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Trauma-Informed Care: Challenges to Developing and Implementing Performance Partnership Pilots to Serve Children

GAO-23-106538 Published: Aug 18, 2023. Publicly Released: Aug 18, 2023.
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Fast Facts

Many children affected by trauma receive services through more than one system, such as child welfare and health care. Communities need to develop and coordinate programs, policies, and practices to ensure that children receive services that address trauma-related needs and actively avoid re-traumatizing them.

To help communities, one initiative lets multiple federal agencies combine their funding to create partnership programs for grant recipients serving children affected by trauma. But use of this approach could pose challenges for state and local governments, such as obtaining buy-in from partners and overcoming confidentiality concerns.

black and white photo of a young child sitting alone in a dark hallway

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What GAO Found

To ensure that youth receive trauma-informed care across systems and in a coordinated manner, communities need support to build infrastructure and capacity. Congress may authorize a variety of approaches to help build infrastructure and capacity. One such approach is performance partnerships that allow a federal agency or multiple federal agencies to provide grant recipients flexibility in how they use funding across two or more programs. In exchange for these flexibilities, recipients commit to improve agreed-upon outcomes and assess progress towards them.

However, state and local governments and other organizations may face challenges in using performance partnership pilots to serve children exposed to trauma, such as:

  • developing trust and buy-in among partners,
  • achieving goals without sufficient time for planning, and
  • overcoming privacy concerns that could undermine data sharing efforts, which would be central to developing and implementing partnerships and trauma-informed systems.

Why GAO Did This Study

Senate Report 115-150 includes a provision for GAO to, among other things, identify barriers or challenges faced by organizations that receive funding from multiple federal programs to serve children exposed to trauma.

GAO reviewed key reports related to performance partnerships and trauma-informed care, as well as federal agency documents and prior GAO reports. In addition, GAO interviewed a former Office of Management and Budget official who helped create and implement performance partnership pilots for disconnected youth, individuals who provided technical assistance to and wrote the guide about the Multi-System Trauma-Informed Collaborative, and Substance Abuse and Mental Health Services Administration officials who facilitate and coordinate the work of the federal Interagency Task Force on Trauma-Informed Care.

For more information, contact Kathryn A. Larin at (202) 512-7215 or

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Audit objectivesChildrenData sharingFederal assistance programsHealth careHealth services administrationJuvenile justicePublic healthTrauma careLocal governments