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Readiness to Change: A Pathway to the Adoption of Trauma-Sensitive Teaching. Behav Sci (Basel) 2022; 12:bs12110445. [DOI: 10.3390/bs12110445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Creating a trauma-sensitive classroom requires a shift in perspective from viewing a student’s problematic behavior as a function of poor character to considering it contextually. However, a trauma-sensitive perspective may be insufficient for school staff to implement trauma-sensitive practices. Theoretically, motivation, or readiness to change (R2C), is needed to adopt any new behavior. Therefore, the purpose of this study was to examine the role of R2C in the relation between attitudes related to trauma-informed care (ARTIC) and the adoption of trauma-sensitive practices in a school setting. The targeted elementary school primarily serves Black students (83%), living below the federal poverty line. All staff attended an in-service training about trauma-sensitive schools (TSS), in which trauma-sensitive strategies were modeled, and student-friendly, emotional regulation materials were provided. Teachers and staff (n = 40) were assessed one year after receiving the TSS training. Participants reported their ARTIC, R2C, and trauma-informed strategy adoption. Using PROCESS Model 4, R2C fully mediated the relation between ARTIC and reported use of specific trauma-sensitive classroom strategies (β = 0.19, bootstrapped SE = 0.12, 95% LLCI = 0.04, 95% ULCI = 0.49). Facilitating R2C is essential when implementing trauma-sensitive school strategies. System-wide policies that may help promote the uptake of trauma-sensitive practices are described.
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Implementing Trauma Informed Care in Human Services: An Ecological Scoping Review. Behav Sci (Basel) 2022; 12:bs12110431. [DOI: 10.3390/bs12110431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/16/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Trauma and toxic stress are growing public health concerns with increasing risks to morbidity and mortality. Trauma informed care is an organizational response that challenges providers to adapt principled based approaches that seek to reduce adverse effects of care and support healing. However, there is a scarcity of empirical evidence on how trauma informed care is implemented in systems. A preferred reporting items for systematic reviews and meta-analysis-compliant scoping review based on Arksey, and O’Malley’s five steps model was conducted. Four databases, PubMed, Scopus, Embase and PsychINFO were searched for English articles published since 2000. Studies were included if they reported on trauma informed care delivered by services that support adults and there was some reference to implementation or organizational implications. Of 1099 articles retrieved, 22 met the inclusion criteria. Findings suggest that trauma informed care is being implemented in a range of human services, including at the city/state level. While implementation research is still at an early stage in this field, the findings elucidate several challenges when implementing this approach across systems of care. An ecological lens is used to present findings at the macro, mezzo, and micro level, and these are further discussed with reference to practice, policy, and research.
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Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
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Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
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BARGEMAN MARIA, ABELSON JULIA, MULVALE GILLIAN, NIEC ANNE, THEUER ANIA, MOLL SANDRA. Understanding the Conceptualization and Operationalization of Trauma-Informed Care Within and Across Systems: A Critical Interpretive Synthesis. Milbank Q 2022; 100:785-853. [PMID: 36161340 PMCID: PMC9576242 DOI: 10.1111/1468-0009.12579] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Policy Points In order to achieve successful operationalization of trauma-informed care (TIC), TIC policies must include conceptual clarity regarding the definition of both trauma and TIC. Furthermore, TIC requires clear and cohesive policies that address operational factors such as clearly delineated roles of service providers, protocol for positive trauma screens, necessary financial infrastructure, and mechanisms of intersectoral collaboration. Additionally, policy procedures need to be considered for how TIC is provided at the program and service level as well as what TIC means at the organizational, system, and intersectoral level. CONTEXT Increased recognition of the epidemiology of trauma and its impact on individuals within and across human service delivery systems has contributed to the development of trauma-informed care (TIC). How TIC can be conceptualized and implemented, however, remains unclear. This study seeks to review and analyze the TIC literature from within and across systems of care and to generate a conceptual framework regarding TIC. METHODS Our study followed a critical interpretive synthesis methodology. We searched multiple databases (Campbell Collaboration, Econlit, Health Systems Evidence, Embase, ERIC, HealthSTAR, IPSA, JSTOR, Medline, PsychINFO, Social Sciences Abstracts, Sociological Abstracts and Web of Science),as well as relevant gray literature and information-rich websites. We used a coding tool, adapted to the TIC literature, for data extraction. FINDINGS Electronic database searches yielded 2,439 results and after inclusion/exclusion criteria were applied, a purposive sample of 98 information-rich articles was generated. Conceptual clarity and definitional understanding of TIC is lacking in the literature, which has led to poor operationalization of TIC. Additionally, infrastructural and ideological barriers, such as insufficient funding and service provider "buy-in," have hindered TIC implementation. The resulting conceptual framework defines trauma and depicts critical elements of vertical TIC, including the bidirectional relationship between the trauma-affected individual and the system, and horizontal TIC, which requires intersectoral collaboration, an established referral network, and standardized TIC language. CONCLUSIONS Successful operationalization of TIC requires policies that address current gaps in systems arrangements, such as the lack of funding structures for TIC, and political factors, such as the role of policy legacies. The emergent conceptual framework acknowledges critical factors affecting operationalization.
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Affiliation(s)
| | - JULIA ABELSON
- Centre for Health Economics & Policy AnalysisMcMaster University
| | - GILLIAN MULVALE
- Health Policy and Management, DeGroote School of BusinessMcMaster University
| | - ANNE NIEC
- Department of Psychiatry & Behavioural NeurosciencesMcMaster University
| | - ANIA THEUER
- Health Policy PhD ProgramMcMaster University
| | - SANDRA MOLL
- School of Rehabilitation ScienceMcMaster University
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Brener L, Horwitz R, Rance J, Gray R, Poeder F, Bryant J. Establishing the impact of consumer participation in alcohol and other drug treatment settings in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1183-e1193. [PMID: 34328677 DOI: 10.1111/hsc.13525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
It is generally recognised that engaging consumers to participate in policy making, programming, and practice is fundamental to effective alcohol and other drug (AOD) treatment, however, literature continues to document challenges and barriers to its implementation in AOD settings. This study reports on an evaluation of the Consumer Participation Project implemented in key non-government AOD services in Australia. Data collection consisted of an online survey of 86 staff members at the five participating AOD services and 27 consumer interviews. The survey examined staff attitudes towards and beliefs about consumer participation, perceived current levels of consumer participation and service changes as a result of the consumer participation project. The qualitative arm explored consumer's prior knowledge and current experiences of consumer participation. Staff who took part in the consumer participation training offered as part of the project were more likely to believe that service changes could encourage greater consumer participation rather than any barriers associated with consumer circumstances. Additionally, while services offered low-level involvement consumer activities, there were fewer examples of mid- and high-level activities being conducted at the different services. Consumers discussed the significance of being actively involved in their AOD treatment service while stressing the importance of proper training and support for those engaging in consumer participation. This research highlights the benefits of consumer participation in AOD treatment and suggests that most consumer participation activities undertaken at present are "low" level involvement concerned with providing and receiving information from consumers. Importantly, however, our study did demonstrate some support for "high" level involvement activities and service providers being open to doing more to encourage consumer participation.
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Affiliation(s)
- Loren Brener
- University of New South Wales, Sydney, Australia
| | | | - Jake Rance
- University of New South Wales, Sydney, Australia
| | - Rebecca Gray
- University of New South Wales, Sydney, Australia
| | - Fiona Poeder
- Network of Alcohol and other Drugs Agencies, Woolloomooloo, NSW, Australia
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Masin-Moyer M, Kim JC, Engstrom M, Solomon P. A Scoping Review of the Trauma Recovery and Empowerment Model (TREM). TRAUMA, VIOLENCE & ABUSE 2022; 23:699-715. [PMID: 33167792 DOI: 10.1177/1524838020967862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The link between interpersonal trauma and negative biopsychosocial outcomes has been well-documented. Integrated treatments that address trauma, mental health, and substance use among women with trauma histories have been found to be more effective than treatments that focus separately on these concerns. Since the early 2000s, the Trauma Recovery and Empowerment Model (TREM) has been described as a "promising" integrated trauma group therapy for women. Despite widespread recognition and implementation of TREM, its effectiveness has not been clearly established. The present scoping review is the first systematic effort to describe the extant literature on TREM and aims to provide an understanding of TREM's effectiveness by organizing and synthesizing the available empirical data. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, a systematic search was conducted using PubMed, PsycINFO, SW Abstracts, Scopus, Embase, and Web of Science. Quantitative dissertation findings not published elsewhere and peer-reviewed journal articles published in English that reported outcomes from TREM intervention research with adult women were included. Twelve of the initial 385 publications identified met the inclusion criteria and reported data from nine studies. TREM demonstrated statistically significant effects on posttraumatic stress disorder, anxiety, psychological/psychosomatic distress, and substance use. A more limited set of findings suggests that TREM may also be associated with additional gains, including self-esteem, relationship power, social support, attachment, and spiritual well-being. Future research should replicate findings, use random assignment to groups, involve larger sample sizes and more representative samples, examine optimal duration, and identify components that facilitate change.
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Affiliation(s)
- Melanie Masin-Moyer
- School of Social Policy and Practice, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica Cho Kim
- School of Social Policy and Practice, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Malitta Engstrom
- School of Social Policy and Practice, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Phyllis Solomon
- School of Social Policy and Practice, 6572University of Pennsylvania, Philadelphia, PA, USA
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Esfeld J, Pennings K, Rooney A, Robinson S. Integrating Trauma-Informed Yoga into Addiction Treatment. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2021. [DOI: 10.1080/15401383.2021.1972067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jordan Esfeld
- Loyola University New Orleans, New Orleans, United States
| | | | - Annie Rooney
- Loyola University New Orleans, New Orleans, United States
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Abstract
Abstract
Purpose of Review
Maternal prenatal substance use presents a multilevel risk to child development and parenting. Although parenting interventions are increasingly integrated into substance use treatment, prenatal parenting processes have not received equal attention within these interventions. This article aims to synthesize the evidence on the specific prenatal risk factors affecting the development of early parenting of substance-using mothers, as well as interventions focusing on those factors.
Recent Findings
Both neurobiological and psychosocial risk factors affect the prenatal development of parenting in the context of maternal substance use. Maternal–fetal attachment, mentalization, self-regulation, and psychosocial risks are important in treatment and highly intertwined with abstinence. Although parenting interventions seem to be highly beneficial, most studies have not differentiated between pre- and postnatal interventions or described pregnancy-specific intervention elements.
Summary
Due to the salience of pregnancy in treating substance-using parents, interventions should begin prenatally and include pregnancy-specific parenting focus. Further research on prenatal interventions is warranted.
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Isobel S, Wilson A, Gill K, Howe D. 'What would a trauma-informed mental health service look like?' Perspectives of people who access services. Int J Ment Health Nurs 2021; 30:495-505. [PMID: 33219725 DOI: 10.1111/inm.12813] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
Trauma-informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re-traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma-informed. However, how Australian mental health services should deliver trauma-informed care is not well documented. Efforts towards trauma-informed care in any setting require engagement with those who receive care. This qualitative study used an experience-based co-design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question 'what would a trauma-informed mental health service look like?' Focus groups were held with consumers (n = 10) and carers (n = 10). Thematic analysis of transcripts identified that consumers and carers consider that trauma-informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma-informed care across settings.
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Affiliation(s)
- Sophie Isobel
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Allyson Wilson
- Mental Health Services, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Katherine Gill
- Consumer Led Research Network, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Howe
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
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Caplan R, Nelson G, Distasio J, Isaak C, Edel B, Piat M, Macnaughton E, Kirst M, Patterson M, Aubry T, Mulligan S, Goering P. Indigenous and non-Indigenous parents separated from their children and experiencing homelessness and mental illness in Canada. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2753-2772. [PMID: 33032366 DOI: 10.1002/jcop.22455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
The purpose of this study is to examine the parent-child experiences of Indigenous and non-Indigenous mothers and fathers experiencing homelessness, mental illness, and separation from their children. A qualitative thematic analysis of baseline and 18-month follow-up narrative interviews was used to compare 12 mothers (n = 8 Indigenous and n = 4 nonindigenous) with 24 fathers (n = 13 Indigenous and n = 11 non-Indigenous). First, it was found that children are more central in the lives of mothers than fathers. Second, Indigenous parents' narratives were characterized by interpersonal and systemic violence, racism and trauma, and cultural disconnection, but also more cultural healing resources. Third, an intersectional analysis showed that children were peripheral in the lives of non-Indigenous fathers, and most central to the identities of Indigenous mothers. Gender identity, Indigenous, and intersectional theories are used to interpret the findings. Implications for future theory, research, and culturally relevant intervention are discussed.
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Affiliation(s)
- Rachel Caplan
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | - Geoffrey Nelson
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | - Jino Distasio
- Department of Geography, University of Winnipeg, Winnipeg, Canada
| | | | - Betty Edel
- End Homelessness Winnipeg, Winnipeg, Canada
| | - Myra Piat
- Douglas Mental Health University Institute, Department of Psychiatry & School of Social Work, McGill University, Montreal, Canada
| | - Eric Macnaughton
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | - Maritt Kirst
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | | | - Tim Aubry
- Department of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | | | - Paula Goering
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
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Alunni-Menichini K, Bertrand K, Roy L, Brousselle A. Current emergency response in montreal: How does it fit in the services offered to homeless people who use substances? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102758. [PMID: 32482488 DOI: 10.1016/j.drugpo.2020.102758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
Background This paper presents an assessment of the current emergency response to homeless people who use substances in Montreal, a major North American city. This project addresses the rising concern about homelessness in high-income countries. Several studies have shown that homeless people frequently use emergency services (i.e., police, paramedical, and hospital), especially in the context of substance use. Yet, the key actors' perspectives are poorly documented. Method Our team conducted a needs analysis using a deliberative democratic evaluation. Data collection strategies included an intersectoral World Café (n = 34, including police, specialized professionals, community stakeholders, political representatives, researchers, and people who have been homeless) and individual interviews with health professionals (n = 5) and homeless people (n = 8). We performed a thematic content analysis based on a conceptual framework of access to health care and of collaboration. Findings This study provided key information on the role of emergency services and the needs of key actors, in terms of the dimensions of access to health care (approachability, acceptability, availability, and appropriateness) and continuity. Our main results show that, according to the participants, the emergency response is relevant when homeless people are a danger to themselves or to others, and during episodes of acute physical and psychological care. However, emergency service providers still stigmatize homelessness and substance use, which negatively affects intervention quality. Finally, our main results highlight the interdependence between the emergency services and health, social, and community services. Conclusion The emergency response is necessary and appropriate in some situations. It remains important to intervene upstream and to improve the attitudes and practices of emergency service providers. Finally, it is necessary to adapt services to the needs of homeless substance users and improve service continuity, for example, by adopting a population-based approach.
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Affiliation(s)
- Kristelle Alunni-Menichini
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue de Louvain Est, Montréal (QC), H2M 2E8
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue de Louvain Est, Montréal (QC), H2M 2E8
| | - Laurence Roy
- School of Physical & Occupational Therapy, McGill University, Davis House, 3654 Promenade Sir-William-Osler, Montreal (QC), H3G 1Y5, Canada; Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal, 6875 LaSalle Boulevard, Montreal (QC), H4H 1R3, Canada
| | - Astrid Brousselle
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; School of Public Administration, Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Rd (Ring Rd), Human & Social Development Building, Room A302, Victoria (BC), V8P 5C2, Canada
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Nizum N, Yoon R, Ferreira-Legere L, Poole N, Lulat Z. Nursing interventions for adults following a mental health crisis: A systematic review guided by trauma-informed principles. Int J Ment Health Nurs 2020; 29:348-363. [PMID: 31904178 DOI: 10.1111/inm.12691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 11/28/2022]
Abstract
There exists a growing need for health and service providers to respond to persons in a manner that recognizes the prevalence and impact of trauma in individuals and prevent inadvertent re-traumatization in the routine process of care. The experience of mental health crisis in of itself can have traumatic and impactful effects on individuals. Trauma-informed approaches to care offer a framework to provide crisis intervention responses that are based on the acknowledgement of the prevalence and impact of trauma and define trauma not by the event per se, but by the impact of an experience of trauma. The integration of trauma-informed principles in the context of crisis intervention is a current practice gap. In order to inform a portion of a best-practice guideline for registered nurses and the interprofessional team, a systematic literature review was conducted to primarily identify nursing interventions within four weeks of a mental health crisis, with a secondary focus on identifying particular interventions that included trauma-informed principles. The systematic review yielded 21 quantitative and qualitative studies related to nursing interventions for mental health crisis, 10 of which referred to one or more principles of trauma-informed approaches. There was a lack of studies on nursing interventions explicitly linked to implementation of trauma-informed principles, highlighting future research needs and focused efforts to integrate trauma-informed principles into crisis intervention practices.
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Affiliation(s)
- Nafsin Nizum
- Guideline Development Methodologist, Registered Nurses' Association of Ontario, Toronto, Ontario, Canada
| | - Rosanra Yoon
- Nurse Practitioner, The Jean Tweed Centre, Toronto, Ontario, Canada
| | - Laura Ferreira-Legere
- Former Guideline Development Methodologist, Registered Nurses' Association of Ontario, Toronto, Ontario, Canada
| | - Nancy Poole
- Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada
| | - Zainab Lulat
- Guideline Development Methodologist, Registered Nurses' Association of Ontario, Toronto, Ontario, Canada
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Kahan D, Lamanna D, Rajakulendran T, Noble A, Stergiopoulos V. Implementing a trauma-informed intervention for homeless female survivors of gender-based violence: Lessons learned in a large Canadian urban centre. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:823-832. [PMID: 31814189 DOI: 10.1111/hsc.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 06/10/2023]
Abstract
Gender-based violence is associated with an elevated risk of physical and psychological harm for girls and women. This study examines service user and provider experiences of a trauma-informed, peer-facilitated group psychosocial intervention (Peer Education and Connection through Empowerment [PEACE]) targeting female-identified youth experiencing homelessness and gender-based violence. Participants were recruited among service users and providers of the intervention, delivered in Toronto, Canada. We conducted 19 semi-structured interviews between May and October 2017, engaging 12 service users and 7 additional stakeholders (including social service providers, peers and program administrators). We elicited participant perspectives on the acceptability of the intervention and key enablers of successful implementation and engagement of the target population. Qualitative transcripts were analysed using thematic analysis. Service users, including survivors of sexual exploitation, forced marriage and honour crimes, described satisfaction with and acceptability of the intervention. A number of factors were perceived by service users and providers as contributing to the intervention's successful implementation, including a focus on service user needs, program quality, flexibility and accessibility and strong inter-and intra-agency networks. Introducing peers as mentors led to challenges that could be mitigated through peer mentor education and training to maintain healthy boundaries and enhance peer mentor retention. The need for clear guidelines on the management of trauma disclosures in community settings and a systems-wide approach to service provider and administrator training in the effective integration of peer support services also emerged as important areas for future development. A group-based, trauma-informed and peer-supported psychosocial intervention was acceptable to service users and providers and successfully engaged female-identified survivors of gender-based violence who were also experiencing homelessness. Findings add to the scant knowledge base on interventions to support this population and identify important areas for future research.
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Affiliation(s)
| | - Denise Lamanna
- Centre for Addition and Mental Health, Toronto, ON, Canada
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Strike C, Robinson S, Guta A, Tan DH, O'Leary B, Cooper C, Upshur R, Chan Carusone S. Illicit drug use while admitted to hospital: Patient and health care provider perspectives. PLoS One 2020; 15:e0229713. [PMID: 32134973 PMCID: PMC7058273 DOI: 10.1371/journal.pone.0229713] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/12/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Across North America, the opioid overdose epidemic is leading to increasing hospitalizations of people who use drugs (PWUD). However, hospitals are ill-prepared to meet the needs of PWUD. We focus on illicit drug use while admitted to hospital and how PWUD and health care providers describe, respond, and attempt to manage its use. METHODS AND FINDINGS Using varied purposive methods in Toronto and Ottawa, we recruited n = 24 PWUD (who self-reported that they were living with HIV and/or HCV infection; currently or had previously used drugs or alcohol in ways that were harmful; had a hospital admission in the past five years) and n = 26 health care providers (who were: currently working in an academic hospital as a physician, nurse, social worker or other allied health professional; and 2) providing care to this patient group). All n = 50 participants completed a short, socio-demographic questionnaire and an audio-recorded semi-structured interview about receiving or providing acute care in a hospital between 04/2014 and 05/2015. Patient participants received $25 CAD and return transit fare; provider participants received a $50 CAD gift card for a bookseller. All participants provided informed consent. Audio-recordings were transcribed verbatim, corrected, and uploaded to NVivo 10. Using the seven-step framework method, transcripts were coded line-by-line and managed using NVvivo. An analytic framework was created by grouping and mapping the codes. Preliminary analyses were presented to advisory group members for comment and used to refine the interpretation. Questionnaire data were managed using SPSS version 22.0 and descriptive statistics were used to describe the participants. Many but not all patient participants spoke about using psycho-active substances not prescribed to them during a hospital admission. Attempts to avoid negative experiences (e.g., withdrawal, boredom, sadness, loneliness and/or untreated pain) were cited as reasons for illicit drug use. Most tried to conceal their illicit drug use from health care providers. Patients described how their self-reported level of pain was not always believed, tolerance to opioids was ignored, and requests for higher doses of pain medications denied. Some health care providers were unaware of on-site illicit drug use; others acknowledged it occurred. Few could identify a hospital policy specific to illicit drug use and most used their personal beliefs to guide their responses to it (e.g., ignore it, increase surveillance of patients, reprimands, loss of privileges/medications, threats of immediate discharge should it continue, and substitution dosing of medication). CONCLUSIONS Providers highlighted gaps in institutional guidance for how they ought to appropriately respond to in-hospital substance use. Patients attempted to conceal illicit drug use in environments with no institutional policies about such use, leading to varied responses that were inconsistent with the principles of patient centred care and reflected personal beliefs about illicit drug use. There are increasing calls for implementation of harm reduction approaches and interventions in hospitals but uptake has been slow. Our study contributes to this emerging body of literature and highlights areas for future research, the development of interventions, and changes to policy and practice.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Samantha Robinson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
| | - Darrell H. Tan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | | | - Curtis Cooper
- Division of Infectious Diseases, University of Ottawa, Ottawa, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
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15
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Finch J, Ford C, Grainger L, Meiser-Stedman R. A systematic review of the clinician related barriers and facilitators to the use of evidence-informed interventions for post traumatic stress. J Affect Disord 2020; 263:175-186. [PMID: 31818775 DOI: 10.1016/j.jad.2019.11.143] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/05/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND A number of evidence-informed interventions for PTSD have been developed and recommended by clinical guidelines. Despite efforts to disseminate these approaches, there remains a gap between evidence and practice, and research has started to identify a number of barriers to the implementation of evidence-informed interventions. METHODS This systematic review aimed to synthesise the relevant literature, both quantitative and qualitative, relating to clinicians' perceived barriers and facilitators. Literature searches were conducted to identify relevant studies. Data were analysed using content analysis to categorise key barriers and facilitators. RESULTS A literature search identified 34 relevant studies. Four levels of barriers and facilitators were identified, covering intervention, client, clinician and system factors. The most commonly cited barriers identified include inflexibility of manualised approaches, fear of increasing client distress, working with comorbidities and a lack of training and support. Quality appraisal rated the majority of studies as strong, with five studies receiving an adequate rating. LIMITATIONS The review was limited to studies published in the English language, therefore introducing a risk of bias as perceived barriers and facilitators may be culturally influenced. Additionally the heterogeneity of studies may impact upon comparability, only allowing for a broad analysis and not exploring barriers and facilitators in more detail. CONCLUSIONS Lack of training, confidence and knowledge relating to the implementation of evidence-informed interventions for PTSD were commonly reported. A better-informed understanding into the challenges and facilitators experienced by clinicians can help inform implementation needs and should be considered in the development and implementation of training initiatives.
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Affiliation(s)
- Jodie Finch
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia NR4 7TJ, United Kingdom.
| | - Catherine Ford
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia NR4 7TJ, United Kingdom
| | - Lauren Grainger
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia NR4 7TJ, United Kingdom
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia NR4 7TJ, United Kingdom
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16
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Bosk EA, Paris R, Hanson KE, Ruisard D, Suchman NE. Innovations in Child Welfare Interventions for Caregivers with Substance Use Disorders and Their Children. CHILDREN AND YOUTH SERVICES REVIEW 2019; 101:99-112. [PMID: 32831444 PMCID: PMC7437721 DOI: 10.1016/j.childyouth.2019.03.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Families who enter the Child Welfare System (CWS) as a result of a caregiver's substance use fare worse at every stage from investigation to removal to reunification (Marsh et. al 2007). Intervening with caregivers with Substance Use Disorders (SUDs) and their children poses unique challenges related to the structure and focus of the current CWS. Research demonstrates that caregivers with SUDs are at a greater risk for maladaptive parenting practices, including patterns of insecure attachment and difficulties with attunement and responsiveness (Suchman, 2006). Caregivers with SUDs have also often experienced early adversity and trauma. However, traditional addiction services generally offer limited opportunities to focus on parenting or trauma, and traditional parenting programs rarely address the special needs of parents with SUDs. This article details four innovative interventions that integrate trauma-informed addiction treatments with parenting for families involved in the child welfare system. Common mechanisms for change across programs are identified as critical components for intervention. This work suggests the need for a paradigm shift in how cases involving caregivers with substance use disorders are approached in the child welfare system.
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Affiliation(s)
- Emily A Bosk
- Assistant Professor of Social Work, Rutgers University, the State University of New Jersey
| | - Ruth Paris
- Associate Professor and Chair, Clinical Practice Department, Boston University School of Social Work
| | - Karen E Hanson
- Assistant Clinical Professor of Social Work, Yale University School of Medicine, Yale Child Study Center
| | - Debra Ruisard
- Chief Clinical Officer, The Center for Great Expectations
| | - Nancy E Suchman
- Yale University School of Medicine, Department of Psychiatry and Yale Child Study Center
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17
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Polmanteer RSR, Keefe RH, Brownstein-Evans C. Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. SOCIAL WORK IN HEALTH CARE 2019; 58:220-235. [PMID: 30346906 DOI: 10.1080/00981389.2018.1535464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Abstract
Postpartum depression (PPD) is a mental health disorder that affects approximately 20% of all new mothers. PPD frequently co-occurs with and is exacerbated by trauma, particularly for women from vulnerable populations. Trauma-informed care (TIC) is a best practice that recognizes the importance of, and takes steps to promote recovery from, trauma while preventing retraumatization. Despite its potential utility, there is limited research published on TIC, including how TIC is operationalized across practice settings. Further, despite the prevalence and negative effects of untreated PPD, to date there have been limited articles published on TIC and PPD. The purpose of this article is to provide a TIC framework for service delivery for women diagnosed with PPD including explicit strategies for how TIC should be structured across roles, settings, and systems. Implications for health practice, policy, and future research are provided.
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Affiliation(s)
| | - Robert H Keefe
- b School of Social Work , University at Buffalo, SUNY , Buffalo , New York , USA
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18
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Systematic Review of Suicidal Behaviour in Individuals Who Have Attended Substance Abuse Treatment. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9994-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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