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Barry AR, Hoffman E, Martinez-Charleston E, DeMario M, Stewart J, Mohiuddin M, Mihelicova M, Brown M. Trauma-informed interactions within a trauma-informed homeless service provider: Staff and client perspectives. JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 52:415-434. [PMID: 38093668 DOI: 10.1002/jcop.23102] [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: 06/30/2023] [Revised: 10/26/2023] [Accepted: 11/21/2023] [Indexed: 02/10/2024]
Abstract
This study aims to provide practical insights for developing trauma-informed interaction strategies between service providers and participants in homeless service organizations (HSOs). Twelve providers and 17 participants were interviewed for a qualitative study on trauma-informed care (TIC) within an HSO. Thematic analysis revealed six themes regarding provider approaches to TIC interactions with participants: provide a sounding board, promote safety, foster understanding and respect, build relationships and trust, facilitate connection to services, and ensure flexibility in service provision. Participants noted three themes regarding their views of TIC interactions with providers: possess education and experience, build relationships and trust, and demonstrate supportive interpersonal styles. This study describes the application of TIC within an HSO, emphasizing the importance of supportive, positive interactions that promote understanding, respect, and trust. It highlights key factors in service provision. The findings expand our understanding of TIC implementation in HSOs and suggest areas for improvement.
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Affiliation(s)
- Amanda R Barry
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | - Erin Hoffman
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | | | - Milena DeMario
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | - Justine Stewart
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | | | | | - Molly Brown
- Department of Psychology, DePaul University, Chicago, Illinois, USA
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Soran D. A practical guide to the trauma-informed physical examination. JAAPA 2024; 37:42-45. [PMID: 38386932 DOI: 10.1097/01.jaa.0000997712.61508.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT About two-thirds of patients have a trauma history, such as experiencing abuse or community violence. Clinicians must be knowledgeable about trauma because of its high prevalence and long-lasting effect on patients. The medical encounter can be triggering for patients with a history of trauma, especially when power differentials are intensified, such as during the physical examination. Clinicians can improve the interaction by incorporating simple trauma-informed techniques, such as adjusting communication, positioning, and contact during the physical examination. These modifications foster a sense of patient safety and collaborative decision-making. This article describes the background of trauma-informed care and outlines trauma-informed techniques for physical examinations.
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Affiliation(s)
- Diana Soran
- Diana Soran practices at Boynton Health-University of Minnesota, in Minneapolis, Minn. The author has disclosed no potential conflicts of interest, financial or otherwise
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Corridan CL, Dawson SE, Mullan S. Potential Benefits of a 'Trauma-Informed Care' Approach to Improve the Assessment and Management of Dogs Presented with Anxiety Disorders. Animals (Basel) 2024; 14:459. [PMID: 38338102 PMCID: PMC10854685 DOI: 10.3390/ani14030459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024] Open
Abstract
Dog caregiver reporting on the spectrum of fearful-aggressive behaviours often describes 'unpredictable' or 'exaggerated' responses to a situation/animal/person. A possible explanation for these behavioural responses considers that the dog is reacting to triggered memories for which the dog has a negative association. For many dogs undergoing veterinary behavioural treatment or rehabilitation through a canine rescue organisation, the assessing clinician relies on "proxy" reporting of the history/background by a caregiver (dog owner, foster carer, or shelter personnel). Detailed information on the event or circumstances resulting in this negative association may be limited or absent altogether. Consideration of a trauma-informed care (TIC) approach, currently applied in a wide range of human psychology and social care fields, may be helpful in guiding the clinical approach taken. The literature relating to adverse early experience (AEE) and trauma-informed care (TIC) in puppies/dogs compared to children/adults was evaluated to identify common themes and conclusions identified across both species. In the absence of known/identifiable trauma, behavioural assessment and management should consider that a 'problem' dog may behave as it does, as the result of previous trauma. The dog can then be viewed through a lens of empathy and understanding, often lacking for dogs presenting with impulsive, reactive, or aggressive behaviours. Assessment must avoid re-traumatising the animal through exposure to triggering stimuli and, treatment options should include counselling of caregivers on the impact of adverse early experiences, consideration of the window of tolerance, and TIC behavioural modification techniques.
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Affiliation(s)
| | - Susan E. Dawson
- Research Fellow in Psychology, University of Manchester, Manchester M13 9PL, UK
| | - Siobhan Mullan
- Animal Welfare & Ethics, UCD School of Veterinary Science, Belfield, D04 V1W8 Dublin, Ireland;
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Ha M, Rowe A, Hendrix K, Anwar S, Mang K, Wen F, Coon K, Bragg J, Foulks K, Miller-Cribbs J, Jelley M. Use of Metaphor as an Explanation Tool in Adverse Childhood Experiences Simulation Training. Perm J 2023; 27:72-81. [PMID: 37876251 PMCID: PMC10723095 DOI: 10.7812/tpp/22.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) have profound implications for adult health. Health care practitioners need effective communication tools for trauma-sensitive inquiries with patients. This study aimed to describe characteristics of effective metaphor use by health care trainees when discussing ACEs and health with adult patients, and to provide example metaphors for clinicians to use to sensitively address ACEs. METHODS Trainees engaged in a videorecorded simulation as part of a model to teach health care practitioners communication skills related to ACEs. Videos were identified in which the trainee used a metaphor to help explain ACEs during the encounter. Encounter segments that used metaphors were transcribed and metaphor type, duration, and recurrence were coded using a standardized rubric. Each metaphor was scored for effectiveness and basic statistical analysis was conducted. RESULTS Of the 122 videos reviewed, 24 types of metaphors were used, with the most common being the overloaded backpack (n = 24). Mean metaphor duration was 37 s (SD = 24 s). Metaphors rated as effective were shorter and less variable in duration (31.8 s, SD = 14.7 s) than those rated as ineffective (39 s, SD = 34 s). No one metaphor performed significantly better and most of the metaphors were evaluated as being adequate or effective. CONCLUSION Literary devices like metaphors may be efficient and effective explanatory tools to improve clinician communication skills and patient understanding in addressing sensitive topics, such as ACEs. Minimal time investment is required to employ metaphors in ACEs discussions. The authors found no single metaphor that to be clearly superior, indicating that patient-centered metaphor use may improve communication between clinicians and patients who experienced childhood trauma.
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Affiliation(s)
- Monica Ha
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Allyson Rowe
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Katlynn Hendrix
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Summer Anwar
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Khup Mang
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Frances Wen
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Kim Coon
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Jedediah Bragg
- University of Oklahoma, Anne and Henry Zarrow School of Social Work, Norman, OK, USA
| | - Kristin Foulks
- University of Oklahoma-Tulsa Simulation Center, Norman, OK, USA
| | - Julie Miller-Cribbs
- University of Oklahoma, Anne and Henry Zarrow School of Social Work, Norman, OK, USA
| | - Martina Jelley
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
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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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Lee CH, Santos CD, Brown T, Ashworth H, Lewis JJ. Trauma-Informed Care for Acute Care Settings: A Novel Simulation Training for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11327. [PMID: 37520013 PMCID: PMC10376910 DOI: 10.15766/mep_2374-8265.11327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/11/2023] [Indexed: 08/01/2023]
Abstract
Introduction Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim. Methods Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation. Results Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant (p ≤ .01). Discussion Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.
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Affiliation(s)
| | | | - Taylor Brown
- Second-Year Resident, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
| | - Henry Ashworth
- First-Year Resident, Department of Emergency Medicine, Highland Hospital, Alameda Health System
| | - Jason J. Lewis
- Assistant Professor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
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Lathan EC, Britt A, Ravi M, Ash MJ, McAfee E, Wallace S, Johnson CB, Woods-Jaeger B, Powers A, Michopoulos V. WHEN REPRODUCTION IS NO LONGER AUTONOMOUS: FEELING RESPECTED BY MATERNITY CARE PROVIDERS MODERATES THE ASSOCIATION BETWEEN AUTONOMY IN DECISION MAKING AND BIRTH-RELATED PTSD SYMPTOMS IN A COMMUNITY SAMPLE OF POSTPARTUM BLACK WOMEN. J Trauma Dissociation 2023; 24:520-537. [PMID: 37233983 PMCID: PMC10330569 DOI: 10.1080/15299732.2023.2212406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
Black individuals are at particularly high risk for birth-related posttraumatic stress disorder (PTSD) symptoms, in part due to a lack of opportunity to lead maternity care decisions. Maternal care providers need evidence-based ways to reduce pregnant persons' risk for birth-related PTSD symptoms despite reduced autonomy in decision making resulting from heightened restrictions on reproductive rights. We investigated whether a potential relation between autonomy in decision making and birth-related PTSD symptoms would be moderated by being mistreated or feeling respected by maternity care providers in a community sample of Black women (N = 52; Mage = 28.2 years, SDage = 5.7 years) seeking maternity care at a public hospital in the southeastern United States. At six weeks postpartum, participants completed measures assessing autonomy in decision making, current birth-related PTSD symptoms, number of mistreatment events, and feelings of respect from providers during pregnancy, childbirth, and the postpartum period. Autonomy in decision making was negatively correlated with birth-related PTSD symptoms, r=-.43, p < .01. An interaction between autonomy in decision making and mistreatment by providers was trending toward significance, B=-.23, SE=.14, p = .10. Autonomy in decision making and feeling respected by maternity care provider interacted to predict birth-related PTSD symptoms, B = .05, SE=.01, p < .01. Feeling respected by providers may buffer against the negative effects of lack of autonomy in decision making on birth-related PTSD symptoms, highlighting the importance of providers' ability to convey respect to pregnant patients when they cannot lead care decisions.
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Affiliation(s)
- Emma C. Lathan
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abby Britt
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Meghna Ravi
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Marcia J. Ash
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth McAfee
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Shimarith Wallace
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Colin B. Johnson
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Briana Woods-Jaeger
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Abigail Powers
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
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Mendez A, Bosk EA, Keller A, Williams-Butler A, Hardan T, Ruisard DJ, MacKenzie MJ. Expanding the Trauma-Informed Care Measurement Toolkit: An Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC-45) Scale with SUD Workers in PIMH. Behav Sci (Basel) 2023; 13:471. [PMID: 37366724 DOI: 10.3390/bs13060471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X2 = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains.
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Affiliation(s)
- Alicia Mendez
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA
| | - Emily A Bosk
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA
| | - Amanda Keller
- School of Social Work, McGill University, Montreal, QC H3A 1B9, Canada
| | | | - Tareq Hardan
- School of Social Work, McGill University, Montreal, QC H3A 1B9, Canada
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Pakhomova TE, Nicholson V, Fischer M, Ferguson J, Moore DM, Salters K, Lester RT, Kremer H, Dawydiuk N, Barrios R, Parashar S. Exploring Primary Healthcare Experiences and Interest in Mobile Technology Engagement Amongst an Urban Population Experiencing Barriers to Care. QUALITATIVE HEALTH RESEARCH 2023:10497323231167829. [PMID: 37225177 DOI: 10.1177/10497323231167829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Mobile phone-based engagement approaches provide potential platforms for improving access to primary healthcare (PHC) services for underserved populations. We held two focus groups (February 2020) with residents (n = 25) from a low-income urban neighbourhood (downtown Vancouver, Canada), to assess recent healthcare experiences and elicit interest in mobile phone-based healthcare engagement for underserved residents. Note-based analysis, guided by interpretative description, was used to explore emerging themes. Engagement in PHC was complicated by multiple, intersecting personal-level and socio-structural factors, and experiences of stigma and discrimination from care providers. Perceived inadequacy of PHC services and pervasive discrimination reported by participants indicate a significant and ongoing need to improve client-provider relationships to address unmet health needs. Mobile phone-based engagement was endorsed, highlighting phone ownership and client-provider text-messaging, facilitated by non-clinical staff such as peers, as helpful to strengthening retention and facilitating care team connection. Concerns raised included reliability, cost, and technology and language accessibility.
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Affiliation(s)
- Tatiana E Pakhomova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Matthew Fischer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Joanna Ferguson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Richard T Lester
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Hayden Kremer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Nicole Dawydiuk
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
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Linnemørken LTB, Stangeland H, Reme SE, Stensland SØ. Performance and acceptability of the Stressful Life Events Screening Questionnaire in a chronic pain population: a mixed-methods study. Pain Rep 2023; 8:e1072. [PMID: 37114243 PMCID: PMC10129107 DOI: 10.1097/pr9.0000000000001072] [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: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 04/29/2023] Open
Abstract
Introduction Pain-related fear, anxiety, and avoidance may play key roles in the chronification of pain and related disability. For practitioners, knowledge about the source or drivers of these fears, including patients' exposure to potentially traumatic events (PTEs) and related posttraumatic stress symptoms, could be particularly helpful in guiding their treatment approach. Objectives We aimed to investigate whether the use of a brief screening for PTEs could help inform chronic pain treatment. Methods The performance and acceptability of the Stressful Life Events Screening Questionnaire (SLESQ) was assessed among 567 adult patients (59% women, mean age 48.1 years) meeting at a hospital outpatient pain clinic. The sensitivity, specificity, and 20 months temporal stability of the SLESQ, assessing exposure to 14 specific trauma types followed by a 15th item capturing exposure to "other events," were assessed through digital administration and follow-up interviews with 55 participants. The qualitative responses of 158 participants reporting exposure to "other events" were reviewed and assessed based on fulfillment of the A Criterion for traumatic events in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The acceptability of the SLESQ was assessed in clinical interviews with 12 participants. Results The SLESQ demonstrated acceptable sensitivity (70.0%), high specificity (94.9%), and moderate temporal stability (κ = 0.66, P < 0.001). Participants' qualitative elaborations of "other events" were largely (76.3%) consistent with Criterion A events. The screening was well accepted and welcomed. Conclusion The results indicate that the use of a brief screening for potential trauma may be helpful to guide clinical practice in chronic pain settings.
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Affiliation(s)
- Lene Therese Bergerud Linnemørken
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Division for Health Services, Department of Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- Corresponding author. Address: Division of Emergencies and Critical Care, Department of Research and Development, Building 18, Oslo University Hospital, POB 4956 Nydalen, 0424 Oslo, Norway. Tel.: +4747313851. E-mail address: (L.T.B. Linnemørken)
| | - Helle Stangeland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Synne Øien Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Development, Oslo University Hospital, Oslo, Norway
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Cerny S, Berg-Poppe P, Anis M, Wesner C, Merrigan M, LaPlante K. Outcomes from an interprofessional curriculum on trauma-informed care among pediatric service providers. J Interprof Care 2023; 37:288-299. [PMID: 35687015 DOI: 10.1080/13561820.2022.2070142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The effects of trauma on the health of individuals have been well established as a major public health concern. However, the integration of trauma-informed practices within the multidisciplinary pediatric health care system still faces significant challenges and barriers. This study sought to understand the changes in knowledge, behaviors, and attitudes related to trauma-informed care following administration of a trauma-informed educational intervention. Eighteen pediatric professionals participated in this interprofessional study design. The intervention included several components of self-study, face-to-face active learning experiences, presentations, and case discussions. Six weeks following the intervention, participants engaged in a follow-up focus group dialogue. To crystallize the transformative impact of education in practice, the study used both quantitative and qualitative data. Quantitative data was measured using the Attitudes Related to Trauma Informed Care (ARTIC) scale, while a focus group was used to understand the subjective experiences of participants and the effects of participation on practice. Results showed statistically significant pre- to post-programming improvements across all ARTIC domains. Qualitative themes aligned with the quantitative findings, indicating a sense of empowerment through knowledge, as well as an enhanced awareness of systematic challenges to implementation of trauma-informed care approaches.
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Affiliation(s)
- Shana Cerny
- Department of Occupational Therapy, University of South Dakota, Vermillion, SD, United States
| | - Patti Berg-Poppe
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, United States
| | - Musheera Anis
- Department of Public Health & Health Sciences, University of South Dakota, Vermillion, SD, United States
| | - Chelsea Wesner
- Department of Public Health & Health Sciences, University of South Dakota, Vermillion, SD, United States
| | - Mary Merrigan
- Department of Addiction Counseling & Prevention, University of South Dakota, Vermillion, SD, United States
| | - Kathy LaPlante
- Department of Social Work, University of South Dakota, Vermillion, SD, United States
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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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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Loeb DF, Durfee J, Monson S, Bayliss EA, Garcia C, Kline D, Barrett K, Rinehart D. Prevalence of adverse childhood experiences and post traumatic stress disorder symptoms in a primary care safety-net population: Implications for healthcare service needs. Gen Hosp Psychiatry 2022; 77:102-108. [PMID: 35596962 DOI: 10.1016/j.genhosppsych.2022.04.001] [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: 08/27/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We characterized the prevalence and associated characteristics of Adverse Childhood Experiences (ACEs) and Post-traumatic stress disorder (PTSD) in a safety net system and assessed patient preferences for trauma informed care. METHODS We performed a cross-sectional survey among adult patients attending primary care at three urban federally qualified healthcare centers. We used a method of recruitment that included both convenience and systemic sampling. The survey included the ACEs Questionnaire, the PTSD for DSM 5 (PC-PTSD5), and trauma-informed care preferences. We accessed Electronic Health Records for demographic and clinical data. We used descriptive and multivariable statistical analyses. RESULTS 303 of 481 (63%) patients that were approached participated. Most participants (81%) had one or more ACEs and 38% had four or more. 88 (29%) patients screened positive for current PTSD. ACEs was associated with a diagnosis of mental illness (p = 0.0125) and substance use disorders (p = 0.01). Patients with ACEs >/=4 or positive PC-PTSD reported stress in attending medical visits and that trauma-informed provider behaviors would make their visits less stressful. CONCLUSIONS Rates of ACES and current PTSD symptoms were high in this population and support the need for research to evaluate universal trauma-informed care strategies for safety-net healthcare systems.
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Affiliation(s)
- Danielle F Loeb
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America.
| | - Joshua Durfee
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, United States of America
| | - Samantha Monson
- Ambulatory Care Services, Denver Health and Hospital Authority, 777 Bannock St., M.C. 1916, Denver, CO 80204, United States of America
| | - Elizabeth A Bayliss
- Kaiser Permanente Colorado Institute for Health Research, 2550 South Parker Road, Aurora, CO 80014, United States of America; Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America
| | - Christine Garcia
- Ambulatory Care Services, Denver Health and Hospital Authority, 777 Bannock St., M.C. 1916, Denver, CO 80204, United States of America
| | - Danielle Kline
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America
| | - Kaeli Barrett
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, United States of America
| | - Deborah Rinehart
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America; Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, United States of America
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15
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Boucher N, Darling-Fisher CS, Sinko L, Beck D, Granner J, Seng J. Psychometric Evaluation of the TIC Grade, a Self-Report Measure to Assess Youth Perceptions of the Quality of Trauma-Informed Care They Received. J Am Psychiatr Nurses Assoc 2022; 28:319-325. [PMID: 32907448 PMCID: PMC7943641 DOI: 10.1177/1078390320953896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Agencies and clinical practices are beginning to provide trauma-informed care (TIC) to their clients. However, there are no measures to assess clients' perceptions of and satisfaction with the TIC care they have received. A 20-item questionnaire, the TIC Grade, was developed, based on the National Center for Trauma-Informed Care principles of TIC, to assess the patient or client perception of the TIC provided in settings that serve adolescents and emerging adults. OBJECTIVE The goal of this project was to evaluate the psychometric properties of the TIC Grade instrument and to make recommendations for use of the full measure and its short form-an overall letter grade. STUDY DESIGN The TIC Grade questionnaire was administered to youth over the age of 18 years from four community partners providing care to vulnerable young adults. Potential participants were offered questionnaires at the end of their visit. Those interested in participating left their completed anonymous questionnaire in a locked box to maintain confidentiality. Questionnaires were collected from 100 respondents; 95 were complete enough to include in analyses for psychometric evaluation. RESULTS The findings of this project support the reliability and usability of the 20-item TIC Grade measure to assess youth's perceptions of the quality of TIC they received. CONCLUSIONS This TIC-specific, behaviorally worded client report measure can assist service delivery organizations to assess their success at implementing TIC and to identify areas where further staff training and support are needed.
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Affiliation(s)
- Nicole Boucher
- Nicole Boucher, PhD, CPNP-PC, University of Michigan, Ann Arbor, MI, USA
| | | | - Laura Sinko
- Laura Sinko, PhD, RN, CCTS-I, University of Pennsylvania, Philadelphia, PA, USA
| | - Dana Beck
- Dana Beck, PhD, MSN, FNP-B University of Michigan, Ann Arbor, MI, USA
| | - Josie Granner
- Josie Granner, BSN, RN, University of Michigan, Ann Arbor, MI, USA
| | - Julia Seng
- Julia Seng, PhD, CNM, FAAN, University of Michigan, Ann Arbor, MI, USA
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16
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Christou-Ergos M, Wiley KE, Leask J, Shapiro GK. Traumatic Events and Vaccination Decisions: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10060911. [PMID: 35746519 PMCID: PMC9230365 DOI: 10.3390/vaccines10060911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent vaccination decisions. MEDLINE, PsycINFO and CINHAL electronic databases were searched, and 1551 articles were screened for eligibility. Of the 52 articles included in full-text assessment, five met the eligibility criteria. Findings suggest that the experience of trauma is associated with individual vaccination decisions. Social and practical factors related to both trauma and vaccination may mediate this relationship. As this is a relatively new field of inquiry, future research may help to clarify the nuances of the relationship. This review finds that the experience of psychological trauma is associated with vaccination intention and behaviour and points to the potential importance of a trauma-informed approach to vaccination interventions during the current global effort to achieve high COVID-19 vaccine coverage.
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Affiliation(s)
- Maria Christou-Ergos
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Correspondence:
| | - Kerrie E. Wiley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada;
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17
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Bliton JN, Zakrison TL, Vong G, Johnson DA, Rattan R, Hanos DS, Smith RN. Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents. J Am Coll Surg 2022; 234:1238-1247. [PMID: 35703822 DOI: 10.1097/xcs.0000000000000183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made.
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Affiliation(s)
- John N Bliton
- From the Wellstar Atlanta Medical Center, Atlanta, GA (Bliton)
| | - Tanya L Zakrison
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Gerard Vong
- Emory University, Center for Ethics, Atlanta, GA (Vong)
| | - Dwane A Johnson
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL (Rattan)
| | - Dustin S Hanos
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
| | - Randi N Smith
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
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18
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Chrystal JG, Frayne S, Dyer KE, Moreau JL, Gammage CE, Saechao F, Berg E, Washington DL, Yano EM, Hamilton AB. Women Veterans' Attrition from the VA Health Care System. Womens Health Issues 2022; 32:182-193. [PMID: 34972600 DOI: 10.1016/j.whi.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient attrition from the Veterans Health Administration (VA) health care system could undercut its mission to ensure care for eligible veterans. Attrition of women veterans could exacerbate their minority status and impede systemic efforts to provide high-quality care. We obtained women veterans' perspectives on why they left or continued to use VA health care. METHODS A sampling frame of new women veteran VA patients was stratified by those who discontinued (attriters) and those who continued (non-attriters) using VA care. Semistructured interviews were conducted from 2017 to 2018. Transcribed interviews were coded for women's decision-making, contexts, and recommendations related to health care use. RESULTS Fifty-one women veterans (25 attriters and 26 non-attriters) completed interviews. Reasons for attrition included challenging patient care experiences (e.g., provider turnover, claim processing challenges) and the availability of private health insurance. Personal experiences with VA care (e.g., gender-specific care) were impactful in women's decision to use VA. The affordability of VA care was influential for both groups to stay connected to services. More than one-third of women originally categorized as attriters described subsequently reentering or planning to reenter VA care. Suggestions to decrease attrition included increasing outreach, improving access, and continuing to tailor care delivery to women veterans' needs. CONCLUSIONS Understanding the drivers of patients' decisions to use or not use the VA is critical for the development of strategies to improve retention of current patients and optimize health outcomes for veterans. Women veterans described complex reasons why they left or continued using VA, with cost/affordability playing an important role even in considerations of returning to VA after a long hiatus.
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Affiliation(s)
- Joya G Chrystal
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California.
| | - Susan Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Karen E Dyer
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Jessica L Moreau
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Cynthia E Gammage
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Fay Saechao
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, California
| | - Eric Berg
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Semel Institute/NPI, Los Angeles, California
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Varghese L, Emerson A. Trauma-informed care in the primary care setting: An evolutionary analysis. J Am Assoc Nurse Pract 2022; 34:465-473. [PMID: 34618717 DOI: 10.1097/jxx.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The high prevalence of trauma in the United States and its adverse effects on patient wellbeing has led to the adoption of trauma-informed care (TIC) in some specialized health care services. However, the implementation of TIC in primary care, where many nurse practitioners (NPs) provide services, is relatively uncommon and the concept not well-defined. Trauma includes physically and emotionally devastating experiences that have a lasting impact on individuals. OBJECTIVES To synthesize a definition of TIC in the primary care setting for NPs to guide future practice and research. DATA SOURCES We searched CINAHL, PsycINFO, Social Work Abstracts, Scopus, and PubMed for articles published 2010-2020 that described the use of TIC in primary care. Rodgers' evolutionary method and the framework method of analysis were used to identify attributes and contexts of TIC in primary care and synthesize a definition. Thirty-one articles from nursing, medical, and social work sources were selected, including data-based studies ( n = 15) and thought pieces ( n = 16). Attributes, antecedents, and consequences were combined to provide a definition grounded in the literature. CONCLUSION Trauma-informed care in primary care is a strengths-based approach in which trained, trauma-aware health care professionals provide services that prioritize safety, empowerment, and support, resulting in improved patient satisfaction and health care engagement in individuals who have experienced trauma. IMPLICATIONS FOR PRACTICE A clearly defined concept provides a starting point for developing strategies to help NPs recognize and respond more effectively to the needs of patients who have experienced trauma.
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Affiliation(s)
- Latha Varghese
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
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20
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Gannon BS, Gregg A, Wang H, Marshall ME, Yerby LG, Jenkins C, Parton JM. A medical home for children in foster care reduces expenditures. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2039146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Brian S. Gannon
- College of Community Health Sciences, Pediatrics, The University of Alabama, Tuscaloosa, AL, USA
| | - Abbey Gregg
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Hui Wang
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Lea G. Yerby
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Caroline Jenkins
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
| | - Jason M. Parton
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
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21
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Goddard A, Jones R, Etcher L. Trauma informed care in nursing: A concept analysis. Nurs Outlook 2022; 70:429-439. [DOI: 10.1016/j.outlook.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/18/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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22
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Chapman KA, Machado SS, van der Merwe K, Bryson A, Smith D. Exploring Primary Care Non-Attendance: A Study of Low-Income Patients. J Prim Care Community Health 2022; 13:21501319221082352. [PMID: 35259972 PMCID: PMC8918768 DOI: 10.1177/21501319221082352] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION While evidence has been established on the impact of medical appointment non-attendance on the healthcare system and patient health, previous research has not focused on how poverty and rurality may influence patient experiences with non-attendance. This paper explores patient perceptions of non-attendance among those experiencing poverty in a rural U.S county to better inform providers to the context in which their patients make attendance-related decisions. METHODS Using a grounded theory approach, we conducted semi-structured interviews with 32 U.S. low-income adults in the rural Western U.S. who recurrently missed primary care appointments. We also used a questionnaire to assess individual characteristics related to health, resiliency, personal mastery, medical mistrust, life chaos, and adverse childhood experiences. RESULTS Participants identified 3 barriers to attending appointments: appointment disinterest, competing demands, and insufficient systems. Appointment disinterest stemmed from physical and mental health issues, misalignment between needs and treatment, and comfort with the provider. Competing demands included family responsibilities, employment, and relationships. Finally, participants reported that current scheduling and transportation systems were helpful but insufficient. To provide further context, participants also reported low overall health, moderate levels of medical mistrust, life chaos, and mastery, moderate to low resilience, and very a high number of adverse childhood experiences. CONCLUSIONS Results point to the need for modified structures that allow low-income patients more control over their personal health and highlight opportunities for clinics to address patients' lack of interest and fear in the medical encounter.
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Affiliation(s)
| | - Stephanie S Machado
- Oregon Institute of Technology, Klamath Falls, OR, USA.,California State University, Chico, Chico, CA, USA
| | | | - Ashley Bryson
- Klamath Health Partnership, Klamath Falls, OR, USA.,Oregon Health & Science University, Klamath Falls, OR, USA
| | - Dwight Smith
- Oregon Health & Science University, Klamath Falls, OR, USA
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Kokokyi S, Klest B, Anstey H. A patient-oriented research approach to assessing patients' and primary care physicians' opinions on trauma-informed care. PLoS One 2021; 16:e0254266. [PMID: 34242358 PMCID: PMC8270182 DOI: 10.1371/journal.pone.0254266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To gather patients' and primary care physicians' (PCP) opinions on trauma-informed Care (TIC) and to investigate the acceptability of recommendations developed by patient, family, and physician advisors. DESIGN Cross-sectional research survey design and patient engagement. SETTING Canada, 2017 to 2019. PARTICIPANTS English-speaking adults and licensed PCPs residing in Canada. MAIN OUTCOME MEASURES Participants were given a series of questionnaires including a list of physician actions and a list of recommendations consistent with TIC. RESULTS Patients and PCPs viewed TIC as important. Both patients and PCPs rated the following recommendations as helpful and likely to positively impact patient care: physician training, online trauma resource centres, information pamphlets, the ability to extend appointment times, and clinical pathways for responding to trauma. PCPs' responses were significantly more positive than patients' responses. CONCLUSION TIC is important to patients and PCPs. Patients and PCPs believe changes to physician training, patient engagement, and systemic factors would be helpful and likely to positively impact patient care. Future research needs to be conducted to investigate whether these recommendations improve patient care.
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Affiliation(s)
- Seint Kokokyi
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bridget Klest
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Hannah Anstey
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Isobel S, Wilson A, Gill K, Howe D. 'What would a trauma-informed mental health service look like?' Perspectives of people who access services. Int J Ment Health Nurs 2021; 30:495-505. [PMID: 33219725 DOI: 10.1111/inm.12813] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
Trauma-informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re-traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma-informed. However, how Australian mental health services should deliver trauma-informed care is not well documented. Efforts towards trauma-informed care in any setting require engagement with those who receive care. This qualitative study used an experience-based co-design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question 'what would a trauma-informed mental health service look like?' Focus groups were held with consumers (n = 10) and carers (n = 10). Thematic analysis of transcripts identified that consumers and carers consider that trauma-informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma-informed care across settings.
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Affiliation(s)
- Sophie Isobel
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Allyson Wilson
- Mental Health Services, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Katherine Gill
- Consumer Led Research Network, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Howe
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
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25
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McNamara M, Cane R, Hoffman Y, Reese C, Schwartz A, Stolbach B. Training Hospital Personnel in Trauma-Informed Care: Assessing an Interprofessional Workshop With Patients as Teachers. Acad Pediatr 2021; 21:158-164. [PMID: 32492574 DOI: 10.1016/j.acap.2020.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/08/2020] [Accepted: 05/16/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Trauma-informed care (TIC) and violence intervention programs (VIPs) facilitate psychosocial healing and reduce injury recidivism for children and families affected by community violence. To integrate a VIP into 2 Level 1 Pediatric Trauma Centers, an educational initiative was developed and co-taught by pediatricians and former patients. The primary aim was to increase provider-driven patient referrals to the VIP. A secondary aim was to improve all participants' comfort levels in 5 areas of TIC. METHODS Referrals to the VIP from 2014 to 2018 were tracked and analyzed. A curriculum based on Five Points of TIC was developed and offered to interprofessional groups of hospital employees. Pediatricians and former patients recovering from violent injury facilitated the workshops. Twenty-two workshops were attended by 318 providers and hospital staff members from 2015 to 2018. Pre- and postworkshop surveys asked participants to rate their comfort levels with 5 areas of TIC. RESULTS Provider-driven patient identification increased from 34.8% to 86.8% over the study period. For the entire cohort, participants' self-assessment of comfort levels with TIC improved by 21% (P < .001), with medical students' scores improving the most (24%). Residents were less likely to complete the workshop than fellows or attendings (P = .03). CONCLUSIONS This novel curriculum was associated with a change in practice patterns, as well as a closer relationship between the VIP and pediatric hospital systems. All professional groups experienced an improvement in comfort levels with the Five Points of TIC. Future study on information retention and other patient care-related outcomes is needed.
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Affiliation(s)
- Meredithe McNamara
- Division of Adolescent Medicine, Department of Pediatrics, University of Illinois - Chicago (M McNamara and A Schwartz).
| | - Rachel Cane
- Johns Hopkins University (R Cane), Baltimore, MD
| | - Yael Hoffman
- Department of Pediatrics, University of Chicago (Y Hoffman and B Stolbach), Chicago, Ill
| | - Carol Reese
- Department of Trauma and Burns, John H. Stroger Hospital of Cook County (C Reese), Chicago, Ill
| | - Alan Schwartz
- Division of Adolescent Medicine, Department of Pediatrics, University of Illinois - Chicago (M McNamara and A Schwartz)
| | - Bradley Stolbach
- Department of Pediatrics, University of Chicago (Y Hoffman and B Stolbach), Chicago, Ill
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26
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Loeb TB, Ebor MT, Smith-Clapham AM, Chin D, Novacek DM, Hampton-Anderson JN, Norwood-Scott E, Hamilton AB, Brown AF, Wyatt GE. How Mental Health Professionals Can Address Disparities in the Context of the COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 27:60-69. [PMID: 34025223 DOI: 10.1037/trm0000292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Coronavirus 2019 (COVID-19) pandemic is an unparalleled crisis, yet also a unique opportunity for mental health professionals to address and prioritize mental and physical health disparities that disproportionately impact marginalized populations. Black, Indigenous, and People of Color (BIPOC) have long experienced structural racism and oppression, resulting in disproportionately high rates of trauma, poverty, and chronic diseases that span generations and are associated with increased COVID-19 morbidity and mortality rates. The current pandemic, with the potential of conferring new trauma exposure, interacts with and exacerbates existing disparities. To assist mental health professionals in offering more comprehensive services and programs for those who have minimal resources and the most profound barriers to care, four critical areas are highlighted as being historically problematic and essential to address: (a) recognizing psychology's role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice. Recommendations are provided to promote equity at the structural (e.g., nationwide, federal), professional (e.g., the mental health professions), and individual (e.g., practitioners, researchers) levels.
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Affiliation(s)
- Tamra Burns Loeb
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Megan T Ebor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Amber M Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Dorothy Chin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Derek M Novacek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095.,Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Joya N Hampton-Anderson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, 30322
| | - Enricka Norwood-Scott
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095.,Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research (GIM and HSR), University of California Los Angeles, CA, USA, 90095.,Division of GIM and HSR, Olive View-UCLA Medical Center, Sylmar, CA, USA, 91342
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
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27
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Fallon B, Lefebvre R, Collin-Vézina D, Houston E, Joh-Carnella N, Malti T, Filippelli J, Schumaker K, Manel W, Kartusch M, Cash S. Screening for economic hardship for child welfare-involved families during the COVID-19 pandemic: A rapid partnership response. CHILD ABUSE & NEGLECT 2020; 110:104706. [PMID: 32919762 PMCID: PMC7472971 DOI: 10.1016/j.chiabu.2020.104706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Pandemics have a wide range of economic, health and social consequences related to both the spread of a disease and efforts made by government leaders to contain it which may be particularly detrimental for the child welfare-involved population. This is because child welfare agencies serve some of the highest needs children and families. A significant proportion of these families face economic hardship, and as a result of containment measures for COVID-19, more families inevitably will. OBJECTIVE Given the range of negative consequences related to the pandemic and the evolving supports available to families, child protection workers needed a clinical tool to guide and support work with families informed by an understanding of economic hardship. The objective of this paper is to report on the development and implementation strategy of a tool to be used for practice intervention during the pandemic. METHODS Action research methodology was utilized in the creation of the clinical tool. The tool's development and implementation occurred through an academic/child welfare sector partnership involving child welfare agencies representing diverse regions and populations in Ontario, Canada. Factor analysis of representative child welfare data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) on economic hardship was used to inform the development of questions on the clinical tool. RESULTS The development and implementation strategy of the clinical tool are described, including the results from analyses of the OIS-2018. CONCLUSIONS Future directions for the project are discussed, including considerations for using this tool beyond the pandemic.
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Affiliation(s)
- Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada.
| | - Rachael Lefebvre
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | | | - Emmaline Houston
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | | | - Tina Malti
- Department of Psychology, University of Toronto, Canada
| | - Joanne Filippelli
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | | | - Wendy Manel
- Catholic Children's Aid Society of Toronto, Canada
| | | | - Scottye Cash
- College of Social Work, The Ohio State University, USA
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Shah AN, Auger KA, Sucharew HJ, Mangeot C, Childress K, Haney J, Shah SS, Simmons JM, Beck AF. Effect of Parental Adverse Childhood Experiences and Resilience on a Child's Healthcare Reutilization. J Hosp Med 2020; 15:645-651. [PMID: 32490805 PMCID: PMC7657653 DOI: 10.12788/jhm.3396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with poor health outcomes in adults. Resilience may mitigate this effect. There is limited evidence regarding how parents' ACEs and resilience may be associated with their children's health outcomes. OBJECTIVE To determine the association of parental ACEs and resilience with their child's risk of unanticipated healthcare reutilization. DESIGN, SETTING, AND PARTICIPANTS We conducted a prospective cohort study (August 2015 to October 2016) at a tertiary, freestanding pediatric medical center in Cincinnati, Ohio. Eligible participants were English-speaking parents of children hospitalized on a Hospital Medicine or Complex Services team. A total of 1,320 parents of hospitalized children completed both the ACE questionnaire and the Brief Resilience Scale Survey. EXPOSURE Number of ACEs and Brief Resilience Scale Score among parents. MAIN OUTCOMES Unanticipated reutilization by children, defined as returning to the emergency room, urgent care, or being readmitted to the hospital within 30 days of hospital discharge. RESULTS In adjusted analyses, children of parents with 4 or more ACEs had 1.69-times higher odds (95% CI, 1.11-2.60) of unanticipated reutilization after an index hospitalization, compared with children of parents with no ACEs. Resilience was not significantly associated with reutilization. CONCLUSION Parental history of ACEs is strongly associated with higher odds of their child having unanticipated healthcare reutilization after a hospital discharge, highlighting an intergenerational effect. Screening may be an important tool for outcome prediction and intervention guidance following pediatric hospitalization.
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Affiliation(s)
- Anita N Shah
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Mayerson Center for Safe and Healthy Children, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Corresponding Author: Anita Shah, DO, MPH; ; Telephone: 513-636-7994; Twitter @DrAnita_Shah
| | - Katherine A Auger
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Heidi J Sucharew
- Biostatistics and Epidemiology, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Colleen Mangeot
- Biostatistics and Epidemiology, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kelsey Childress
- Division of Hospital Medicine, Department of Pediatrics, Kaiser South Sacramento, Sacramento, California
| | - Julianne Haney
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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29
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Purtle J. Systematic Review of Evaluations of Trauma-Informed Organizational Interventions That Include Staff Trainings. TRAUMA, VIOLENCE & ABUSE 2020; 21:725-740. [PMID: 30079827 DOI: 10.1177/1524838018791304] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Enthusiasm for trauma-informed practice has increased dramatically. Organizational interventions that train staff about trauma-informed practice are frequently used to promote trauma-informed systems change, but evidence about these interventions' effects has not been integrated. A systematic review was conducted of studies that evaluated the effects of organizational interventions that included a "trauma-informed" staff training component. A search was conducted in July 2017 and studies were identified in PubMed, PsycINFO, and the Published International Literature on Traumatic Stress database, limited to articles published in English after 2000. Six hundred and thirty-two articles were screened and 23 met inclusion criteria. Seventeen studies used a single group pretest/posttest design, five used a randomized controlled design, and one used a quasi-experimental design with a nonrandomized control group. The duration of trauma-informed trainings ranged from 1 hr to multiple days. Staff knowledge, attitudes, and behaviors related to trauma-informed practice improved significantly pre-/posttraining in 12 studies and 7 studies found that these improvements were retained at ≥1month follow-up. Eight studies assessed the effects of a trauma-informed organizational intervention on client outcomes, five of which found statistically significantly improvements. The strength of evidence about trauma-informed organization intervention effects is limited by an abundance of single group, pretest/posttest designs with short follow-up periods, unsophisticated analytic approaches, and inconsistent use of assessment instruments. In addition to addressing these methodological limitations, priorities for future research include understanding intervention effects on clients' perceptions of care and the mechanisms through which changes in staff knowledge and attitudes about trauma-informed practice influence client outcomes.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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30
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Trauma-Informed Care in Primary Health Settings-Which Is Even More Needed in Times of COVID-19. Healthcare (Basel) 2020; 8:healthcare8030340. [PMID: 32937966 PMCID: PMC7551418 DOI: 10.3390/healthcare8030340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 12/01/2022] Open
Abstract
Included in the general practitioner’s (GP) core competencies is the ability to adopt a person-centered approach, and the use of the biopsychosocial model in their clinical work. Traumatic events (TEs) are frequently experienced within the population and are known to dysregulate the stress response system and to be associated with psychiatric and physical disorders. GPs may feel reluctant to confront TEs for a variety of reasons, such as a lack of sufficient training in trauma-informed care or a fear of causing harm when discussing a patient’s more complicated issues, among others. This perspective paper aims to review the existing studies that support the practice of trauma-informed healthcare and to summarise best practices. Studies have shown that patients appreciate the questions that clinicians ask them about trauma-related issues and that they understand that this can be important for their healthcare. Furthermore, asking about trauma-related issues in a patient-centered and empathic way can result in better doctor–patient relationships, which improves the levels of satisfaction of both the patient and the doctor with the consultation, as well as improved health-related outcomes. As past traumatic experiences increase the risk of developing post-traumatic stress disorder on exposure to a new TE, the onset of the COVID-19 pandemic has led to trauma-informed care becoming even more important if the strategy is to continue to invest in preventive medicine.
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31
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Kanzler KE, Ogbeide S. Addressing trauma and stress in the COVID-19 pandemic: Challenges and the promise of integrated primary care. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2020; 12:S177-S179. [PMID: 32584101 DOI: 10.1037/tra0000761] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Integrated primary care settings are ideal locations for treatment of posttraumatic stress concerns as primary care is the principal access point for mental health treatment in the United States. The COVID-19 global pandemic will increase the necessity of posttraumatic stress-related psychological care for vulnerable populations and frontline providers through traditional and virtual methods; integrated primary care settings are rapidly adapting to meet this need. Integrating more behavioral health clinicians into primary care clinics will provide better access to whole-person care when it is needed most. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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32
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Saadi A, Cheffers ML, Taira B, Trotzky-Sirr R, Parmar P, Samra S, Morrison JL, Shah S, Schneberk T. Building Immigration-Informed, Cross-Sector Coalitions: Findings from the Los Angeles County Health Equity for Immigrants Summit. Health Equity 2019; 3:431-435. [PMID: 31448353 PMCID: PMC6707036 DOI: 10.1089/heq.2019.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In December 2017, the Los Angeles County Office of Immigrant Affairs and Board of Supervisors, alongside local health care and legal providers, convened the Health Equity for Immigrants and Families Summit to advance a vision for immigrant health. We describe the four critical concepts identified by stakeholders to address the varied needs of immigrants in an increasingly anti-immigrant political environment: (1) Recognizing immigration status as a modifiable social determinant of health; (2) Adopting the concept of “Immigration-Informed Care” within health care institutions; (3) Establishing immigration-focused medical-legal partnerships; and (4) Building coordinated systems based on knowledge of local stakeholders, policies, and funding mechanisms.
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Affiliation(s)
- Altaf Saadi
- National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California
| | - Mary L Cheffers
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Breena Taira
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - Rebecca Trotzky-Sirr
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Parveen Parmar
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Shamsher Samra
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Janina L Morrison
- Primary Care Internal Medicine, The Wellness Center, LAC+USC Medical Center, Los Angeles, California
| | - Sural Shah
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California.,Division of Internal Medicine-Pediatrics, University of California Los Angeles, Los Angeles, California
| | - Todd Schneberk
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California
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Chaudhri S, Zweig KC, Hebbar P, Angell S, Vasan A. Trauma-Informed Care: a Strategy to Improve Primary Healthcare Engagement for Persons with Criminal Justice System Involvement. J Gen Intern Med 2019; 34:1048-1052. [PMID: 30912031 PMCID: PMC6544694 DOI: 10.1007/s11606-018-4783-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/20/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022]
Abstract
Trauma is pervasive in the USA, but disproportionately present in individuals and communities burdened by poverty, violence, and exposure to the criminal justice system. Engagement in clinical care, especially community-based primary care, is particularly important in the immediate period following community reentry from incarceration, where opportunities to engage clients in services are essential for improved health and reduced recidivism. Trauma-informed care offers an important and innovative opportunity for healthcare systems and primary care providers to improve quality of care and the patient experience, thereby increasing longitudinal engagement of marginalized and hard-to-reach patient populations like persons with criminal justice system exposure. Trauma-informed care implementation includes educating providers and transforming practices to incorporate safety, trust, peer support, collaboration, empowerment, and cultural perspectives into everyday operations and care delivery. While comprehensive trauma-informed care involves transformation on a system level, trauma-informed approaches can also be adopted by the individual provider to improve the clinical consultation. By recognizing the role of trauma and its impact on an individual's physical, emotional, and behavioral health, providers and clients can build mutual trust, focus on individual growth, and begin to foster healing.
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Affiliation(s)
- Simran Chaudhri
- Health Access Equity Unit, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
- Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
| | - Kimberly Caramanica Zweig
- Health Access Equity Unit, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
- Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Preetha Hebbar
- Health Access Equity Unit, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
- Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Sonia Angell
- Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York City, NY, USA
| | - Ashwin Vasan
- Health Access Equity Unit, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
- Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York City, NY, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
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34
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Bergman AA, Hamilton AB, Chrystal JG, Bean-Mayberry BA, Yano EM. Primary Care Providers' Perspectives on Providing Care to Women Veterans with Histories of Sexual Trauma. Womens Health Issues 2019; 29:325-332. [PMID: 31027706 DOI: 10.1016/j.whi.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND One in four women Veterans who use the Veterans Health Administration (VA) screen positive for military sexual trauma and may need trauma-sensitive care and coordination. VA primary care providers (PCPs), women veterans' main source of care, need to be well-versed in trauma-sensitive approaches to care. Women veterans' numerical minority in the VA can make provider exposure to female patients inconsistent, which may impede PCP experience in providing appropriate care. To inform strategies for improving trauma-sensitive primary care, we sought to better understand PCPs' current approaches to providing care to women veterans with sexual trauma histories. METHODS We conducted semistructured telephone interviews with PCPs (n = 28) practicing in VA primary care clinics. Participants were asked about their experiences delivering trauma-sensitive care as well as best practices. Interviews were recorded, transcribed, and analyzed for major themes regarding barriers to and facilitators of trauma-sensitive care. RESULTS Participants expressed challenges delivering care to women with sexual trauma histories, including 1) insufficient time, 2) lack of perceived proficiency and/or personal comfort (with general physical examinations as well as gender-specific care such as Pap, breast, and pelvic examinations), and 3) difficulties with fostering positive patient-provider relationships. Access to mental health resources was noted as a key facilitator of providing trauma-sensitive care. Participants also shared existing (and potential) best practices and recommendations, such as paying special attention to patient behavioral cues related to comfort. CONCLUSIONS PCPs delivering care to women in VA facilities may benefit from an increased awareness of best practices to facilitate the delivery of trauma-sensitive care.
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Affiliation(s)
- Alicia A Bergman
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, North Hills, California.
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Joya G Chrystal
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Bevanne A Bean-Mayberry
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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35
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Whitaker RC, Herman AN, Dearth-Wesley T, Smith HG, Burnim SB, Myers EL, Saunders AM, Kainz K. Effect of a Trauma-Awareness Course on Teachers' Perceptions of Conflict With Preschool-Aged Children From Low-Income Urban Households: A Cluster Randomized Clinical Trial. JAMA Netw Open 2019; 2:e193193. [PMID: 31026037 PMCID: PMC6487571 DOI: 10.1001/jamanetworkopen.2019.3193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Adverse childhood experiences are common and are associated with changes in early development and learning, but training early childhood educators in trauma-informed approaches to care has not been evaluated with randomized clinical trials. OBJECTIVE To determine whether a 6-session (12-week) professional development course, "Enhancing Trauma Awareness," improved the quality of teachers' relationships with the children in their classrooms. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial conducted from September 2017 to May 2018 allocated classrooms by a computer-generated random sequence to intervention (attend Enhancing Trauma Awareness course) and control (no course) groups. Outcomes were reported by participants via survey and analyzed by group allocation. Classrooms under the auspice of the School District of Philadelphia, Pennsylvania, serving 3- and 4-year-old children living in low-income households were invited to participate. Lead and/or assistant teachers from 63 of 348 eligible classrooms (18.1%) agreed to participate, and none were excluded. Of 96 enrolled teachers, 93 (96.9%) were assessed at follow-up (61 of 63 classrooms [96.8%]). EXPOSURES In September 2017, 32 classrooms (48 teachers) were assigned to receive a professional development course that taught about the effects of trauma using a group-based relational process, and 31 classrooms (48 teachers) received no intervention. Teachers completed online surveys immediately before and after the course. Exploratory focus groups with intervention teachers (n = 15) were conducted 5 months after the course ended. MAIN OUTCOMES AND MEASURES The primary outcome was teacher-children relationship quality, with a hypothesized decrease in teacher-children conflict scores. Secondary outcomes included relational capacities (eg, empathy, emotion regulation, and dispositional mindfulness). Focus group themes described teachers' experience of the course. RESULTS Of 96 teachers enrolled, 93 (96.9%) were women, and 58 (60.4%) were 40 years and older. Follow-up surveys were completed by 46 teachers (95.8%) in the control group and 47 (97.9%) in the intervention group, of whom 38 (79.2%) attended 4 or more course sessions. Adjusting for baseline values, mean (SE) conflict scores after the course were not significantly different between course participants (15.8 [0.6]) and controls (15.0 [0.6]) (effect size = 0.16; 95% CI, -0.19 to 0.52). There were no significant between-group differences in secondary outcomes. However, in focus groups, the teachers reported improvements in teacher-children relationship quality and several related relational capacities. CONCLUSIONS AND RELEVANCE A course to enhance trauma awareness among preschool teachers did not reduce teacher-children conflict scores, yet qualitative assessments suggested the potential for improved teacher-children relationship quality. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03303482.
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Affiliation(s)
- Robert C. Whitaker
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- Previously affiliated with Department of Epidemiology and Biostatistics, Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Allison N. Herman
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- Previously affiliated with Department of Epidemiology and Biostatistics, Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Tracy Dearth-Wesley
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- Previously affiliated with Department of Epidemiology and Biostatistics, Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Hannah G. Smith
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- Previously affiliated with Department of Epidemiology and Biostatistics, Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
- Now affiliated with College of Medicine, State University of New York Upstate Medical University, Syracuse
| | - Samuel B. Burnim
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
| | - Ellen L. Myers
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
| | - Allison M. Saunders
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
| | - Kirsten Kainz
- School of Social Work, University of North Carolina, Chapel Hill
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Palfrey N, Reay RE, Aplin V, Cubis JC, McAndrew V, Riordan DM, Raphael B. Achieving Service Change Through the Implementation of a Trauma-Informed Care Training Program Within a Mental Health Service. Community Ment Health J 2019; 55:467-475. [PMID: 29705979 DOI: 10.1007/s10597-018-0272-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/19/2018] [Indexed: 11/26/2022]
Abstract
As evidence continues to accumulate for the association between childhood trauma and long-term adverse outcomes, Trauma-Informed Care (TIC) approaches are emerging as fundamental to contemporary mental health services. To evaluate a workshop designed to influence mental health practitioners in TIC principles and practices. Nursing, medical and allied health professionals completed pre and post measures of confidence, awareness and attitudes towards TIC practice. The workshop was rated as highly relevant and useful to clinician's practice. Participants' self-reported confidence, awareness and attitudes towards TIC significantly increased (p < .001) and the perceived number of barriers to working within a TIC framework significantly decreased (p < .05). Child and Adolescent Mental Health clinicians routinely screened for trauma and 80% had received training in a trauma specific intervention at follow-up. This brief training provides an important foundation for the development of trauma-informed, evidence-based mental health services.
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Affiliation(s)
- Nicola Palfrey
- Australian Child and Adolescent Trauma Loss and Grief Network, ANU Medical School, The Canberra Hospital, Garran, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry & Addiction Medicine, ANU Medical School, The Canberra Hospital, Level 2, Blg 4, PO Box 11, Garran, ACT, 2606, Australia.
| | - Velissa Aplin
- Australian Child and Adolescent Trauma Loss and Grief Network, ANU Medical School, The Canberra Hospital, Garran, Australia
- Child & Adolescent Mental Health Services, ACT Mental Health, Justice Health and Alcohol and Drug Services (MHJHDAS), Canberra, ACT, Australia
| | - Jeffery C Cubis
- Academic Unit of Psychiatry & Addiction Medicine, ANU Medical School, The Canberra Hospital, Level 2, Blg 4, PO Box 11, Garran, ACT, 2606, Australia
- Child & Adolescent Mental Health Services, ACT Mental Health, Justice Health and Alcohol and Drug Services (MHJHDAS), Canberra, ACT, Australia
| | - Virginia McAndrew
- Child & Adolescent Mental Health Services, ACT Mental Health, Justice Health and Alcohol and Drug Services (MHJHDAS), Canberra, ACT, Australia
| | - Denise M Riordan
- Child & Adolescent Mental Health Services, ACT Mental Health, Justice Health and Alcohol and Drug Services (MHJHDAS), Canberra, ACT, Australia
| | - Beverley Raphael
- Academic Unit of Psychiatry & Addiction Medicine, ANU Medical School, The Canberra Hospital, Level 2, Blg 4, PO Box 11, Garran, ACT, 2606, Australia
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Stevens N, Lillis T, Wagner L, Tirone V, Hobfoll S. A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors. J Psychosom Obstet Gynaecol 2019; 40:66-74. [PMID: 29164970 PMCID: PMC6117213 DOI: 10.1080/0167482x.2017.1398727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study evaluated the feasibility and acceptability of an integrated (psychological and obstetric) intervention for pregnant abuse survivors with posttraumatic stress symptoms (PTS) from low-income, ethno-racial minority backgrounds. METHODS Trauma-sensitive obstetrics to promote control, anxiety-reduction and empowerment (TO-CARE) offers cognitive-behavioral therapy (CBT) coping skills delivered over six sessions by therapists, coupled with trauma-sensitive obstetric care from specially-trained obstetric physicians. RESULTS Participants were 21 women who completed at least three sessions of CBT, totaling 51.2% of eligible participants. Participants received approximately one-third (M = 2.29; SD = 2.15) of their prenatal visits with obstetric residents trained in trauma-sensitive care. Nearly all participants (95%) reported that they benefited from the intervention. Although most participants demonstrated improvement in PTS, only four demonstrated reliable improvement, and two demonstrated reliable improvement in depression symptoms. These improvements appeared to be maintained at postpartum follow-up for two of the participants. CONCLUSIONS Our findings suggest that TO-CARE was acceptable to pregnant abuse survivors and may be a promising intervention to reduce symptoms of distress. Implications of the low retention rate for the CBT (51.2%) are discussed in the context of interventions for low-income minority pregnant women. Limitations regarding feasibility of the integrated intervention are discussed.
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Affiliation(s)
- N.R. Stevens
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - T.A. Lillis
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - L. Wagner
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - V. Tirone
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - S.E. Hobfoll
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
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Elisseou S, Puranam S, Nandi M. A Novel, Trauma-Informed Physical Examination Curriculum for First-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10799. [PMID: 30800999 PMCID: PMC6376894 DOI: 10.15766/mep_2374-8265.10799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/06/2019] [Indexed: 05/13/2023]
Abstract
Introduction Trauma is prevalent in the general population in various forms and has lasting effects on health. Physicians routinely examine patients who have experienced trauma, although most providers lack training in trauma-informed care, a well-established framework for providing quality care to trauma survivors. To address this gap, we implemented a novel curriculum on trauma-informed physical examination skills for first-year medical students. Methods We held a large-group lecture for 148 first-year medical students and 40 faculty members to introduce a framework for a trauma-informed physical examination, using a standardized patient for demonstration. The framework included specific language and behaviors to employ before, during, and after the examination in order to enhance patients' sense of safety, control, and trust. Students then transitioned to small groups to practice performing vital signs using a trauma-informed approach, with supervision from MD faculty. Results Five-point scales were used to evaluate students' knowledge gained from the session and satisfaction with the session. Overall satisfaction with the session was rated as 4.08 (SD = 0.81), and students felt that the session was highly effective in defining a trauma-informed physical examination (4.29, SD = 0.70). Discussion The session was well received and effective in teaching future physicians trauma-informed skills. We offer other institutions a model for incorporating trauma-informed care into clinical skills curricula.
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Affiliation(s)
- Sadie Elisseou
- Assistant Professor of Clinical Medicine, The Warren Alpert Medical School of Brown University
| | - Sravanthi Puranam
- Medical Student, The Warren Alpert Medical School of Brown University
| | - Meghna Nandi
- Medical Student, The Warren Alpert Medical School of Brown University
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Parent S, Barrios R, Nosyk B, Ye M, Bacani N, Panagiotoglou D, Montaner J, Ti L. Impact of Patient-Provider Attachment on Hospital Readmissions Among People Living With HIV: A Population-Based Study. J Acquir Immune Defic Syndr 2018; 79:551-558. [PMID: 30204719 PMCID: PMC6231958 DOI: 10.1097/qai.0000000000001857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hospital readmission 30 days after discharge is associated with adverse health outcomes, and people living with HIV (PLWH) experience elevated rates of hospital readmission. Although continuity of care with a health care provider is associated with lower rates of 30-day readmission among the general population, little is known about this relationship among PLWH. The objective of this study is to examine whether engaging with the same provider, defined as patient-provider attachment, is associated with 30-day readmission for this population. SETTING Data were derived from the Seek and Treat for Optimal Prevention of HIV in British Columbia cohort. METHODS Using generalized estimating equation with a logit link function, we examined the association between patient-provider attachment and 30-day hospital readmission. We determined whether readmission was due to all cause or to a similar cause as the index admission. RESULTS Seven thousand thirteen PLWH were hospitalized during the study period. Nine hundred twenty-one (13.1%) were readmitted to hospital for all cause and 564 (8.0%) for the similar cause as the index admission. Patient-provider attachment was negatively associated with 30-day readmission for all causes (adjusted odds ratio = 0.85, confidence interval = 0.83 to 0.86). A second multivariable model indicated that patient-provider attachment was also negatively associated with 30-day readmission for a similar cause (adjusted odds ratio = 0.86, confidence interval = 0.84 to 0.88). CONCLUSIONS Our results indicate that a higher proportion of patient-provider attachment was negatively associated with 30-day hospital readmission among PLWH. Our study findings support the adoption of interventions that seek to build patient-provider relationships to optimize outcomes for PLWH and enhance health care sustainability.
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Affiliation(s)
- Stephanie Parent
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Dimitra Panagiotoglou
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Meine K. Pregnancy unshackled: Increasing equity through implementation of perinatal depression screening, shared decision making, and treatment for incarcerated women. Nurs Forum 2018; 53:437-447. [PMID: 29968928 DOI: 10.1111/nuf.12271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perinatal depression (PD) is one of the most common medical complications of pregnancy. The prevalence of women in correctional settings has grown eight-fold in the last 30 years. A quarter of these women were either pregnant or within a year postpartum when entering custody. Recommendations to screen and treat all pregnant women for PD are being implemented nationwide. LOCAL PROBLEM In 2016, 71% of pregnant women entering Milwaukee County Jail had minimal or no prenatal care and significant rates of high-risk medical and social risk factors. The jail system was not screening for PD. METHODS The Plan-Do-Study-Act method of quality improvement (QI), with four rapid cycles, was utilized. Patient tracer interviews and refusal rates were collected for baseline data two months preceding implementation. Data was analyzed using run charts to evaluate the impact of interventions on outcomes. INTERVENTION PD screening was implemented with the Edinburgh Perinatal Depression Scale, and if scored positive, the Healthwise shared decision-making tool was utilized for therapy options and treatment initiated. RESULTS A total of 101 women were seen, 93 were offered screening, 76 were screened, 43 were positive, and 37 started treatment within the facility. That is, 46% to 57 % of this aggregate of women who screen positive for PD and a decrease in patient refusal rates was seen throughout the process. CONCLUSION Rapid cycle QI was effective in standardizing PD screening and treatment. Replication of this project across correctional systems would help to bridge a gap of equitable care for incarcerated women.
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Affiliation(s)
- Katherine Meine
- University of Wisconsin Oshkosh, College of Nursing, 800 Algoma Boulevard, Oshkosh, WI 54901
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Talisman NW, Hurtado-de-Mendoza A, Saunders PA, Green BL. Validation of a Standardized Patient Checklist for Patient-Centered Communication: The G-PACER. MEDICAL SCIENCE EDUCATOR 2018; 28:367-373. [PMID: 30167344 PMCID: PMC6110535 DOI: 10.1007/s40670-018-0558-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study sought to validate the Georgetown PAtient-CEnteredness Rating Scale (G-PACER) standardized patient (SP) checklist as a measure of patient-centered communication in patient-provider interactions. Patient centeredness is associated with improved doctor-patient communication and better health outcomes. Simulated medical encounters using SPs are an important way to teach and evaluate provider communication skills, yet validated SP scales that focus on patient-centered communication are limited. Two versions of an SP checklist of provider interaction behaviors, the G-PACER, were developed as part of a training designed to improve relationships between providers and patients who have experienced trauma. Concurrent validity of the G-PACER was assessed with Roter Interaction Analysis System (RIAS) summary scores, particularly the patient-centeredness summary score. Item-total correlations were conducted to determine which items should be retained for future versions of the scale. Scores on the G-PACER were significantly correlated with the RIAS Patient-Centeredness score. Correlation analysis also revealed significant associations between G-PACER Total Score and RIAS Global Affect Ratings. The twelve-item version of the G-PACER performed at a commensurate level with the longer version; thus, it's use is recommended in future research. This study represents an important step in the development of reliable, valid, and efficient tools to add to those available for evaluating patient-provider interactions from the SP perspective.
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Affiliation(s)
| | | | - Pamela A Saunders
- Departments of Neurology and Psychiatry, Georgetown University School of Medicine
| | - Bonnie L Green
- Department of Psychiatry, Georgetown University School of Medicine
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Monahan-Kreishman M, Ingarfield L. Creating Campus Communities of Care: Supporting Sexual Violence Survivors. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/ss.20254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vu C, Rothman E, Kistin CJ, Barton K, Bulman B, Budzak-Garza A, Olson-Dorff D, Bair-Merritt MH. Adapting the Patient-Centered Medical Home to Address Psychosocial Adversity: Results of a Qualitative Study. Acad Pediatr 2017; 17:S115-S122. [PMID: 28865642 DOI: 10.1016/j.acap.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/04/2017] [Accepted: 01/21/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The patient-centered medical home (PCMH) seeks to improve population health. However, PCMH models often focus on improving treatment of chronic diseases rather than on addressing psychosocial adversity. We sought to gather key stakeholder input about how PCMHs might feasibly and sustainably address psychosocial adversity within their patient populations. METHODS We conducted 25 semistructured interviews with key stakeholders, such as physicians, nurses, medical assistants, and patients. The audiorecorded interviews focused on participants' perceptions of the best ways to modify the PCMH to address patients' psychosocial adversity. To facilitate information gathering, a fictional patient case was presented. Analyses were conducted using a 3-stage content-analysis process. RESULTS Participants identified provider-related and systems-level changes necessary for addressing these psychosocial adversities effectively. On the provider level, participants thought that practitioners should foster trusting relationships with patients and should be emotionally present as patients describe their life experiences. Participants also emphasized that providers need to have sensitive conversations about adversity and resilience. On a systems level, participants discussed that documentation must balance privacy and include relevant information in the medical record. In addition, care should be delivered not by a single provider but by a team that has a longitudinal relationship with the patient; this care team should include behavioral health support. CONCLUSIONS Participants provided practical strategies and highlighted provider and systems level changes to adequately address patients' prior psychosocial adversity. Future studies need to assess the degree to which such a trauma-informed approach improves patient access, outcomes, and care quality, and reduces cost.
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Affiliation(s)
- Cecilia Vu
- Boston University School of Public Health, Boston, Mass
| | - Emily Rothman
- Boston University School of Public Health, Boston, Mass
| | - Caroline J Kistin
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | | | | | | | - Megan H Bair-Merritt
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass.
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Brown JD, King MA, Wissow LS. The Central Role of Relationships With Trauma-Informed Integrated Care for Children and Youth. Acad Pediatr 2017; 17:S94-S101. [PMID: 28185977 DOI: 10.1016/j.acap.2017.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/30/2016] [Accepted: 01/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Primary care plays an essential role in the primary and secondary prevention of children's mental health problems. A growing series of trials have shown the capacity of primary care providers to deliver care that specifically addresses risks to healthy social and emotional development by incorporating mental health services into their routines and integrating their work with the mental health care system. In this article elements common to various integration schemes that seem essential to their success are described. METHODS Narrative review, combining conclusions from 3 previous systematic reviews. RESULTS Trusting, personal relationships between patients and providers, and among collaborating providers, are a critical element of successful trauma-informed integrated care. Patient-provider relationships are essential to disclosure of sensitive concerns, to engaging patients in care, and to designing care that is responsive to individual patient needs. Studies of patient-centered care and psychotherapy suggest ways that these relationships can be built and maintained. Provider-provider relationships are, in turn, essential to coordinating the work of the range of providers and services needed to address trauma prevention and treatment. These relationships can form within a variety of organizational structures but building them might require staff training, redesign of work flows, and support from organizational structures and goals. CONCLUSIONS A variety of interventions at the patient-provider, clinical site, system, and policy levels can foster relationships and provide the foundation for care capable of addressing promotion of social and emotional well-being in general and trauma prevention and treatment in particular.
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Affiliation(s)
| | - Melissa A King
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Lawrence S Wissow
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Md.
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Weiss D, Kassam-Adams N, Murray C, Kohser KL, Fein JA, Winston FK, Marsac ML. Application of a Framework to Implement Trauma-Informed Care Throughout a Pediatric Health Care Network. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:55-60. [PMID: 28252468 DOI: 10.1097/ceh.0000000000000140] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION To evaluate the initial application of a recently published three-step framework for implementing trauma-informed care (TIC) in a pediatric health care network by applying Framework for Spread. METHODS In steps 1 and 2 of the framework, we established commitment from the health care network leadership and initial interest in TIC among clinical providers (step 1), set evidence-based training goals and created the associated TIC training content (step 2). In step 3, 440 health care professionals (from 27 health care teams) participated in single-session, 1-hour training that covered the psychological impact of injury- and illness-related trauma, identification of traumatic stress symptoms, and how to respond to children exposed to potentially traumatic events. A concomitant quality improvement project allowed us to assess potential changes in training participants' favorable attitudes toward the integration of TIC and confidence in delivering TIC. RESULTS Compared with pretraining, participants demonstrated increases in attitude toward TIC, t(293) = 5.8, P < .001, Cohen's d = 0.32, and confidence in delivering TIC, t(293) = 20.9, P < .001, Cohen's d = 1.09. DISCUSSION Trainings were effective in achieving proximal goals targeting attitudes and confidence, thereby demonstrating the feasibility and clinical relevance of TIC training when implemented according to the three-step framework. Future research should examine methods of training to reach wide audiences to promote systematic change and evaluate changes in patient outcomes associated with providers' implementation of TIC.
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Affiliation(s)
- Danielle Weiss
- Ms. Weiss: Research Assistant, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Kassam-Adams: Research Associate Professor of Clinical Psychology in Pediatrics, Perelman School of Medicine, University of Pennsylvania, Associate Director for Behavioral Research, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, and Director of the Center for Pediatric Traumatic Stress; Past President, International Society for Traumatic Stress Studies. Ms. Murray: Training Manager, Violence Prevention Initiative, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. Ms. Kohser: Research Coordinator, Center for Injury Research and Prevention; Project Coordinator, Center for Pediatric Traumatic Stress, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Fein: Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Director, Violence Prevention Initiative, The Children's Hospital of Philadelphia, and Director of Advocacy & Health Policy, The Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Winston: Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Attending Physician, Founder and Scientific Director, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, and Director of the National Science Foundation Industry, University Cooperative Research Center, the Center for Child Injury Prevention Studies. Dr. Marsac: Assistant Professor of Pediatrics, College of Medicine, Kentucky University, and Kentucky Children's Hospital, Lexington, KY
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