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Zolnikov TR, Guerra JL, Furio F, Dennis J, Ortega C. A qualitative study understanding immigrant Latinas, violence, and available mental health care. DIALOGUES IN HEALTH 2023; 2:100112. [PMID: 38515490 PMCID: PMC10953983 DOI: 10.1016/j.dialog.2023.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 03/23/2024]
Abstract
Women from Latin American countries experience high levels of psychological and physical abuse and violence. Immigrant Latina women are often subjected to a patriarchal system in both family and government, which has resulted in a variety of complex and far-reaching outcomes. This qualitative study sought to understand the experiences of immigrant Latina women who were exposed to violence, as well as their access to mental health care. This study used 20 interviews with immigrant Latina women from El Salvador, Guatemala, and Mexico who had accessed mental health services in California. The primary themes that emerged from analysis of the data included motivating factors for seeking services (e.g., motherhood, community, hope, and mental health needs), barriers to accessing services (e.g., fatalism, marianismo, stigma, finances, language barriers, threats, abuse, and systemic insensitivity), and treatment and solutions (e.g., empathy, advocacy, and community approaches). These results appeared to be indicative of the importance of addressing sociopolitical, historical, and cultural trauma as an imperative component of effective treatment. In this context, the authors explore liberation psychology, a concept and approach that promotes social justice values and emphasizes the empowerment of immigrant Latina women in clinical practice. It is recommended that the historical sociocultural abuse of immigrant Latina women be thoughtfully considered and discussed in the therapeutic process to create lasting psychological change. Future research, policy efforts, and program development, including psychotherapeutic treatment modalities, should focus specifically on marginalized groups facing barriers to mental health care in order to increase access and effectiveness of treatment.
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Affiliation(s)
- Tara Rava Zolnikov
- California Southern University, School of Behavioral Sciences, Costa Mesa, CA, United States of America
- National University, Department of Community Health, San Diego, CA, United States of America
| | - Jose Luis Guerra
- California Southern University, School of Behavioral Sciences, Costa Mesa, CA, United States of America
| | - Frances Furio
- California State University, Sacramento, Division of Social Work, Sacramento, CA, United States of America
| | - Jessica Dennis
- California Southern University, School of Behavioral Sciences, Costa Mesa, CA, United States of America
| | - Carolyn Ortega
- California Southern University, School of Behavioral Sciences, Costa Mesa, CA, United States of America
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Koo A, Irwin J, Sturgis M, Schwartz A, Hasnain M, Davis E, Stillerman A. Is Academic Medicine Prepared to Teach About the Intersection of Childhood Experiences and Health? An Exploratory Survey of Faculty. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:225-233. [PMID: 36877822 DOI: 10.1097/ceh.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Childhood experiences affect health across the lifespan. Evidence-based strategies targeting early-life stress are emerging. Nevertheless, faculty physicians' preparation to incorporate this science into practice has not been well studied. This study explores medical faculty knowledge and beliefs, timing and route of knowledge acquisition, perceived relevance and application of study topics, and characteristics associated with concept mastery. METHODS The authors developed and administered an exploratory survey to faculty from six departments at two medical schools. The team analyzed responses using quantitative and qualitative methods. RESULTS Eighty-one (8.8%) eligible faculty completed the survey. Of respondents, 53 (65.4%) achieved high knowledge, 34 (42.0%) high beliefs, and 42 (59.1%) high concept exposure question scores, but only 6 (7.4%) through a formal route. Although 78 (96.8%) respondents indicated that survey concepts are relevant, only 18 (22.2%) reported fully incorporating them in their work, and 48 (59.2%) identified the need for additional coaching. Respondents reporting full incorporation were significantly more likely to attain high concept exposure scores (17 respondents, 94.4%, versus 25 respondents, 39.7%, P < .001). Quantitative and qualitative analysis highlighted limited respondent awareness of trauma prevalence among health care workers, lack of familiarity with interventions, and time and resource challenges addressing childhood adversity. DISCUSSION Although survey respondents had some familiarity with study concepts and perceived their relevance, most are not fully applying them. Results suggest that exposure to study concepts is associated with full incorporation. Therefore, intentional faculty development is essential to prepare faculty to include this science in practice.
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Affiliation(s)
- Angie Koo
- Dr. Koo : PGY-2 Resident Physician in the Department of Psychiatry, Olive View-University of California Los Angeles Medical Center, Sylmar, CA. Dr. Irwin : PGY-1 Resident Physician in the Department of Pediatrics, University of California San Francisco, San Francisco, CA. Dr. Sturgis : PGY-1 Resident in the Department of Urology, Rush Medical College, Chicago, IL. Dr. Schwartz : Michael Reese Endowed Professor and Interim Head in the Department of Medical Education, Research Professor and Director of the Pediatrics Research Core in the Department of Pediatrics, and JD Candidate in the Chicago School of Law, University of Illinois Chicago, Chicago, IL. Dr. Hasnain : Professor and Associate Head of Faculty Development & Research in the Department of Family and Community Medicine, Associate Dean for Faculty Development, Director of Patientcentered Medicine Scholars Program, and Co-Director, ENGAGE-IL University of Illinois Chicago, Chicago, IL. Dr. Davis : Associate Professor in the Department of Internal Medicine, Rush University Medical Center, Chicago, IL. Dr. Stillerman : Clinical Assistant Professor of Family and Community Medicine and Medical Director of the Office of Community Engagement/Mile Square School Health Centers, University of Illinois Chicago, and Co-Founder of The Center for Trauma, Health Equity, and Neurobiology (THEN), Chicago, IL
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3
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Selwyn CN, Lathan EC, Platt T, Minchew L. How Healthcare Providers Reconcile Bad Things Happening to Good Patients: The Role of Just World Beliefs in Attitudes toward Trauma-Informed Care. J Trauma Dissociation 2023; 24:640-654. [PMID: 36987779 DOI: 10.1080/15299732.2023.2195404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/21/2023] [Indexed: 03/30/2023]
Abstract
Despite prevalent trauma exposure among patients seeking health care, as well as widespread frameworks for enacting trauma-informed care, the uptake of trauma-informed practices such as trauma screening and referral among health-care providers remains relatively low. The current study sought to assess the roles of health-care providers' personal histories of adverse childhood experiences (ACEs) and personal beliefs in the just-world hypothesis in understanding their attitudes toward trauma-informed care. Advanced practice graduate nursing students (N = 180; M age = 34.6 years) completed a self-reported survey assessing their personal history of ACEs, global belief in a just world, and attitudes related to trauma-informed care. Results indicated the relation between providers' ACEs and attitudes toward trauma-informed care was fully mediated by their beliefs in a just world, such that providers reporting higher ACEs scores also report greater endorsement of attitudes consistent with trauma-informed care due to less belief in a just world. Implications for both health-care providers' themselves and cultural shifts necessary for provision of trauma-informed health care are discussed.
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Affiliation(s)
- Candice N Selwyn
- Department of Community Mental Health Nursing, University of South Alabama, Mobile, Alabama, USA
| | - Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Terrie Platt
- Department of Maternal Child Nursing, University of South Alabama, Mobile, Alabama, USA
| | - Leigh Minchew
- Department of Maternal Child Nursing, University of South Alabama, Mobile, Alabama, USA
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4
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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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5
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Berman S, Brown T, Mizelle C, Diep T, Gerber MR, Jelley M, Potter LA, Rush P, Sciolla A, Stillerman A, Trennepohl C, Weil A, Potter J. Roadmap for Trauma-Informed Medical Education: Introducing an Essential Competency Set. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:882-888. [PMID: 36862618 DOI: 10.1097/acm.0000000000005196] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Research has established that trauma is nearly universal and a root cause of numerous health and social problems, including 6 of the 10 leading causes of death, with devastating consequences across the life course. Scientific evidence now recognizes the complex injurious nature of structural and historical trauma (i.e., racism, discrimination, sexism, poverty, and community violence). Meanwhile, many physicians and trainees grapple with their own trauma histories and face direct and secondary traumatization on the job. These findings substantiate the profound impact of trauma on the brain and body and why trauma training is critical to the education and practice of physicians. However, a critical lag remains in translating essential research insights into clinical teaching and care. Recognizing this gap, the National Collaborative on Trauma-Informed Health Care Education and Research (TIHCER) formed a task force charged with developing and validating a summary of core trauma-related knowledge and skills for physicians. In 2022, TIHCER released the first-ever validated set of trauma-informed care competencies for undergraduate medical education. The task force focused on undergraduate medical education so that all physicians would be taught these foundational concepts and skills from the outset of training, recognizing that faculty development is needed to achieve this goal. In this Scholarly Perspective, the authors offer a roadmap for implementation of trauma-informed care competencies starting with medical school leadership, a faculty-student advisory committee, and sample resources. Medical schools can use the trauma-informed care competencies as a scaffold to customize integration of curricular content (what is taught) and efforts to transform the learning and clinical environments (how it is taught). Using the lens of trauma will ground undergraduate medical training in the latest science about the pathophysiology of disease and provide a framework to address many of our greatest challenges, including health disparities and professional burnout.
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Affiliation(s)
- Sarah Berman
- S. Berman is a third-year psychiatry resident, Cambridge Health Alliance, Cambridge, Massachusetts; ORCID: https://orcid.org/0000-0003-1037-8798
| | - Taylor Brown
- T. Brown is a second-year emergency medicine resident, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-1893-9142
| | - Cecelia Mizelle
- C. Mizelle is a third-year medical student, University of North Carolina, Chapel Hill, North Carolina; ORCID: http://orcid.org/0000-0003-4401-1927
| | - Thang Diep
- T. Diep is a youth engagement specialist, Center for the Pacific Asian Family, Los Angeles, California; ORCID: https://orcid.org/0000-0002-5256-0320
| | - Megan R Gerber
- M.R. Gerber is professor of medicine, Albany Medical College, Albany, New York; ORCID: https://orcid.org/0000-0002-8444-5554
| | - Martina Jelley
- M. Jelley is professor of medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; ORCID: https://orcid.org/0000-0002-7816-2865
| | - Laura A Potter
- L.A. Potter is a third-year medical student, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/0000-0001-6912-9214
| | - Patricia Rush
- P. Rush is codirector, Center for Collaborative Study of Trauma, Health Equity, and Neurobiology (THEN), Chicago, Illinois; ORCID: https://orcid.org/0000-0001-9775-7541
| | - Andres Sciolla
- A. Sciolla is professor of psychiatry, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/0000-0002-0713-2183
| | - Audrey Stillerman
- A. Stillerman is assistant professor of family medicine, University of Illinois, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0713-2183
| | - Christopher Trennepohl
- C. Trennepohl is a second-year psychiatry resident, University of Illinois, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1745-0908
| | - Amy Weil
- A. Weil is professor of medicine and social medicine, University of North Carolina, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-7671-0397
| | - Jennifer Potter
- J. Potter is professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-6221-8895
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Severson E, Olson JK, Hyde A, Brémault-Phillips S, Spiers J, King S, Bick J, Lipschutz R, Verstraeten BSE, Olson DM. Experiencing Trauma During or Before Pregnancy: Qualitative Secondary Analysis After Two Disasters. Matern Child Health J 2023; 27:944-953. [PMID: 36897470 DOI: 10.1007/s10995-023-03625-4] [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] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Despite the existing knowledge about stress, trauma and pregnancy and maternal stress during natural disasters, little is known about what types of trauma pregnant or preconception women experience during these disasters. In May 2016, the worst natural disaster in modern Canadian history required the evacuation of nearly 90,000 residents of the Fort McMurray Wood Buffalo (FMWB) area of northern Alberta. Among the thousands of evacuees were an estimated 1850 women who were pregnant or soon to conceive. In August 2017, Hurricane Harvey devastated areas of the United States including Texas, with 30,000 people forced to flee their homes due to the intense flooding. OBJECTIVE To explore immediate and past traumatic experiences of pregnant or preconception women who experienced one of two natural disasters (a wildfire and a hurricane) as captured in their expressive writing. Research questions were: (1) What trauma did pregnant or preconception women experience during the fire and the hurricane? (2) What past traumatic experiences, apart from the disasters, did the women discuss in their expressive writing? METHODS A qualitative secondary analysis of expressive writing using thematic content analysis was conducted on the expressive writing of 50 pregnant or preconception women who experienced the 2016 Fort McMurray Wood Buffalo Wildfire (n = 25) and the 2017 Houston Hurricane Harvey (n = 25) Narrative data in the form of expressive writing entries from participants of two primary studies were thematically analyzed. One of the expressive writing questions was used in this analysis: "What is the most traumatic, upsetting experience of your entire life, especially that you have never discussed in great detail with others?" NVivo 12 supported thematic content analysis. RESULTS For some women, the disasters elicited immense fear and anxiety that surpassed previous traumatic life events. Others, however, disclosed significant past traumas that continue to impact them, including betrayal by a loved one, abuse, maternal health complications, and illness. CONCLUSION We recommend a strengths-based and trauma-informed care approach in both maternal health and post-disaster relief care.
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Affiliation(s)
- Emily Severson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Joanne K Olson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ashley Hyde
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jude Spiers
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Suzanne King
- Douglas Hospital Research Centre & Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Johanna Bick
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Rebecca Lipschutz
- Department of Clinical Psychology, University of Houston, Houston, TX, USA
| | | | - David M Olson
- Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada.
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Schwartzman JM, Williams ZJ, Paterson AV, Jacobs AX, Corbett BA. Community-guided measurement-based care for autistic youth and adults receiving psychotherapy: A conceptual overview and pilot implementation study of MBC-AUT. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221143587. [PMID: 36632662 PMCID: PMC10333447 DOI: 10.1177/13623613221143587] [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: 01/13/2023]
Abstract
LAY ABSTRACT Autistic youth and adults are more likely to experience psychiatric symptoms (e.g. depression, anxiety) and to use psychiatric services than non-autistic people, yet research on evidence-based approaches to enhance psychiatric care for autistic people is limited. Measurement-based care is an evidence-based approach to psychotherapy that improves outcomes for clients, clinicians, and organizations by routinely administering and evaluating measures to clients. Despite this, research on measurement-based care systems for autistic clients is sparse. To address this gap, we developed an autism-adapted measurement-based care (MBC-AUT) system for and with autistic people and pilot tested the system in an outpatient psychiatry clinic to investigate the preliminary feasibility, acceptability, benefits, and barriers to this system for clients and clinicians. Findings suggested that the MBC-AUT system was a feasible and acceptable system for the first 18 autistic youth, their caregivers, and autistic adults to use the system. In semi-structured interviews, clients and clinicians discussed the benefits of the MBC-AUT system to various therapeutic processes, as well as several important barriers to the use of the system. We offer potential solutions to address these barriers and to reduce client and clinician burden, and propose future directions for this line of research to increase access to more autistic people. As autistic clients continue to seek psychological services amid social landscapes of increasing complexity (e.g. COVID-19 pandemic), efforts to enhance the delivery of psychotherapy for this population are critical.
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Affiliation(s)
| | | | | | | | - Blythe A Corbett
- Vanderbilt University Medical Center, USA.,Vanderbilt University, USA
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Ford-Gilboe M, Varcoe C, Wuest J, Campbell J, Pajot M, Heslop L, Perrin N. Trajectories of Depression, Post-Traumatic Stress, and Chronic Pain Among Women Who Have Separated From an Abusive Partner: A Longitudinal Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1540-NP1568. [PMID: 35512192 PMCID: PMC9709554 DOI: 10.1177/08862605221090595] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing.
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Affiliation(s)
- Marilyn Ford-Gilboe
- Arthur Labatt Family School of
Nursing, Western
University London, ON, Canada
| | - Colleen Varcoe
- School of Nursing,
University
of British Columbia, Vancouver, BC,
Canada
| | - Judith Wuest
- Faculty of Nursing,
University
of New Brunswick, Fredericton, NB,
Canada
| | | | - Michelle Pajot
- Arthur Labatt Family School of
Nursing, Western
University London, ON, Canada
| | - Lisa Heslop
- Arthur Labatt Family School of
Nursing, Western
University London, ON, Canada
| | - Nancy Perrin
- Johns Hopkins University School of
Nursing, Baltimore, MA, USA
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Sherin KM, Stillerman AJ, Chandrasekar L, Went NS, Niebuhr DW. Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine. AJPM FOCUS 2022; 1:100039. [PMID: 37791246 PMCID: PMC10546534 DOI: 10.1016/j.focus.2022.100039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Introduction Childhood adversity profoundly influences health, well-being, and longevity. Prevention and interventions to mitigate its harmful effects are essential. The American College of Preventive Medicine reviewed the research literature and other professional and governmental statements about adverse childhood experiences to support the development of evidence-based and population-focused recommendations about prevention, screening, and mitigation interventions for childhood adversity. Methods We performed an umbrella review to find, assess and synthesize the evidence from systematic reviews focused on 3 key questions: the prevention or mitigation of the effects of adverse childhood experiences; the association of screening for adverse childhood experiences with various benefits, including health outcomes; and the effectiveness and harms of interventions in individuals with elevated adverse childhood experience scores. Adverse childhood experience‒related recommendations from 6 professional and governmental organizations were also reviewed. On the basis of these reviews, the American College of Preventive Medicine developed a position statement through consensus. Results A total of 8 systematic reviews, including 260 studies in total, were identified and combined with adverse childhood experiences‒related recommendations from 6 professional organizations to support the American College of Preventive Medicine recommendations. The American College of Preventive Medicine offers 7 adverse childhood experiences‒related recommendations focused on screening, education/training, policy/practice, and research: 2 are evidence-based, and 5 are based on expert opinion. Notably, regarding secondary prevention of adverse childhood experiences, the American College of Preventive Medicine endorses population-level surveillance and research around childhood adversity but not adverse childhood experience screening in individual clinical encounters. Conclusions Despite limitations in the heterogeneity and quality of the published systematic reviews, the extant literature supports the American College of Preventive Medicine recommendations. Interventions to enhance protective factors and prevent and mitigate the consequences of adverse childhood experiences and other childhood adversity are promising and require further implementation and research.
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Affiliation(s)
- Kevin M. Sherin
- Department of Family Medicine & Rural Health, Florida State University College of Medicine, Orlando, Florida
- Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida
| | - Audrey J. Stillerman
- Department of Family and Community Medicine, School Health Centers, Office of Community Engagement and Neighborhood Health Partnerships, University of Illinois Chicago, Chicago, Illinois
| | - Laxmipradha Chandrasekar
- Family Medicine Residency, AdventHealth Sebring, Sebring, Florida
- Clinical Operations, Clinica Mi Salud, Orlando, Florida
| | - Nils S. Went
- Collaborative Care Clinician, Clinica Mi Salud, Orlando, Florida
- Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, New York
| | - David W. Niebuhr
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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10
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Gum AM, Goldsworthy M, Guerra L, Salloum A, Grau M, Gottstein S, Horvath C, Fields A, Crowder J, Holley R, Ruth LJ, Hanna K. Trauma-informed patient and public-engaged research: Development and evaluation of an online training programme. Health Expect 2022; 26:388-398. [PMID: 36345789 PMCID: PMC9854293 DOI: 10.1111/hex.13668] [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: 07/28/2022] [Revised: 10/17/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION As patients, members of the public, and professional stakeholders engage in co-producing health-related research, an important issue to consider is trauma. Trauma is very common and associated with a wide range of physical and behavioural health conditions. Thus, it may benefit research partnerships to consider its impact on their stakeholders as well as its relevance to the health condition under study. The aims of this article are to describe the development and evaluation of a training programme that applied principles of trauma-informed care (TIC) to patient- and public-engaged research. METHODS A research partnership focused on addressing trauma in primary care patients ('myPATH') explicitly incorporated TIC into its formation, governance document and collaborative processes, and developed and evaluated a free 3-credit continuing education online training. The training was presented by 11 partners (5 professionals, 6 patients) and included academic content and lived experiences. RESULTS Training participants (N = 46) positively rated achievement of learning objectives and speakers' performance (ranging from 4.39 to 4.74 on a 5-point scale). The most salient themes from open-ended comments were that training was informative (n = 12) and that lived experiences shared by patient partners were impactful (n = 10). Suggestions were primarily technical or logistical. CONCLUSION This preliminary evaluation indicates that it is possible to incorporate TIC principles into a research partnership's collaborative processes and training about these topics is well-received. Learning about trauma and TIC may benefit research partnerships that involve patients and public stakeholders studying a wide range of health conditions, potentially improving how stakeholders engage in co-producing research as well as producing research that addresses how trauma relates to their health condition under study. PATIENT OR PUBLIC CONTRIBUTION The myPATH Partnership includes 22 individuals with professional and lived experiences related to trauma (https://www.usf.edu/cbcs/mhlp/centers/mypath/); nine partners were engaged due to personal experiences with trauma; other partners are community-based providers and researchers. All partners contributed ideas that led to trauma-informed research strategies and training. Eleven partners (5 professionals, 6 patients) presented the training, and 12 partners (8 professionals, 4 patients) contributed to this article and chose to be named as authors.
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Affiliation(s)
- Amber M. Gum
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,Department of Mental Health Law & PolicyUniversity of South FloridaTampaFloridaUSA,Department of Internal MedicineUniversity of South FloridaTampaFloridaUSA
| | - Mary Goldsworthy
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,Department of Mental Health Law & PolicyUniversity of South FloridaTampaFloridaUSA
| | - Lucy Guerra
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,Department of Internal MedicineUniversity of South FloridaTampaFloridaUSA
| | - Alison Salloum
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,School of Social WorkUniversity of South FloridaTampaFloridaUSA
| | - Meredith Grau
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,Crisis Center of Tampa BayTampaFloridaUSA
| | - Sheri Gottstein
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA
| | - Carol Horvath
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA
| | - Annanora Fields
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA
| | - Johnny Crowder
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA
| | - Robb Holley
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,Department of Mental Health Law & PolicyUniversity of South FloridaTampaFloridaUSA
| | - Leigh J. Ruth
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,Department of Psychiatry and Behavioral NeurosciencesUniversity of South FloridaTampaFloridaUSA
| | - Karim Hanna
- myPATH PartnershipUniversity of South FloridaTampaFloridaUSA,Department of Family MedicineUniversity of South FloridaTampaFloridaUSA
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11
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Recent Stressful Life Events, Lifetime Traumatic Events, Missed Visits, and Antiretroviral Adherence Among Black Women With HIV in the Southeastern United States: A Cross-sectional Study. J Assoc Nurses AIDS Care 2022; 33:593-604. [PMID: 36094470 DOI: 10.1097/jnc.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Lifetime traumatic events are prevalent among people with HIV and consistently associated with deleterious HIV outcomes. Yet, little is known about the impact of recent stressful events on health outcomes among Black women with HIV (WWH). This cross-sectional study assessed the prevalence of recent stressful events and lifetime traumatic events and their association with HIV outcomes in Black WWH (n = 200) in the Southeastern United States. We evaluated the association between stressful events and HIV outcomes using chi-square tests and unadjusted and adjusted logistic regression analyses. In the unadjusted analyses, missed visits were associated with higher odds of recent stressful events (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.04-1.16) and lifetime traumatic events (OR 1.15, 95% CI 1.05-1.26). In the adjusted analysis, exposure to recent stressful events was independently associated with missed visits (adjusted OR 1.08, 95% CI 1.01-1.15). Interventions addressing recent stressful events are warranted.
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12
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Anand P, Wilson J, Carter B, Bronstein A, Schwartz A, Harrington B, Adams T, Saine ME, Norris A, Metzger D, Short WR, Torgersen J. Clinic screening for adverse childhood experiences in people living with HIV to Improve Care Delivery. AIDS Care 2022; 34:1094-1102. [PMID: 34292107 DOI: 10.1080/09540121.2021.1956416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Adverse childhood experiences (ACEs) are associated with negative health outcomes; however, screening for ACEs is not routinely performed among people living with HIV (PLWH). We conducted a single-center, cross-sectional pilot study to define the (1) prevalence of ACEs in PLWH and (2) acceptability of ACEs screening in routine out-patient clinical care. One hundred participants completed screening: median age of participants was 49 years (interquartile range: 38.5-59.5), 73% male, 66% Non-Hispanic Black/African American, and 47% gay/lesbian. Clinically significant ACEs score, defined as ≥4, was reported in 51%. High ACEs score was more common among participants <50 years old (64.7% vs. 36.7%; p < 0.01), but the prevalence of ACEs ≥4 did not differ by gender, race, ethnicity, or sexual orientation. Among participants with ≥4 ACEs, 44.4% screened negative on both PHQ-9 and PC-PTSD screens. The majority of participants (89%) reported a positive experience with ACEs screening. The prevalence of clinically significant ACEs in this clinic population of PLWH was more than twice that reported in the general population. Routine ACEs screening can improve delivery of trauma-informed care in the HIV primary care setting.
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Affiliation(s)
- Priyanka Anand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jennifer Wilson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Bryce Carter
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Abby Bronstein
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Alexis Schwartz
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | | | - Tracey Adams
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - M Elle Saine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anne Norris
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William R Short
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessie Torgersen
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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13
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Sachdeva J, Nagle Yang S, Gopalan P, Worley LLM, Mittal L, Shirvani N, Spada M, Albertini E, Shenai N, Moore Simas TA, Byatt N. Ensuring Trauma Informed Care in the Obstetric Setting: A vital role for the Psychiatrist. J Acad Consult Liaison Psychiatry 2022; 63:485-496. [PMID: 35513261 DOI: 10.1016/j.jaclp.2022.04.005] [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: 02/03/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Trauma is highly prevalent, and women are twice as likely as men to develop post-traumatic stress disorder following a traumatic exposure. Consequently, many women entering the perinatal period have trauma histories. In the perinatal period, a trauma history, can negatively impact treatment engagement and adversely affect the experience of pregnancy, postpartum and parenting. A trauma informed care approach can mitigate these effects. OBJECTIVES This review aims to summarize literature that can aid psychiatrists in 1) identifying signs and symptoms of trauma in perinatal women 2) integrating elements of trauma informed care into perinatal mental health care, and 3) offering interventions that can minimize adverse outcomes for perinatal women and their children. METHODS A PubMed search was conducted with keywords including trauma, pregnancy, perinatal, post-traumatic stress disorder (PTSD), postpartum PTSD, trauma informed care. RESULTS Perinatal care, given its somewhat invasive nature, has the potential to traumatize or cause re-traumatization. Trauma related disorders are common and can present or worsen in the perinatal period. Trauma can manifest in multiple forms in this population, including exacerbation of pre-existing PTSD, new onset acute stress disorder in the perinatal period or postpartum PTSD secondary to traumatic childbirth. Unaddressed trauma can adversely affect the experience of pregnancy, postpartum and parenting. Psychiatrists caring for women in the perinatal period, are in an ideal position to screen for trauma and offer appropriate intervention. A trauma informed approach to obstetric care can help clinical teams respond to the unique trauma-related challenges that can arise during obstetric care. Trauma informed care, with its emphasis on establishing a culture of safety, transparency, trustworthiness, collaboration, and mutuality can empower health care providers and systems with powerful tools to respond to trauma and its myriad effects in a strengths-based manner. By applying a trauma-informed lens, psychiatrists can help their obstetric colleagues provide patient-centered compassionate care and treatment. CONCLUSIONS Applying a trauma informed approach to evaluation and treatment of perinatal populations could decrease the toll trauma has on affected women and their children.
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Affiliation(s)
- Jyoti Sachdeva
- Associate Professor of Psychiatry and Obstetrics and Gynecology, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, 260 Stetson St. Suite 3200, Cincinnati, OH 45219.
| | - Sarah Nagle Yang
- Associate Professor of Psychiatry, University of Colorado School of Medicine
| | - Priya Gopalan
- Associate Professor of Psychiatry, University of Pittsburgh School of Medicine
| | - Linda L M Worley
- Professor of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences
| | - Leena Mittal
- Chief, Division of Women's Mental Health , Brigham and Women's Hospital , Instructor of Psychiatry, Harvard Medical School
| | | | - Meredith Spada
- Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Neeta Shenai
- Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine
| | - Tiffany A Moore Simas
- Professor of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Health
| | - Nancy Byatt
- Professor with Tenure of Psychiatry, Obstetrics & Gynecology and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Heal
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14
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Drake SA, Burton C. Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective. JOURNAL OF FORENSIC NURSING 2022; 18:85-90. [PMID: 35143439 DOI: 10.1097/jfn.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Forensic nurses engaged in medicolegal death investigations experience trauma-induced responses in responding to, investigating, and documenting sudden unexpected deaths. The trauma of these repeated experiences often results in diminished performance, job dissatisfaction, and burnout. The principles of trauma-informed care are not new but have not been incorporated into death investigation practices. When coupled with medicolegal death investigation procedures, application of these principles can help to alleviate distress for forensic nurses, colleagues, and decedents of concerned families. This case series illustrates how the principles of trauma-informed care can be implemented to enhance communication, deescalate emotional or threatening situations, and prevent retraumatization in the context of medicolegal death investigations.
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Affiliation(s)
- Stacy A Drake
- Author Affiliations:Texas A&M University College of Nursing
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15
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Interpersonal violence and painful bladder symptoms in community-dwelling midlife to older women. Am J Obstet Gynecol 2022; 226:230.e1-230.e10. [PMID: 34555321 PMCID: PMC8923635 DOI: 10.1016/j.ajog.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/27/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Women are more likely to present with genitourinary complaints immediately after exposure to interpersonal violence, but little is known about the long-term effects of violence on women's urologic health, including their susceptibility to bladder pain and infections. OBJECTIVE To determine whether lifetime interpersonal violence exposure and current posttraumatic stress disorder (PTSD) symptoms are associated with the prevalence or severity of painful bladder symptoms and a greater lifetime history of antibiotic-treated urinary tract infections in community-dwelling midlife and older women. STUDY DESIGN We examined the cross-sectional data from a multiethnic cohort of community-dwelling women aged 40 to 80 years enrolled in a northern California integrated healthcare system. Women completed structured self-report questionnaires about their past exposure to physical and verbal/emotional intimate partner violence and sexual assault. The symptoms of PTSD were assessed using the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Civilian version. Additional structured self-report measures assessed the current bladder pain, other lower urinary tract symptoms, and the history of antibiotic-treated urinary tract infections. Multivariable logistic regression models examined self-reported interpersonal violence exposure history and current PTSD symptoms in relation to current bladder pain and antibiotic-treated urinary tract infection history. RESULTS Among 1974 women (39% non-Latina White, 21% Black, 20% Latina, and 19% Asian), 22% reported lifetime interpersonal violence exposure, 22% reported bladder pain, and 60% reported a history of ever having an antibiotic-treated urinary tract infection. Lifetime experiences of sexual assault (odds ratio, 1.39; [95% confidence interval, 1.02-1.88]) and current PTSD symptoms (odds ratio, 1.96; [95% confidence interval, 1.45-2.65]) were associated with current bladder pain. A lifetime experience of physical intimate partner violence was associated with having a urinary tract infection at any time in life previously (odds ratio, 1.38; [95% confidence interval, 1.00-1.86]), as was emotional intimate partner violence (odds ratio, 1.88; [95% confidence interval, 1.43-2.48]), sexual assault (odds ratio, 1.44; [95% confidence interval, 1.09-1.91]), and current PTSD symptoms (odds ratio, 1.54; [95% confidence interval, 1.16-2.03]). CONCLUSION In this ethnically diverse, community-based cohort, lifetime interpersonal violence exposures and current PTSD symptoms were independently associated with current bladder pain and the lifetime history of antibiotic-treated urinary tract infections in midlife to older women. The findings suggest that interpersonal violence and PTSD symptoms may be underrecognized markers of risk for urologic pain and infections in women, highlighting a need for trauma-informed care of these issues.
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16
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Chin MH. New Horizons-Addressing Healthcare Disparities in Endocrine Disease: Bias, Science, and Patient Care. J Clin Endocrinol Metab 2021; 106:e4887-e4902. [PMID: 33837415 PMCID: PMC8083316 DOI: 10.1210/clinem/dgab229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.
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Affiliation(s)
- Marshall H Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago
- Corresponding author contact information: Marshall H. Chin, MD, MPH, University of Chicago, Section of General Internal Medicine, 5841 South Maryland Avenue, MC2007, Chicago, Illinois 60637 USA, (773) 702-4769 (telephone), (773) 834-2238 (fax), (e-mail)
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17
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Willie TC, Alexander KA, Kershaw T, Campbell JC, Stockman JK. No Longer the Exception, but the Standard: Integrating Trauma-Informed Policy and Pre-exposure Prophylaxis Implementation for Women. Womens Health Issues 2021; 31:415-419. [PMID: 34175198 PMCID: PMC8448947 DOI: 10.1016/j.whi.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | - Trace Kershaw
- Department of Social and Behavioral Sciences, New Haven, Connecticut
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, California
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18
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Davis K, Dawson-Rose C, Cuca YP, Shumway M, Machtinger E. Ending intimate partner violence among women living with HIV: How attachment and HIV stigma inform understanding and intervention. SOCIAL WORK IN HEALTH CARE 2021; 60:543-560. [PMID: 34396939 DOI: 10.1080/00981389.2021.1963026] [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: 08/30/2020] [Revised: 06/30/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
This mixed-methods, exploratory study examined why women living with HIV (WLHIV) stay in intimate partner violence (IPV) relationships and what helps end IPV in their lives. WLHIV (n = 108) who experienced IPV and were patients at two HIV primary care clinics in San Francisco completed quantitative surveys; 15 participants also completed a qualitative interview. Qualitative data showed HIV stigma was the most cited reason for staying in an IPV relationship, followed by substance use, and then by themes of attachment insecurity. Quantitative data indicated that most participants accessed HIV services and rated them as more helpful than other community resources to end IPV in their lives. Enduring attachment relationships with HIV medical and social service providers and their attachment-enhancing actions and attributes were critical to participants addressing IPV and coping with HIV stigma. This study highlights the important role that HIV providers and clinics can play in addressing IPV among WLHIV.
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Affiliation(s)
- Katy Davis
- Department of Community Health Systems, School of Nursing, University of California, UCSF School of Nursing, San Francisco, California, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, UCSF School of Nursing, San Francisco, California, USA
| | - Yvette P Cuca
- Department of Community Health Systems, School of Nursing, University of California, UCSF School of Nursing, San Francisco, California, USA
| | - Martha Shumway
- Department of Psychiatry, University of California, UCSF Department of Psychiatry, San Francisco, California, USA
| | - Edward Machtinger
- UCSF Division of Internal Medicine, Department of Medicine, Center to Advance Trauma-informed Care, UCSF School of Medicine, San Francisco, California, USA
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19
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20
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Gargano LM, Locke SH, Alper HE, Brite J. Hospitalizations among World Trade Center Health Registry Enrollees Who Were under 18 Years of Age on 9/11, 2001-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147527. [PMID: 34299982 PMCID: PMC8303493 DOI: 10.3390/ijerph18147527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/02/2023]
Abstract
Much of the literature on hospitalizations post-September 11, 2001 (9/11) focuses on adults but little is known about post-9/11 hospitalizations among children. Data for World Trade Center Health Registry enrollees who were under 18-years old on 9/11 were linked to New York State hospitalization data to identify hospitalizations from enrollment (2003–2004) to December 31, 2016. Logistic regression was used to analyze factors associated with hospitalization. Of the 3151 enrollees under age 18 on 9/11, 243 (7.7%) had at least one 9/11-related physical health hospitalization and 279 (8.9%) had at least one 9/11-related mental health hospitalization. Individuals of non-White race, those living in New York City Housing Authority housing, those exposed to the dust cloud on 9/11, and those with probable 9/11-related PTSD symptoms were more likely to be hospitalized for a 9/11-related physical health condition. Older age and having probable 9/11-related PTSD symptoms at baseline were associated with being hospitalized for a 9/11-related mental health condition. Dust cloud exposure on 9/11 and PTSD symptoms were associated with hospitalizations among those exposed to 9/11 as children. Racial minorities and children living in public housing were at greater risk of hospitalization. Continued monitoring of this population and understanding the interplay of socioeconomic factors and disaster exposure will be important to understanding the long-term effects of 9/11.
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Affiliation(s)
| | - Sean H. Locke
- Correspondence: ; Tel.: +1-718-786-4452; Fax: +1-718-786-4006
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21
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Buzi RS. Obstetric Trauma-Informed Care: Pregnant Adolescents' Voices. J Pediatr Adolesc Gynecol 2021; 34:279-280. [PMID: 33934844 DOI: 10.1016/j.jpag.2021.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 10/21/2022]
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22
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Goldstein E, Topitzes J, Benton SF, Sarino KP. Evaluation of a Motivation-Based Intervention to Reduce Health Risk Behaviors among Black Primary Care Patients with Adverse Childhood Experiences. Perm J 2021; 24:1-9. [PMID: 33482960 DOI: 10.7812/tpp/19.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Considerable evidence suggests that greater attention should be paid to the impact of trauma among low-income, racial/ethnic minority patients living in urban communities. The goal of this article is to evaluate a 2-session, motivational intervention designed to motivate a change in health risk behaviors among low-income, self-identified Black/African American patients with adverse childhood experiences (ACEs). METHODS Qualitative self-reported data described helpful aspects of the intervention and those that could be improved. Eligible participants with 1 or more ACEs being seen in a community-based clinic were interviewed by a mental health clinician researcher for 2 in-person sessions scheduled 1 month apart. Content analysis was performed using a general inductive approach to identify core themes. RESULTS In total, 36 of 40 participants completed both sessions, with the majority reporting a high rate of satisfaction. Participants emphasized the importance of talking with a trained professional who could listen without judgment, understand patient challenges, clarify patient goals, and facilitate behavior change plans. Suggestions for improvement included modifying structure and content, enhancing clinic environment, improving linkages to behavioral health, and increasing communication and collaboration with clinicians. CONCLUSION Participant evaluation data gathered for this study suggest that through the practice of asking, listening, and accepting, clinicians can help patients who have been exposed to childhood adversity better understand themselves and promote healthy coping behaviors. This study provides preliminary data on the needs of underserved patients that can be utilized to develop and deliver health promotion interventions using a trauma-informed approach in community-based clinics.
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Affiliation(s)
- Ellen Goldstein
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI
| | - James Topitzes
- Institute for Child and Family Well-Being, University of Wisconsin-Milwaukee Helen Bader School of Social Welfare, Milwaukee, WI
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23
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Selwyn CN, Lathan E. Helping Primary Care Patients Heal Holistically via Trauma-Informed Care. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Geller RJ, Decker MR, Adedimeji AA, Weber KM, Kassaye S, Taylor TN, Cohen J, Adimora AA, Haddad LB, Fischl M, Cunningham S, Golub ET. A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018. J Womens Health (Larchmt) 2020; 29:1256-1267. [PMID: 32996812 DOI: 10.1089/jwh.2019.7972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.
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Affiliation(s)
- Ruth J Geller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Tonya N Taylor
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sarah Cunningham
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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25
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Abstract
At a San Francisco primary care clinic, trauma is recognized as a root cause of many health challenges.
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Affiliation(s)
- Brian Rinker
- This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/ . Brian Rinker ( ) is an independent journalist in San Francisco, California
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26
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Miller-Cribbs J, Bragg J, Wen F, Jelley M, Coon KA, Hanks H, Howell D, Randall K, Isaacson M, Rodriguez K, Sutton G. An evaluation of a simulation and video-based training program to address adverse childhood experiences. Int J Psychiatry Med 2020; 55:366-375. [PMID: 32883135 DOI: 10.1177/0091217420951064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adverse Childhood Experiences (ACEs) are multiple sources of maltreatment and household dysfunction with tremendous impact on health. A trauma-informed (TI) approach is preferred when working with patients with ACEs. The Professional ACEs-Informed Training for Health© (PATH©) educational program and simulation experience using standardized patients (SP) was developed to help healthcare professionals address ACEs with adults. PATH© is a 3-4 hour curriculum comprised of lecture and discussion, video-based demonstration, simulation experience, and debriefing. It was first developed for primary care (PC) residents in family medicine and internal medicine, and subsequently modified for occupational therapy (OT) and physical therapy (PT) students. This study evaluates a preliminary dataset focusing on PATH© skills of PC residents and OT and PT students during simulation. Recordings of 53 learner-SP encounters from 15 OT and PT students and 38 PC residents were coded using standardized behavioral codes. A subset of ten recordings of PC residents who participated in simulations in the first and fourth year of the training program allowed for evaluation of training outcomes over time. Results showed that medical residents and OT and PT students demonstrated skills during SP encounters congruent with TI training on addressing ACEs with adults, particularly in explaining ACEs, demonstrating empathy, collaborative treatment planning, and stigma reduction. PC residents showed both positive and negative changes in PATH©-specific skills from year 1 to 4 of the training program. This study supports the PATH© model and simulation-based training in preparing clinicians to address ACEs with adults and provides insight into further curriculum improvement.
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Affiliation(s)
- Julie Miller-Cribbs
- Anne and Henry Zarrow School of Social Work, University of Oklahoma, Norman, OK, USA
| | - Jedediah Bragg
- Anne and Henry Zarrow School of Social Work, University of Oklahoma, Norman, OK, USA
| | - Frances Wen
- Department of Family and Community Medicine, The OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Martina Jelley
- Department of Internal Medicine, The OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Kim A Coon
- Department of Psychiatry, The OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Heather Hanks
- Anne and Henry Zarrow School of Social Work, University of Oklahoma, Norman, OK, USA
| | - Daniel Howell
- Anne and Henry Zarrow School of Social Work, University of Oklahoma, Norman, OK, USA
| | - Ken Randall
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma-Tulsa, Tulsa, OK, USA
| | - Mary Isaacson
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma-Tulsa, Tulsa, OK, USA
| | | | - Ginger Sutton
- Department of Family and Community Medicine, The OU-TU School of Community Medicine, Tulsa, OK, USA
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Stapp EK, Williams SC, Kalb LG, Holingue CB, Van Eck K, Ballard ED, Merikangas KR, Gallo JJ. Mood disorders, childhood maltreatment, and medical morbidity in US adults: An observational study. J Psychosom Res 2020; 137:110207. [PMID: 32745641 PMCID: PMC7855245 DOI: 10.1016/j.jpsychores.2020.110207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Mood disorders, child maltreatment, and medical morbidity are associated with enormous public health burden and individual suffering. The effect of mood disorders on medical morbidity, accounting for child maltreatment, has not been studied prospectively in a large, representative sample of community-dwelling US adults. This study tested the effects of mood disorders and child maltreatment on medical morbidity, and variation by subtypes. METHODS Participants were noninstitutionalized US adults in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093 wave 1, N = 34,653 wave 2). Mood disorders included lifetime DSM-IV episodes of depression, dysthymia, mania, or hypomania. Child maltreatment was defined as sexual, physical, or emotional abuse, or physical or emotional neglect before age 18. Survey-weighted zero-inflated poisson regression was used to study effects on medical morbidity, a summary score of 11 self-reported medical conditions. Results were adjusted for age, sex, ethnicity/race, income, substance use disorders, smoking, and obesity. RESULTS Mood disorders and child maltreatment additively associated with medical morbidity at study entry and three years later, with similar magnitude as obesity and smoking. Mania/hypomania (incidence rate ratio [IRR] 1.06, 95% CI 1.01-1.10) and child sexual (IRR 1.08, 95% CI 1.04-1.11) and emotional (IRR 1.05, 95% CI 1.01-1.10) abuse were associated with higher medical morbidity longitudinally. CONCLUSIONS Child maltreatment is common, and its long-range negative effect on medical morbidity underscores the importance of trauma-informed care, and consideration of early life exposures. History of mania/hypomania should be considered in medical practice, and physical health must be emphasized in mental health care.
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Affiliation(s)
- Emma K Stapp
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stacey C Williams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luther G Kalb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Kennedy Krieger Institute, Baltimore, MD, USA
| | - Calliope B Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Decker MR, Wood SN, Hameeduddin Z, Kennedy SR, Perrin N, Tallam C, Akumu I, Wanjiru I, Asira B, Frankel A, Omondi B, Case J, Clough A, Otieno R, Mwiti M, Glass N. Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya. BMJ Glob Health 2020; 5:bmjgh-2019-002091. [PMID: 32675229 PMCID: PMC7368487 DOI: 10.1136/bmjgh-2019-002091] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Intimate partner violence (IPV) threatens women’s health and safety globally, yet services remain underdeveloped and inaccessible. Technology-based resources exist, however, few have been adapted and tested in low-resource settings. We evaluate the efficacy of a community-partnered technology solution: culturally and linguistically adapted version of the myPlan app, a tailored safety decision-making and planning intervention, administrated by trained lay professionals. Methods This randomised, controlled, participant-blinded superiority trial compares safety-related outcomes at baseline, immediate post intervention and 3-month follow-up among women at risk of and experiencing IPV in Nairobi, Kenya. Women were randomised (1:1 ratio) to: (1) myPlan Kenya (intervention); or (2) standard IPV referrals (control). Primary outcomes were safety preparedness, safety behaviour and IPV; secondary outcomes include resilience, mental health, service utilisation and self-blame. Results Between April 2018 and October 2018, 352 participants (n=177 intervention, n=175 control) were enrolled and randomly assigned; 312 (88.6%, n=157 intervention, n=155 control) were retained at 3 months. Intervention participants demonstrated immediate postintervention improvement in safety preparedness relative to control participants (p=0.001). At 3 months, intervention participants reported increased helpfulness of safety strategies used relative to control participants (p=0.004); IPV reduced in both groups. Among women reporting the highest level of IPV severity, intervention participants had significant increase in resilience (p<0.01) compared with controls, and significantly decreased risk for lethal violence (p<0.01). Conclusions Facilitated delivery of a technology-based safety intervention appropriately adapted to the context demonstrates promise in improving women’s IPV-related health and safety in a low-resource, urban setting. Trial registration number Pan African Clinical Trial Registry (PACTR201804003321122).
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Affiliation(s)
- Michele R Decker
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA .,Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon N Wood
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zaynab Hameeduddin
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Rachel Kennedy
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | | | | | | | - Ariel Frankel
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - James Case
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Amber Clough
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | | | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center for Global Health, Johns Hopkins University, Baltimore, Maryland, USA
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Pinals DA, Callahan L. Evaluation and Restoration of Competence to Stand Trial: Intercepting the Forensic System Using the Sequential Intercept Model. Psychiatr Serv 2020; 71:698-705. [PMID: 32237983 DOI: 10.1176/appi.ps.201900484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The sequential intercept model (SIM) is used to reduce the penetration of persons with mental illness and substance use disorders in the criminal legal system. Its framework recommends identifying individuals with mental illness at various decision points of criminal case processing, from arrest to return from incarceration, so that they can be diverted toward treatment rather than permeate deeper into the criminal justice system. Communities frequently use the model to augment and inform jail diversion services. Despite the model's widespread adoption, individuals with serious mental illness, intellectual and developmental disabilities, and disorders affecting neurocognition and behavior are often found ineligible for such diversion because their competence to stand trial (CST) warrants evaluation, which effectively pauses their criminal case processes. If found incompetent to stand trial, these people can be ordered for competence restoration treatment, creating a pathway that is different from jail diversion options. Traditional community mental health services and courts await resolution by the "forensic system" before linking these individuals to needed services, and often these linkages are lacking. This review aims to describe and demystify these forensic processes and to highlight the potential use of the SIM to decrease jail stays and maximize community service connections for individuals with some of the most impairing mental health conditions who are involved in the justice system and for whom diversion is a safe option. The authors offer specific examples of intercept opportunities at each step involved in evaluations of CST and in the competence restoration processes.
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Affiliation(s)
- Debra A Pinals
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pinals); Policy Research Associates, Delmar, New York (Callahan)
| | - Lisa Callahan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pinals); Policy Research Associates, Delmar, New York (Callahan)
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Lewis-O'Connor A, Warren A, Lee JV, Levy-Carrick N, Grossman S, Chadwick M, Stoklosa H, Rittenberg E. The state of the science on trauma inquiry. ACTA ACUST UNITED AC 2020; 15:1745506519861234. [PMID: 31456510 PMCID: PMC6713964 DOI: 10.1177/1745506519861234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Within the context of longitudinal medical care for adults, health care providers
have a unique opportunity to inquire and respond to the traumatic life
experiences affecting the health of their patients, as well as a responsibility
to minimize retraumatizing these patients during medical encounters. While there
is literature on screening women for intimate partner violence, and there is
emerging data on pediatric screening for adverse life experiences, there is
sparse literature on inquiry of broader trauma histories in adult medical
settings. This lack of research on trauma inquiry results in an absence of
guidelines for best practices, in turn making it challenging for policy makers,
health care providers, and researchers to mitigate the adverse health outcomes
caused by traumatic experiences and to provide equitable care to populations
that experience a disproportionate burden of trauma. This state of the science
summarizes current inquiry practices for patients who have experienced trauma,
violence, and abuse. It places trauma inquiry within an anchoring framework of
trauma-informed care principles, and emphasizes a focus on resilience. It then
proposes best practices for trauma inquiry, which include tiered screening
starting with broad trauma inquiry, proceeding to risk and safety assessment as
indicated, and ending with connection to interventions.
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Affiliation(s)
- Annie Lewis-O'Connor
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical school, Boston, MA, USA.,3 Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Abi Warren
- 2 Harvard Medical school, Boston, MA, USA.,3 Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeannie V Lee
- 2 Harvard Medical school, Boston, MA, USA.,3 Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nomi Levy-Carrick
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical school, Boston, MA, USA.,4 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Samara Grossman
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical school, Boston, MA, USA.,5 Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Mardi Chadwick
- 2 Harvard Medical school, Boston, MA, USA.,6 Center for Community Health and Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Hanni Stoklosa
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical school, Boston, MA, USA.,4 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eve Rittenberg
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical school, Boston, MA, USA.,3 Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Einbond J, Diaz A, Cossette A, Scriven R, Blaustein S, Arden MR. Human Trafficking in Adolescents: Adopting a Youth-centered Approach to Identification and Services. Prim Care 2020; 47:307-319. [PMID: 32423716 DOI: 10.1016/j.pop.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article describes core design features of a youth-centered approach to care that 2 organizations-Mount Sinai Adolescent Health Center and Covenant House New Jersey-use to serve clients in nontraditional primary care settings and subsequently illustrates the ways in which this approach succeeds at identifying and serving youth who have experienced human trafficking. Primary care providers are uniquely positioned to connect adolescent human trafficking survivors to existing protection and treatment resources. The primary care community can adapt these interventions for adolescent patients who have experienced human trafficking and become key personnel on the frontline of recovery and prevention.
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Affiliation(s)
- Julia Einbond
- Covenant House New Jersey, 330 Washington Street, Newark, NJ 07102, USA.
| | - Angela Diaz
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai Adolescent Health Center (MSAHC), 320 East 94th Street, New York, NY 10128, USA
| | | | - Rosalyn Scriven
- Covenant House New Jersey, 330 Washington Street, Newark, NJ 07102, USA
| | - Silvia Blaustein
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai Adolescent Health Center (MSAHC), 320 East 94th Street, New York, NY 10128, USA
| | - Martha R Arden
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai Adolescent Health Center (MSAHC), 320 East 94th Street, New York, NY 10128, USA
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Interpersonal Trauma as a Marker of Risk for Urinary Tract Dysfunction in Midlife and Older Women. Obstet Gynecol 2019; 135:106-112. [PMID: 31809425 DOI: 10.1097/aog.0000000000003586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine relationships between interpersonal trauma exposures and urinary symptoms in community-dwelling midlife and older women. METHODS We analyzed cross-sectional data from a multiethnic cohort of women aged 40-80 years enrolled in an integrated health care system in California. Lifetime history of intimate partner violence (IPV) and sexual assault, current posttraumatic stress disorder (PTSD) symptoms, and current urinary symptoms were assessed using structured-item questionnaires. Multivariable-adjusted logistic regression models examined associations between traumatic exposures and PTSD symptoms with any weekly urinary incontinence, stress-type incontinence, urgency-type incontinence, and nocturia two or more times per night. RESULTS Of the 1,999 participants analyzed, 21.7% women reported lifetime emotional IPV, 16.2% physical IPV, 19.7% sexual assault, and 22.6% reported clinically significant PTSD symptoms. Overall, 45% reported any weekly incontinence, 23% stress-type incontinence, 23% urgency-type incontinence, and 35% nocturia. Exposure to emotional IPV was associated with any weekly incontinence (odds ratio [OR] 1.33, 95% CI 1.04-1.70), stress-type incontinence (OR 1.30, 95% CI 1.00-1.65), urgency-type incontinence (OR 1.30, 95% CI 1.00-1.70), and nocturia (OR 1.73, 95% CI 1.36-2.19). Physical IPV exposure was associated with nocturia (OR 1.35, 95% CI 1.04-1.77), but not incontinence. Sexual assault history was not associated with weekly incontinence of any type or nocturia. Symptoms of PTSD were associated with all urinary symptoms assessed, including any weekly incontinence (OR 1.46, 95% CI 1.15-1.85), stress-type incontinence (OR 1.70, 95% CI 1.32-2.20), urgency-type incontinence (OR 1.60, 95% CI 1.24-2.06), and nocturia (OR 1.95, 95% CI 1.55-2.45). CONCLUSION More than 20% of women in this multiethnic, community-based cohort reported a history of IPV, PTSD symptoms, or both, which were associated with symptomatic urinary tract dysfunction. Findings highlight the need to provide trauma-informed care of midlife and older women presenting with urinary symptoms.
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Traynor K. Clinic views patients through trauma-informed lens. Am J Health Syst Pharm 2019; 76:1454-1455. [DOI: 10.1093/ajhp/zxz177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cuca YP, Shumway M, Machtinger EL, Davis K, Khanna N, Cocohoba J, Dawson-Rose C. The Association of Trauma with the Physical, Behavioral, and Social Health of Women Living with HIV: Pathways to Guide Trauma-informed Health Care Interventions. Womens Health Issues 2019; 29:376-384. [PMID: 31303419 DOI: 10.1016/j.whi.2019.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/25/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Trauma is increasingly recognized as a near-universal experience among women living with HIV (WLHIV) and a key contributor to HIV acquisition, morbidity, and mortality. METHODS We present data from the baseline analysis of a planned intervention trial of the impact of trauma-informed health care on physical, behavioral, and social health outcomes of WLHIV in one clinic, with a particular focus on quality of life and viral suppression. Data were collected through interviewer-administered surveys and electronic health record data abstraction. RESULTS Among 104 WLHIV, 97.1% of participants reported having experienced lifetime trauma, and participants had experienced on average 4.2 out of 10 Adverse Childhood Experiences. WLHIV with more lifetime trauma were significantly more likely to report post-traumatic stress disorder, depression, and anxiety symptoms; significantly more likely to report potentially harmful alcohol and drug use; and had a significantly poorer quality of life. In addition, women who had experienced more lifetime trauma were significantly less likely to report being on and adhering to HIV medications, although trauma was not significantly associated with having an undetectable HIV viral load. CONCLUSIONS These data suggest that trauma is associated with much of the morbidity and mortality experienced by WLHIV. The results of this study support the implementation and study of trauma-informed approaches to health care for WLHIV.
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Affiliation(s)
- Yvette P Cuca
- Department of Community Health Systems, UCSF School of Nursing, San Francisco, California.
| | - Martha Shumway
- UCSF School of Medicine, Department of Psychiatry, San Francisco, California
| | - Edward L Machtinger
- UCSF Women's HIV Program, San Francisco, California; UCSF Center to Advance Trauma-informed Health Care, UCSF Department of Medicine, San Francisco, California
| | - Katy Davis
- UCSF Women's HIV Program, San Francisco, California
| | - Naina Khanna
- Positive Women's Network-USA, Oakland, California
| | - Jennifer Cocohoba
- UCSF Women's HIV Program, San Francisco, California; UCSF School of Pharmacy, San Francisco, California
| | - Carol Dawson-Rose
- Department of Community Health Systems, UCSF School of Nursing, San Francisco, California
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Dawson-Rose C, Cuca YP, Shumway M, Davis K, Machtinger EL. Providing Primary Care for HIV in the Context of Trauma: Experiences of the Health Care Team. Womens Health Issues 2019; 29:385-391. [PMID: 31272763 DOI: 10.1016/j.whi.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 05/16/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Trauma-informed health care for women living with human immunodeficiency virus (HIV) attends not only to HIV treatment, but also to the many common physical and emotional health consequences of trauma. One principle of providing trauma-informed care is the acknowledgement that working with a population that has experienced extensive trauma affects the team members who care for them in the clinic, as well as the interactions between those team members. METHODS To understand the needs of one primary health care team, we conducted in-depth interviews with 21 providers, staff, and collaborators who provide care to patients within the clinic. We used symbolic interaction and grounded theory methods to examine how interactions unfold within the clinic and how they are influenced by trauma. RESULTS The clinic team serves a highly traumatized and vulnerable population. Within this context, interactions between clinic staff unfold and trauma surfaces, and power dynamics play out along the lines of professional hierarchy. Although power differences cause tension within the clinic, professional hierarchy also serves as an important division of labor in times of medical crises. CONCLUSIONS Clinic power dynamics may be influenced to improve the care environment for patients, and to realize a more effective and satisfying trauma-informed health care clinic for both patients and staff.
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Affiliation(s)
- Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California.
| | - Yvette P Cuca
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Martha Shumway
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Katy Davis
- Division of General Internal Medicine, Women's HIV Program, University of California, San Francisco, San Francisco, California
| | - Edward L Machtinger
- Division of General Internal Medicine, Women's HIV Program, University of California, San Francisco, San Francisco, California
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36
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Young-Wolff KC, Sarovar V, Sterling SA, Leibowitz A, McCaw B, Hare CB, Silverberg MJ, Satre DD. Adverse childhood experiences, mental health, substance use, and HIV-related outcomes among persons with HIV. AIDS Care 2019; 31:1241-1249. [PMID: 30887831 DOI: 10.1080/09540121.2019.1587372] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
While persons with HIV (PWH) have benefited from significant advances in treatment and resulting longevity, mental health problems remain elevated in this population. Adverse childhood experiences (ACEs) are common among PWH and may negatively affect mental health and HIV-related outcomes. We examined the association between ACEs, depression and anxiety symptoms, substance use, antiretroviral therapy (ART) adherence, and HIV-clinical indicators in a sample of 584 PWH at risk for unhealthy alcohol use enrolled in a primary care-based alcohol intervention study. The sample was 96.9% male, 63.0% non-Hispanic white, with an average age of 49.0 years. ACEs were highly prevalent: 82.5% reported ≥1 ACE, including 34.2% reporting 1-2 ACEs, 25.0% reporting 3-4 ACEs, and 23.3% reporting ≥5 ACEs. Adjusting for demographics, having 1-2, 3-4 or ≥5 ACEs was significantly associated with anxiety (ORs (95%CI): 3.41 (1.13-10.33), 4.36 (1.42-3.36), and 3.96 (1.28-12.19), respectively) and poorer mental health quality of life (Betas (SE): -3.21 (1.40), -6.23 (1.51), and -7.09 (1.54), respectively), but not with other outcomes. Trauma-informed interventions to reduce anxiety and improve mental health quality of life in PWH may reduce the negative health sequelae of ACEs.
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Affiliation(s)
- Kelly C Young-Wolff
- a Division of Research, Kaiser Permanente , Oakland , CA , USA.,b Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California , San Francisco , CA , USA
| | - Varada Sarovar
- a Division of Research, Kaiser Permanente , Oakland , CA , USA
| | | | - Amy Leibowitz
- a Division of Research, Kaiser Permanente , Oakland , CA , USA
| | - Brigid McCaw
- c Family Violence Prevention Program, Kaiser Permanente , Oakland , CA , USA
| | - Charles B Hare
- d Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center , San Francisco , CA , USA
| | | | - Derek D Satre
- a Division of Research, Kaiser Permanente , Oakland , CA , USA.,b Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California , San Francisco , CA , USA
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Maguire D, Taylor J. A Systematic Review on Implementing Education and Training on Trauma-Informed Care to Nurses in Forensic Mental Health Settings. JOURNAL OF FORENSIC NURSING 2019; 15:242-249. [PMID: 31764528 DOI: 10.1097/jfn.0000000000000262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Engaging in trauma-informed approaches in nonforensic mental health settings improves therapeutic relationships, promotes healing, promotes posttraumatic growth, improves staff well-being, and fosters hope and empowerment, yet little is known of its influences in forensic settings. This literature review explores trauma-informed education and its training implications for nurses working in forensic mental health. METHOD Using a range of electronic databases, a systematic search of literature was carried out focusing on trauma-informed practice in adult forensic mental health settings. Before searching, predefined inclusion and exclusion criteria were agreed. FINDINGS After duplication removal, abstract review, and full screening, nine articles met review criteria for inclusion. A thematic analysis of the literature identified two key themes: "education for trauma-informed practice" and "applying theory into practice." Each had several subordinate themes. IMPLICATIONS FOR FORENSIC PRACTICE Organizations and their staff must recognize that operational change and ongoing training will be required. By adopting a trauma-informed approach, forensic mental health nurses can better understand their patients' traumatic experiences, improve their therapeutic relationships, and engage patients in collaborative care. Training in trauma-informed care should start with nurses who will change their personal practice and can support and train their colleagues.
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Affiliation(s)
- Donna Maguire
- Author Affiliations: Community Forensic Mental Health Services, NHS Ayrshire and Arran
| | - James Taylor
- School of Health & Life Sciences, University of the West of Scotland
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Befus DR, Kumodzi T, Schminkey D, St Ivany A. Advancing Health Equity and Social Justice in Forensic Nursing Research, Education, Practice, and Policy: Introducing Structural Violence and Trauma- and Violence-Informed Care. JOURNAL OF FORENSIC NURSING 2019; 15:199-205. [PMID: 31764523 DOI: 10.1097/jfn.0000000000000264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Initial conceptualizations of violence and trauma in forensic nursing have remained relatively narrowly defined since the specialty's inception. The advent of trauma-informed care has been important but has limitations that obfuscate social and structural determinants of health, equity, and social justice. As forensic nursing practice becomes more complex, narrow definitions of violence and trauma limit the effectiveness of trauma-informed care in its current incarnation. In keeping with the nursing model of holistic care, we need ways to teach, practice, and conduct research that can accommodate these increasing levels of complexity, including expanding our conceptualizations of violence and trauma to advance health equity and social justice. The objective of this article is to introduce the concepts of structural violence and trauma- and violence-informed care as equity-oriented critical paradigms to embrace the increasing complexity and health inequities facing forensic nursing practice.
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Affiliation(s)
- Deanna R Befus
- Author Affiliations: Arthur Labatt Family School of Nursing, Western University
| | | | - Donna Schminkey
- College of Health and Behavioral Studies, James Madison University
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