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Ferkul S, Agabani Z, Minami O, Bormann J, Le Foll B, Lobo L, Hassan AN. The acceptability and feasibility of a virtual mantram program for patients with posttraumatic stress disorder and substance use disorders: mixed method results. BMC Complement Med Ther 2024; 24:9. [PMID: 38166894 PMCID: PMC10759462 DOI: 10.1186/s12906-023-04312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is a need for expanded options for therapeutic interventions for patients with posttraumatic stress disorder (PTSD) and substance use disorder (SUD). The study aimed to examine evidence for the feasibility, safety, and acceptability of a virtual Mantram Repetition Program for adults with PTSD and SUD. METHODS This project utilized mixed-method design (explanatory sequential design) to collect quantitative and qualitative data to evaluate the program in terms of its feasibility and acceptability. The program took place over Webex, an encrypted virtual platform. The group ran over 8 weeks, was 90 min in length, and facilitated by two individuals per cohort. Each group had 4-5 participants given each group cycle. The study used the Mantram Repetition Program which is a brief mindfulness based non-tramua focused group intervention. RESULTS Out of 43 participants enrolled, 5 people (11.6%) did not commence the program and 8 (18.6%) participants dropped out after commencing the program, resulting in 35 completers (81.4% retention rate). Treatment completion and retention were above 70%. Qualitative data explained several aspects of the program's acceptability including delivery methods, informative material provided and gaining a practical mindful tool to manage symptoms. CONCLUSIONS This study showed quantitative and qualitative evidence of the Mantram Repetition Program's feasibility, acceptability and safety to be used with individuals with PTSD-SUD. Although further evaluation of virtual Mantram Program to control group in longitudinal trials is needed to identify how it compares with other interventions in the field. CLINICAL TRIAL REGISTRATION NUMBER NCT05058963, (28/09/2021).
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Affiliation(s)
- Sean Ferkul
- Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Third Floor, Toronto, ON, M6J 1H4, Canada
| | - Zena Agabani
- Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Third Floor, Toronto, ON, M6J 1H4, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Osamu Minami
- Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Third Floor, Toronto, ON, M6J 1H4, Canada
| | - Jill Bormann
- Hahn School of Nursing and Health Sciences, San Diego, CA, USA
- Beyster Institute of Nursing Research, San Diego, CA, USA
- University of San Diego, San Diego, CA, USA
| | - Bernard Le Foll
- Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Third Floor, Toronto, ON, M6J 1H4, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A1, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, ON, L9M 1G3, Canada
| | - Leah Lobo
- Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Third Floor, Toronto, ON, M6J 1H4, Canada
| | - Ahmed N Hassan
- Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Third Floor, Toronto, ON, M6J 1H4, Canada.
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A1, Canada.
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia.
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2
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Davis LL, Urganus A, Gagnon-Sanschagrin P, Maitland J, Qu W, Cloutier M, Guérin A, Aggarwal J. Patient journey before and after a formal post-traumatic stress disorder diagnosis in adults in the United States - a retrospective claims study. Curr Med Res Opin 2023; 39:1523-1532. [PMID: 37817472 DOI: 10.1080/03007995.2023.2269839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/09/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE To describe post-traumatic stress disorder (PTSD)-related symptoms and frequent psychiatric comorbidities, treatments received, healthcare resource utilization (HRU), and healthcare costs pre- and post-PTSD diagnosis among adults in the United States. METHODS Adults with PTSD who received a PTSD-related pharmacological treatment (selective serotonin reuptake inhibitor [SSRI], serotonin-norepinephrine reuptake inhibitor [SNRI], atypical antipsychotic [AA]) within 24 months of the first observed PTSD diagnosis (index date) were identified using MarketScan Commercial Database (2015-2020). Study outcomes were assessed during the 6-month pre-diagnosis and 24-month post-diagnosis periods. Subgroup analyses included patients treated or not treated with AAs post-PTSD diagnosis. RESULTS Of the overall patients (N = 26,306; mean age at diagnosis 39.5 years; 73.3% female), 85.9% had PTSD-related symptoms and frequent psychiatric comorbidities during the 6 months pre-diagnosis. Patients treated with AAs post-PTSD diagnosis (N = 9,298) tended to have higher rates of PTSD-related symptoms and comorbidities at diagnosis than those not treated with AAs (N = 7,011). Following diagnosis, the most commonly observed first-line treatments were SSRI (67.4%), AA (23.4%), and SNRI (22.6%). The rate of PTSD-related symptoms and comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs increased during the 6 months post-diagnosis relative to the 6 months pre-diagnosis and then declined over time during the 24 months post-diagnosis. CONCLUSIONS The PTSD diagnosis was associated with increased rates of symptoms and frequent psychiatric comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs, pointing to increased patient monitoring. Within 6 to 12 months after the PTSD diagnosis, these outcomes tended to reduce, perhaps as patients were obtaining targeted and effective care.
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Affiliation(s)
- Lori L Davis
- Research Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | | | | | | | - Wendi Qu
- Analysis Group, Inc, Montréal, Canada
| | | | | | - Jyoti Aggarwal
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
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3
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Williamson MLC, Stickley MM, Armstrong TW, Jackson K, Console K. Diagnostic accuracy of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within a civilian primary care sample. J Clin Psychol 2022; 78:2299-2308. [PMID: 35763419 DOI: 10.1002/jclp.23405] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aims to evaluate the diagnostic accuracy of the Primary Care Posttraumatic Stress Disorder (PTSD) Screen for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) (PC-PTSD-5) as a screening tool for the identification of PTSD among a civilian sample receiving behavioral health treatment within a primary care setting. Validation within a civilian sample will increase the generalizability of the PC-PTSD-5 as a brief screening measure to identify PTSD within primary care practices. METHOD The present study is a retrospective review of data (N = 198) collected as part of a patient registry for an integrated behavioral health consultation service within a primary care clinic. The PC-PTSD-5 was administered as part of a standardized set of brief screening measures and a standard clinical interview. Diagnostic validation was accomplished via a consensus model between a board-certified family medicine physician and a licensed psychologist along with medical/psychology trainees. RESULTS Fifty-two participants (26.26%) out of 198 who completed the PC-PTSD-5 were diagnosed with PTSD. The PC-PTSD-5 demonstrated excellent diagnostic accuracy (area under the curve = 0.933, 95% confidence interval [CI]: 0.901-0.965). A cutoff score of 4 maximized sensitivity (sensitivity% = 100) while maintaining acceptable specificity (specificity% = 85.2). This score also maximized efficiency (κ[0.5] = 0.77, SE = 0.05, 95% CI: 0.67-0.86) and maintained a good (≥0.60) quality index for specificity (κ[0] = 0.61). CONCLUSION The PC-PTSD-5 maintained strong diagnostic accuracy within a civilian primary care sample.
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Affiliation(s)
- Meredith L C Williamson
- Department of Primary Care & Population Health, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Mariah M Stickley
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Trey W Armstrong
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Kaylee Jackson
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Katie Console
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
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4
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Sharif N, Karasavva V, Thai H, Farrell S. "We're Working in a Trauma Avoidant Culture": A Qualitative Study Exploring Assertive Community Treatment Providers' Perspectives on Working with Trauma and PTSD in People with Severe Mental Illness. Community Ment Health J 2021; 57:1478-1488. [PMID: 33423131 DOI: 10.1007/s10597-020-00764-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022]
Abstract
Assertive Community Treatment (ACT) is the most widely used evidence-based community mental health intervention for people with severe mental illness (SMI). Despite research showing that the vast majority of those with SMI have traumatic histories, the ACT service model does not have consistent guidelines on how to address trauma in their client population. This study employed thematic-analysis through interviewing ACT providers to better understand their perspectives on working with trauma in clients. Five overarching themes with 21 sub-themes emerged: the role and scope of ACT teams and model regarding trauma, discussions of trauma with clients, current treatment of trauma, barriers to working with trauma, and recommendations for enabling trauma discussions and treatment. Some examples for recommendations were: a need for more training regarding trauma, increasing resources like including a psychologist and trauma specialized professionals on the team, more support from leadership, and a cultural change from medicalization. Implications of the barriers and suggestions are discussed.
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Affiliation(s)
- Noor Sharif
- School of Psychology, University of Ottawa, Vanier Hall, Ottawa, ON, Canada.
| | | | - Helen Thai
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Susan Farrell
- The Royal Ottawa Health Care Group, Ottawa, ON, Canada
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5
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Lathan EC, Selwyn CN, Langhinrichsen-Rohling J. The "3 Es" of trauma-informed care in a federally qualified health center: Traumatic Event- and Experience-related predictors of physical and mental health Effects among female patients. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:703-724. [PMID: 33301611 DOI: 10.1002/jcop.22488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/06/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
Federally Qualified Health Centers (FQHCs) are a fast-growing source of healthcare for women with intersectional identities, or those most frequently exposed to and negatively impacted by interpersonal trauma. According to the "3 E" conceptualization of trauma, certain Event- and Experience-related characteristics of a trauma predict victims' physical and mental health Effects. The "3 Es" have yet to be studied in female FQHC patients. The current study examined the prevalence of interpersonal trauma and interrelationships among traumatic Event-related factors (e.g., cumulative trauma by victim-perpetrator relationship), Experience-related factors (e.g., betrayal, resilience), and Effects (e.g., somatic symptoms, posttraumatic stress (PTS), anxiety/depression, mistrust, reduced sense of safety) among 138 predominantly Black (89.1%) women receiving care at an FQHC in the southeastern U.S. Roughly 65% of participants (n = 86) endorsed exposure to at least one type of interpersonal trauma. More cumulative trauma was significantly correlated with more somatic, PTS, and anxious/depressive symptoms, and a reduced sense of safety. Experiences of betrayal and/or resilience were better predictors of PTS and anxious/depressive symptoms and lack of safety than Event-related factors. Findings support the need for the implementation of trauma-informed care within community-based health centers. Healthcare providers should consider women's subjective experience of trauma when screening for exposure and providing trauma-sensitive care.
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Affiliation(s)
- Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Candice N Selwyn
- Department of Community Mental Health Nursing, University of South Alabama, Mobile, Alabama, USA
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6
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Ellinghaus C, Truss K, Liao Siling J, Phillips L, Eastwood O, Medrano C, Bendall S. "I'm tired of being pulled from pillar to post": A qualitative analysis of barriers to mental health care for trauma-exposed young people. Early Interv Psychiatry 2021; 15:113-122. [PMID: 31957219 DOI: 10.1111/eip.12919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/23/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
AIM Traumatic experiences in childhood are pervasive and associated with a range of deleterious mental health outcomes. Despite this, trauma-exposed young people often do not seek help from mental health services. While barriers to care for general mental health concerns are well established, less is known about those specifically facing young people who have experienced trauma. The present paper sought to examine the barriers in seeking mental health care faced by trauma-exposed young people through a qualitative analysis of online forums where individuals discuss and seek informal support for trauma. METHODS This study used a qualitative, netnographic design, following the six-step LiLEDDa framework, developed for the analysis of online forums. Posts about trauma written in 2016 from five Internet forums targeting young people were included and analysed via thematic analysis. RESULTS Barriers to mental health care for trauma-exposed young people were categorized into two interrelated themes: (a) structural and (b) relational barriers. Structural barriers related to practical challenges faced when accessing and engaging with mental health services. Relational barriers focused on interpersonal relationships with mental health service providers and how these influenced experiences of, and consequent engagement with, services. CONCLUSIONS Trauma-exposed young people appear to experience multiple barriers to mental health care, whereby interactions between structural and relational barriers determine ongoing engagement. Service-wide reform including trauma-informed mental health training for practitioners is urgently needed to improve access to care and engagement for this vulnerable group.
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Affiliation(s)
- Carli Ellinghaus
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie Truss
- Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jocelyn Liao Siling
- Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Phillips
- Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oliver Eastwood
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Carmen Medrano
- Orygen, Parkville, Victoria, Australia.,Sant Joan de Deu Terres de Lleida Mental Health Service, Lleida, Spain.,Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain
| | - Sarah Bendall
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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7
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Dawson RL, Calear AL, McCallum SM, McKenna S, Nixon RDV, O'Kearney R. Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. J Trauma Stress 2021; 34:81-91. [PMID: 33043507 DOI: 10.1002/jts.22596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/23/2020] [Accepted: 07/27/2020] [Indexed: 12/30/2022]
Abstract
We undertook a systematic review to assess the efficacy of exposure-based writing therapies (WTs) for trauma-exposed adults with subthreshold or clinical levels of posttraumatic stress disorder. Four databases (PsycINFO, Medline, Wiley Online, PILOTS) were searched for randomized controlled trials (RCTs) of exposure-based WTs. A total of 13 RCTs that reported on results from 17 WT versus control comparisons were included. The primary outcomes were posttraumatic stress symptom severity at posttreatment and/or clinical response. An overall unclear or high risk of bias was identified in 84.6% of studies. In comparison to both waitlist k = 3, Hedges' g = -0.97, 95% CI [-1.20, -0.73], and placebo writing conditions, k = 9, Hedges' g = -0.48, 95% CI [-0.87, -0.08], WTs were more beneficial to participants. There was no evidence of a difference between WTs that were longer in duration compared to other psychotherapy, k = 2; pooled OR = 1.42; 95% CI [0.83, 2.43]. These findings indicate that exposure-based WTs are effective when compared to waitlist and placebo writing control conditions. The evidence needs to be considered in the context of the modest number of studies conducted to date, the high methodological heterogeneity between the studies, and the high or unclear risk of bias across many studies. Further research is needed to increase the evidence base regarding the efficacy of WTs for posttraumatic stress. Future research should also measure the mediators and predictors of outcomes to further develop protocols and understand which variants of WTs work for different populations or individuals.
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Affiliation(s)
- Rachelle L Dawson
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Sonia M McCallum
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Sarah McKenna
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Reginald D V Nixon
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, Australia
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Cook JM, Zeber JE, Simiola V, Rossom R, Scherrer JF, Owen-Smith AA, Ahmedani BK, Zolfaghari K, Copeland LA. Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems. J Clin Psychol Med Settings 2020; 28:221-228. [PMID: 32048114 DOI: 10.1007/s10880-020-09706-8] [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: 10/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC). The purpose of this study was to compare the clinical characteristics and health care utilization of PTSD patients diagnosed in PC versus in specialty mental health care (MHC) across five large, civilian, not-for-profit healthcare systems. Electronic claims and medical record data on patients treated during 2014 were analyzed. Treatment was considered in terms of initiation and dose (i.e., psychotherapy sessions; pharmacotherapy-prescription psychotropics). Of 5256 patients aged 15-88 with a diagnosis of PTSD, 84.4% were diagnosed by a MHC provider. Patients diagnosed by MHC providers had 4 times the rate of and more enduring psychotherapy than those diagnosed by PC providers. Receipt of psychotropics varied by provider type, with generally higher prescription fill levels for patients in MHC. Strategies to better align patient needs with access and treatment modality in PC settings are needed.
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Affiliation(s)
- Joan M Cook
- Yale School of Medicine, New Haven, CT, USA. .,Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA.
| | - John E Zeber
- University of Massachusetts, Amherst, MA, USA.,Central Texas Veterans Health Care System, Tempe, TX, USA
| | - Vanessa Simiola
- Kaiser Permanente, Center for Integrated Health Care Research, Honolulu, HI, USA
| | | | | | - Ashli A Owen-Smith
- Kaiser Permanente Center for Research and Evaluation, Atlanta, GA, USA.,Georgia State University School of Public Health, Atlanta, GA, USA
| | | | - Kiumars Zolfaghari
- Center for Applied Health Research, Baylor Scott & White Health, Dallas, TX, USA
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9
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Valentine D, Kurzweil A, Zabar S, Lewis A. Objective Structured Clinical Exams (OSCE) are a feasible method of teaching how to discuss a nonepileptic seizure diagnosis. Epilepsy Behav 2019; 100:106526. [PMID: 31654939 DOI: 10.1016/j.yebeh.2019.106526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Presenting the diagnosis of psychogenic nonepileptic seizures (PNES) can be a difficult task, but disclosing this information effectively is important to optimize patient outcomes. We sought to develop a standardized method to teach neurology residents how to introduce the diagnosis of PNES via an objective structured clinical examination (OSCE) with a standardized patient (SP). METHODS In conjunction with the New York University School of Medicine Simulation Center (NYSIM), we designed an OSCE in which a resident had to inform a SP of her diagnosis of PNES and discuss a treatment plan. The SP was provided with details to gradually disclose depending on what the resident said about the history of her episodes, triggers for her episodes and her history of sexual abuse. Each encounter was observed by an attending physician who provided real-time feedback to the resident after the session. Additionally, the SP completed an objective written checklist of items the resident should have covered in the session and gave them verbal feedback. RESULTS Twenty-six adult neurology (n = 22), child neurology (n = 3), and neuropsychiatry (n = 1) residents participated in this OSCE in 2018 and 2019, with full data available for 25 participants. Residents reported the OSCE was very useful (mean Likert score of 4.9/5). They felt moderately prepared (mean Likert score 3.8/5) and rated their performance as a mean of 3.3/5. On the SP's checklist, most residents were rated as Well Done in the domains of information gathering, relationship development, and education and counseling. Only in the domain of psychosocial assessment were most residents rated as Not Done (only 7/25 inquired about past trauma as a risk factor for PNES). SIGNIFICANCE The OSCEs are a feasible and useful way to teach neurology residents about discussing PNES, as they allow for provision of real-time practice and feedback in a safe environment without real patients.
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Affiliation(s)
- David Valentine
- Department of Neurology, New York University School of Medicine, New York, NY, United States of America.
| | - Arielle Kurzweil
- Department of Neurology, New York University School of Medicine, New York, NY, United States of America
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, NY, United States of America
| | - Ariane Lewis
- Department of Neurology, New York University School of Medicine, New York, NY, United States of America; Department of Neurosurgery, New York University School of Medicine, New York, NY, United States of America
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10
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Goldstein E, Murray-García J, Sciolla AF, Topitzes J. Medical Students' Perspectives on Trauma-Informed Care Training. Perm J 2018; 22:17-126. [PMID: 29401053 DOI: 10.7812/tpp/17-126] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Adults exposed to traumatic events during childhood commonly seek medical services, but health care practitioners hesitate to address and assess early trauma despite its known negative health effects. This study examines medical students' perspectives on a brief course that addressed the health care needs of patients exposed to adverse childhood experiences. METHODS A convenience sample of 20 University of California, Davis medical students from the Summer Institute on Race and Health received 6 hours of trauma-informed care training. The course was delivered in 2-hour modules during the course of 3 days, and included lectures, discussions, and practice. A questionnaire assessing students' perspectives on training benefits, current practice challenges, and necessary resources to provide trauma-informed medical care was distributed posttraining. RESULTS From the students' perspectives, this course increased their ability to recognize various clinical manifestations of adverse childhood experience exposure in adult patients. Students said they learned how to ask about and respond to adverse childhood experience disclosures and identify necessary resources to responsibly implement trauma-informed care in medical settings. Students identified provision of adequate resources and links to appropriate treatment identified as common challenges in providing health care to trauma-affected patients. CONCLUSION Study findings illustrate that trauma training can fill a knowledge gap and provide associated benefits for medical students. Initial training may pique students' interest by demonstrating the relevance of trauma knowledge in clinical practice; additional training likely is needed to support skills and confidence.
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Affiliation(s)
- Ellen Goldstein
- Postdoctoral Fellow at the University of Wisconsin-Madison Department of Family Medicine and Community Health Primary Care Research Fellowship.
| | - Jann Murray-García
- Assistant Health Sciences Clinical Professor at the Betty Irene Moore School of Nursing at the University of California, Davis.
| | - Andrés F Sciolla
- Associate Professor of Clinical Psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of California, Davis.
| | - James Topitzes
- Associate Professor at the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee and the Clinical Director of the Institute for Child and Family Well-Being.
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11
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Goldstein E, Athale N, Sciolla AF, Catz SL. Patient Preferences for Discussing Childhood Trauma in Primary Care. Perm J 2017; 21:16-055. [PMID: 28333604 DOI: 10.7812/tpp/16-055] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Exposure to traumatic events is common in primary care patients, yet health care professionals may be hesitant to assess and address the impact of childhood trauma in their patients. OBJECTIVE To assess patient preferences for discussing traumatic experiences and posttraumatic stress disorder (PTSD) with clinicians in underserved, predominantly Latino primary care patients. DESIGN Cross-sectional study. MAIN OUTCOME MEASURE We evaluated patients with a questionnaire assessing comfort to discuss trauma exposure and symptoms using the Adverse Childhood Experiences (ACE) Study questionnaire and the Primary Care-PTSD screen. The questionnaire also assessed patients' confidence in their clinicians' ability to help with trauma-related issues. Surveys were collected at an integrated medical and behavioral health care clinic. RESULTS Of 178 adult patients asked, 152 (83%) agreed to participate. Among participants, 37% screened positive for PTSD, 42% reported 4 or more ACEs, and 26% had elevated scores on both measures. Primary Care-PTSD and ACE scores were strongly positively correlated (r = 0.57, p < 0.001). Most patients agreed they were comfortable being asked about trauma directly or through screening questionnaires and did not oppose the inclusion of trauma-related information in their medical record. In addition, most patients perceived their clinician as comfortable asking questions about childhood trauma and able to address trauma-related problems. CONCLUSION Screening is acceptable to most primary care patients regardless of trauma exposure or positive PTSD screening. Findings may aid primary care clinicians to consider screening regularly for ACEs and PTSD to better serve the health care needs of trauma-exposed patients.
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Affiliation(s)
- Ellen Goldstein
- Doctoral Graduate from the Betty Irene Moore School of Nursing at the University of California, Davis.
| | - Ninad Athale
- Family Physician at OLE Health, an Associate Medical Director of County Campus, the Medical Director of Napa County Alcohol and Drug Services, and a Volunteer Clinical Instructor at the University of California, Davis School of Medicine.
| | - Andrés F Sciolla
- Associate Professor at the Department of Psychiatry and Behavioral Sciences at the University of California, Davis.
| | - Sheryl L Catz
- Professor of Nursing Science from the Betty Irene Moore School of Nursing at the University of California, Davis.
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12
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[Experiences of Life and Work of a Group of Epidemiologists in Training in Order to Address Mental Health Problems and Issues at Local and Departmental Level. Medellin, 2013]. ACTA ACUST UNITED AC 2015; 43:203-11. [PMID: 26574077 DOI: 10.1016/j.rcp.2014.04.001] [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: 01/17/2014] [Revised: 03/15/2014] [Accepted: 04/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine, from the point of view of a group of epidemiologists in training, their life experiences and work related to addressing mental health problems and mental health issues. METHODS An exploratory qualitative-descriptive study was conducted using ethnographic tools, non-participant observation, note-taking, and group interviews (FG). RESULTS The participants mentioned that mental health and mental health issues are managed and poorly differentiated either by them and the community in general. They also said they were not ready to handle mental problems, or have the support of services for patient care, as mental health issues have not yet been clearly dimensioned by society. Epidemiology has its limitations, it focuses on knowledge of the physical-biological aspects and the use of quantitative approach with poor integration of the qualitative approach, thus hindering the understanding of a phenomenon that exceeds the limits of a research approach. CONCLUSIONS This approach to issues of health and mental illness widens the view of knowledge from only a single focus. It includes an understanding of the qualitative approach as an option to advance the knowledge and recognition of a public health problem overshadowed by stigma and apathy of society.
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