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Herlitz L, Ashford E, Baldwin J, Powell C, Woodman J. Care-experienced young people's views and experiences of accessing general practice and dental services and attending health reviews in England: a qualitative study. BMC PRIMARY CARE 2024; 25:318. [PMID: 39210261 PMCID: PMC11360303 DOI: 10.1186/s12875-024-02569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Children in care and care leavers have worse health outcomes than their peers without care experience. This study addresses an evidence gap in exploring care-experienced young people's views and experiences of accessing general practice and dental services and attending health reviews in England. METHODS We conducted a qualitative study using podcasting as a creative medium. We recruited young people from two sites: one in South England (A) and one in greater London (B). We held two paired discussions in site A and two focus groups in site B, with 14 participants in total. Participants were aged between 13 and 22 years and were diverse in gender, ethnicity, and care experiences. Data were analysed thematically using candidacy theory as a theoretical framework. RESULTS Mental health was a prevailing concern for participants, but general practice was not considered a place to discuss it. Most participants reported distant relationships with primary healthcare professionals and considered opening-up to a professional to be risky, for example, it could result in an unknown/unwanted outcome. A lack of time and personal connection in appointments, and experiences of feeling judged, dismissed, or misunderstood, hindered young people's ability to disclose mental health or relationship concerns. Participants reported variation in the timeliness and location of services, with salient examples of extensive waiting periods for braces. Participants perceived annual health reviews to be largely inconsequential. CONCLUSIONS Any primary care presentation by a care-experienced young person should trigger additional professional curiosity. To build rapport and trust, professionals should not underestimate the power of active listening, being reliable and honest, and small acts of thoughtfulness, for example, ensuring medical letters are provided promptly. Carers and other trusted professionals should help care-experienced young people to understand the role of primary care and support them with access. Health reviews may not be of value to all young people in care. Further research is needed to examine primary healthcare access for care-experienced young people with significant safeguarding and healthcare needs.
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Affiliation(s)
- Lauren Herlitz
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Emily Ashford
- Thomas Coram Research Unit, UCL Social Research Institute, 55 Gordon Square, London, UK
| | - James Baldwin
- Toucan Theatre Limited, 7 Bell Yard, London, WC2A 2JR, UK
| | - Claire Powell
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jenny Woodman
- Thomas Coram Research Unit, UCL Social Research Institute, 55 Gordon Square, London, UK
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Pro G, Horton H, Tody B, Gu M, Washington T, Williams A, Gorvine MM, Johnson O, Lovelady N, Jackson T, Ray A, Montgomery B, Zaller N. National and state-level trends in the availability of mental health treatment services tailored to individuals ordered to treatment by a court: United States, 2016, 2018, and 2020. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02589-8. [PMID: 38193943 DOI: 10.1007/s00127-023-02589-8] [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: 06/19/2023] [Accepted: 10/30/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE We sought to identify trends and characteristics associated with the availability of tailored mental health services for individuals involved in the criminal justice system and ordered to treatment by a court, nationally in the US and by state. METHODS We used National Mental Health Services Survey to identify outpatient mental health treatment facilities in the US (2016 n = 4744; 2018 n = 4626; 2020 n = 4869). We used clustered multiple logistic regression to identify changes over time as well as facility- and state-level factors associated with the availability of specialty court-ordered services. RESULTS Slightly more than half of the outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation between states. Nationally, there was a significant increase in the odds of offering court-ordered treatment in 2020 compared to 2016 (aOR = 1.16, 95% CI = 1.06-1.27, p < 0.01). Notable associations included offering integrated substance use treatment (versus none, aOR = 2.95, 95% CI = 2.70-3.22, p < 0.0001) and offering trauma therapy (versus none, aOR = 2.05, 95% CI = 1.85-2.27, p < 0.0001). CONCLUSION The availability of mental health services for individuals ordered to treatment by a court is growing nationally but several states are lagging behind. Court ordered treatment is a promising strategy to improve health and reduce reliance on the carceral system as a healthcare provider. At the same time, we express caution around disparities within behavioral health courts and advocate for equity in access to incarceration alternatives.
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Affiliation(s)
- George Pro
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Heather Horton
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brooklyn Tody
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mofan Gu
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Taylor Washington
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashley Williams
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Margaret M Gorvine
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - O'Dell Johnson
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nakita Lovelady
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Timikia Jackson
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Azizi Ray
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Brooke Montgomery
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nick Zaller
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Morrison M. The Mass Incarceration Trauma Framework: A Conceptual Model for Understanding Trauma among Individuals Who Experience Incarceration. SOCIAL WORK 2023; 69:8-16. [PMID: 37935034 DOI: 10.1093/sw/swad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 11/09/2023]
Abstract
The Mass Incarceration Trauma (MIT) framework is a conceptual model for understanding the role of trauma in the lives of individuals who experience incarceration in the United States. This population faces poverty, violence, and discrimination across the life span. The MIT framework is guided by an ecological systems perspective, a foundational theoretical approach in social work that recognizes that effective assessment and intervention require an understanding of the complex contexts in which individuals live. The MIT framework presents the cumulative trauma exposures commonly faced by this population before, during, and after incarceration at the individual, social, environmental, and historical levels. Because traumatic stress undermines health and daily functioning, it is essential that interventions for this population address both the ongoing risk for trauma exposure and the consequences of multiple, repeated past exposures across ecological systems. It is to be hoped that a new and fundamental focus on the poverty, contexts of violence, and lifetime disadvantages experienced by those who cycle through prisons in the United States might reframe the question of how our society should prevent and respond to crime as well as respond to those swept into the criminal justice system.
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Chou WYS, Gaysynsky A. A relationship-centered approach to addressing mistrust. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:320-323. [PMID: 37732639 DOI: 10.1080/17538068.2023.2258683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
- ICF Next, Rockville, MD, USA
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Walter ZC, Carlyle M, Kerswell N, Mefodeva V, Nixon RDV, Cobham VE, Hides L. Study protocol: implementing and evaluating a trauma-informed model of care in residential youth treatment for substance use disorders. Front Psychiatry 2023; 14:1169794. [PMID: 37840800 PMCID: PMC10572352 DOI: 10.3389/fpsyt.2023.1169794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Comorbidity between Substance Use Disorders and trauma/post-traumatic stress disorder (PTSD) is common, particularly within residential treatment services. Comorbidity is associated with poorer treatment retention and treatment outcomes. Integrated treatment approaches are increasingly recommended but are still under examined in residential treatment services. This study will implement and evaluate a novel model of trauma-informed care (TIC) in a youth (18-35 years) residential substance use treatment service. Methods and analysis A single-armed, phase 1 implementation trial will be conducted in one residential treatment service. The model, co-developed with staff, incorporates: (i) workforce development in TIC through staff training and clinical supervision; adaptions to the service (ii) policies, procedures, and physical settings and (iii) treatment program adaptions (in delivery style and content) to be more trauma-informed; (iv) client screening and feedback for trauma and PTSD at service entry; and (v) the provision of support, referral and/or trauma-focused therapy to those with PTSD. Service outcomes will include adherence to the TIC model and client treatment completion. Client substance use and mental health measures will be collected at service entry, and 1-, 3-, 6- and 12-months follow up. Staff outcomes, including workplace satisfaction, burnout, and fatigue, as well as perceptions and confidence in delivering TIC will be collected at baseline, and at 3-, 6-, 12- and 18-months following training in the model. The sustainability of the delivery of the TIC model of care will be evaluated for 12 months using service and staff outcomes. Ethics and dissemination The study has received ethical approval by the University of Queensland (Approval number: 2020000949). The results will be disseminated through publication in a peer-reviewed scientific journal, presentations at scientific conferences, and distributed via a report and presentations to the partner organization.Clinical trial registration: ACTRN12621000492853.
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Affiliation(s)
- Zoe C. Walter
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Molly Carlyle
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Nick Kerswell
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Valeriya Mefodeva
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Reg D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, SA, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Vanessa E. Cobham
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Children’s Health Queensland, Child and Youth Mental Health Service, Brisbane, QLD, Australia
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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Reid C, Bennetts SK, Nicholson JM, Amir LH, Chamberlain C. Rural primary care workforce views on trauma-informed care for parents experiencing complex trauma: A descriptive study. Aust J Rural Health 2023; 31:98-113. [PMID: 36083418 PMCID: PMC10947110 DOI: 10.1111/ajr.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An important service system for rural parents experiencing complex trauma is primary health care. AIM To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma-informed care in rural primary health care. MATERIAL & METHODS This study used a descriptive, cross-sectional design. It involved an on-line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study-developed and included, a 21-item Knowledge, Attitudes and Practices tool, a 16-item Barriers and Enablers to Trauma-Informed Care Implementation tool, and three open-ended questions. RESULTS The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma-informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self-rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic-specific services). Open-ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths-based and outcome-focused approaches. DISCUSSION & CONCLUSION Primary health care is an important driver of population health and well-being and critical in rural contexts. Our findings suggest this sector needs a rural trauma-informed care implementation strategy to address structural barriers. This also requires policy and system development. Long-term investment in the rural workforce and primary care service settings is essential to integrate trauma-informed care.
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Affiliation(s)
- Carol Reid
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Shannon K. Bennetts
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- Intergenerational Health Group, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Jan M. Nicholson
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Lisa H. Amir
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social EquityMurdoch UniversityPerthWestern AustraliaAustralia
- Centre for Health EquityThe University of MelbourneMelbourneVictoriaAustralia
- The Lowitja InstituteMelbourneVictoriaAustralia
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Zordan R, Lethborg C, Forster J, Mason T, Walker V, McBrearty K, Torcasio C. Development, implementation, and evaluation of a trauma-informed simulation-based training program for graduate nurses: A single arm feasibility and pilot study. NURSE EDUCATION TODAY 2022; 117:105460. [PMID: 35878452 DOI: 10.1016/j.nedt.2022.105460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/30/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The chance of hospital staff encountering a patient with a trauma history is high. The way health services are offered and carried out are important when engaging with people who have experienced trauma. Implementing training in trauma-informed care (TIC) is part of a cultural change of benefit to both patients and staff. Simulation-based training is a well-accepted method to reduce staff fear and anxiety when working with individuals in distress and to address issues relating to bias and stigma. OBJECTIVES To provide simulation-based TIC training to graduate nurses. DESIGN A three-phase process was undertaken to i) create the intervention, ii) determine feasibility, and iii) evaluate the developed training. SETTING A 600-bed inner-city tertiary hospital in Melbourne, Victoria. PARTICIPANTS Graduate nurses undertaking their first year of employment (n = 23). METHODS The content of the training was created using evidence derived from a literature review, a scoping study of available resources, and expert consensus. A pre/post-test within-groups design to assess the safety, acceptability, and effectiveness of the training was undertaken. RESULTS The Trauma Informed-Simulation Based Training (TI-SBT) aims to increase TIC knowledge and promote TIC behaviours. It is delivered face-to-face over one day and encompasses an education component followed by three immersive patient simulations using professional actors. Analysis found significant improvement in TIC knowledge (p ≤ 0.001, 95% CI = -3.53, -0.47) and behaviours (p = 0.013, 95% CI = -8.88, -5.03). No significant differences were found in measures of anxiety and confidence. Satisfaction with all aspects of the training was high. Qualitatively, participants provided concrete examples of changes to their practice to facilitate TIC. CONCLUSIONS The developed and novel TI-SBT is a feasible (safe, acceptable, and effective) way of introducing TIC to graduate nurses. These findings provide strong evidence to support a more rigorous evaluation of the training by randomised controlled trial. The TI-SBT has the capacity to not only improve patient care but the experience of hospital staff.
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Affiliation(s)
- Rachel Zordan
- St Vincent's Hospital, Melbourne, Education and Learning, Victoria Parade, Fitzroy, Victoria 3065, Australia; University of Melbourne, Medicine, Dentistry and Health Sciences, Australia.
| | - Carolyn Lethborg
- St Vincent's Hospital, Melbourne, Department of Social Work, Victoria Parade, Fitzroy, Victoria 3065, Australia; University of Tasmania, Centre for Rural Health, Australia.
| | - John Forster
- St Vincent's Hospital, Melbourne, Consultation and Liaison Psychiatry, Victoria Parade, Fitzroy, Victoria 3065, Australia.
| | - Toni Mason
- St Vincent's Hospital, Melbourne, Aboriginal Health Unit, Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Virginia Walker
- St Vincent's Hospital, Melbourne, Education and Learning, Victoria Parade, Fitzroy, Victoria 3065, Australia.
| | - Katherine McBrearty
- St Vincent's Hospital, Melbourne, Education and Learning, Victoria Parade, Fitzroy, Victoria 3065, Australia.
| | - Clarissa Torcasio
- St Vincent's Hospital, Melbourne, Education and Learning, Victoria Parade, Fitzroy, Victoria 3065, Australia.
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Baguso GN, Aguilar K, Sicro S, Mañacop M, Quintana J, Wilson EC. "Lost trust in the system": system barriers to publicly available mental health and substance use services for transgender women in San Francisco. BMC Health Serv Res 2022; 22:930. [PMID: 35854359 PMCID: PMC9295874 DOI: 10.1186/s12913-022-08315-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little is known about the barriers to mental health and substance use services for trans women living with HIV. We conducted a qualitative study with trans women living with HIV and providers to explore barriers to mental health and substance use services in San Francisco. METHODS We conducted focus group discussions and key informant interviews with a total of 15 medical, mental health, substance use, and social service providers and trans women living with HIV. We identified, analyzed, and reported themes using thematic analysis and derived themes directly from the data. RESULTS Our study participants identified two main themes and three subthemes. One main theme is that trans women and providers have lost trust in the system due to (a) lack of a linkage system between referrals and services, (b) structural barriers such as service location, language capacity, clinic hours, and (c) constant changes in services available. Another main theme is anti-trans and mental health stigma. CONCLUSIONS Interventions to coordinate linkage from medical to mental health and substance use (MHSU) services are urgently needed to facilitate the utilization of MHSU services. Other interventions to improve quality monitoring and system improvement, and to address multiple stigmas broadly in society are needed to improve unmet MHSU service needs among trans women living with HIV in San Francisco.
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Affiliation(s)
- Glenda N Baguso
- San Francisco Department of Public Health, San Francisco, USA.
- University of California San Francisco, UCSF, San Francisco, USA.
| | - Karen Aguilar
- San Francisco Department of Public Health, San Francisco, USA
| | - Sofia Sicro
- San Francisco Department of Public Health, San Francisco, USA
| | | | - Jerry Quintana
- San Francisco Department of Public Health, San Francisco, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, USA
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Lovell RC, Greenfield D, Johnson G, Eljiz K, Amanatidis S. Optimising outcomes for complex trauma survivors: assessing the motivators, barriers and enablers for implementing trauma informed practice within a multidisciplinary health setting. BMC Health Serv Res 2022; 22:434. [PMID: 35366859 PMCID: PMC8975732 DOI: 10.1186/s12913-022-07812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Complex trauma is a significant public health issue with detrimental health, interpersonal and psychological impacts, which can impede client recovery and result in multiple representations. 'Trauma Informed Practice' (TIP) is an evidence-based model which ensures safe and effective services for clients and staff. This study examines health professional's use of TIP, and the motivators, enablers and barriers to implementation in a multidisciplinary setting. METHODS A mixed methods study with 24 front-line clinicians and managers within a community health setting in Australia. A purpose designed, expert validated TIP checklist was completed, followed by semi-structured focus groups. Survey data was reported using descriptive statistics. Focus group data was digitally recorded, transcribed and thematically analysed. RESULTS Ten key factors were identified motivating, restricting or enabling TIP implementation. Seven were organisational factors including supportive and informed management, flexibility of service models, levels of service demands, resource availability, education opportunities, good client outcomes, and reporting requirements. Philosophical approach, team orientation, and vicarious trauma/stress management were three individual professional factors. Critically, alignment in two ways was necessary for successful implementation, that is: in knowledge and understanding across organisational role levels - clinician, manager and executive; and, in professional philosophy and team orientation of individual clinicians. CONCLUSION Providing TIP is essential for ensuring optimum client outcomes for trauma survivors and for maintaining workforce wellbeing. Although the increasing uptake to TIP is evident within the health setting, further attention is required to address the tension between service models focused on efficiently servicing whole populations and those attuned to effectively meeting the needs of high risk groups. A complex strategy to unite therapeutic and managerial goals is necessary if client, professional and organisational needs are to be effectively met.
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Affiliation(s)
- Renee C. Lovell
- Community Health Services, Sydney Local Health District, Sydney, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
| | - David Greenfield
- South Western Sydney Clinical School, The Simpson Centre for Health Services Research, UNSW Medicine, Sydney, Australia
| | - George Johnson
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
| | - Kathy Eljiz
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Sydney, Australia
| | - Sue Amanatidis
- Community Health Services, Sydney Local Health District, Sydney, Australia
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Varghese L, Emerson A. Trauma-informed care in the primary care setting: An evolutionary analysis. J Am Assoc Nurse Pract 2022; 34:465-473. [PMID: 34618717 DOI: 10.1097/jxx.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The high prevalence of trauma in the United States and its adverse effects on patient wellbeing has led to the adoption of trauma-informed care (TIC) in some specialized health care services. However, the implementation of TIC in primary care, where many nurse practitioners (NPs) provide services, is relatively uncommon and the concept not well-defined. Trauma includes physically and emotionally devastating experiences that have a lasting impact on individuals. OBJECTIVES To synthesize a definition of TIC in the primary care setting for NPs to guide future practice and research. DATA SOURCES We searched CINAHL, PsycINFO, Social Work Abstracts, Scopus, and PubMed for articles published 2010-2020 that described the use of TIC in primary care. Rodgers' evolutionary method and the framework method of analysis were used to identify attributes and contexts of TIC in primary care and synthesize a definition. Thirty-one articles from nursing, medical, and social work sources were selected, including data-based studies ( n = 15) and thought pieces ( n = 16). Attributes, antecedents, and consequences were combined to provide a definition grounded in the literature. CONCLUSION Trauma-informed care in primary care is a strengths-based approach in which trained, trauma-aware health care professionals provide services that prioritize safety, empowerment, and support, resulting in improved patient satisfaction and health care engagement in individuals who have experienced trauma. IMPLICATIONS FOR PRACTICE A clearly defined concept provides a starting point for developing strategies to help NPs recognize and respond more effectively to the needs of patients who have experienced trauma.
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Affiliation(s)
- Latha Varghese
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
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Ramadurai D, Knoeckel J, Stace RJ, Stella S. Feasibility and Impact of Trauma-Informed Care Training in Internal Medicine Residency: A Pilot Study. Cureus 2022; 14:e22368. [PMID: 35321063 PMCID: PMC8934586 DOI: 10.7759/cureus.22368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: Mounting evidence indicates that early life trauma is highly prevalent and associated with adverse health outcomes later in life. However, primary care providers report lacking the training to effectively address trauma encountered in daily practice. There is a paucity of research describing the implementation and evaluation of trauma-informed care (TIC) curricula within Graduate Medical Education. Methods: We piloted a three-hour TIC workshop facilitated by a community-based psychologist expert to assess the feasibility and impact of TIC training on Internal Medicine (IM) residents’ knowledge, attitudes and skills related to TIC. Participants were a subset of IM residents in a health-equity-focused curricular pathway in the University of Colorado IM Residency. Residents completed anonymous surveys one week before and after the workshop, and a final survey 10 weeks later. Residents who did not participate in the workshop completed a similar baseline survey (control group). Data were analyzed using matched pair T-tests. Results: Fourteen of 20 residents (70%) who participated in the pilot workshop completed the initial survey. Of these, 10 (71%) completed the first post-workshop survey, and seven (50%) completed the final survey. We observed significant improvements in residents’ self-reported knowledge, attitudes and skills related to TIC. The majority of residents in the control group reported a desire for TIC training. Conclusions: TIC is an important curricular gap in IM training. A single, brief TIC workshop was feasible and was associated with improved self-reported knowledge, attitudes and skills among IM residents.
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Gannon BS, Gregg A, Wang H, Marshall ME, Yerby LG, Jenkins C, Parton JM. A medical home for children in foster care reduces expenditures. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2039146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Brian S. Gannon
- College of Community Health Sciences, Pediatrics, The University of Alabama, Tuscaloosa, AL, USA
| | - Abbey Gregg
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Hui Wang
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Lea G. Yerby
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Caroline Jenkins
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
| | - Jason M. Parton
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
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Johnson KA, Hunt T, Puglisi LB, Maeng D, Epa-Llop A, Elumn JE, Nguyen A, Leung A, Chen R, Shah Z, Wang J, Johnson R, Chapman BP, Gilbert L, El-Bassel N, Morse DS. Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration. Front Psychiatry 2022; 13:867445. [PMID: 35693964 PMCID: PMC9186377 DOI: 10.3389/fpsyt.2022.867445] [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: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND U.S. women recently released from incarceration experience significantly higher rates of trauma and exacerbation of mental health conditions, and the period following release has been identified as a window of heightened risk for mental health distress and human immunodeficiency virus (HIV), sexually transmitted infections (STI) and hepatitis C (HCV) transmissions. Despite these vulnerabilities, and an urgent need for supports, optimal engagement strategies remain unclear. WORTH Transitions is a program made up of two evidence-based interventions focused on improving the health of women returning to the community from incarceration with substance use disorders. Combining the two was designed to reduce HIV/STIs/HCV risks and increase overall health treatment engagement using a community health worker led intervention. METHODS We examined associations between trauma, mental health symptomology, and HIV/STI/HCV outcomes among women who engaged in the WORTH Transitions intervention (N = 206) Specifically, bivariate and longitudinal multivariate models were created to examine associations between trauma and mental health distress (defined as depressive and PTSD symptoms), on (1) types of engagement in HIV/STIs/HCV prevention and behavioral health services; and (2) HIV/STIs/HCV risk outcomes. The women who engaged in the intervention were 18 years and older and some were White, Black and other racial or ethnic minority. RESULTS PTSD symptomology and being a Black or indigenous woman of color was significantly (p = 0.014) associated with individual or group session engagement. Neither trauma nor PTSD symptoms were associated with higher HIV/STIs/HCV risks. Instead, relative to those who did not engage in HIV/STI/HCV risky behaviors, PTSD symptomology (p = 0.040) was associated with more than 3-fold increase in the probability of being lost to follow up (relative risk ratio = 3.722). CONCLUSION Given the impact of PTSD-related symptoms on driving both engagement in HIV/STIs/HCV prevention services and intervention attrition among women leaving incarceration, physical and behavioral health interventions must be both overtly trauma- and mental health-informed. As was the case with WORTH Transitions, physical and behavioral health services for this population must include intentional and active support of the forms of treatment participants endorse to ensure maximal engagement.
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Affiliation(s)
- Karen A Johnson
- University of Alabama School of Social Work, Tuscaloosa, AL, United States
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Lisa B Puglisi
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Daniel Maeng
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Amali Epa-Llop
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, United States
| | - Johanna E Elumn
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Antoinette Nguyen
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Ashley Leung
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Rachel Chen
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Zainab Shah
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Jiayi Wang
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Rachel Johnson
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Diane S Morse
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States.,Department of Medicine, University of Rochester School of Medicine, Rochester, NY, United States
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15
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Guest H. A concept analysis of trauma-informed care. Nurs Forum 2021; 56:1000-1007. [PMID: 34216387 DOI: 10.1111/nuf.12626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
AIM This concept analysis aims to provide an in-depth analysis of the concept of trauma-informed care and explore the use of this concept in nursing, using Walker and Avant's method. BACKGROUND Trauma-informed care is a priority for nurses caring for patients with previous trauma. Many forms of trauma exist. Various types of trauma may not be apparent without appropriate assessment. Therefore, nurses must approach all patients with the components of trauma-informed care. DESIGN Concept analysis. DATA SOURCE PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO databases were searched for articles in English. The final sample consisted of 23 documents published from 2015 to 2020. REVIEW METHODS Concept analyzed using Walker and Avant's eight-step method. RESULTS Four defining attributes of trauma-informed care were identified as recognition, knowledge, concern, and respect. Definitions, the use of the concept of trauma-informed care, antecedents, consequences, and empirical referents are described. Model, borderline, and contrary cases are discussed. CONCLUSION Many forms of trauma exist. Various types of trauma may not be apparent without appropriate assessment. Therefore, establishing an operational definition of trauma-informed care has implications and significance in victim identification and the provision of trauma-informed care, advocacy, and nursing and interdisciplinary research.
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Affiliation(s)
- Heather Guest
- College of Nursing and Health Sciences, University of Texas, Tyler, Texas, USA.,Nurse Faculty, Traditional Undergraduate Program, Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA
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'Missingness' in health care: Associations between hospital utilization and missed appointments in general practice. A retrospective cohort study. PLoS One 2021; 16:e0253163. [PMID: 34166424 PMCID: PMC8224850 DOI: 10.1371/journal.pone.0253163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/31/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Are multiple missed appointments in general practice associated with increased use of hospital services and missingness from hospital care? This novel study explores this in a population representative sample for the first time. Design, setting, participants A large, retrospective cohort (n = 824,374) of patient records from a nationally representative sample of GP practices, Scotland, 2013–2016. Requested data were extracted by a Trusted Third Party for the NHS, anonymised and linked to a unique patient ID, in the NHS Safehaven for analysis using established NHS Scotland linkage. We calculated the per-patient number of GP missed appointments from individual appointments and investigated the likelihood of hospital appointment or admission outcomes using a negative binomial model offset by number of GP appointments made. These models also controlled for age, sex, Scottish Index of Multiple Deprivation (SIMD) and number of long- term conditions (LTCs). Main outcome measures Hospital attendance: Outpatient clinic attendances; hospital admissions; Emergency Department (ED) attendances. Hospital missingness: ‘Did not attend’ (DNAs) outpatient clinic appointments, ‘irregular discharges’ from admissions, and ‘left before care completed’ ED care episodes. Results Attendance: Patients in the high missed GP appointment (HMA) category were higher users of outpatient services (rate ratio (RR) 1.90, 95% confidence intervals (CI) 1.88–1.93) compared to those who missed none (NMA) with a much higher attendance risk at mental health services (RR 4.56, 95% CI 4.31–4.83). HMA patients were more likely to be admitted to hospital; general admissions (RR 1.67, 95% CI 1.65–1.68), maternity (RR 1.24, 95% CI 1.20–1.28) and mental health (RR 1.23, 95% CI 1.15–1.31), compared to NMA patients. Missing GP appointments was not associated with ED attendance; (RR 1.00, CI 0.99–1.01). Missingness: HMA patients were at greater risk of missing outpatient appointments (RR 1.62, 95% CI 1.60–1.64) than NMA patients; with a much higher risk of non-attendance at mental health services (RR 7.83, 95% CI 7.35–8.35). Patients were more likely to leave hospital before their care plan was completed-taking ‘irregular discharges’ (RR 4.56, 95% CI 4.31–4.81). HMA patients were no more at risk of leaving emergency departments ‘without care being completed’ (RR1.02, 95 CI 0.95–1.09). Conclusions Patients who miss high numbers of GP appointments are higher users of outpatient and inpatient hospital care but not of emergency departments, signalling high treatment burden. The pattern of ‘missingness’ is consistent from primary care to hospital care: patients who have patterns of missing GP appointments have patterns of missing many outpatient appointments and are more likely to experience ‘irregular discharge’ from in-patient care. Missingness from outpatient mental health services is very high. Policymakers, health service planners and clinicians should consider the role and contribution of ‘missingness’ in health care to improving patient safety and care.
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Winetsky D, Fox A, Nijhawan A, Rich JD. Treating Opioid Use Disorder and Related Infectious Diseases in the Criminal Justice System. Infect Dis Clin North Am 2021; 34:585-603. [PMID: 32782103 DOI: 10.1016/j.idc.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides an overview of the diagnosis and management of opioid use disorder and its infectious complications among populations with criminal justice involvement. Opioid use disorder and chronic infections such as human immunodeficiency virus and hepatitis C virus are highly prevalent among incarcerated individuals and some of the unique features of correctional facilities present challenges for their appropriate medical management. We outline evidence-based strategies for integrated, patient-centered treatment during incarceration and the potentially hazardous transition back to the community upon release.
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Affiliation(s)
- Daniel Winetsky
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 8 W-876, New York, NY 10032, USA; HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Fox
- Department of Internal Medicine, Montefiore Medical Center, 305 East 161th Street, Room 4, Bronx, NY, USA
| | - Ank Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Josiah D Rich
- Department of Medicine, Brown University, 164 Summit Avenue, Providence, RI 02906, USA; Department of Epidemiology, Brown University, 164 Summit Avenue, Providence, RI 02906, USA
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Moreland A, Ressler KJ. A Perspective for Understanding Trauma and the Criminal Juvenile Justice System: Using a Trauma-Informed Lens for Meaningful and Sustained Change. Harv Rev Psychiatry 2021; 29:216-224. [PMID: 33660626 DOI: 10.1097/hrp.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma exposure and posttraumatic stress disorder are common and are associated with a wide range of negative psychiatric and physical outcomes. Furthermore, a large percentage of justice-involved youth have high rates of trauma exposure and trauma-related symptoms. Addressing these issues would improve outcomes at the level of the justice system overall and in the lives of justice-involved youth. Nonetheless, awareness, education, and implementation of trauma-informed approaches in the criminal juvenile justice system are lacking. This article explores current literature that operationalizes trauma-informed practices and approaches in the criminal and juvenile justice systems. Unfortunately, there is no shared understanding or definition of trauma and no predictability in trauma-informed practices and approaches in the criminal juvenile justice system. Despite the presence of written policies, the application and execution of such policies are limited and inconsistent throughout the system. These limitations contribute to ongoing, systemic institutional racism, lack of mental health or substance abuse treatment, limited diversion options, and unnecessary jail and prison sentences, which together amplify financial and humanitarian costs. We argue that in order for the criminal juvenile justice system to become trauma-informed, it should (1) meet basic needs of clients, (2) check and change narratives, and check underlying assumptions, (3) focus on skill building/habilitation, (4) move away from punishment and toward rehabilitation and humanitarian approaches, and (5) heal and support members that work in and for the system. We conclude that there is a need to improve processes for education, training, and coaching in, and consistent application of, trauma-informed practices and approaches within the criminal and juvenile justice systems.
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Affiliation(s)
- Alisha Moreland
- From the Department of Psychiatry, Oregon Health Sciences University (Dr. Moreland); Harvard Medical School (Dr. Ressler); McLean Hospital, Belmont, MA (Dr. Ressler)
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Puing AG, Li X, Rich J, Nijhawan AE. Emergency department utilization by people living with HIV released from jail in the US South. HEALTH & JUSTICE 2020; 8:16. [PMID: 32594269 PMCID: PMC7321540 DOI: 10.1186/s40352-020-00118-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Incarceration is disruptive to HIV care, often resulting in poor retention in care for people living with HIV (PLWH) after jail release. This gap in HIV care might result in potentially preventable emergency department (ED) utilization. We analyzed demographic, incarceration, socioeconomic and clinical data for PLWH released from the Dallas County Jail to the community (1450 incarcerations, 1155 unique individuals) between January 2011 and November 2013. RESULTS The study population consisted of predominantly men (77%), with a mean age of 39 years, 67% were black and 14% were Hispanic; half of the releasees visited the ED at least once during the first-year post-jail. In adjusted analyses, female gender, family awareness of HIV status, serious mental illness, and late engagement to HIV care were significantly associated with higher ED utilization. Compared to the general Dallas population, PLWH released from jail had a 5-fold higher proportion of ED visits classified as related to substance use or mental health. CONCLUSIONS Further efforts are needed to improve the transition from incarceration to community-based HIV care, substance use disorder treatment and mental health services, and to directly address re-engagement in HIV care for out-of-care PLWH who visit the ED.
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Affiliation(s)
| | - Xilong Li
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Josiah Rich
- Department of Internal Medicine and Epidemiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ank E Nijhawan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9169, USA.
- Parkland Health and Hospital Systems, Dallas, TX, USA.
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McLeod KE, Korchinski M, Young P, Milkovich T, Hemingway C, DeGroot M, Condello LL, Fels L, Buxton JA, Janssen PA, Granger-Brown A, Ramsden V, Buchanan M, Martin RE. Supporting women leaving prison through peer health mentoring: a participatory health research study. CMAJ Open 2020; 8:E1-E8. [PMID: 32071141 PMCID: PMC7028165 DOI: 10.9778/cmajo.20190106] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND During the transition between prison and community, people are at greatly increased risk for adverse health outcomes. This study describes a peer health mentoring program that supports women in the first 3 days after their release from a provincial correctional facility in British Columbia. METHODS We used a participatory health research framework to develop multimethod processes to describe the Unlocking the Gates Peer Health Mentoring Program. Mentors are women with incarceration experience. Between 2013 and 2018, women released from Alouette Correctional Centre for Women were invited to access the program. All program clients were invited to participate in the surveys and interviews. We analyzed survey and interview data using descriptive analysis for quantitative data and content analysis for qualitative data. RESULTS There were 346 program contacts from 340 women over the study period. For every contact, a telephone interview was conducted. Among the 346 contacts, 173 women met their mentor, of whom 172 (99.4%) completed the intake and consent forms. A total of 105 women (61.0%) completed a program activity feedback survey at the end of the mentoring period. Women identified a range of needed supports during the transition from prison to community, including access to clothing, social assistance, housing and health care. Participants described a mix of emotions surrounding release, including excitement, anxiety, hope, and a wish for understanding and support. Within 3 days of release, 49 participants (46.7%) had accessed a family physician, and 89 (84.8%) had accessed at least 1 community resource. Ninety-eight participants (93.3%) reported that their mentor assisted them in accessing community resources. INTERPRETATION Peer health mentoring provides valuable, multifaceted support in helping women to navigate health and social services and to meet their basic needs. Strengthening health supports during the transition from prison to community is critical to promoting the health and well-being of women leaving prison.
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Affiliation(s)
- Katherine E McLeod
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Mo Korchinski
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Pamela Young
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Tammy Milkovich
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Christine Hemingway
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Michelle DeGroot
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Lara-Lisa Condello
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Lynn Fels
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Jane A Buxton
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Patricia A Janssen
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Alison Granger-Brown
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Vivian Ramsden
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Marla Buchanan
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
| | - Ruth Elwood Martin
- School of Population and Public Health (McLeod, Korchinski, Young, Milkovich, Hemingway, Buxton, Janssen, Elwood Martin) and Collaborating Centre for Prison Health and Education (McLeod, Korchinski, Young, Milkovich, Hemingway, Condello, Fels Buxton, Granger-Brown Ramsden, Elwood Martin), University of British Columbia, Vancouver, BC; First Nations Health Authority (DeGroot), BC; Justice Studies (Condello), Nicola Valley Institute of Technology, Burnaby, BC; Arts Education (Fels), Simon Fraser University; BC Centre for Disease Control (Buxton); Child and Family Research Institute (Janssen), Vancouver, BC; Fielding Graduate University (Granger-Brown), Santa Barbara, Calif.; Department of Academic Family Medicine (Ramsden), University of Saskatchewan, Saskatoon, Sask.; Counselling Psychology Program (Buchanan), Education and Counselling Psychology, Faculty of Education, and Centre for Group Counselling and Trauma (Buchanan), University of British Columbia, Vancouver, BC
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21
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Saadi A, Cheffers ML, Taira B, Trotzky-Sirr R, Parmar P, Samra S, Morrison JL, Shah S, Schneberk T. Building Immigration-Informed, Cross-Sector Coalitions: Findings from the Los Angeles County Health Equity for Immigrants Summit. Health Equity 2019; 3:431-435. [PMID: 31448353 PMCID: PMC6707036 DOI: 10.1089/heq.2019.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In December 2017, the Los Angeles County Office of Immigrant Affairs and Board of Supervisors, alongside local health care and legal providers, convened the Health Equity for Immigrants and Families Summit to advance a vision for immigrant health. We describe the four critical concepts identified by stakeholders to address the varied needs of immigrants in an increasingly anti-immigrant political environment: (1) Recognizing immigration status as a modifiable social determinant of health; (2) Adopting the concept of “Immigration-Informed Care” within health care institutions; (3) Establishing immigration-focused medical-legal partnerships; and (4) Building coordinated systems based on knowledge of local stakeholders, policies, and funding mechanisms.
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Affiliation(s)
- Altaf Saadi
- National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California
| | - Mary L Cheffers
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Breena Taira
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - Rebecca Trotzky-Sirr
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Parveen Parmar
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Shamsher Samra
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Janina L Morrison
- Primary Care Internal Medicine, The Wellness Center, LAC+USC Medical Center, Los Angeles, California
| | - Sural Shah
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California.,Division of Internal Medicine-Pediatrics, University of California Los Angeles, Los Angeles, California
| | - Todd Schneberk
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
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