000 or more (n = 1). Of the seven parents, two reported to be married to their partner, four were cohabitating with their partner but not married, and one reported to be divorced from their partner. Participants reported that relationship length with their partners ranged from 9 months to 137 months (M = 79 months, SD = 48.27).

Procedure

The Institutional Review Board approved the study procedures. Over the group’s duration, the primary investigators were supervised to ensure best research practices and handle any issues promptly. Recruitment was conducted from mid-July 2023 to late January in 2024. Participants for the study were recruited primarily through initial recruitment flyers at local daycares, public elementary school counselors, and other mental health agencies in the area. Additionally, flyers were advertised on various social media sites (Facebook, Reddit, etc.), including well-known parenting groups in the area. Snowball sampling strategies were employed to connect with other possible participants.

Approximately 16 parents contacted the research team regarding participation. Of those 16, seven were eligible and agreed to participate. For analytic purposes, parents with multiple children in the 5–10 age range were asked to select a target child they feel is most “challenging” to parent. For parents who were contacted after the start date of the program, the researchers employed a waitlist control, which included completing the three surveys and then joining the group in the next wave. The intervention group participated in eight 90-minute group sessions over eight modules. Each week, two MFTs presented the information, and, when available, a third team member served as a moderator and notetaker Figure 1.

Fig. 1.

Flow of participants in study

Measures

Before the parenting group intervention, participants completed a demographic information questionnaire assessing their age, how they describe themselves, race, ethnicity, education level, household income, the number of children, and levels of religiosity and spirituality. Participants also filled out structured assessments regarding individual functioning, romantic relationship functioning, and family functioning. Additionally, participants completed a semi-structured interview about their interest in attending the parenting group, hopes and concerns, along with information about their family and romantic relationship.

The Major Depression Inventory (MDI; Bech et al., 2001) is a 12-item measure assessing depressive symptoms. A sample item of the scale is “Have you felt low in spirits or sad?”. Each item was rated on a 6-point Likert scale (0 = none of the time to 5 = all of the time). The highest score between items 8a and 8b and 10a and 10b were used and then sum all items from 1 to 10, with higher scores indicating more depressive symptoms. The clinical cutoff of 21 indicates clinically significant levels of depression. This measure showed acceptable reliability when averaged over the three time points (α = 0.67).

The Generalized Anxiety Disorder Scale (GAD-7; Spitzer et al., 2006) is a 7-item questionnaire that assesses anxiety symptoms. A sample item of the measure is “Feeling nervous, anxious, or on edge.” Each item was rated on a 4-point Likert scale (0 = not at all to 3 = nearly every day). The summed total score was used, with higher scores indicating more anxiety symptoms. A total score of 0 to 5 indicates mild, 6 to 10 moderate, 11 to 15 moderately severe, and 16–21 severe anxiety symptoms. This measure showed excellent reliability when averaged over the three time points (α = 0.90).

The Adverse Childhood Experiences (ACEs; Centers for Disease Control and Prevention, 2020) is a 10-item measure that assesses adverse childhood experiences, such as physical, emotional, sexual abuse, or neglect. The ACEs questionnaire is a well-established and widely used instrument. A sample item of the measure is “Did a parent or other adult in the household often swear at you, insult you, put you down, or humiliate you? Did they act in a way that made you afraid that you might be physically hurt?”. Each item was rated on a 2-point Likert scale (0 = no to 1 = yes). A total score was summed and used, with higher scores indicating more adverse childhood experiences. A total score of 4 or more is considered a significant number of adverse childhood experiences. For each item marked as “yes”, frequency was measured with a 3-point Likert scale (1 = once to 3 = often), with higher scores indicating greater risk of health and social problems. This measure showed good reliability (α = 0.82).

The Perceived Stress Scale (PSS; Cohen et al., 1983) is a 10-item measure assessing perceived stress. A sample item of the measure is “In the last month, how often have you been upset because of something that happened unexpectedly?” Each item was rated on a 5-point Likert scale (0 = never to 4 = very often). Four positively worded questions were reverse. The total score was used, with higher scores indicating a greater level of perceived stress. Scores ranging from 0 to 13 are considered as low, 14 to 26 moderate, and 27 to 40 high perceived stress. This measure showed excellent reliability when averaged over the three time points (α = 0.90).

The Ineffective Arguing Inventory (IAI; Kurdek, 1994) is an 8-item measure assessing conflict resolution styles in parent couples. A sample item of the measure is “Our arguments are left hanging and unresolved.” Each item was rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Three positively worded questions were reverse coded, including “By the end of an argument, each of us has been given a fair hearing.”, “Overall, I’d say we’re pretty good at solving our problems.”, and “Overall, our arguments are brief and quickly forgotten.” The total score was used, with higher scores indicating many arguments with partners. Scores of 8 and lower are considered as low/little and 40 and higher high/many arguments. This measure showed good reliability when averaged over the three time points (α = 84).

The Couple Satisfaction Index (CSI; Funk & Rogge, 2007) is a measure that assesses couple satisfaction. In this study, we used the abbreviated 4-item version of the scale. Each item was rated on a 6-point Likert scale (0 = not at all true to 5 = completely true). The total score was used, with higher scores indicating higher levels of relationship satisfaction. This measure showed good reliability when averaged over the three time points (α = 0.88).

The Family Resilience Scale (FRS; Chow et al., 2022) is a 16-item measure assessing family resilience. A sample item of the measure is “We can compromise when problems come up.” Each item was rated on a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). Total score was used, with higher scores indicating higher levels of family resilience. This measure showed acceptable reliability when averaged over the three time points (α = 0.61).

The Parental Stress Scale (PaSS; Berry & Jones, 1995) is an 18-item measure assessing parental stress. A sample item of the measure is “Caring for my child(ren) sometimes takes more time and energy than I have to give.” Each item was rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Eight positively worded questions were reverse coded. The total score was used, with higher scores indicating higher levels of parental stress. This measure showed excellent reliability when averaged over the three time points (α = 0.91).

At module 4 of the intervention, participants completed a mid-test survey assessing individual functioning, romantic relationship functioning, and family functioning using the same structured assessments. Following the final session, participants completed a post-test survey assessing individual functioning, romantic relationship functioning, and family functioning using the same questionnaires. Additionally, participants completed a semi-structured post-intervention interview regarding their relationship satisfaction and parenting stress. Participants also reported their experiences in the parenting group and what parts of it were helpful or could be improved.

At the end of each module, participants scored the usefulness of each module’s curriculum using a session skills assessment (SSA). The SSA assessed if they found the content, discussion, and activity to be not helpful (0) to very helpful (3). There was also a comment section, designed for participants to give feedback about the session.

Data Analysis

Data analysis included examination of both qualitative and quantitative data collected in the pilot study. Survey data from all three time points (pre, mid, and post) were combined and cleaned to complete preliminary analyses. These preliminary analyses were conducted to assess descriptive statistics and examine normality utilizing SPSS (version 25.0; IBM Corp, 2017). Next, participants’ change over time was reviewed. Primary outcomes were examined using means and standard deviations (see Table 2). Each group session recording was transcribed and reviewed. The transcripts were systematically organized and categorized into meaningful themes and patterns. These themes were coupled with the quantitative data to understand how the qualitative data converged, diverged, or expanded upon our quantitative findings. The qualitative exemplars were chosen to highlight key interventions throughout the module and participant insights on these interventions.

Table 2.

Pre-, Mid, and Post- treatment scores

Scale	Pre-Treatment		Mid-Treatment		Post-Treatment
	Mean	SD	Mean	SD	Mean	SD
MDI	12.71	5.65	11.00	5.67	10.71	7.20
GAD-7	10.14	6.67	10.67	6.71	10.00	4.83
PSS	19.43	6.60	17.67	6.77	18.43	6.40
IAI	23.86	8.00	24.80	5.63	24.67	5.00
CSI	12.71	7.36	13.40	2.79	13.17	6.37
FRS	47.43	3.55	46.00	7.29	49.14	3.58
PaSS	27.00	12.01	36.83	8.23	35.86	13.77

Note. MDI = Major Depression Inventory; GAD-7 = Generalized Anxiety Disorder Scale, PSS = Perceived Stress Scale; IAI = Ineffective Arguing Inventory; CSI = Couple Satisfaction Index; FRS = Family Resilience Scale; PaSS = Parental Stress Scale

Results

Acceptability

The parenting group began with six participants at the beginning of the eight-module period. At module two, a partner of an existing participant joined, bringing the total to seven. Overall, parents reported high satisfaction with the intervention and module topics (see Table 3). Further, at the end of the eight modules, all seven participants said that they found the group useful and would recommend it to another parent. In the exit interview, participants provided qualitative data to support their satisfaction with the group. One participant said, “TIPS for parents provided a safe space to learn and grow. I gained many tools in my tool belt to help me gain a better understanding of myself and my child. I appreciate the thoughtfulness of the topics covered and support provided by the facilitators. Sometimes parenting can feel isolating, it was very encouraging to have a small community of support and strength.”

Table 3.

Session skills assessment module material feedback

	Content		Discussion		Activity		Learned
	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Module 1	2.60	0.89	3.20	0.84	3.20	1.10	2.40	0.55
Module 2	3.50	0.54	3.50	0.84	3.33	0.82	3.00	0.63
Module 3	3.29	0.76	3.43	0.79	3.43	0.77	3.29	0.76
Module 4	3.86	0.38	3.71	0.49	3.71	0.49	3.57	0.79
Module 5	3.57	0.53	3.29	0.76	3.57	0.53	3.14	0.90
Module 6	3.50	0.58	3.75	0.50	3.75	0.50	3.50	0.58
Module 7	3.83	0.41	3.83	0.41	3.67	0.52	4.00	0.00
Module 8	3.50	0.55	3.83	0.41	3.83	0.41	3.67	0.52

Note. SD = Standard Deviation

In the final group meeting, parents were asked which topics from the curriculum were the most useful. This feedback showed the overall experience from each module. Parents reported that the most helpful modules that improved their confidence and knowledge about parenting were Module 2 (“We are the Family History Holders”) and Module 4 (“How to Understand My Child’s Response System”). Regarding module 2, one participant shared,

I felt like every [module] that we went through kept leading back to [module] two, because it really showed us like you never know how much something affected you growing up could really go into how you are today…We don’t want to be like our parents or some of the things that we did like about our parents is like what we kind of do today.

Another participant reflected, “It was the most meaningful day, I think. But all of it… it’s been meaningful every day. But that day was like, number one.” Regarding module 4, another participant said,

It’s hard to say which [module] I liked the most. But I do feel like this was a very helpful one… I absolutely now am more verbal when they when we’re having this (*signals hand model of the brain*) and I start to feel it, instead of letting it build. I will just say [to my child] I’m getting frustrated right now we need to stop this. I think it’s helped him because he knows mom’s reached that point.

Quantitative Outcomes

Beneficial changes were reported for the MDI, GAD-7, PSS, CSI, and FRS. There were decreases in anxiety scores and perceived stress. Additionally, there were increases in couple satisfaction and family resilience. This suggests favorable individual and relational outcomes.

Figure 2 illustrates plots of individual changes over the three-time points when participants were surveyed on outcome variables. As shown, there was variability in participants’ scores over time.

Fig. 2.

Individual Scores Over Intervention

Participant Insights

After examining the changes in the participants’ scores over time, qualitative analyses were completed to provide an understanding of the changes in the scores. Each module, empirically supported trauma and parenting inventions were used. Analyzing the parent’s responses demonstrated a better understanding of the parenting program’s mechanism of change. The quotes selected identify how the participants voiced that these interventions impacted their lives. Most depicted gaining an understanding of how they were taught these behaviors and being a parent having to model for their children’s behaviors that they want to see. This action includes recognizing their own response signals and furthering their understanding of a child’s development. These exemplars help demonstrate the participants’ perspectives of each module’s purpose and lasting impression. The first example, from module two highlighted the intergenerational impact of trauma on parenting messages and practices. The participant shared,

I just want to add some perspective going back to like the family history, um, this perspective. About 140 years ago, 74% of his area was enslaved. Right? My grandmother was born in 1953, same as my grandfather. Their parents were born in the 1920s. So that’s a hundred years ago. Their parenthood was taught or was affected and influenced by slavery. And so seeing that trickle down, because I was raised by my mother and my grandparents…I got some perspective that allowed me to tap into some grace. And also, going far back to your statement of like how they did the best that they could, because that was something that I had to work through with them at eighteen, nineteen…But people can’t give you what they don’t have. And I realized that, uh, my people was in a place with a lot of challenges.

This next example showcased an increased awareness of physiological responses and identification of where those learned behaviors originated.

Sometimes when my partner does things, it triggers me and it makes me go back to my childhood and it’s like, no you don’t do that, like no, don’t do that. That’s not what you’re gonna do to our child…. we’re not gonna do that to our children. We’re breaking the generational cycle.

One participant reflected on the importance of a safe group environment:

The more tools the better, anything and everything helps, I think, but the group itself because you did get this chance to have the back and forth. You can read, and you can listen to things…but it’s different when you’re having that shared experience.

Discussion

There is a need for trauma-informed parenting support for parents of elementary school-aged children. TIPS (Trauma-Informed Parenting Skills) was developed to help bridge the gap for this population. The curriculum was created using synthesized material from extant theoretical and empirical studies and a trauma-informed lens. This study provides preliminary evidence that TIPS can help parents’ individual, relational, and family functioning. Specifically, our results showed decreases in depression, anxiety, and perceived stress, along with increases in couple satisfaction and family resilience. Our group is unique in that it targets the parents and teaches skills for the parents themselves to use and to teach and model to their children.

Aligned with several foundational trauma works (van der Kolk, 2005; Fraiberg et al., 1975), the parents emphasized the importance of understanding generational patterns that have been passed down directly through their parenting styles. This understanding of generational patterns combined with understanding their own and noticing others’ nervous system responses can help highlight a sense of empowerment within the parents through the ability to make different choices for themselves and their children. This intervention process mechanism supports the tri-phasic approach combined with Polyvagal theory (Herman, 1992; Porges, 2009) and supports modification for both individual and group settings. The hope is that participants will continue to practice these skills following the end of the group, which would likely maintain or improve outcomes measured post-group.

Although the findings of this study are promising, there are limitations. This study was completed with only one wave and a small sample size. The small sample size also limits the generalizability of findings, as the sample may not adequately represent diverse populations. While the materials emphasized practicing cultural humility and included diverse parental perspectives, future research should aim to replicate these findings with larger, more diverse samples to enhance external validity and provide a more comprehensive understanding of these associations. Additionally, broadening the curriculum to focus on the parent dyad could increase the sample size and provide deeper insights into the intervention’s effects. Furthermore, randomized controlled trials (RCTs) comparing participants assigned to the intervention group with those who are not could help determine its true effectiveness.

Presently, the intervention assesses outcomes over the group period, and no further information was completed after the final interview, which limits the understanding of lasting outcomes or maintenance of change. Further, all assessments used in this study are self-report measures, which could lead to responder bias. Participants may have underreported or overestimated specific experiences based on their subjective interpretation of the material. Of note, two measures that tend to perform well in other samples showed low reliability in our sample. We believe this is largely impacted by our small sample size. Future research could benefit from having longitudinal follow-ups after the conclusion of the intervention to assess for lasting change from the measurement packet and interviews. Given the promising findings from this pilot study, it would be beneficial to assess for maintenance of the intervention effects.

Despite the limitations of this study, its contribution to the area of trauma-informed parenting groups is sizeable. TIPS indicates acceptability and promising findings of trauma-informed parenting practices in individual, relational, and group contexts. The significant implications for TIPS parenting group intervention could be alternative support for those who have experienced trauma but do not have adequate resources or the desire for extensive trauma therapy. However, more research is required, and there should be continued work in this area of study.

Funding

No funding was received to support this study.

Declarations

Confllict of Interests

The authors have no conflicts of interest to declare relevant to this article’s content. The data that support the findings of this study are available from the corresponding authors upon reasonable request. The Institutional Review Board at Florida State University granted permission for this study. Participants were engaged in a verbal informed consent process and completed a written informed consent document.