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Antonikowski AA, Malhotra K, Allen JS, Galbraith D, Gerber MR. Trauma-Informed Health Care Practice in the Adolescent Well Visit. Prim Care 2024; 51:561-570. [PMID: 39448093 DOI: 10.1016/j.pop.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
Trauma-informed care (TIC) is a patient-centered, strength-based approach to caring for and empowering patients. The adolescent well visit is an opportune moment to assess and address the impact of trauma. Given the well-documented impact of trauma exposure on adolescent health, and the relationship present between social determinants of health and trauma, physicians and advanced practice practitioners are well positioned to utilize TIC in the medical visit. This article will explore tools to incorporate trauma-informed practices in adolescent well visits in the context of medical care, mental health screening, and in promoting health equity.
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Affiliation(s)
- Angela Adger Antonikowski
- Division of Community Outreach & Medical Education, Department of Psychiatry, Office of Medical Education, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA.
| | - Krithika Malhotra
- Department of Family and Community Medicine, Feinberg School of Medicine, Northwestern University, 1475 East Belvidere Road, Grayslake, IL 60030, USA
| | - Jay-Sheree Allen
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - D'Nea Galbraith
- Division of Community Outreach & Medical Education, Office of Medical Education, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Megan R Gerber
- Department of Medicine, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
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Maude P, James R, Searby A. The use of Open Dialogue in Trauma Informed Care services for mental health consumers and their family networks: A scoping review. J Psychiatr Ment Health Nurs 2024; 31:681-698. [PMID: 38230967 DOI: 10.1111/jpm.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 01/18/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Open Dialogue was developed in Finland in the 1980s by clinical psychologist, Jaakko Seikkula. It is a development of family therapy, recognises previous trauma and has proven to be very effective in situations of acute mental illness, and in particular psychosis. Trauma Informed Care is a practice based on the understanding of and responsiveness to the impact of trauma. When people have experienced trauma, they may have difficulties in their everyday life and experience negative physical health outcomes as well as the risk of developing mental ill health. Open Dialogue is aligned to mental health care which aims to be trauma-informed, person-centred and rights-based. Examples exist of the use of both approaches for service delivery with limited evaluation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, no formal evaluation has been made of the use of open dialogue as a Trauma Informed therapy approach to support individuals and their family networks. Although both approaches recognise the impact of trauma on individuals, no study has explored the effectiveness of this treatment combination for use by mental health nurses. This review is timely as it provides insights into contemporary services that are trauma informed and have used Open Dialogue to extend therapy work with individuals and their family/networks. This scoping review was able to determine whether recommendations for clinical practice and training in Open Dialogue with Trauma Informed Care approaches could be identified. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review provided a broad overview on the current types of trauma-informed care services incorporating Open Dialogue approaches into their practice. The literature, though sparce, identifies that Trauma Informed Care recognises multiple origins for mental ill health. Open dialogue has an affinity with the common values of mental health nurses. As combined therapies, they are demonstrating usefulness in engaging families and people in their journey towards recovery. Rigid adherence to Open Dialogue focus and delivery as well as training practices could be revised to make them more open to what people and their families wish to discuss. The person with mental ill health and previous trauma should be able to direct the narrative. Trauma Informed Practice principles could be adapted to improve consumer satisfaction with Open Dialogue approaches. ABSTRACT INTRODUCTION: A large proportion of people who access mental health services have a lived experienced of trauma and are more likely to have a history of complex trauma. Open Dialogue and Trauma Informed Care practices identify previous trauma as a factor related to later psychosis. This scoping review has identified similarities and contrasts in how an Open Dialogue and Trauma Informed Care approach have been combined to complement one another for clinical work with people presenting with psychosis and previous trauma. AIM We aimed to answer the following research question in this scoping review: What is known of the combined use of Open Dialogue and Trauma Informed Care practice when working with consumers and their family networks? As such, the purpose of this paper was to explore the application to practice and identify if any training existed and been evaluated. METHOD This scoping review was based on the Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Grey literature was also searched through Psyche Info and Google Scholar for books, Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2013 to January 2023. RESULTS Five distinct themes were identified from the literature: (1) Linking open dialogue with trauma, (2) Response to treatment, (3) Empowerment and information sharing, (4) Interpretation by clinical services, (5) Staff training outcomes. DISCUSSION Some tentative recommendations for practice recognised the individuals' unique story and perspective, suggested that trauma is an important concept to assess. Services practising as Trauma Informed Services that have incorporated an Open Dialogue approach have mixed experiences. The use of Open Dialogue may have some benefits for family work and exploring consumer narratives while building a network of support. However, consumers identified similar frustrations with service delivery as with the family therapy literature. For example, it was difficult to bring family members together and difficult to discuss previous traumatic events in front of family. People experiencing training in Open Dialogue reported it taking a slow pace and not what they were familiar with. IMPLICATIONS FOR PRACTICE Open Dialogue can facilitate engagement of consumers and their family networks and greater recognition of the peer workforce to promote collaboration in therapy is needed. Future research should also focus on evaluating the effectiveness of such services and comparing their outcomes across regions.
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Affiliation(s)
- Phil Maude
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, Latrobe University, Bendigo, Australia
| | - Russell James
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Adam Searby
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Australia
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Carra K, McKinstry C, Baillie L, Daniell R, Clews A. Enhancing occupational therapy service provision with military veterans through policy reform: Findings from a national survey. Aust Occup Ther J 2024; 71:369-378. [PMID: 38239013 DOI: 10.1111/1440-1630.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Almost half a million Australians have served with the Australian Defence Force. Given the high prevalence of physical and mental health conditions and complexity of civilian life adjustment after military service, high-quality occupational therapy services are critical. However, there is limited description of occupational therapy service provision to individuals funded by the Australian Department of Veterans' Affairs to inform government policy. The aim of this study was to describe the practice of Australian occupational therapists working with former service members and identify opportunities to enhance practice and policy. METHODS A cross-sectional study using an online survey was conducted to collect information from occupational therapists providing services to Department of Veterans' Affairs clients. Frequency analyses were performed to describe quantitative data. Qualitative data were analysed using thematic analysis. No consumer or community involvement occurred. RESULTS Participants included 123 Australian occupational therapists residing in metropolitan (47%), regional (28%) and rural/remote (23%) areas. Most occupational therapists (69%) had over 15 years of clinical experience and worked in private practice (87%). Common interventions included home modifications, equipment prescription and assistive technology (77%), goal-oriented rehabilitation (16%) and activities of daily living or function assessments and education (13%). Three themes describing practice issues were identified: (1) Service provision as rewarding yet underfunded, (2) Administrative complexity and lack of understanding of the occupational therapy role and (3) Need for specialist professional development opportunities. CONCLUSION Australian occupational therapists are providing a range of services to Department of Veterans' Affairs clients although mostly relating to physical conditions. Occupational therapy practice with former Australian Defence Force members should be expanded to meet their diverse and complex needs. Further research and education are needed to support use of specialist knowledge and interventions. Advocacy by peak associations and policy reform are urgently required to ensure sustainable services, particularly in rural areas.
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Affiliation(s)
- Kylie Carra
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Violet Vines Marshman Centre of Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Laura Baillie
- DLS Allied Health Pty Ltd, Strathdale, Bendigo, Australia
| | | | - Amery Clews
- Unity Point Health, St Luke's Hospital, Cedar Rapids, Iowa, USA
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Gelkopf M, Berger R, Dicker-Oren SD, Lapid Pickman L, Greene T. Trauma history predicts depression and posttraumatic stress symptoms better than a psychiatric diagnosis: Comparing wartime, routine time, and early COVID-19 in Israel. Stress Health 2024; 40:e3254. [PMID: 37165573 DOI: 10.1002/smi.3254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
Individuals with a psychiatric diagnosis and those with a history of trauma are at high risk for depression and posttraumatic stress symptoms (PTSS) following exposure to new traumatic events. Nevertheless, research is scarce on how having both a psychiatric diagnosis and a trauma history affect reactions to new traumatic events, and how different trauma types may affect individuals with a psychiatric diagnosis. We thus examined whether different stressful contexts (War and COVID-19) affected individuals with and without a psychiatric diagnosis differentially and whether results might be explained by prior trauma exposure. In the same cohort, we assessed depression and PTSS during wartime (2014), routine time (2016), and during the COVID-19 pandemic (2020) in a sample with (n = 89) and without (n = 104) a self-reported psychiatric diagnosis. This cohort was recruited during the 2014 Israel-Gaza War using social media, snowballing and outreach to mental health rehabilitation centres. We used a linear mixed modelling approach on data from the entire sample, as well as on the two study groups separately. We found that trauma history predicted PTSS and depression whereas a history of psychiatric diagnosis did not. Regarding trauma types, we found that individuals in the psychiatric diagnosis group relative to themselves had more symptoms during COVID-19 compared to war and routine time, while those without diagnosis had more PTSS and depression symptoms during wartime compared to routine time and COVID-19. In conclusion, a traumatic past may have an important influence on reactions to different types of traumatic events. Distinct traumatic events may affect individuals with or without a psychiatric diagnosis differentially.
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Affiliation(s)
- Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rony Berger
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv-Yafo, Israel
- Center for Compassionate and Mindful Education, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Sheila Daniela Dicker-Oren
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Liron Lapid Pickman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Clinical, Educational and Health Psychology, University College London, London, UK
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Irvin N. A Balancing Act: Navigating Fear, Bias, Safety, and Equity in Managing Agitated Patients. Ann Emerg Med 2024; 83:120-122. [PMID: 38245226 DOI: 10.1016/j.annemergmed.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Nathan Irvin
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Moon KJ, Stephenson S, Hasenstab KA, Sridhar S, Seiber EE, Breitborde NJK, Nawaz S. Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State. J Behav Health Serv Res 2024; 51:132-145. [PMID: 38017296 DOI: 10.1007/s11414-023-09865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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Sheehan L, Sayer J, Siddiqi M, Qin S, Glover L. How African Americans With Severe Mental Illness and Trauma Experience Diet and Exercise. JOURNAL OF HUMAN SERVICES 2023; 42:5-21. [PMID: 37337561 PMCID: PMC10278965 DOI: 10.52678/001c.74364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
African Americans have a higher prevalence of obesity and obesity-related diseases than other racial/ethnic groups; among persons with serious mental illness (SMI), African Americans fare worse as well. This qualitative study focused on the perceptions of African Americans with SMI in regard to 1) their experiences with diet and exercise behaviors post trauma and 2) how diet and exercise programming can address trauma. A community-based participatory research (CBPR) team developed the interview guide, research protocols, and conducted three focus groups. The team used thematic analysis to analyze the data. Participant (N = 27) responses on the experience of trauma were coded into the following themes: 1) emotional eating, 2) appetite loss, 3) hesitancy to exercise due to community violence, 4) staying home due to mental health symptoms, and 5) substance use. Themes around how programming can address trauma included: 1) support, 2) communication, 3) strategies to avoid trauma, and 4) engagement in programming. Findings suggest the need for human service professionals to infuse trauma-informed communications and practices throughout programming, incorporate peer-led services and address concerns related to community violence.
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Affiliation(s)
| | - Janis Sayer
- Advocates for Human Potential (United States)
| | | | - Sang Qin
- Illinois Institute of Technology
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Wilson A, Hurley J, Hutchinson M, Lakeman R. Trauma-informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study. Int J Ment Health Nurs 2023; 32:829-838. [PMID: 36705234 DOI: 10.1111/inm.13120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/28/2023]
Abstract
Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.
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Affiliation(s)
- Allyson Wilson
- Southern Cross University, Lismore, New South Wales, Australia
| | - John Hurley
- Southern Cross University, Lismore, New South Wales, Australia
| | | | - Richard Lakeman
- Southern Cross University, Lismore, New South Wales, Australia
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Dryden‐Mead T, Nelson B, Bendall S. "They may be confronting but they are good questions to be asking" young people's experiences of completing a trauma and PTSD screening tool in an early psychosis program. Psychol Psychother 2022; 95:1090-1107. [PMID: 35942544 PMCID: PMC9804455 DOI: 10.1111/papt.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a history of inadequate enquiry about, and assessment of, trauma in young people within Early Psychosis services and even when screening does occur there is little known about how young people experience this process. AIMS This study aimed to explore young people's experiences of completing a trauma and PTSD screening tool when receiving a service in an Early Psychosis Program. METHOD Semi-structured interviews were conducted with 10 young people, aged 18-24 years, to explore their subjective experience of this process. Transcripts were analysed via interpretative phenomenological analysis. RESULTS Four super-ordinate themes were identified: (i) an emotional experience, (ii) the importance of the relationship with the clinician, (iii) an opportunity to reflect on past experiences, and (iv) the ability to be able to provide honest responses. Results from this study indicated that young people expected to be asked about their trauma experiences, acknowledged that this was challenging for them but found that this was made easier due to the relationship they had built with the clinician, the timing of the screening and also, possibly, by the written style format of the questionnaires. CONCLUSIONS Young people in this study accepted the need for screening for traumatic histories, and expected to be asked about their traumatic experiences, despite the possibility of a short-term increase in distress. The support offered by a trusted clinician, whom the young person had built a relationship with, appeared to be an important component to the willingness and the ability of the young person to complete the questionnaires. This reinforces the fact that screening for trauma in an early psychosis service can be conducted in a way that is safe and acceptable to young people.
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Affiliation(s)
- Tracey Dryden‐Mead
- Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | - Sarah Bendall
- Orygen, the National Centre of Excellence in Youth Mental Health and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
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10
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Lu W, Srijeyanthan J, Mueser KT, Yanos PT, Parrott JS, Siriram A, Gottlieb JD, Marcello S, Silverstein SM. Predictors of undocumented PTSD in persons using public mental health services. Psychiatry Res 2022; 317:114892. [PMID: 36257204 DOI: 10.1016/j.psychres.2022.114892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 01/05/2023]
Abstract
Individuals diagnosed with serious mental illness (SMI) have greater trauma exposure and are at increased risk for posttraumatic stress disorder (PTSD). However, PTSD is rarely documented in their clinical records. This study investigated the predictors of PTSD documentation among 776 clients with SMI receiving public mental health services, who had probable PTSD as indicated by a PTSD Checklist score of at least 45. Only 5.3% of clients had PTSD listed as a primary diagnosis, and 8.4% had PTSD as a secondary diagnosis, with a total 13.7% documentation rate. PTSD documentation rate was highest for clients with major depression (18.8%) compared to those with schizophrenia (4.1%) or bipolar disorder (6.3%). Factors that predicted a lower likelihood of having a chart diagnosis of PTSD included being diagnosed with schizophrenia/schizoaffective disorder or bipolar disorder. Factors that predicted a higher likelihood of having a chart diagnosis of PTSD included being of non-white race, being female, and experiencing eight or more types of traumatic events. Findings highlight the need for PTSD screening and trauma informed care for clients with SMI receiving public mental health services.
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Affiliation(s)
- Weili Lu
- Rutgers University, School of Health Professions, USA
| | | | | | - Philip T Yanos
- John Jay College, City University of New York, 524W 59th St., 10th Floor, New York, NY 10019, USA.
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Champine RB, Hoffman EE, Matlin SL, Strambler MJ, Tebes JK. "What Does it Mean to be Trauma-Informed?": A Mixed-Methods Study of a Trauma-Informed Community Initiative. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:459-472. [PMID: 35018088 PMCID: PMC8736308 DOI: 10.1007/s10826-021-02195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 05/04/2023]
Abstract
Trauma during childhood has the potential to adversely affect one's physical, cognitive, emotional, and social development across the life span. However, the adverse effects of trauma can be prevented and mitigated through holistic services and supports that are trauma-informed. The Pottstown Trauma-Informed Community Connection (PTICC) is a community-based initiative that aims to build a trauma-informed community through training diverse stakeholders (e.g., school staff, providers, community leaders, parents) on the potential signs and symptoms of child trauma and how to create safe physical and emotional environments for children and families. This paper presents findings from a mixed-methods study of education and community partners' (N = 82) experiences in PTICC and their understandings of what it means to become trauma-informed. Paired sample t-tests found significant changes in participants' beliefs about trauma-informed practice, but there were no changes in participants' perceptions of the impacts of PTICC on their use of trauma-informed practices and supports. Focus groups with education (n = 6) and community (n = 5) partners found that participants regarded being "trauma-informed" as reframing one's perspective, being more self-reflective, acquiring skills to respond more effectively to others who have experienced trauma, and having a sense of hope for the future. Findings also revealed perceived benefits of trauma training and challenges associated with getting others to buy-in to trauma-informed work. Potential methodological considerations for future community-engaged research in building trauma-informed communities are discussed. These considerations include the need to address ceiling effects, disaggregate data, and mitigate challenges associated with participant engagement.
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Affiliation(s)
- Robey B. Champine
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI 48502 USA
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
| | - Erin E. Hoffman
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
- College of Science and Health, Department of Psychology, DePaul University, Chicago, IL 60604 USA
| | - Samantha L. Matlin
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
- The Scattergood Foundation, 1501 Cherry Street, Philadelphia, PA 19102 USA
| | - Michael J. Strambler
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
| | - Jacob Kraemer Tebes
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
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12
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Kerman N, Ecker J, Tiderington E, Gaetz S, Kidd SA. Workplace trauma and chronic stressor exposure among direct service providers working with people experiencing homelessness. J Ment Health 2022; 32:424-433. [PMID: 34983295 DOI: 10.1080/09638237.2021.2022629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Service providers working with people experiencing homelessness can be directly and indirectly exposed to trauma and other chronic stressors in their work. The types of individuals that are most at-risk of problematic outcomes from traumatic event exposure are unknown. AIM This study examined exposure to and effects of workplace traumas and stressors among service providers working with people experiencing homelessness in Canada. METHODS A cross-sectional survey was completed by 701 direct service providers working in the homeless service, supportive housing, and harm reduction sectors. Descriptive statistics, hierarchical multiple regression, and double moderation models were used in the analysis. RESULTS Employment in homeless service settings, service provision to single adults, and more time in direct contact with service users were each positively associated with the frequency of exposure to critical events and chronic stressors. Younger age, lived experience of behavioural health problems, more frequent exposure to chronic stressors, and less social support from coworkers were significantly correlated with post-traumatic stress and general psychological distress. Emotional support from supervision moderated the relationship between direct exposure to workplace critical events and post-traumatic stress. CONCLUSIONS More trauma-informed psychosocial supports tailored to the needs of direct service providers working with people experiencing homelessness are needed.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Canada
| | - John Ecker
- Canadian Observatory on Homelessness, York University, Toronto, Canada
| | - Emmy Tiderington
- School of Social Work, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Stephen Gaetz
- Faculty of Education, York University, Toronto, Canada
| | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Abstract
The integration of trauma-informed care practices into the care of obstetric patients requires an understanding of psychological trauma, its impact on this population, and how trauma-informed care can be adapted to improve outcomes for those patients with a previous history of trauma or for those that experience peripartum trauma. System-based changes to policies, protocols, and practices are needed to achieve sustainable change. Maternal morbidity and mortality that result from trauma-related and other mental health conditions in the peripartum period are significant. Innovative approaches to the prevention of negative birth experiences and retraumatization during labor and delivery are needed.
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Affiliation(s)
- Tracey M Vogel
- Department of Anesthesiology, West Penn Hospital/Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
| | - Erica Coffin
- Obstetric Anesthesia, Department of Anesthesiology, West Penn Hospital/Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA. https://twitter.com/coffin_erica
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Mitchell S, Shannon C, Mulholland C, Hanna D. Reaching consensus on the principles of trauma-informed care in early intervention psychosis services: A Delphi study. Early Interv Psychiatry 2021; 15:1369-1375. [PMID: 33169532 PMCID: PMC8451918 DOI: 10.1111/eip.13068] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
AIM The current study sought to conceptualize and reach consensus on the principles of trauma-informed care in early intervention psychosis services. METHODS A three-phase Delphi method was employed in this study. Experts included researchers, service providers and Experts by Experience in the area of early intervention in psychosis. In the initial qualitative phase, an expert panel (n = 57) shared their views on the constituents of trauma-informed care in early intervention psychosis services. Thematic analysis led to the generation of statement items. The expert panel was asked to rate the extent to which each statement item was an essential principle of trauma-informed care, leading to consensus of endorsed principles. RESULTS Qualitative analysis of the first phase data led to the identification of 185 distinct statements which were compiled into an online questionnaire for the panel to rate in Phase 2. The Phase 2 questionnaire was completed by 42 experts, with the endorsement of seven principles. In Phase 3, the panel were invited to re-rate 24 statements. This phase was completed by 39 panel members, with the acceptance of a further nine principles. Consensus was achieved resulting in the endorsement of 16 essential principles of trauma-informed care. CONCLUSIONS The study offers novel understanding of the conceptualisation of trauma-informed care in early intervention services and suggests principles which are widely agreed by experts in the field. The recommendations may inform the adoption of consistently delivered trauma-informed care in early interventions in psychosis and facilitate the evaluation and development of services.
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Affiliation(s)
- Sinéad Mitchell
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - Ciaran Shannon
- STEP Team, Northern Health and Social Care Trust, Antrim, Northern Ireland
| | - Ciaran Mulholland
- STEP Team, Northern Health and Social Care Trust, Antrim, Northern Ireland.,School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Donncha Hanna
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
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15
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Langhout RD, Rodriguez Ramirez D, Vaccarino‐Ruiz SS, Alonso Blanco V, Quinteros K, Copulsky D, Lopezzi MA. Teaching and Learning During A Pandemic: How one Graduate Community Psychology Class Quickly Incorporated Healing Justice Into Our Practices. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:249-265. [PMID: 34237167 PMCID: PMC8426737 DOI: 10.1002/ajcp.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this first-person account, we describe the changes we made to align our graduate student-level community psychology class with a healing justice model. We undertook this intervention because the class started in March, at the beginning of the COVID-19 pandemic stay-at-home directive in our region. We describe the facets of a healing justice model, which promotes radical healing and collective action in a trauma-informed environment. We then discuss the changes we made to the class to better align with healing justice, including how enrolled students (i.e., co-authors) experienced the process of the course (e.g., reworking the syllabus, starting class with check-ins and an exercise to engage our parasympathetic nervous systems), as well as the content of the course (e.g., service projects to support people who are undocumented, unhoused, or minoritized in other ways; photovoice). We end with implications for teaching community psychology, including the importance of universal design, and for scholar-activist PhD programs.
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Affiliation(s)
| | | | | | | | | | - Daniel Copulsky
- Psychology DepartmentUniversity of California Santa CruzSanta CruzCAUSA
| | - Miguel A. Lopezzi
- Psychology DepartmentUniversity of California Santa CruzSanta CruzCAUSA
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16
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Bendall S, Eastwood O, Cox G, Farrelly-Rosch A, Nicoll H, Peters W, Bailey AP, McGorry PD, Scanlan F. A Systematic Review and Synthesis of Trauma-Informed Care Within Outpatient and Counseling Health Settings for Young People. CHILD MALTREATMENT 2021; 26:313-324. [PMID: 32536207 DOI: 10.1177/1077559520927468] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
There is growing consensus that outpatient health services for young people (aged 12-25 years) need to deliver trauma-informed care to ameliorate the effects of trauma, offer safe treatments, and avoid retraumatization. Trauma-informed care has become a familiar term for many professionals; however, its operating definition lacks clarity. MEDLINE, Embase, and PsycINFO were systematically searched to clarify what trauma-informed care is, and what it should achieve in these settings. We reviewed 3,381 unique records, of which 13 met criteria for inclusion. Content analysis identified 10 components of trauma-informed care as it has been operationalized in practice: seven of these occurred at the system-level (interagency collaboration; service provider training; safety; leadership, governance and agency processes; youth and family/carer choice in care; cultural and gender sensitivity; youth and family/carer participation), and three involved trauma-specific clinical practices (screening and assessment; psychoeducation; therapeutic interventions). There is a need for greater consensus regarding an operating definition of trauma-informed care and further research into outcomes for young people and their families/carers.
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Affiliation(s)
- Sarah Bendall
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Oliver Eastwood
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Georgina Cox
- Northern Centre for Child Development, Melbourne, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Anna Farrelly-Rosch
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Helen Nicoll
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Wilma Peters
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Alan P Bailey
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Faye Scanlan
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
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17
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Johannessen DA, Nordfjærn T, Geirdal AØ. Work-Related Satisfaction among Clinicians Working at Inpatient Treatment Facilities for Substance Use Disorder: The Role of Recovery Orientation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147423. [PMID: 34299874 PMCID: PMC8303105 DOI: 10.3390/ijerph18147423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022]
Abstract
Several psychosocial factors have been suggested as facilitators of change among inpatients treated for substance use disorder (SUD). Research suggests that staff members are also influenced by the practice in which they are involved, and by contextual psychosocial factors at their treatment facilities. This cross-sectional questionnaire survey study was conducted to investigate the role of recovery-orientated interventions in describing work-related satisfaction among clinicians at inpatient SUD treatment facilities. The respondents (n = 407) rated items indicating work-related satisfaction and the degree of recovery orientation at their treatment facilities. The main findings of two block regression analyses indicated that clinicians’ work-related satisfaction was positively influenced by inpatients’ opportunities to pursue their goals and choices, and negatively influenced by inpatient involvement. The change in clinicians’ work-related satisfaction could not be described by the degree of individually tailored and varied interventions at the treatment facility. Clinicians should be supported and involved in the process of implementing measures to increase inpatient involvement in the treatment programmes, and treatment measures that enable inpatients to pursue their goals and choices should be enhanced. The findings of this and previous studies indicate that a recovery-oriented framework promotes clinicians’ work-related satisfaction and has an enabling influence on both inpatients and clinicians.
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Affiliation(s)
- Dagny Adriaenssen Johannessen
- Blue Cross East, 0182 Oslo, Norway
- Department of Social Work, Child Welfare and Social Policy, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
- Correspondence:
| | - Trond Nordfjærn
- Department of Psychology, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway;
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, 7006 Trondheim, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
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18
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Turkmani S, Homer CSE, Dawson AJ. Understanding the Experiences and Needs of Migrant Women Affected by Female Genital Mutilation Using Maternity Services in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051491. [PMID: 32110898 PMCID: PMC7084919 DOI: 10.3390/ijerph17051491] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for non-therapeutic reasons. Changing patterns of migration in Australia and other high-income countries has meant that maternity care providers and health systems are caring for more pregnant women affected by this practice. The aim of the study was to identify strategies to inform culturally safe and quality woman-centred maternity care for women affected by FGM who have migrated to Australia. An Appreciative Inquiry approach was used to engage women with FGM. We conducted 23 semi-structured interviews and three focus group discussions. There were four themes identified: (1) appreciating the best in their experiences; (2) achieving their dreams; (3) planning together; and (4) acting, modifying, improving and sustaining. Women could articulate their health and cultural needs, but they were not engaged in all aspects of their maternity care or considered active partners. Partnering and involving women in the design and delivery of their maternity care would improve quality care. A conceptual model, underpinned by women’s cultural values and physical, emotional needs, is presented as a framework to guide maternity services.
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Affiliation(s)
- Sabera Turkmani
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo NSW 2007, Australia;
- Correspondence:
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne VIC 3004, Australia;
| | - Angela J. Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo NSW 2007, Australia;
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19
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Sichel CE, Burson E, Javdani S, Godfrey EB. Theorizing Safety Informed Settings: Supporting Staff at Youth Residential Facilities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:405-417. [PMID: 30758850 DOI: 10.1002/ajcp.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Each year approximately 48,000 youth are incarcerated in residential placement facilities (YRFs) in the United States. The limited existing literature addressing the workforce in these settings paints a complicated picture. The YRF workforce is highly motivated to work with legal system involved youth. However, YRF staff report high rates of burnout, job fatigue, and work-related stress. The current paper proposes solutions to persistent problems faced by staff in these settings by integrating literature from criminology, organizational psychology, trauma-informed care, and community psychology. In doing so, we highlight previously overlooked aspects of intervention for trauma-organized settings and respond to recent calls for community psychologists to take a more active role in the adaptation of trauma-informed care in community settings. We conclude by advancing three recommendations, drawn from setting-level theory and inspired by the principles of trauma-informed care, to transform YRFs.
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Affiliation(s)
- Corianna E Sichel
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Esther Burson
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Shabnam Javdani
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Erin B Godfrey
- Department of Applied Psychology, New York University, New York, NY, USA
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20
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Townley G, Brown M, Sylvestre J. Community Psychology and Community Mental Health: A Call for Reengagement. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:3-9. [PMID: 29315707 DOI: 10.1002/ajcp.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Community psychology is rooted in community mental health research and practice and has made important contributions to this field. Yet, in the decades since its inception, community psychology has reduced its focus on promoting mental health, well-being, and liberation of individuals with serious mental illnesses. This special issue endeavors to highlight current efforts in community mental health from our field and related disciplines and point to future directions for reengagement in this area. The issue includes 12 articles authored by diverse stakeholder groups. Following a review of the state of community mental health scholarship in the field's two primary journals since 1973, the remaining articles center on four thematic areas: (a) the community experience of individuals with serious mental illness; (b) the utility of a participatory and cross-cultural lens in our engagement with community mental health; (c) Housing First implementation, evaluation, and dissemination; and (d) emerging or under-examined topics. In reflection, we conclude with a series of challenges for community psychologists involved in future, transformative, movements in community mental health.
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Affiliation(s)
- Greg Townley
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Molly Brown
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - John Sylvestre
- Center for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
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