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Berring LL, Holm T, Hansen JP, Delcomyn CL, Søndergaard R, Hvidhjelm J. Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review. Healthcare (Basel) 2024; 12:908. [PMID: 38727465 PMCID: PMC11083630 DOI: 10.3390/healthcare12090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| | - Tine Holm
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark;
| | - Jens Peter Hansen
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Retspsykiatrisk Forskningsenhed, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - Christian Lie Delcomyn
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department for Forensic Psychiatry, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark
| | - Rikke Søndergaard
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
| | - Jacob Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Center Sct Hans, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark;
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Ohtsuka MS, Shannon K, Zucchet A, Krüsi A, Bingham B, King D, Axl-Rose T, Braschel M, Deering KN. Prevalence and Social-Structural Correlates of Gender-Based Violence Against Women Living With HIV in Metro Vancouver, Canada. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4562-4588. [PMID: 36317864 PMCID: PMC9899311 DOI: 10.1177/08862605221118611] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Violence experienced by cisgender (cis) and gender minority women living with HIV is known to be high. More work is needed to better understand how to support women living with HIV who have experienced violence. The objectives of this study are therefore to identify the prevalence and correlates of violence by any perpetrator among women living with HIV in a Canadian setting. Data were drawn from 9 years (January, 2010 to February, 2019) of a longitudinal community-based open cohort study of 350+ cis and trans women living with HIV who were living and/or accessed care in Metro Vancouver, Canada (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment "SHAWNA"). Participants completed baseline and biannual follow-up interviews. Bivariate and multivariable logistic regression with generalized estimating equations (GEE) were performed to identify correlates of recent (last 6 months) violence (physical and/or sexual) by any perpetrator. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CIs) are presented. At baseline, prevalence of violence was high: 95.5% (recent = 19.4%) of participants reported lifetime physical and/or sexual violence, 94.8% (recent = 17.9%) reported lifetime physical violence, and 84.5% (recent = 5.7%) reported lifetime sexual violence. In multivariable logistic regression with GEE, the following variables were associated with higher odds of recent physical/sexual violence: youth (<30 years) (AOR: 1.60, 95% CI [1.15, 2.22]), recent unstable housing/homelessness (AOR: 1.96, 95% CI [1.30, 2.97]), recent food insecurity (AOR: 1.57, 95% CI [1.13, 2.17]), recent incarceration (AOR: 1.85, 95% CI [1.18, 2.91]), recent opioid use (AOR: 1.38, 95% CI [1.04, 1.82]), recent stimulant use (AOR: 2.48, 95% CI [1.72, 3.56]), and lifetime HIV status disclosure without consent (AOR: 1.59, 95% CI [1.13, 2.24]). Trauma- and violence-informed (TVI) policies that include a focus on confidentiality and safe disclosure practices should be integrated into existing housing, incarceration, and harm reduction programs, and HIV care and practice for women living with HIV. Programs and policies that address high levels of violence remain critical.
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Affiliation(s)
- Mika S. Ohtsuka
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alyssa Zucchet
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Brittany Bingham
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Desire King
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Tara Axl-Rose
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | | | - Kathleen N. Deering
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Jain JP, Sheira LA, Frongillo EA, Neilands TB, Cohen MH, Wilson TE, Chandran A, Adimora AA, Kassaye SG, Sheth AN, Fischl MA, Adedimeji AA, Turan JM, Tien PC, Weiser SD, Conroy AA. Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States. AIDS 2022; 36:1861-1869. [PMID: 35950940 PMCID: PMC9529878 DOI: 10.1097/qad.0000000000003329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US). DESIGN We analyzed longitudinal data collected among 1717 WLHIV in the Women's Interagency HIV Study (WIHS). METHODS From 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (<95%) adherence and at least one missed HIV care appointment without rescheduling in the past 6 months. Mediation analyses were performed to test whether heavy drinking and illicit drug use mediated the associations between GBV and the two HIV outcomes. RESULTS The mean age was 47 (standard deviation = 9), 5% reported experiencing GBV, 17% reported suboptimal adherence and 15% reported at least one missed appointment in the past 6 months. Women who experienced GBV had a significantly higher odds of suboptimal adherence [adjusted odds ratio (aOR) = 1.99; 95% confidence interval (CI) = 1.40-2.83] and missed appointments (aOR = 1.92, 95% CI = 1.32-2.33). Heavy drinking and illicit drug use mediated 36 and 73% of the association between GBV and suboptimal adherence and 29 and 65% of the association between GBV and missed appointments, respectively. CONCLUSIONS Substance use is an underlying mechanism through which GBV affects outcomes along the HIV care continuum among WLHIV in the US. To optimize HIV treatment and care among women, interventions should address the combined epidemics of substance use, violence, and HIV.
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Affiliation(s)
| | - Lila A Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, New York
| | - Aruna Chandran
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Seble G Kassaye
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Anandi N Sheth
- School of Medicine, Emory University, Atlanta, and Grady Health System, Atlanta, Georgia
| | | | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Janet M Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Phyllis C Tien
- Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California, USA
| | - Sheri D Weiser
- Center for AIDS Prevention Studies, University of California, San Francisco
| | - Amy A Conroy
- Center for AIDS Prevention Studies, University of California, San Francisco
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Thurston IB, Howell KH, Kaufman CC, Mandell JE, Decker KM. Parenting in matched pairs of women of color experiencing intimate partner violence and living with and without HIV. J Trauma Stress 2021; 34:1005-1015. [PMID: 34637554 DOI: 10.1002/jts.22737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/11/2022]
Abstract
This study explored the associations between depression and parenting among women of color with low income levels who were exposed to intimate partner violence (IPV) and HIV. Participants were 60 Black, multiracial, and Hispanic/Latina mothers (Mage = 36.66, SD = 6.99) in the midsouth region of the United States. Mothers were recruited from community organizations and reported their experiences with IPV, HIV, depression, potentially traumatic events (PTE), parenting practices, and child maladaptive functioning. Participants living with HIV and experiencing recent IPV (i.e., cases) were matched on age, race, ethnicity, and educational attainment with mothers experiencing recent IPV (i.e., controls), for a matched sample of 30 pairs. Analyses were conducted to examine how HIV status moderated the associations between depressive symptoms and both negative and positive parenting while accounting for PTE, child maladaptive functioning, and IPV severity. The moderation model for negative parenting was significant, f2 = 0.58, but the moderation model for positive parenting was not, p = .346. Specifically, moderation was supported, B = 0.43, 95% CI [0.03, 0.83], t(53) = 2.17, p = .035, indicating that the association between depressive symptoms and negative parenting was moderated by HIV status. The findings highlight the added burden of a physical health condition on parenting practices. Given the role of negative parenting (i.e., inconsistency, poor monitoring, corporal punishment) in exacerbating poor health outcomes among children exposed to adversity, clinicians and researchers must develop family-based strategies to decrease these practices.
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Affiliation(s)
- Idia B Thurston
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
- Department of Health Promotion and Community Health Sciences, Texas A&M Health, College Station, Texas, USA
| | - Kathryn H Howell
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Caroline C Kaufman
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica E Mandell
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kristina M Decker
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
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Sales JM, Anderson KM, Kokubun CW. Application of the Consolidated Framework for Implementation Research to Facilitate Violence Screening in HIV Care Settings: a Review of the Literature. Curr HIV/AIDS Rep 2021; 18:309-327. [PMID: 33866483 DOI: 10.1007/s11904-021-00555-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the literature on violence screening practices within HIV care settings globally as well as identified salient multi-level barriers and facilitators for adopting and implementing violence screening within HIV care. We utilized the Consolidated Framework for Implementation Research (CFIR) to systematically identify multi-level factors related to violence screening within HIV services. RECENT FINDINGS Across the 15 articles included, several highly salient CFIR constructs emerged as particularly relevant for violence screening adoption and implementation within HIV including inner setting factors, outer setting factors, as well as select constructs specific to characteristics of the violence screening process, the individuals charged with screening, and violence screening execution. This review underscores the importance of considering CFIR constructs to bolster successful violence screening implementation in HIV care settings. We describe several potential implementation strategies to overcome the most salient barriers identified across this limited body of summarized research.
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Affiliation(s)
- Jessica M Sales
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Katherine M Anderson
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Caroline W Kokubun
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Enane LA, Apondi E, Omollo M, Toromo JJ, Bakari S, Aluoch J, Morris C, Kantor R, Braitstein P, Fortenberry JD, Nyandiko WM, Wools‐Kaloustian K, Elul B, Vreeman RC. "I just keep quiet about it and act as if everything is alright" - The cascade from trauma to disengagement among adolescents living with HIV in western Kenya. J Int AIDS Soc 2021; 24:e25695. [PMID: 33838007 PMCID: PMC8035676 DOI: 10.1002/jia2.25695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION There are approximately 1.7 million adolescents living with HIV (ALHIV, ages 10 to 19) globally, including 110,000 in Kenya. While ALHIV experience poor retention in care, limited data exist on factors underlying disengagement. We investigated the burden of trauma among disengaged ALHIV in western Kenya, and its potential role in HIV care disengagement. METHODS We performed in-depth qualitative interviews with ALHIV who had disengaged from care at two sites, their caregivers and healthcare workers (HCW) at 10 sites, from 2018 to 2020. Disengagement was defined as not attending clinic ≥60 days past a missed scheduled visit. ALHIV and their caregivers were traced through phone calls and home visits. Interviews ascertained barriers and facilitators to adolescent retention in HIV care. Dedicated questions elicited narratives surrounding traumatic experiences, and the ways in which these did or did not impact retention in care. Through thematic analysis, a conceptual model emerged for a cascade from adolescent experience of trauma to disengagement from HIV care. RESULTS Interviews were conducted with 42 disengaged ALHIV, 34 caregivers and 28 HCW. ALHIV experienced a high burden of trauma from a range of stressors, including experiences at HIV disclosure or diagnosis, the loss of parents, enacted stigma and physical or sexual violence. A confluence of factors - trauma, stigma and isolation, and lack of social support - led to hopelessness and depression. These factors compounded each other, and resulted in complex mental health burdens, poor antiretroviral adherence and care disengagement. HCW approaches aligned with the factors in this model, suggesting that these areas represent targets for intervention and provision of trauma-informed care. CONCLUSIONS Trauma is a major factor underlying disengagement from HIV care among Kenyan adolescents. We describe a cascade of factors representing areas for intervention to support mental health and retention in HIV care. These include not only the provision of mental healthcare, but also preventing or addressing violence, trauma and stigma, and reinforcing social and familial support surrounding vulnerable adolescents. In this conceptualization, supporting retention in HIV care requires a trauma-informed approach, both in the individualized care of ALHIV and in the development of strategies and policies to support adolescent health outcomes.
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Affiliation(s)
- Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Moi Teaching and Referral HospitalEldoretKenya
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Clemette Morris
- Indiana University‐Purdue University‐IndianapolisIndiana UniversityIndianapolisINUSA
| | - Rami Kantor
- Division of Infectious DiseasesDepartment of MedicineBrown University Apert Medical SchoolProvidenceRIUSA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of EpidemiologyIndiana University Fairbanks School of Public HealthIndianapolisINUSA
- Dalla Lana School of Public HealthDivision of EpidemiologyUniversity of TorontoTorontoONCanada
- Department of MedicineCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - J Dennis Fortenberry
- Division of Adolescent MedicineDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of Child Health and PediatricsCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - Kara Wools‐Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Batya Elul
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
- Department of Health System Design and Global HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Arnhold Institute for Global HealthNew YorkNYUSA
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