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Gilroy H, Kobina A, Bhaloo T. Trauma-Informed Development and Education: Turning the TIDE on Transition to Practice. J Contin Educ Nurs 2024; 55:501-508. [PMID: 39226264 DOI: 10.3928/00220124-20240829-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
BACKGROUND Transition to practice (TTP), the first year of a nurse's career postlicensure, is widely recognized as a stressful time. Previous trauma exposure and additional workplace trauma exacerbate the stress of this transitional period. Trauma-informed environments are associated with clinician wellness and engagement. Because workforce training for leaders is a necessary precursor to developing supportive environments, we studied changes in trauma knowledge, awareness, and attitudes among TTP leaders. METHOD Our mixed methods study included administering the Attitudes Related to Trauma-Informed Care Scale (ARTIC) pre- and post-training, with additional open-ended questions about the impact of training. RESULTS Paired data from participants showed overall mean improvement that was statistically significant, with a large effect size. Statistically significant knowledge gains related to trauma recognition and safety, how to respond to trauma, and how to promote healthy behaviors. CONCLUSION Our study underscores the importance of trauma education, which not only increased awareness but also prompted nurse leaders to reflect on enhanced support for early nursing professionals. [J Contin Educ Nurs. 2024;55(10):501-508.].
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Beehag N, Dryer R, McGrath A, Krägeloh C, Medvedev O. Trauma-informed care beliefs scale-comprehensive for child welfare carers using Rasch analysis. CHILD ABUSE & NEGLECT 2024; 155:106966. [PMID: 39153342 DOI: 10.1016/j.chiabu.2024.106966] [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: 05/07/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The literature on trauma-informed care practices (TIC) indicates that this framework is beneficial for young people, carers, and staff. However, a significant gap in the literature and practice is the absence of psychometrically sound scales to measure carer adherence to TIC principles. Emerging evidence suggests that TIC practices shift carer attitudes and beliefs, which mediate positive outcomes for both carers and young people. OBJECTIVE To develop a theoretically comprehensive and psychometrically sound measure of carer TIC beliefs using Rasch methodology. PARTICIPANTS AND SETTING Active carers (N = 719, M = 43 years, SD = 10.7 years) from online support groups in Australia, Canada, the United States of America, the United Kingdom, and the Republic of Ireland completed the questionnaire online. METHODS Based on previous research (e.g., limitations of the Trauma-Informed Belief Scale-Brief [TIBS-B]; Beehag, Dryer, et al., 2023a) and a scoping review of the TIC literature (Beehag, 2023), 61 candidate items were created that covered the three main characteristics of carer-related TIC theory (i.e., beliefs on TIC strategies to manage trauma symptoms, beliefs on the impact of adverse childhood experiences (ACE), and beliefs on the importance of self-care/reflection). The resulting data was subjected to Rasch analyses. RESULTS Following analyses and minor modifications, a 35-item version of the questionnaire was confirmed, which fitted the Rasch model and demonstrated unidimensionality, reasonable targeting, and sound internal consistency reliability (Person Separation Index = 0.81). CONCLUSIONS The TIBS-C is a psychometrically sound measure of child welfare carer TIC beliefs. Future studies are needed to provide further evidence of its validity (e.g., predictive validity), reliability (e.g., test-retest reliability) and clinical utility.
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Affiliation(s)
- Nathan Beehag
- Charles Sturt University, School of Psychology, Bathurst, Australia.
| | - Rachel Dryer
- Australian Catholic University, School of Psychology, Sydney, Australia.
| | - Andrew McGrath
- Charles Sturt University, School of Psychology, Bathurst, Australia.
| | - Chris Krägeloh
- Auckland University of Technology, School of Psychology and Neuroscience, Auckland, New Zealand.
| | - Oleg Medvedev
- The University of Waikato, School of Psychology, Waikato, New Zealand.
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Stewart SL, Cloutier S, King G, Withers A. Evaluating a Trauma-Informed Care Training Program for Mental Health Clinicians. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:981-998. [PMID: 39309338 PMCID: PMC11413404 DOI: 10.1007/s40653-024-00639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 09/25/2024]
Abstract
The aim of this study was to evaluate the interRAI Trauma-Informed Care (TIC) training program based on evidence-informed Collaborative Action Plans. Focus groups and the Attitude Related Trauma-Informed Care (ARTIC) questionnaire addressed clinicians' and mental health professionals' attitudes toward the application of TIC with their child and youth clients. An explanatory sequential design was conducted. In total, 105 clinicians and mental health professionals who participated in a 4-hour, in-person or virtual TIC training, two comprehensive seminars, and 28 trauma-informed training web-based modules completed the ARTIC questionnaire. Researchers conducted seven focus groups with clinicians/participants (N = 23) to discuss the views and effectiveness of the interRAI TIC educational training modules. To quantitatively measure the change of attitudes towards TIC, descriptive statistical analysis was completed using the means and standard deviation of the ARTIC scores at the initial time point, the follow-up time point, and the difference between scores at both time points. Paired sample t-tests were conducted on both the overall score and each of the subscales in each of the three samples (total sample, online subsample, and hybrid subsample). A thematic analysis was conducted to generate qualitative findings from the focus groups. Findings from the quantitative and qualitative analyses suggest that the interRAI TIC training provided clinicians with an improved sense of knowledge and ability to apply trauma-informed care planning with their clients.
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Affiliation(s)
- Shannon L. Stewart
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
| | - Sarah Cloutier
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
| | - Gabrielle King
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
| | - Abigail Withers
- Faculty of Education, University of Western, 1137 Western Rd, London, ON N6G 1G7 Canada
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Keesler JM, Wu W, Presnell J, Fukui S. Trauma-informed climate scale-10 and attitudes related to trauma-informed care-10: An examination of scale psychometrics using data from disability service providers. Disabil Health J 2024; 17:101583. [PMID: 38278724 DOI: 10.1016/j.dhjo.2024.101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Assessment is fundamental to the implementation of trauma-informed care. As trauma-informed care advances among organizations supporting people with intellectual and developmental disabilities (IDD), it is critical that they have access to validated assessment tools. OBJECTIVE This is the first study to examine the psychometric properties of two brief measures associated with trauma-informed care, Trauma-Informed Climate Scale (TICS-10) and Attitudes Related to Trauma-Informed Care (ARTIC-10), using data from the IDD service industry. METHODS We employed structural equation modeling to examine the factor structure, reliability of TICS-10 and ARTIC-10, and construct validity with the ProQOL using secondary data from 374 service providers. RESULTS We confirmed the factorial validity of TICS-10 and ARTIC-10 with single factor solutions; however, modifications were necessary to achieve adequate model fit. CONCLUSIONS The current study provides initial evidence of the validity and reliability of TICS-10 and ARTIC-10 when used within organizations supporting people with IDD. Recommendations for subsequent improvements and future research of the scales are provided.
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Affiliation(s)
- John M Keesler
- Indiana University Bloomington, School of Social Work, 2631 East Discovery Parkway, C3155, Bloomington, IN, 47401, USA.
| | - Wei Wu
- Indiana University Purdue University at Indianapolis, School of Science, 402N. Blackford Street, Indianapolis, IN, 46202, USA
| | - Jade Presnell
- Indiana University Purdue University at Indianapolis, School of Social Work, 902 W. New York Street, Indianapolis, IN, 46202, USA
| | - Sadaaki Fukui
- Indiana University Purdue University at Indianapolis, School of Social Work, 902 W. New York Street, Indianapolis, IN, 46202, USA
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Browne AJ, Varcoe C, Ford-Gilboe M, Wathen CN, Wilson E, Bungay V, Perrin N. Using a health equity lens to measure patient experiences of care in diverse health care settings. PLoS One 2024; 19:e0297721. [PMID: 38843218 PMCID: PMC11156339 DOI: 10.1371/journal.pone.0297721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/12/2024] [Indexed: 06/09/2024] Open
Abstract
People who are structurally disadvantaged and marginalized often report poor health care experiences, such as inequitable treatment, due to intersecting forms of stigma and discrimination. There are many measures of patient experiences of care, however, few are designed to measure equity-oriented health care. In alignment with ongoing calls to integrate actions in support of health equity, we report on the development and testing of patient-reported experience measures that explicitly use a health equity and intersectional lens. Our analysis focuses on two different scales: the Equity-Oriented Health Care Scale-Ongoing, which was evaluated in primary health care settings where patients have an ongoing relationship with providers over time, and the Equity-Oriented Health Care Scale-Episodic, which was tested in an emergency department where care is provided on an episodic basis. Item Response Theory was used to develop and refine the scales. The psychometric properties of each scale were also evaluated. The Equity-Oriented Health Care Scale-Ongoing was first tested with a cohort of 567 patients. The Equity-Oriented Health Care Scale-Episodic was subsequently tested in an emergency department setting with 284 patients. Results of the Item Response Theory analysis for each scale yielded a brief index that captured the level of equity-oriented care when care is ongoing (12 items) or episodic (9 items). Both scales showed evidence of internal consistency and concurrent validity, based on a high correlation with quality of care. They are brief, easy-to-administer patient-reported experience measures that can support organizations to monitor quality of care. Their availability enhances the possibility of measuring equity-oriented health care in diverse contexts and can provide nuanced understandings of quality of care through an intersectional and equity lens.
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Affiliation(s)
- Annette J. Browne
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, BC, Canada
| | - Colleen Varcoe
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, BC, Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Vicky Bungay
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, BC, Canada
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
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Keyes TS, Patin K, Jaggers JW. A Trauma-Informed Workshop Targeting the Attitudes of Mental Health Providers in a Rural, Racially Diverse Community Bordering Tribal lands. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:187-196. [PMID: 38938933 PMCID: PMC11199420 DOI: 10.1007/s40653-023-00584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 06/29/2024]
Abstract
Purpose This study examines a three-day trauma informed workshop with 32 mental health providers in a rural community that borders an American Indian reservation to determine if there is an association with positive trauma-informed care (TIC) attitudes. Methods Thirty-two workshop participants were invited to take the Attitudes Related to Trauma Informed Care (ARTIC-45) scale pre-workshop, post-, and six months- after the workshop. Results were analyzed at the group-level using t-tests and Wilcoxon signed-rank tests for subscales that were not normally distributed. Results Pre- to Post- (Time 1) findings reveal statistically significant positive changes in all ARTIC subscales. However, post-workshop to six months follow-up (Time 2) four subscales showed statistically significant decreases. This seems to be an indication that these trauma-informed attitudes, knowledge, and beliefs had gotten worse with time. There were three subscales without significant change. Conclusion The findings should be interpreted with caution but point to plausible implications related to the decline in trauma-informed attitudes such as, lack of ongoing training following the workshop, limitations in workforce and resources within the rural community, unaddressed implicit bias, and needing more organizational leadership buy-in and resources.
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Affiliation(s)
- Tasha Seneca Keyes
- Department of Social Work, ELB 632, California State University, San Marcos 333 S. Twin Oaks Valley Rd, San Marcos, CA 92096 USA
| | - Kara Patin
- College of Social Work, University of Utah, Salt Lake, UT USA
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Lembke EJ, Linderkamp F, Casale G. Trauma-sensitive school concepts for students with a refugee background: a review of international studies. Front Psychol 2024; 15:1321373. [PMID: 38756485 PMCID: PMC11098281 DOI: 10.3389/fpsyg.2024.1321373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/11/2024] [Indexed: 05/18/2024] Open
Abstract
Children and adolescents with a refugee background are at high risk for traumatization. Once they arrive in safe countries, schools are the institutions where teachers are responsible for caring for them sensitively and competently. Furthermore, schools are organized in learning groups consisting of multiple peers of the same age, which provides excellent opportunities for social learning and experiences of social support. In this respect, schools are the appropriate places where preventive concepts can be applied to students with a refugee background. This systematic review summarizes studies that examine or evaluate existing international concepts of trauma-sensitive schools for supporting traumatized students with a refugee background. Based on N = 41 selected articles, 17 relevant concepts of trauma-sensitive schools were identified. In 35.3% of the concepts, traumatized students with a refugee background are explicitly included in the target group of the concept, while 47.1% of the concepts refer to groups of students with trauma as a result of various adverse childhood experiences, which also occur more frequently within the population of refugee children and adolescents 17.6% of the concepts contain specific adaptations for pupils with a refugee background. The majority of these concepts were developed in the United States. Additional concepts can be reported for Australia, the United Kingdom, Turkey, and Cambodia. Based on available empirical data, no significant effectiveness regarding the researched concepts' effects on academic and other school-related data can be determined. Although some studies indicate positive effects concerning school-related target variables, most of the studies have only limited significance due to inadequate research designs and methodological deficiencies. Therefore, there is a great need for further development, careful implementation, and evaluation of trauma-sensitive concepts in schools, especially for the growing group of refugee students.
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Affiliation(s)
- Eva J. Lembke
- School of Education, Institute of Educational Research, University of Wuppertal, Wuppertal, Germany
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Choi K, Ayala L, Lierly R, Bustamante D, Cioppa-Fong B, Mead M, Mkroyan HJ, Morris E, Babajanyan I, Maryanov D. Implementing the NCTSN Trauma-Informed Organizational Assessment (TIOA) for Improving Trauma-Informed Care in Inpatient Child Psychiatry. J Am Psychiatr Nurses Assoc 2024; 30:722-732. [PMID: 37853611 PMCID: PMC11141099 DOI: 10.1177/10783903231171590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Children and adolescents receiving inpatient psychiatric services have disproportionately high levels of exposure to trauma and adversity. The National Child Traumatic Stress Network Trauma-Informed Organizational Assessment (TIOA) is a comprehensive tool intended to guide implementation of trauma-informed care, but it has not yet been applied in inpatient settings. AIMS The purpose of this quality improvement project was to describe trauma-informed care in inpatient child/adolescent psychiatry with the TIOA, examine relatedness among trauma-informed care domains, and explore barriers or facilitators to applying trauma-informed care. METHODS This quality improvement project used mixed methods. We conducted a web-based survey in Summer 2022 with staff members (clinical and administrative) at two inpatient child/adolescent psychiatric units in California to assess trauma-informed care practices with the TIOA (87 items). Qualitative follow-up interviews were offered to interested participants. A correlation matrix and cluster analyses were used to examine relationships among TIOA domains; qualitative data were analyzed thematically. RESULTS There were 69 survey respondents and seven qualitative interviews. TIOA domain scores ranged from a low of 2.3 to a high of 3.2, indicating that practices were occurring only "rarely" to "sometimes." There were two major themes identified from qualitive interviews: (a) barriers to trauma-informed care in an inpatient context that can be resource-constrained or coercive; and (b) discovering strategies to provide trauma-informed care despite structural barriers. CONCLUSION Organizational interventions targeting any domains of trauma-informed care are needed in inpatient settings given limited uptake of trauma-informed care.
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Affiliation(s)
- Kristen Choi
- Kristen Choi, PhD, RN, FAAN, University of California, Los Angeles, Los Angeles, CA, USA; Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Leilanie Ayala
- Leilanie Ayala, PMHNP-BC, Sutter Center for Psychiatry, Sacramento, CA, USA; University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca Lierly
- Rebecca Lierly, PhD, Sutter Center for Psychiatry, Sacramento, CA, USA
| | - Daniela Bustamante
- Daniela Bustamante, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Benjamin Cioppa-Fong
- Benjamin Cioppa-Fong, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Meredith Mead
- Meredith Mead, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Hagop J. Mkroyan
- Hagop J. Mkroyan, MSN, PMHNP-BC, Nutrix Care Partners, Los Angeles, CA, USA
| | - Elizabeth Morris
- Elizabeth Morris, PsyD, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Irina Babajanyan
- Irina Babajanyan, AMFT, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Daniel Maryanov
- Daniel Maryanov, MSN, RN, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
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Davis PA, Hubbard D, Gladdis T, Nitkin C, Hansen K, Keith-Chancy E, Godwin J, Staggs V, Babbar S, Hardy M, Ashbaugh J, Carter BS. Improving attitudes toward trauma-informed care in the neonatal intensive care unit through comprehensive multi-disciplinary education. J Perinatol 2024; 44:650-658. [PMID: 38383575 DOI: 10.1038/s41372-024-01897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study measured staff understanding and integration of trauma-informed care following comprehensive education. STUDY DESIGN This mixed method design used the validated Attitudes Related to Trauma-Informed Care (ARTIC) scale and open-ended survey questions via REDCap optional surveys. Trauma-informed care education was made available to staff members in a level IV NICU. Pre- and post-intervention ARTIC scores were compared and post-intervention REDCap surveys were analyzed. RESULT There were 245 multi-disciplinary NICU team members who completed the ARTIC survey before and/or after the educational intervention; and 764 REDCap surveys were completed throughout the study time. ARTIC scores increased from pre- to post-training both for participants with data at both time points (0.5 SD mean increase) and among those with data at only one time point (0.4 SD mean increase). Content analysis of the REDCap survey corroborated the ARTIC results. CONCLUSION System-wide trauma-informed education can achieve measurable effect in a NICU setting.
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Affiliation(s)
- Patricia A Davis
- Department of Social Work, Children's Mercy-Kansas City, Kansas City, MO, USA.
| | - Dena Hubbard
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Tiffany Gladdis
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Division of Developmental and Behavioral Medicine, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Chris Nitkin
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kara Hansen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Erin Keith-Chancy
- University of Kansas School of Nursing - Undergraduate Faculty, Kansas City, MO, USA
| | - Jennifer Godwin
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Vincent Staggs
- Biostatistics & Epidemiology Core, Children's Mercy-Kansas City; School of Medicine, University of Missouri-at Kansas City, Kansas City, MO, USA
- Statistical Consulting & Research, IDDI, Inc., Raleigh, NC, USA
| | - Shilpa Babbar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Michelle Hardy
- Neonatal Intensive Care Unit, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Jacqulin Ashbaugh
- Neonatal Intensive Care Unit, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Brian S Carter
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Pediatric Bioethics Center, Children's Mercy-Kansas City, Professor of Pediatrics, School of Medicine, Kansas City, MO, USA
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Berring LL, Holm T, Hansen JP, Delcomyn CL, Søndergaard R, Hvidhjelm J. Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review. Healthcare (Basel) 2024; 12:908. [PMID: 38727465 PMCID: PMC11083630 DOI: 10.3390/healthcare12090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| | - Tine Holm
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark;
| | - Jens Peter Hansen
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Retspsykiatrisk Forskningsenhed, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - Christian Lie Delcomyn
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department for Forensic Psychiatry, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark
| | - Rikke Søndergaard
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
| | - Jacob Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Center Sct Hans, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark;
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Zufer I, Fix RL, Stone E, Cane R, Sakran JV, Nasr I, Hoops K. Documentation of Trauma-Informed Care Elements for Young People Hospitalized After Assault Trauma. J Surg Res 2024; 296:665-673. [PMID: 38359681 DOI: 10.1016/j.jss.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/01/2024] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Violent traumatic injury, including firearm violence, can adversely impact individual and community health. Trauma-informed care (TIC) can promote resilience and prevent future violence in patients who have experienced trauma. However, few protocols exist to facilitate implementation of TIC for patients who survive traumatic injury. The purpose of the study is to characterize documentation of TIC practices and identify opportunities for intervention in a single academic quaternary care center. METHODS This study is a retrospective chart review analyzing the documentation of trauma-informed elements in the electronic medical record of a random sample of youth patients (ages 12-23) admitted for assault trauma to the pediatric (n = 50) and adult trauma (n = 200) services between 2016 and mid-2021. Descriptive statistics were used to summarize patient demographics, hospitalization characteristics, and documentation of trauma-informed elements. Chi-square analyses were performed to compare pediatric and adult trauma services. RESULTS Among pediatric and adult assault trauma patients, 36.0% and 80.5% were hospitalized for firearm injury, respectively. More patients admitted to the pediatric trauma service (96%) had at least one trauma-informed element documented than patients admitted to the adult service (82.5%). Social workers were the most likely clinicians to document a trauma-informed element. Pain assessment and social support were most frequently documented. Safety assessments for suicidal ideation, retaliatory violence, and access to a firearm were rarely documented. CONCLUSIONS Results highlight opportunities to develop trauma-informed interventions for youth admitted for assault trauma. Standardized TIC documentation could be used to assess risk of violent reinjury and mitigate sequelae of trauma.
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Affiliation(s)
- Insia Zufer
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca L Fix
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rachel Cane
- Division of Pediatric Hospital Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Joseph V Sakran
- Johns Hopkins Medicine, Department of Surgery, Baltimore, Maryland
| | - Isam Nasr
- Johns Hopkins Medicine, Department of Surgery, Baltimore, Maryland
| | - Katherine Hoops
- Department of Anesthesiology and Critical Care Medicine, Department of Health Policy and Management, Johns Hopkins Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Goldenthal HJ, Gill T, Rivera C, Gouze KR, Cicchetti C. Implementing trauma-informed care in a special education setting: An initial exploration of a multi-tiered model. EVALUATION AND PROGRAM PLANNING 2024; 103:102407. [PMID: 38367349 DOI: 10.1016/j.evalprogplan.2024.102407] [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: 05/03/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/19/2024]
Abstract
Implementing trauma-informed care in a special education environment serving youth from historically marginalized communities with high levels of exposure to potentially traumatic events (PTEs) requires a systematic tiered approach consistent with public health guidelines. Little is known about the implementation of this framework in special education settings where youth have significant emotional and behavioral difficulties. To address this need, a consultant-community partnership was forged between a hospital providing mental health services and a therapeutic day school that serves a special education cooperative. The current case study explores the design and implementation of a three-tiered model of trauma-informed care in a special education setting. This study will address the specific practices implemented at each tier, discuss successes and challenges, and summarize future directions for research, practice, and policy.
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Affiliation(s)
| | - Tara Gill
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago, IL, USA
| | - Claudio Rivera
- University of Chicago Medicine, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA
| | - Karen R Gouze
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago, IL, USA
| | - Colleen Cicchetti
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago, IL, USA
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13
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Long T, Aggar C, Grace S. Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care? Midwifery 2024; 131:103950. [PMID: 38359645 DOI: 10.1016/j.midw.2024.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/13/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Continuing education is important to improve midwives' attitudes to trauma-informed care in addressing the needs of women during the perinatal period. This study aimed to evaluate if there was a significant difference in attitudes towards trauma-informed care between midwives who participated in a 2-day trauma-informed care education program and those who did not. METHOD A static group comparison design was adopted with a convenience sample of midwives to analyse differences in attitudes towards trauma-informed care between midwives who received a 2-day TIC education (n = 19, intervention group) and their peers who did not receive the education (n = 18, comparison group). RESULTS The results suggest that midwives who participated in a 2-day trauma-informed care education program had significantly higher scores for positive attitudes towards trauma-informed care compared to those who did not take part in the program and that this effect was sustained at 6 months. CONCLUSION To minimise perinatal trauma for mothers and babies, midwives require specific trauma-informed care education. This study proposes that trauma-informed care education is a foundational pathway for implementing a trauma-informed care framework across a maternity service.
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Affiliation(s)
- Trish Long
- Northern NSW Local Health District, Australia.
| | - Christina Aggar
- Northern NSW Local Health District, Australia; Southern Cross University, Faculty of Health, Australia
| | - Sandra Grace
- Southern Cross University, Faculty of Health, Australia
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Benes C, Lund E. Knowledge and Perspectives of Developmental Language Disorders: The Pilot Development of a Survey of Professionals Working in Law Enforcement. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:969-989. [PMID: 38266216 DOI: 10.1044/2023_ajslp-22-00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE The purpose of this study was to pilot test a survey of professionals within the justice system about their knowledge and perceptions of developmental language disorders (DLDs) and to gather initial data supporting their knowledge and perceptions. METHOD One hundred thirty-six adults in Texas with law enforcement jobs, primarily police officers, participated in this study. Participants completed a survey consisting of 78 questions about their background, experiences with DLD, and beliefs about communication. Additionally, 42 adults who did not work in law enforcement completed the survey twice to establish the initial measures of survey reliability. RESULTS This survey demonstrated sufficient test-retest reliability with adults not in law enforcement, and results indicated the emergence of two subscales within the survey. Law enforcement professionals appeared to have limited knowledge of DLD, and many linked language-related behaviors with credibility. A majority did agree with giving accommodations to individuals who struggle with language and reported interest in receiving training to recognize and accommodate DLD. CONCLUSIONS This pilot study demonstrates a need for collaboration between speech-language pathologists and law enforcement professionals and provides data for a survey that could be used across professional groups in the justice system to measure knowledge and perspectives of DLDs. This work represents an initial step in an iterative process of survey development for law enforcement professionals. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25033718.
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Affiliation(s)
- Clare Benes
- Davies School of Communication Sciences & Disorders, Texas Christian University, Fort Worth
| | - Emily Lund
- Davies School of Communication Sciences & Disorders, Texas Christian University, Fort Worth
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15
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Graham Bn Advanced Prac Cmhn N, Whitaker BSocWk Msw PhD L, Smith BSocSci Hons St Class PhD Oam G, Hurley Cmhn PhD J. Trauma-Informed Care in Acute Adult Public Mental Health Settings: A Scoping Study Examining Implementation. Issues Ment Health Nurs 2024; 45:217-231. [PMID: 38466388 DOI: 10.1080/01612840.2024.2308543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Trauma-informed care (TIC) is not a new concept. Despite TIC being at the forefront of international acute public mental health services policy, and researched since 2006, implementation has been hampered. This paper reports findings from a scoping study examining clinical and lived experience workers experience of TIC in Acute Adult Public Mental Health Services. In this scoping study five databases and grey literature were scanned in 2021 and updated in 2023, to address the question: What is known about TIC concerning the clinical and mental health lived experience workforce in the acute adult public mental health service? Forty-six papers met the inclusion criteria. Analysis revealed commitment in conceptualisation of TIC in mental health policy, requirements for incorporating TIC in acute adult mental health care, and barriers to implementation, including dissonance towards role expectations. The literature calls for investment in implementing TIC, which includes an increased workforce consisting of mental health lived experience workers, clinical staff with TIC knowledge and skills, and specialist TIC experts. Further research is needed to understand more fully the opportunities and barriers to implementing TIC in acute public mental health settings.
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Beebe PhD Pmhnp-Bc Faan LH. Trauma-Informed Care: Where We Have Been, Where We Are Going……. Issues Ment Health Nurs 2024; 45:119-120. [PMID: 38354378 DOI: 10.1080/01612840.2024.2308553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
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Xia W, Wang Y, Wu X, Yang X. Development of a Questionnaire for Measuring Trauma-Informed Care of Nurses Working with Traumatically Injured Patients. J Multidiscip Healthc 2024; 17:367-378. [PMID: 38287968 PMCID: PMC10823872 DOI: 10.2147/jmdh.s437341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
Purpose To develop a new questionnaire for assessing nurses' current situation of knowledge, attitude and practice related to trauma-informed care (TIC) for patients with traumatic injury. Methods By literature review, qualitative interview and Delphi consultation, the 46 preliminary items about trauma-informed care of nurses working with traumatically injured patients were selected. After that, the preliminary questionnaire was distributed to 293 Chinese nurses in relevant departments. The collected data were analyzed by internal reliability, split-half reliability, structural validity and content validity. Results The questionnaire was developed with a total of 30 items in 3 dimensions: 8 items in the TIC knowledge dimension, 10 items in the TIC attitude dimension and 12 items in the TIC practice dimension. The Cronbach's alpha coefficient was 0.939, and the content validity was 0.971. Conclusion This designed questionnaire shews receptable reliability and validity, which could be used to assess the knowledge, attitude and practice of nurses in application of trauma-informed care for traumatically injured patients.
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Affiliation(s)
- Weiping Xia
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
- Department of Surgical Inpatient, United Family Hospital, Shanghai, 200335, People’s Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaojie Yang
- Department of Orthopedics, Jiangyin Hospital Affiliated to Nantong University, Jiang Yin, 214400, People’s Republic of China
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Hanson CL, Crandall A, Novilla MLB, Bird KT. Psychometric Evaluation of the Trauma-Informed Care Provider Assessment Tool. Health Serv Res Manag Epidemiol 2024; 11:23333928241258083. [PMID: 38867940 PMCID: PMC11168040 DOI: 10.1177/23333928241258083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
The increasing recognition of adverse childhood experiences as a significant factor in adult health outcomes underscores the need for trauma-informed care (TIC) in healthcare settings. The purpose of this study was to assess the psychometric properties of the TIC Provider Assessment Tool (TIC-PAT) designed for primary care providers. The TIC-PAT aligns with the TIC Pyramid framework and assesses both universal trauma precautions and trauma-specific care. A total of 176 primary care providers in the United States completed the TIC-PAT through an anonymous online survey. Findings through exploratory and confirmatory factor analyses revealed a unidimensional (one-factor) model, consolidating questions into a concise 10-item measure. This study contributes an efficient assessment tool for the provision of TIC by primary care providers in healthcare settings, promoting better patient-provider interactions and enhancing provider awareness of trauma's impact on health.
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Affiliation(s)
- Carl L. Hanson
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Ali Crandall
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | | | - Kaitlyn Tan Bird
- Department of Public Health, Brigham Young University, Provo, UT, USA
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Selwyn CN, Koon-Magnin S, Dixon V, Rudd A. The Importance of Multidisciplinary Trauma-Informed Training in Addressing Campus-Based Sexual Violence. JOURNAL OF FORENSIC NURSING 2024; 20:12-19. [PMID: 37862460 DOI: 10.1097/jfn.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
ABSTRACT This study investigates the impact of a professional development training series among a multidisciplinary team (MDT) during establishment of a trauma-informed sexual assault response and prevention program at a midsized university in the southeastern United States. MDT members included forensic nurses, advocates, counselors, law enforcement officers, and relevant faculty and staff. After completion of a baseline survey assessing attitudes toward trauma-informed care and perceptions of the team climate within the MDT, team members engaged in a trauma-informed care (TIC) professional development training series consisting of (a) 4-hour-long didactic lectures with incorporated group discussion and (2) one 2-hour in-situ simulation-based training exercise. MDT members subsequently completed 3-month and long-term follow-up surveys to assess the immediate and enduring impacts of the training series.The TIC training series significantly increased MDT members' perceptions of participative safety, task orientation, and support for innovation within the group at the 3-month assessment. No long-term differences were found, likely because of a small sample size and low statistical power.Intensive TIC MDT professional development at the beginning of a campus-wide sexual assault prevention and response initiative enhances psychological safety within the group, evidenced by increased perceptions of participative safety and support for innovation, and builds team cohesiveness around a shared set of tasks. Within the present MDT, the professional development training series also appeared to facilitate adoption of a shared set of values for accomplishing the team's goal of preventing and responding to sexual assault on campus. Recommendations for MDTs with similar goals are discussed.
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Affiliation(s)
- Candice N Selwyn
- Author Affiliations: Community Mental Health Nursing, College of Nursing
| | | | - Victoria Dixon
- Combined-Integrated Clinical & Counseling Psychology Program, College of Arts and Sciences
| | - Alison Rudd
- Simulation Program, Academic Affairs, University of South Alabama
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Miller Itay MR, Turliuc MN. Who Will Save the Savior? The Relationship between Therapists' Secondary Traumatic Stress, Secondary Stress Self-Efficacy, and Attitudes toward Trauma-Informed Care. Behav Sci (Basel) 2023; 13:1012. [PMID: 38131868 PMCID: PMC10740790 DOI: 10.3390/bs13121012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Therapists who treat traumatized preschool children are vulnerable to secondary traumatic stress. This study investigates the relationship between therapists' attitudes toward trauma-informed care (TIC) and risk of secondary traumatic stress, with secondary traumatic self-efficacy as a mediating variable. Participants included Israeli social workers (N = 101) in preschool trauma frameworks, with 97.2% following trauma-informed care principles. The questionnaire combined three instruments: attitudes related to TIC (ARTIC), secondary traumatic stress (STS), and secondary traumatic stress efficacy (STSE). Therapists with less positive attitudes toward trauma-informed care showed higher levels of secondary traumatic stress (r[99] = -0.23, p = 0.019), while more positive attitudes predicted higher levels of secondary traumatic stress efficacy (r[99] = 40, p < 0.001). Secondary traumatic self-efficacy mediated the relationship between attitudes toward trauma-informed care and secondary traumatic stress (z = 2.72, p = 0.006). Therapists' secondary traumatic stress may be reduced by improving positive attitudes toward trauma-informed care and enhancing their secondary traumatic self-efficacy.
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Affiliation(s)
- Miriam Rivka Miller Itay
- Faculty of Psychology and Educational Sciences, Alexandru Ioan Cuza University of Iași, 700506 Iaşi, Romania;
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Nemeth J, Ramirez R, Debowski C, Kulow E, Hinton A, Wermert A, Mengo C, Malecki A, Glasser A, Montgomery L, Alexander C. The CARE Health Advocacy Intervention Improves Trauma-Informed Practices at Domestic Violence Service Organizations to Address Brain Injury, Mental Health, and Substance Use. J Head Trauma Rehabil 2023; 38:439-447. [PMID: 36951455 DOI: 10.1097/htr.0000000000000871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact that domestic violence (DV) service organizations' (SO) agency-wide adoption of CARE had on improving DVSO trauma-informed care (TIC) practices, overall, and in relation to addressing brain injury and mental health. CARE is an advocacy intervention designed to raise DVSOs' capacity to C ONNECT with survivors; A CKNOWLEDGE that head trauma, strangulation, and mental health challenges are common; R ESPOND by accommodating needs in services and providing targeted referrals; and E VALUATE effectiveness of response to meet survivors' stated concerns. We hypothesized that TIC would significantly improve among DVSO staff with the agency's use of CARE. SETTING/PARTICIPANTS/DESIGN Pre- ( n = 53) and 1-year post-CARE ( n = 60) implementation online surveys were completed by staff at 5 DVSOs in Ohio from 2017 to 2019. MAIN MEASURES Trauma-Informed Practice Scales (TIPS) were used to assess agency support and overall staff impression of implementing TIC; scales were modified to assess the use of TIC-practices related to head trauma, strangulation, mental health, suicide, and substance use. Attitudes Regarding Trauma-Informed Care (ARTIC-45) subscales assessed DVSO staff's endorsement of personal and organizational support in implementing TIC practices. Response options on the Survivor Defined Practice Scale (SDPS) were modified to gain staff insight into DVSO's ability to facilitate survivor empowerment. Differences in endorsement of TIC practices between pre- and post-CARE implementation were evaluated using regression models. RESULTS DVSO agency environment ( P < .01) and overall staff impression ( P < .001) regarding implementing TIC practices, and in respect to head trauma ( P < .01), strangulation ( P < .01), mental health ( P < .01), suicide ( P = .04), and substance use ( P < .01), significantly improved with the agency's use of CARE. CARE increased DVSO staff's belief in personal and organizational support to implement TIC ( P < .01 and P = .02, respectively) and in their agency's ability to foster survivor empowerment ( P < .01). CONCLUSION CARE improved TIC practices of DVSOs, overall, and to address brain injury and mental health.
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Affiliation(s)
- Julianna Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus (Drs Nemeth, Montgomery, and Debowski and Mss Wermert, Malecki, and Glasser); Ohio Domestic Violence Network, Columbus (Mss Ramirez, Kulow, and Alexander); Division of Biostatistics, College of Public Health, The Ohio State University (Dr Hinton);and School of Social Work, The Ohio State University, Columbus (Dr Mengo)
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Anderson KM, Piper KN, Kalokhe AS, Sales JM. Implementation of trauma-informed care and trauma-responsive services in clinical settings: a latent class regression analysis. Front Psychiatry 2023; 14:1214054. [PMID: 37915798 PMCID: PMC10616460 DOI: 10.3389/fpsyt.2023.1214054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Engagement and retention in health care is vital to sustained health among people living with HIV (PLWH), yet clinical environments can deter health-seeking behavior, particularly for survivors of interpersonal violence. PLWH face disproportionate rates of interpersonal violence; clinical interactions can provoke a re-experiencing of the sequalae of trauma from violence, called re-traumatization. Trauma-informed care (TIC) is a strengths-based approach to case that minimizes potential triggers of re-traumatization and promotes patient empowerment, increasing acceptability of care. Yet, Ryan White HIV/AIDS clinics, at which over 50% of PLWH received care, have struggled to IMPLEMENT TIC. In this analysis, we sought to (1) identify unique sub-groups of HIV clinics based on clinical attributes (i.e., resources, leadership, culture, climate, access to knowledge about trauma-informed care) and (2) assess relationships between sub-group membership and degree of implementation of TIC and trauma-responsive services offered. Methods A total of 317 participants from 47 Ryan White Federally-funded HIV/AIDS clinics completed a quantitative survey between December 2019 and April 2020. Questions included assessment of inner setting constructs from the Consolidated Framework for Implementation Research (CFIR), perceived level of TIC implementation, and trauma-responsive services offered by each respondent's clinic. We employed latent class analysis to identify four sub-groups of clinics with unique inner setting profiles: Weak Inner Setting (n = 124, 39.1%), Siloed and Resource Scarce (n = 80, 25.2%), Low Communication (n = 49, 15.5%), and Robust Inner Robust (n = 64, 20.2%). We used multilevel regressions to predict degree of TIC implementation and provision of trauma-responsive services. Results Results demonstrate that clinics can be distinctly classified by inner setting characteristics. Further, inner setting robustness is associated with a higher degree of TIC implementation, wherein classes with resources (Robust Inner Setting, Low Communication) are associated with significantly higher odds reporting early stages of implementation or active implementation compared to Weak class membership. Resourced class membership is also associated with availability of twice as many trauma-responsive services compared to Weak class membership. Discussion Assessment of CFIR inner setting constructs may reveal modifiable implementation setting attributes key to implementing TIC and trauma-responsive services in clinical settings. Introduction.
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Affiliation(s)
- Katherine M. Anderson
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Kaitlin N. Piper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Ameeta S. Kalokhe
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Jessica M. Sales
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States
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Wholeben M, Castro Y, Salazar G, Field C. Impact of Trauma-Informed Care Training on Attitudes Among Emergency Department Personnel, Staff Advocates, and Nursing Students. J Trauma Nurs 2023; 30:261-270. [PMID: 37702727 DOI: 10.1097/jtn.0000000000000740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Health care providers may risk retraumatizing patients and intensifying patient distress unless they practice trauma-informed care. As the first line of defense in assisting trauma survivors' physical and emotional recovery, health care providers must use a strengths-based framework that promotes resilience and expands on the trauma survivor's existing resources. OBJECTIVE This study aimed to compare the effect of trauma-informed care training on the attitudes of emergency department personnel, staff advocates, and nursing students toward trauma-informed care. METHODS This study used a pretest-posttest design. Assessment of attitudes toward trauma-informed care was done before and after trauma-informed care training. Data collection occurred from February 2021 through August 2021. Participants included three cohorts of emergency department staff, advocates for trauma survivors, and nursing students. Attitudes toward trauma-informed care were measured using the Attitudes Related to Trauma-Informed Care (ARTIC) Scale. RESULTS A total of 433 participants were studied, including 88 emergency department staff, 123 staff advocates, and 222 nursing students. All three cohorts significantly increased ARTIC Scale scores posttraining (p < .001). At preintervention, all three cohorts significantly differed from each other on ARTIC Scale scores (p < .01). In contrast, postintervention, ARTIC Scale scores did not significantly differ between nursing students and advocates (p = .99). Nursing students showed a significant increase in scores from pre- to postintervention compared with either advocates or emergency department staff. CONCLUSION The results strongly suggest that health care providers can improve attitudes toward trauma-informed care after completing training on the principles and application of trauma-informed care.
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Affiliation(s)
- Melissa Wholeben
- College of Nursing (Dr Wholeben) and Department of Psychology, College of Liberal Arts (Dr Field), The University of Texas at El Paso; Steve Hicks School of Social Work, The University of Texas at Austin (Dr Castro); and Trauma Manager of Education, Prevention, and SANE Program, University Medical Center of El Paso, El Paso, Texas (Ms Salazar)
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Ferrara AM, Panlilio CC, Tirrell-Corbin C. Exploring School Professionals' Definitions of Childhood Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:783-793. [PMID: 37593060 PMCID: PMC10427587 DOI: 10.1007/s40653-023-00550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Little is known about school professionals' definitions of trauma outside of the context of trauma-informed school trainings. METHODS The present study used thematic analysis to explore school professionals' open-ended definitions of childhood trauma (N = 1271). Follow-up chi-square tests of independence were used to investigate differences in professionals' definitions based on their professional role and education. RESULTS Five themes were identified: effects of trauma, events of trauma, solutions to trauma, emotional responses, and no knowledge. Effects of trauma and events of trauma contained ten and five subthemes, respectively. School professionals who identified long-term effects of trauma on students most commonly listed general negative effects (e.g., "An experience or event that can negatively impact that child") instead of effects on specific domains such as behavior or emotions (e.g., "An experience that negatively impacted a child emotionally"). School professionals who identified an event of trauma most commonly provided examples of trauma (e.g., child maltreatment) or a general definition of trauma. School professionals' roles and education were somewhat related to their definitions of childhood trauma. Findings suggest that childcare providers and professionals without a bachelor's degree have gaps in their knowledge of child trauma. CONCLUSIONS These results suggest school professionals have some foundational knowledge about trauma, but it is not universal. To best serve school professionals working with this vulnerable population of students, researchers and practitioners should design future trauma-informed professional development opportunities around school professionals' prior knowledge and understanding of trauma as well as their potential misunderstandings of trauma.
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Affiliation(s)
- Amanda M. Ferrara
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, 228 CEDAR Building University Park, Pennsylvania, PA 16802 USA
| | - Carlomagno C. Panlilio
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, 228 CEDAR Building University Park, Pennsylvania, PA 16802 USA
| | - Christy Tirrell-Corbin
- Department of Human Development and Quantitative Methodology, University of Maryland, 3304 Benjamin Building College Park, Maryland, MD 20742 USA
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Brown LL, Pennings J, Steckel S, Van Zyl M. The organizational trauma resilience assessment: Methods and psychometric properties. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:S446-S455. [PMID: 34928688 PMCID: PMC9326844 DOI: 10.1037/tra0001184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Despite many strengths of trauma-informed care (TIC), critics argue TIC is necessary but alone insufficient, can be deficit focused, lacks construct operationalization, and requires greater inclusion of resilience theory. We sought to address these critiques by creating an assessment tool through an iterative and community-engaged process. METHOD We collected cross-sectional data between May and June 2019 with a convenience sample from 12 sites across the United States (N = 861). Data were analyzed through application of classical test theory and item response theory, using principal components analysis. RESULTS The final 40-item Organizational Trauma Resilience Assessment (OTRA) is sufficiently unidimensional and has a five-factor solution with strong validity and reliability. CONCLUSION We believe this instrument marks the first of its kind to synthesize tenets of organizational resilience with TIC principles. Creation of the OTRA progresses the TIC knowledge base and is a cost-effective and valid method for evaluating organizational culture of trauma resilience. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Leslie Lauren Brown
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College
- Department of Orthopaedic Surgery and Center for Musculoskeletal Research, Vanderbilt University Medical Center
| | - Jacquelyn Pennings
- Department of Orthopaedic Surgery and Center for Musculoskeletal Research, Vanderbilt University Medical Center
| | | | - Michiel Van Zyl
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida
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Baca KJ, Salsbury SA. Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action. Chiropr Man Therap 2023; 31:30. [PMID: 37580756 PMCID: PMC10426155 DOI: 10.1186/s12998-023-00503-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/20/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Trauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs. DISCUSSION This commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas. CONCLUSION Given the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.
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Affiliation(s)
- Kira J Baca
- Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, 52803, USA.
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA, 52803, USA
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Bryan RH, Beitz JM. Trauma-Informed Care: Positive and Adverse Childhood Experiences and WOC Nursing: An Integrative Review. J Wound Ostomy Continence Nurs 2023; 50:276-284. [PMID: 37467405 DOI: 10.1097/won.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Rebecca H Bryan
- Rebecca Bryan, DNP, AGPCNP, APN, New Jersey Department of Children and Families, Trenton, and School of Nursing, Rutgers University-Camden, Camden, New Jersey
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, ANEF, FNAP, FAAN, School of Nursing, Rutgers University-Camden, Camden, New Jersey
| | - Janice M Beitz
- Rebecca Bryan, DNP, AGPCNP, APN, New Jersey Department of Children and Families, Trenton, and School of Nursing, Rutgers University-Camden, Camden, New Jersey
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, ANEF, FNAP, FAAN, School of Nursing, Rutgers University-Camden, Camden, New Jersey
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Mendez A, Bosk EA, Keller A, Williams-Butler A, Hardan T, Ruisard DJ, MacKenzie MJ. Expanding the Trauma-Informed Care Measurement Toolkit: An Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC-45) Scale with SUD Workers in PIMH. Behav Sci (Basel) 2023; 13:471. [PMID: 37366724 DOI: 10.3390/bs13060471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X2 = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains.
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Affiliation(s)
- Alicia Mendez
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA
| | - Emily A Bosk
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA
| | - Amanda Keller
- School of Social Work, McGill University, Montreal, QC H3A 1B9, Canada
| | | | - Tareq Hardan
- School of Social Work, McGill University, Montreal, QC H3A 1B9, Canada
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Kataoka M, Kotake R, Asaoka H, Miyamoto Y, Nishi D. Research note reliability and validity of Japanese version of the trauma-informed care provider survey (TIC provider survey). BMC Res Notes 2023; 16:68. [PMID: 37131236 PMCID: PMC10152421 DOI: 10.1186/s13104-023-06337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Robust instruments to evaluate the ability of trauma-informed care among healthcare workers need to be developed, as this would help the implementation of trauma-informed care to prevent re-traumatization of patients. This study aims to assess the reliability and validity of the Japanese version of the Trauma-Informed Care (TIC) Provider Survey. A total of 794 healthcare workers were surveyed using a self-administered questionnaire, including the TIC Provider Survey, and six measures that were considered to be correlated with it. We calculated the Cronbach's alpha coefficient to investigate the internal consistency of each category of the TIC Provider Survey (knowledge, opinions, self-rated competence, practices, and barriers). Spearman's rank correlation coefficients were used to investigate the correlation between each category of the TIC Provider Survey, and other measures of construct validity. RESULTS Cronbach's alpha coefficients of each category of the TIC Provider Survey were 0.40 (Knowledge), 0.63 (Opinions), 0.92 (Self-rated competence), 0.93 (Practices), and 0.87 (Barriers). The Spearman's rank correlation coefficients were small. We confirmed the reliability of the acceptable levels and examined the validity of modest or unacceptable levels of the Japanese version of the TIC provider survey among Japanese workers in a healthcare setting.
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Affiliation(s)
- Mayumi Kataoka
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Risa Kotake
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7- 3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Asaoka
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7- 3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7- 3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan.
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Heck OC, Ormiston H, Husmann P. Utilizing KAP in Schools: An Evaluation of Educators' and Staff Knowledge, Attitudes, and Practices Related to Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1-13. [PMID: 37359466 PMCID: PMC10098998 DOI: 10.1007/s40653-023-00536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/28/2023]
Abstract
We examined differences in knowledge, attitudes, and practices related to student trauma and trauma-informed practices among various educators and certified staff members in a United States, Midwestern school district. We examined three research questions: 1.) Are there significant differences in knowledge, attitudes, and practices among teachers with differing years' experience? 2.) Are there significant differences in knowledge, attitudes, and practices among primary and secondary educators and staff? 3.) Are there significant differences in knowledge, attitudes, and practices among educators and staff who have participated in professional development (PD) regarding student trauma, and those who have not? We utilized a revised version of the Knowledge, Attitudes, and Practices (KAP) survey (Law, 2019) focused on student trauma. The KAP survey was sent via email to all certified staff members in the school district. No significant differences were found among knowledge and attitudes; however, primary school educators implemented significantly more trauma-informed practices compared to secondary educators. Additionally, educators with PD implemented significantly more trauma-informed practices compared to those without PD. Findings revealed our staff members had similar levels of knowledge and attitudes, though practices differed depending on years' experience, PD, and grades taught. Implications for future research relating to student trauma and the research-to-practice gap are discussed.
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Affiliation(s)
- Olivia C Heck
- Department of Counseling and Educational Psychology, Indiana University School of Education, 201 N Rose Ave, Bloomington, IN 47405 USA
| | - Heather Ormiston
- Department of Counseling and Educational Psychology, Indiana University School of Education, 201 N Rose Ave, Bloomington, IN 47405 USA
| | - Polly Husmann
- Indiana University School of Medicine, 2631 East Discovery Parkway, Bloomington, IN 47408 USA
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O’Toole C, Dobutowitsch M. The Courage to Care: Teacher Compassion Predicts More Positive Attitudes Toward Trauma-Informed Practice. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:123-133. [PMID: 36157295 PMCID: PMC9483284 DOI: 10.1007/s40653-022-00486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE With greater awareness of the prevalence and impact of childhood trauma and adversity, teachers are now assuming a more active role in creating emotionally healthy environments and responding to student distress. However, supporting trauma-affected students can be a source of amplified teacher stress. Compassion has been identified as a promising construct for frontline professionals in terms of promoting psychological wellbeing, and increasing the sensitivity to detect, tolerate and respond to distress in others. It has also been identified as an important aspect of trauma-informed practice. Nevertheless, the role of compassion in teachers' attitudes towards, and readiness for implementing trauma-informed practices has not yet been explored. This study aimed to address this gap. METHODS A sample of 377 primary and post-primary teachers in Ireland completed the Attitudes Related to Trauma-Informed Care Scale, the Professional Quality of Life Scale, the Self-Compassion Scale, and a socio-demographic survey. RESULTS Teachers were found to hold generally positive attitudes toward trauma-informed care. They exhibited low to moderate levels of secondary traumatic stress and burnout, and notably high levels of compassion satisfaction, indicating that they tend to embrace their caring role and find meaning and purpose in their work. Regression analyses showed that compassion satisfaction was the strongest predictor of positive attitudes toward trauma-informed care, followed by self-compassion. Older teachers were more likely to display positive attitudes toward trauma-informed care, whilst teachers in single-sex boys' schools held attitudes that were less favorable. CONCLUSION This study suggests potential benefits for both teachers and students of positioning compassion at the center of educational policy and practice. The results are contextualized within the Irish and international educational landscape.
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Affiliation(s)
- Catriona O’Toole
- Department of Education, Maynooth University, Maynooth, Co Kildare Ireland
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Cerny S, Berg-Poppe P, Anis M, Wesner C, Merrigan M, LaPlante K. Outcomes from an interprofessional curriculum on trauma-informed care among pediatric service providers. J Interprof Care 2023; 37:288-299. [PMID: 35687015 DOI: 10.1080/13561820.2022.2070142] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The effects of trauma on the health of individuals have been well established as a major public health concern. However, the integration of trauma-informed practices within the multidisciplinary pediatric health care system still faces significant challenges and barriers. This study sought to understand the changes in knowledge, behaviors, and attitudes related to trauma-informed care following administration of a trauma-informed educational intervention. Eighteen pediatric professionals participated in this interprofessional study design. The intervention included several components of self-study, face-to-face active learning experiences, presentations, and case discussions. Six weeks following the intervention, participants engaged in a follow-up focus group dialogue. To crystallize the transformative impact of education in practice, the study used both quantitative and qualitative data. Quantitative data was measured using the Attitudes Related to Trauma Informed Care (ARTIC) scale, while a focus group was used to understand the subjective experiences of participants and the effects of participation on practice. Results showed statistically significant pre- to post-programming improvements across all ARTIC domains. Qualitative themes aligned with the quantitative findings, indicating a sense of empowerment through knowledge, as well as an enhanced awareness of systematic challenges to implementation of trauma-informed care approaches.
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Affiliation(s)
- Shana Cerny
- Department of Occupational Therapy, University of South Dakota, Vermillion, SD, United States
| | - Patti Berg-Poppe
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, United States
| | - Musheera Anis
- Department of Public Health & Health Sciences, University of South Dakota, Vermillion, SD, United States
| | - Chelsea Wesner
- Department of Public Health & Health Sciences, University of South Dakota, Vermillion, SD, United States
| | - Mary Merrigan
- Department of Addiction Counseling & Prevention, University of South Dakota, Vermillion, SD, United States
| | - Kathy LaPlante
- Department of Social Work, University of South Dakota, Vermillion, SD, United States
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Ramirez MR, Ryan A, Harding AB, Renfro T, Church TR, Rosebush C, Trotter AG, Xiong BN, Gonzalez J, Woods-Jaeger B. Link for Equity, a community-engaged waitlist randomized controlled trial of a culturally responsive trauma-informed care program for BIPOC students: Design features and characteristics of baseline sample. Contemp Clin Trials 2023; 126:107090. [PMID: 36681238 DOI: 10.1016/j.cct.2023.107090] [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: 06/21/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Link for Equity is a multi-tiered, school-based program of trauma-informed care and cultural humility designed to reduce the impact of Adverse Child Experiences among Black Indigenous and other children of color (BIPOC). This report describes the program, its trial design, and the study participants' baseline characteristics. METHODS We designed a nested waitlist-controlled trial to evaluate Link for Equity's effectiveness in reducing school violence among BIPOC students. Three pairs of school districts, matched on suspension rates and enrollment of Black/African American, Hispanic/Latinx, and American Indian/Alaska Native children, were randomized into either an intervention or delayed intervention (waitlist control) group. A community-engaged approach guided the development of protocols. Within intervention sites, BIPOC students who screened positive for ACEs or posttraumatic stress were also randomized into an immediate and waitlist control group to receive additional one-on-one support from trained school staff. RESULTS The trial was implemented from 2019 to 2021, which overlapped with the pandemic and civil unrest in Minnesota. At baseline, 444 staff and 188 students enrolled in the study. Over a quarter of American Indian/Alaska Native students, 18% of multiple race, 12% of Black/African American, 14% of Hispanic/Latinx students reported 4+ ACEs. Between 44 and 53% of all the BIPOC students in the study were symptomatic for PTSD. Of the enrolled students, 78.7% qualified for one-on-one Link support. CONCLUSION We implemented a multilevel waitlist-controlled trial of Link for Equity using community-engaged methods. Despite school closures during the pandemic, the study persisted with its methods now being employed in an expanded cohort of middle schools. TRIAL REGISTRATION ClinicalTrials.gov (NCT04026477, NCT04026490).
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Affiliation(s)
- Marizen R Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Andrew Ryan
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alyson B Harding
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Tiffaney Renfro
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Timothy R Church
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Christina Rosebush
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexis Grimes Trotter
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Bao Nhia Xiong
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John Gonzalez
- Department of Psychology, Bemidji State University, Bemidji, MN, USA
| | - Briana Woods-Jaeger
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Wathen CN, Schmitt B, MacGregor JCD. Measuring Trauma- (and Violence-) Informed Care: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:261-277. [PMID: 34235986 PMCID: PMC9660280 DOI: 10.1177/15248380211029399] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Trauma- (and violence-) informed care (T(V)IC) has emerged as an important practice approach across a spectrum of care settings; however how to measure its implementation and impact has not been well-examined. The purpose of this scoping review is to describe the nature and extent of available measures of T(V)IC, including the cross-cutting concepts of vicarious trauma and implicit bias. Using multiple search strategies, including searches conducted by a professional librarian from database inception to Summer 2020, 1074 articles were retrieved and independently screened for eligibility by two team members. A total of 228 were reviewed in full text, yielding 13 measures that met pre-defined inclusion criteria: 1) full-text available in English; 2) describes the initial development and validation of a measure, that 3) is intended to be used to evaluate T(V)IC. A related review of vicarious trauma measures yielded two that are predominant in this literature. Among the 13 measures identified, there was significant diversity in what aspects of T(V)IC are assessed, with a clear emphasis on "knowledge" and "safety", and less on "collaboration/choice" and "strengths-based" concepts. The items and measures are roughly split in terms of assessing individual-level knowledge, attitudes and practices, and organizational policies and protocols. Few measures examine structural factors, including racism, misogyny, poverty and other inequities, and their impact on people's lives. We conclude that existing measures do not generally cover the full potential range of the T(V)IC, and that those seeking such a measure would need to adapt and/or combine two or more existing tools.
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Affiliation(s)
- C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London,
Ontario, Canada
| | - Brenna Schmitt
- Arthur Labatt Family School of Nursing, Western University, London,
Ontario, Canada
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Lohmiller K, Gruber H, Harpin S, Belansky ES, James KA, Pfeiffer JP, Leiferman J. The S.I.T.E. Framework: A Novel Approach for Sustainably Integrating Trauma-Informed Approaches in Schools. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1011-1027. [PMID: 36439671 PMCID: PMC9684395 DOI: 10.1007/s40653-022-00461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/16/2023]
Abstract
Students who present as dysregulated due to the impacts of trauma and toxic stress can challenge educators and find themselves improperly or insufficiently supported, punitively consequenced and unable to equitably access education. Trauma-informed approaches based on an understanding of brain development and function have been put forth as best practice for supporting students with trauma histories. The novel Sustainably Integrated Trauma-Informed Education Framework (S.I.T.E. Framework) facilitates systemic integration of trauma-informed approaches across a school and was developed through a community-informed process to address implementation challenges traditionally linked to trauma-informed initiatives. The S.I.T.E Framework promotes the science-based content of the Neurosequential Model in Education (NME) and was piloted during the 2017-18 school year at a metropolitan elementary school in Colorado. Mixed analytic methods identified four components, 1) establish and facilitate school-based Core Team, 2) deliver school-wide professional development training, 3) provide on-site staff support and consultation and 4) conduct a comprehensive evaluation as critical to the successful implementation of the framework. Pilot testing of the S.I.T.E. Framework's innovative, multicomponent structure illustrates the potential for sustainable, whole-school integration of brain-based, trauma-informed approaches that are supportive of both educators and students regardless of their trauma history.
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Affiliation(s)
- Katie Lohmiller
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO USA
| | | | - Scott Harpin
- College of Nursing, University of Colorado, Aurora, CO USA
| | - Elaine S. Belansky
- Center for Rural School Health & Education, Morgridge College of Education, University of Denver, Denver, CO USA
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, CO USA
| | | | - Jenn Leiferman
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO USA
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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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Kataoka M, Kotake R, Asaoka H, Miyamoto Y, Nishi D. Reliability and Validity of the Japanese Version of the Attitudes Related to Trauma-Informed Care (ARTIC-10) Scale. J Trauma Nurs 2022; 29:312-318. [PMID: 36350170 PMCID: PMC9653105 DOI: 10.1097/jtn.0000000000000684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Trauma-informed care is recommended to avoid the inadvertent retraumatization of patients by health care providers. Psychometric evaluation of trauma-informed care instruments is needed. The Japanese version of the Attitudes Related to Trauma-Informed Care (ARTIC-10) Scale has not yet been psychometrically validated. OBJECTIVE The study's objective was to examine the reliability and validity of the ARTIC-10. METHODS This psychometric study of the ARTIC-10 compared with five other scales associated with attitudes related to trauma-informed care used a cross-sectional survey design conducted in November 2020 with a convenience sample of Japanese physicians and nurses recruited from an internet research agency. Participants completed self-administered questionnaires including the (a) ARTIC-10; (b) the Japanese version of the Moral Sensitivity Questionnaire 2018; (c) Patient Health Questionnaire-9; (d) Generalized Anxiety Disorder-7; (e) Stress Underestimation Beliefs; and (f) Negative Acts Questionnaire-Revised. Cronbach's α measured reliability internal consistency, and construct validity was measured by Spearman's rank. RESULTS A total of 794 physicians and nurses completed the surveys. Cronbach's α value of ARTIC-10 was 0.56. Higher scores of ARTIC-10 were positively and significantly correlated with Moral Sensitivity Questionnaire 2018 and negatively and significantly correlated with other scales (r =-.12 to .30). CONCLUSION This study found only modest internal consistency and construct validity of the Japanese version of ARTIC-10 in physicians and nurses. Further study is needed to identify factors that affect the reliability and validity of this Japanese scale to improve its psychometric properties.
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Affiliation(s)
- Mayumi Kataoka
- Departments of Mental Health (Ms Mayumi Kataoka and Dr Nishi) and Psychiatric Nursing (Ms Risa Kotake, Mr Asaoka, and Dr Miyamoto), Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Risa Kotake
- Departments of Mental Health (Ms Mayumi Kataoka and Dr Nishi) and Psychiatric Nursing (Ms Risa Kotake, Mr Asaoka, and Dr Miyamoto), Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Asaoka
- Departments of Mental Health (Ms Mayumi Kataoka and Dr Nishi) and Psychiatric Nursing (Ms Risa Kotake, Mr Asaoka, and Dr Miyamoto), Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuki Miyamoto
- Departments of Mental Health (Ms Mayumi Kataoka and Dr Nishi) and Psychiatric Nursing (Ms Risa Kotake, Mr Asaoka, and Dr Miyamoto), Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Daisuke Nishi
- Departments of Mental Health (Ms Mayumi Kataoka and Dr Nishi) and Psychiatric Nursing (Ms Risa Kotake, Mr Asaoka, and Dr Miyamoto), Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
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The Martinsburg Initiative: A Collaboration Between Public Safety, Public Health, and Schools to Address Trauma and Substance Use. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:S355-S358. [PMID: 36194806 PMCID: PMC9531965 DOI: 10.1097/phh.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Martinsburg Initiative (TMI) is a community-based model developed in Martinsburg, West Virginia, that implements a comprehensive approach to adverse childhood experiences and substance use prevention and mitigation by leveraging partnerships in public health and health care, public safety, and education. TMI receives coordinated federal funding and technical assistance from the Centers for Disease Control and Prevention, the Washington-Baltimore High Intensity Drug Trafficking Agency, and the National Association of County and City Health Officials to integrate evidence-based and promising strategies. It advances such strategies by translating them for implementation within the community, evaluating the reach and potential impact of the model, and by engaging key stakeholders. Preliminary results describing program reach and short-term outcomes collected for a subset of the interventions during implementation are presented. The model uses touchpoints across multiple community sectors in the city of Martinsburg to break the cycle of trauma and substance use across the life span.
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Validation of Trauma-Informed Care Instruments: Emergency Department Environment and Transitional Secondary Environment. J Trauma Nurs 2022; 29:282-290. [DOI: 10.1097/jtn.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Avoiding psychological (re)traumatisation in dentistry when working with patients who are adult survivors of child sex abuse. Br Dent J 2022; 233:666-670. [PMID: 36307712 PMCID: PMC9616715 DOI: 10.1038/s41415-022-5103-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
Introduction Seven percent of the adult population in the UK, including one in six women, report unwanted sexual experiences before the age of 16. The impacts of psychological trauma following child sexual abuse (CSA) creates difficulties for many survivors in accessing dental care due to fears of reminders of abuse, the power imbalance with the dentist and triggered traumatic responses. Aims To analyse and report CSA survivor perspectives of dental care and offer suggestions for practice. Method Qualitative semi-structured interviews of 17 CSA survivors generated data as part of a broader study investigating trust and trustworthiness in survivor-professional relationships. The range of dental interactions and the needs survivors described when receiving dental treatment are presented. Transcripts were analysed using NVivo software and thematic analysis methodology. Results Three main themes were identified: the dental encounter ('it really panics me'); the opportunity to disclose; and choice and control. Conclusion This is the first UK study to present qualitative data from CSA survivors about their experiences of dental care. Survivors wish to access dental care but tailored support is needed to ameliorate reminders of abuse and traumatic stress triggers. Trauma-informed care may address difficulties with treatment if dental staff adopt flexible approaches and work collaboratively with survivors to facilitate relational safety. (Please note, in this paper, 'survivors' refers to those sexually abused as children). Survivors want to access dental care but encounter difficulties resulting from histories of child sex abuse. These difficulties can be overcome when dental practitioners and staff take account of the underlying psychological trauma. Trauma-informed dental treatment prioritises individualised care by offering choice and control.
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Moreland-Capuia A, Dumornay NM, Mangus A, Ravichandran C, Greenfield SF, Ressler KJ. Establishing and validating a survey for trauma-informed, culturally responsive change across multiple systems. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Abstract
Aim
The purpose of the present study was to establish and validate the Survey for Trauma-Informed Systems Change (STISC), a measure of culturally responsive trauma-informed care (TIC) and services that can be administered to professionals in any field or industry.
Subject/methods
The current study with 262 respondents from judicial, healthcare, political, non-profit, and for-profit settings examined the internal consistency reliability and factor structure of the STISC.
Results
A total of 262 respondents from various industries accessed the pre-training survey. Seven of the 59 items were reassigned to alternate subscales and three subscales were merged following correlation analysis. Internal consistency reliability for subscales based on the final item assignments was good or excellent (lower 95% confidence limits for hierarchical omega ≥ 0.85). The root mean square error of approximation estimate for the confirmatory factor analysis based on final item assignments was acceptable (0.073; 90% CI 0.71, 0.76). Neither the comparative fit index value of 0.76 nor the Tucker–Lewis fit index value of 0.75 approached conventional thresholds for acceptable fit.
Conclusion
Given the absence of a validated alternative, this study supports use of the STISC tool to measure the degree of an individual’s trauma-informed knowledge and positive attitudes toward trauma-informed systems change, as well as trauma-informed practices in the workplace. Further study and refinement will aim to determine whether the STISC survey is sensitive to change, which will provide stronger support for the survey’s potential usefulness as a cost-effective method of standardizing trauma-informed systems change programs across multiple fields and industries.
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Bertram JE, Tokac U, Brauch A, Fish AF. Implementing a novel self-care clock strategy as part of a trauma awareness intervention in a university setting. Perspect Psychiatr Care 2022; 58:2612-2621. [PMID: 35478182 DOI: 10.1111/ppc.13101] [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: 01/28/2022] [Revised: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study compared post- and preintervention trauma-informed care attitudes, explored relationships among outcomes, and identified self-care behavior changes participants are willing to make. DESIGN AND METHODS A quasi-experimental study with content analysis was conducted with 96 adults that took part in a Trauma Awareness Intervention including a novel self-care clock. CONCLUSIONS Participants' trauma-informed care attitudes improved (p ≤ 0.05) compared to baseline and were positively related to their post-intervention compassion scores (p < 0.05). Qualitative analyses revealed self-awareness, self-care, empathy, applying a trauma lens, changing the narrative, and student-centeredness as the main themes in participants' responses. PRACTICAL IMPLICATIONS This university-based initiative had a positive impact on attitudes toward trauma and should be explored in other settings, as there is an unmet need for trauma-informed care strategies at the community level.
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Affiliation(s)
- Julie E Bertram
- College of Nursing, University of Missouri-St. Louis, Saint Louis, Missouri, USA
| | - Umit Tokac
- College of Nursing, University of Missouri-St. Louis, Saint Louis, Missouri, USA
| | - Allison Brauch
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Anne F Fish
- College of Nursing, University of Missouri-St. Louis, Saint Louis, Missouri, USA
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Henshaw LA. Building Trauma-Informed Approaches in Higher Education. Behav Sci (Basel) 2022; 12:368. [PMID: 36285937 PMCID: PMC9598185 DOI: 10.3390/bs12100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Trauma-informed approaches serve as an essential framework for human service organizations and are now being applied in education settings, including higher education institutions (HEIs). The increasing incidence of traumatic events, including the global pandemic of COVID-19 and the systemic violence against persons of color, has prompted HEIs to examine how culture and inclusivity are conceptualized in the curriculum and reflected in institutional policy and programming. Within this context, there is a need to identify how trauma-informed approaches at HEIs can be culturally responsive. This article briefly summarizes evidence supporting the rationale for trauma-informed approaches at HEIs and how culture has historically been addressed through cultural competency and cultural humility. Cultural sensitivity and responsiveness are then conceptualized from a trauma-informed lens as informed by the literature. Finally, key concepts and theory relevant to applying culturally responsive trauma-informed approaches at HEIs are defined, with recommendations for policy, research, and practice.
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Affiliation(s)
- Lisa A Henshaw
- Wurzweiler School of Social Work, Yeshiva University, New York, NY 10033, USA
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45
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Roberson MM, Lund E. School-Based Speech-Language Pathologists' Attitudes and Knowledge About Trauma-Informed Care. Lang Speech Hear Serv Sch 2022; 53:1117-1128. [PMID: 36054845 DOI: 10.1044/2022_lshss-21-00172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the attitudes and knowledge of school-based speech-language pathologists toward trauma-informed care. METHOD School-based speech-language pathologists (N = 116) completed the Attitudes Related to Trauma-Informed Care Scale Version 45 Education (ARTIC-45) survey via an online survey platform and provided information about their work experience, history with trauma training, and demographic variables. RESULTS Although speech-language pathologists had responses that, on average, aligned with trauma-informed perspectives, those perspectives varied and were not at ceiling. Characteristics such as age, years of experience, and foster care experience did not significantly influence the results, but self-rating of trauma-informed care knowledge did correlate with the ARTIC-45 survey. Participants who had engaged in trauma-informed care trainings had more trauma-informed perspectives and knowledge than participants who had not. CONCLUSIONS The results of this study provide preliminary evidence that trauma-informed care trainings may benefit those speech-language pathologists working with children who have experienced trauma. This study also provides preliminary evidence supporting the validity of the ARTIC-45 for use with speech-language pathologists.
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Affiliation(s)
- Mikayla M Roberson
- Davies School of Communication Sciences and Disorders, Texas Christian University, Fort Worth
| | - Emily Lund
- Davies School of Communication Sciences and Disorders, Texas Christian University, Fort Worth
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Avery J, Morris H, Jones A, Skouteris H, Deppeler J. Australian Educators' Perceptions and Attitudes Towards a Trauma-Responsive School-Wide Approach. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:771-785. [PMID: 35958717 PMCID: PMC9360270 DOI: 10.1007/s40653-021-00394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 06/15/2023]
Abstract
Staff perceptions and attitudes regarding the introduction of the Reframing Learning and Teaching Environments (ReLATE) trauma-responsive school-wide approach were investigated in three Catholic primary schools in Victoria, Australia. School leaders, teachers, and support staff were interviewed regarding their experiences of the approach either individually or in focus groups. Educator attitudes towards trauma-responsive education was evaluated using the ARTIC-ED Scale, prior to and after participating in the six-month intervention. Qualitative data were interpreted using ecological analysis of the themes arising guided by the trauma informed principles and frameworks of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Trauma Learning Policy Initiative (TLPI). Findings indicated significant shifts towards trauma-responsive practice following the introduction of ReLATE. Strong themes emerged relating to the influence of improved trauma knowledge on perceptions of student behavior, consequent reported adaptations to behavior management practices, strengthened sense of trust and respect in the school climate, the centrality of leadership to effect change, and importance of school-fit to program uptake. Strengths and limitations of ReLATE are considered, along with implications for teacher professional learning, the role of leadership in effecting change and significance of perceived school-fit and collaboration. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-021-00394-6.
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Affiliation(s)
- Julie Avery
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic Australia
| | - Heather Morris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic Australia
| | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic Australia
- School of Business, Warwick University, Coventry, UK
| | - Joanne Deppeler
- School of Education, Monash University, Melbourne, Vic Australia
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MacLochlainn J, Kirby K, McFadden P, Mallett J. An Evaluation of Whole-School Trauma-Informed Training Intervention Among Post-Primary School Personnel: A Mixed Methods Study. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:925-941. [PMID: 35958718 PMCID: PMC9360367 DOI: 10.1007/s40653-021-00432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Students' ability to reach their potential in school-both behaviourally and academically - is linked to their educator's knowledge of child and adolescent development, childhood adversity and trauma, and how these impact learning and behaviour. However, teacher pre-service training programmes often offer inadequate instruction to meet the needs of trauma-impacted students. The purpose of the study was to investigate the benefits of professional development training in trauma-informed approaches on school personnel attitudes and compassion fatigue. There is a paucity of research on whole-school trauma-informed approaches and most have methodological limitations via the absence of a control group. In addressing this gap, the study is one of the first to utilise a control group in the research design to ensure findings are robust. The study utilised a quasi-experimental wait-list control pre-post intervention design to evaluate the efficacy of trauma-informed professional development training. We compared attitudes and compassion fatigue among 216 school personnel (n = 98 intervention, n = 118 comparison) utilising the Attitudes Related to Trauma-Informed Care (ARTIC) scale and the Professional Quality of Life scale (Pro-QoL). Quantitative data was supplemented by qualitative focus group data. Findings demonstrated that school-personnel within the intervention group reported significant improvements in attitudes related to trauma-informed care, and a significant decrease in burnout at 6-month follow-up. Our findings demonstrate that with minimum training on the dynamics of trauma, personnel attached to a school can become more trauma-informed and have more favourable attitudes towards trauma-impacted students and consequently be less likely to experience burnout.
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Affiliation(s)
- Justin MacLochlainn
- School of Psychology, Ulster University, Cromore Road Coleraine campus, Co. Derry, Coleraine, BT52 1SA Northern Ireland
| | - Karen Kirby
- School of Psychology, Ulster University, Cromore Road Coleraine campus, Co. Derry, Coleraine, BT52 1SA Northern Ireland
| | - Paula McFadden
- School of Applied Social and Policy Sc. Institute for Research in Social Sciences, Magee campus, Derry, BT48 7JL Northern Ireland
| | - John Mallett
- School of Psychology, Ulster University, Cromore Road Coleraine campus, Co. Derry, Coleraine, BT52 1SA Northern Ireland
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Black KR, Collin-Vézina D, Brend D, Romano E. Trauma-informed attitudes in residential treatment settings: Staff, child and youth factors predicting adoption, maintenance and change over time. CHILD ABUSE & NEGLECT 2022; 130:105361. [PMID: 34686359 DOI: 10.1016/j.chiabu.2021.105361] [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] [Received: 02/03/2021] [Revised: 09/07/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Little is known about the benefits of implementing trauma-informed care (TIC) training programs for child welfare workers serving in out-of-home treatment settings, or about how staff, child and youth characteristics affect adoption of favorable attitudes towards TIC. OBJECTIVE This study aimed to understand how attitudes towards TIC changed over time for child welfare workers receiving training and monthly supervision sessions. PARTICIPANTS AND SETTING Child welfare workers (n = 429) serving juveniles mandated to protection or offender units (ages = 3-20 years), across 11 child protection agencies in Quebec, Canada. METHODS Participants completed the ARTIC-35 at pre-training, 6 months post-training, and 1 year follow-up. Multilevel mixed effect regression models were fit to examine outcomes for all subscales. RESULTS Participants reported small improvements in attitudes towards TIC at post-training and 1 year follow-up for subscales related to problematic child/youth behavior (β = 0.23-0.32, p's < 0.001). Multilevel modeling revealed that age group (adolescent), unit gender (boys) and legal mandate (offender) predicted higher pre-training TIC ratings for staff in management versus frontline positions across three subscales related to problematic child/youth behavior (β = 0.77-0.93, p's < 0.05) and two subscales related to trauma work and support needs (β = 0.66/0.84, p's < 0.05). CONCLUSIONS Results extend previous research demonstrating an association between TIC training and improved attitudes towards TIC over time, and highlight specific contexts in which frontline staff may experience more difficulty applying TIC-based principles than colleagues in management positions.
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Affiliation(s)
| | | | - Denise Brend
- Department of Applied Human Sciences, Concordia University, Canada
| | - Elisa Romano
- School of Psychology, University of Ottawa, Canada
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Boucher N, Darling-Fisher CS, Sinko L, Beck D, Granner J, Seng J. Psychometric Evaluation of the TIC Grade, a Self-Report Measure to Assess Youth Perceptions of the Quality of Trauma-Informed Care They Received. J Am Psychiatr Nurses Assoc 2022; 28:319-325. [PMID: 32907448 PMCID: PMC7943641 DOI: 10.1177/1078390320953896] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Agencies and clinical practices are beginning to provide trauma-informed care (TIC) to their clients. However, there are no measures to assess clients' perceptions of and satisfaction with the TIC care they have received. A 20-item questionnaire, the TIC Grade, was developed, based on the National Center for Trauma-Informed Care principles of TIC, to assess the patient or client perception of the TIC provided in settings that serve adolescents and emerging adults. OBJECTIVE The goal of this project was to evaluate the psychometric properties of the TIC Grade instrument and to make recommendations for use of the full measure and its short form-an overall letter grade. STUDY DESIGN The TIC Grade questionnaire was administered to youth over the age of 18 years from four community partners providing care to vulnerable young adults. Potential participants were offered questionnaires at the end of their visit. Those interested in participating left their completed anonymous questionnaire in a locked box to maintain confidentiality. Questionnaires were collected from 100 respondents; 95 were complete enough to include in analyses for psychometric evaluation. RESULTS The findings of this project support the reliability and usability of the 20-item TIC Grade measure to assess youth's perceptions of the quality of TIC they received. CONCLUSIONS This TIC-specific, behaviorally worded client report measure can assist service delivery organizations to assess their success at implementing TIC and to identify areas where further staff training and support are needed.
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Affiliation(s)
- Nicole Boucher
- Nicole Boucher, PhD, CPNP-PC, University of Michigan, Ann Arbor, MI, USA
| | | | - Laura Sinko
- Laura Sinko, PhD, RN, CCTS-I, University of Pennsylvania, Philadelphia, PA, USA
| | - Dana Beck
- Dana Beck, PhD, MSN, FNP-B University of Michigan, Ann Arbor, MI, USA
| | - Josie Granner
- Josie Granner, BSN, RN, University of Michigan, Ann Arbor, MI, USA
| | - Julia Seng
- Julia Seng, PhD, CNM, FAAN, University of Michigan, Ann Arbor, MI, USA
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Minne EP, Gorelik G. The Protective Role of Trauma Informed Attitudes on Perceived Stress Among Teachers and School Staff. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:275-283. [PMID: 34336083 PMCID: PMC8310395 DOI: 10.1007/s40653-021-00389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
Trauma-informed care (TIC), a system of behavioral treatment practices that focuses on understanding and responding to the effects of adverse experiences via empathic and non-punitive interactions, is a promising intervention for the treatment of academic and mental health problems among youth. However, the effect of TIC on caregivers themselves is uncertain. Even less is known about the relationship between TIC and the well-being of teachers and school staff. In the current study, we investigated the relationship between exposure to criminal victimization (a known predictor of stress), attitudes toward TIC, and perceived stress among a sample of public school teachers and staff members (N = 396). In line with our predictions, increased victimization was associated with increased perceived stress whereas TIC-favorable attitudes were associated with decreased perceived stress. In addition, older participants exhibited lower perceived stress than younger participants. We discuss the current study's limitations and the implications of the current findings for future research and mental health practice in schools.
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