Feasibility, Acceptability, and Fidelity of a Manualized Trauma Informed Arts-Based Intervention In Family Resource Centers

Background: Trauma exposure is widespread, and many communities lack accessible, non‑stigmatizing supports. Combining Proctor et al. (2011) and the NIH Behavior Change Consortium (Borrelli et al., 2011), this study evaluated three early implementation outcomes: acceptability (stakeholders’ perception of agreeableness, emotional response, comfort, burden, and ethical alignment), feasibility (fit, integration, utility, practicality; and demand/expansion), and fidelity (adherence to core components, dosage, delivery quality, receipt, and enactment). This study assessed whether a manualized adaptation of an arts-based trauma‑informed intervention could be acceptable to participants and facilitators, feasible in Family Resource Centers (FRCs), and delivered with fidelity, and identified implementation barriers and supports that inform scale-up and practice.

Methods: Mixed‑methods pilot across four Indiana FRCs (Sept 2022–Sept 2024), as part of a federally funded project. A Windows Between Worlds, a 35-year-old arts-based trauma-informed program, was manualized in 10‑week sequences for children, youth, and adults and delivered by trained non‑clinical facilitators. Quantitative data consisted of facilitator fidelity forms (n=100), analyzed descriptively. Qualitative data included seven focus groups and nine semi‑structured interviews (N=36 informants (23 participants/ caregivers, 12 facilitators, one FRC leader), analyzed via thematic analysis mapped to implementation outcomes, barriers and supports.

Results: Findings indicated high emotional resonance and satisfaction, reflecting high acceptability. Both participants and facilitators described the intervention as meaningful and restorative—“It was really healing...having that emotional freedom.” Perceived burden was low. Feasibility was adequate; a strong fit was reported, particularly when logistical supports were provided (e.g., meals, childcare, FRC support) as they increased demand and potential expansion; “Providing the meal helped a lot — I wouldn’t be able to come with my daughter at all if it wasn’t.” Barriers included staff time constraints, childcare burdens, rural stigma, workforce turnover, and coordination challenges. Quantitative and qualitative fidelity data indicated high procedural adherence: facilitators consistently delivered the 10‑session structure and used checklists for monitoring; sessions averaged 72 minutes (mean attendance 4.47 participants/ session), and most met fidelity criteria for core components. Training components (e.g., manuals, role-plays, technical assistance) increased facilitator confidence, whereas lapses in facilitator preparation undermined delivery quality. Participants reported sustained practice and improved self‑regulation “It gave me hope”, “I went out and bought all my own supplies and been doing art on my own.”

Conclusions and Implications: In a context of limited access to trauma-informed care, this study is the first to evaluate FRCs as a destigmatized delivery system for manualized, non‑clinical, arts-based, trauma‑informed programming, providing early evidence that non-clinical community facilitators can deliver these models with fidelity, pragmatic feasibility and high acceptability, integrating them into FRC workflows. These findings support expanding low‑barrier, community‑based trauma-informed arts-based services—paired with future outcome and cost‑effectiveness evaluation along with investments in facilitator capacity, logistical supports, and fidelity systems to ensure quality, sustainability, and scalable implementation.