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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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Schleyer W, Zona K, Quigley D, Spottswood M. Group therapy in primary care settings for the treatment of posttraumatic stress disorder: A systematic literature review. Gen Hosp Psychiatry 2022; 77:1-10. [PMID: 35390567 DOI: 10.1016/j.genhosppsych.2022.03.010] [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: 09/12/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This systematic review aims to summarize existing literature on group therapy for the treatment of post-traumatic stress disorder (PTSD) in primary care. METHOD A PRISMA systematic literature review was performed through February 26, 2022 identifying existing studies of group trauma therapy in primary care. Articles were included if they discussed group trauma therapy for primary care patients. Bias was assessed based on sample sizes and presence of control groups. Results are presented as a weighted average of the engagement rate and a qualitative description of overlapping study traits. RESULTS Four studies of group PTSD treatment within primary care were identified with 70 total patients completing group treatment. The weighted treatment engagement rate was 65%. Each utilized distinct group trauma treatment models and reported significant patient improvements in PTSD symptoms on standardized trauma symptom scales. DISCUSSION Group trauma therapy models are available and can be disseminated within primary care settings. Limitations include both the small number of studies and participants. CONCLUSION There have been few studies of group therapy for PTSD in primary care, but these could represent a promising and scalable approach to meet the high need for trauma treatment. Further research is needed regarding implementation feasibility and impact.
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Affiliation(s)
- William Schleyer
- Cambridge Health Alliance/Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Kate Zona
- Cambridge Health Alliance/Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Dan Quigley
- Smith College School for Social Work Lilly Hall, 23 West St, Northampton, MA 01063, United States of America
| | - Margaret Spottswood
- Community Health Centers of Burlington, 617 Riverside Ave., Burlington, VT 05401, United States of America; University of Vermont, Department of Psychiatry, 1 South Prospect Street, Burlington, VT 05401, United States of America.
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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Selwyn CN, Lathan EC, Richie F, Gigler ME, Langhinrichsen-Rohling J. Bitten by the System that Cared for them: Towards a Trauma-Informed Understanding of Patients' Healthcare Engagement. J Trauma Dissociation 2021; 22:636-652. [PMID: 33446088 DOI: 10.1080/15299732.2020.1869657] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The BITTEN theoretical framework of trauma-informed healthcare proposes that each patient presents to a healthcare encounter with a baseline level of historical institutional Betrayal and trauma exposure that interacts with their Indicator for healthcare engagement to potentially Trigger trauma symptoms, impacting patients' Trust in healthcare providers and shaping their current and future Expectations of and Needs for healthcare. The current study sought to test and extend components of the BITTEN theoretical framework to better understand the link between trauma exposure (childhood trauma and institutional betrayal) and healthcare engagement. Results largely supported the propositions of the BITTEN theoretical framework: childhood trauma was directly related to healthcare avoidance behaviors. The relation between childhood trauma and healthcare avoidance was partially mediated by patients' reduced trust in healthcare providers. Further, the relation between childhood trauma and reduced trust in healthcare providers was potentiated by experiences of institutional betrayal. Interpreting patients' interactions with healthcare providers and the healthcare system as a whole in light of their interpersonal and institutional trauma histories is needed to more fully embody trauma-informed healthcare. The BITTEN theoretical framework of trauma-informed healthcare appears to be a viable foundation for developing a trauma-informed understanding of patients' healthcare engagement.
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Affiliation(s)
- Candice N Selwyn
- Department of Community Mental Health Nursing, University of South Alabama, Mobile, USA
| | - Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, USA
| | - Fallon Richie
- Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, USA
| | - Margaret E Gigler
- Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, USA
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Phillippi SW, Beiter K, Thomas CL, Sugarman OK, Wennerstrom A, Wells KB, Trapido E. Medicaid Utilization Before and After a Natural Disaster in the 2016 Baton Rouge-Area Flood. Am J Public Health 2020; 109:S316-S321. [PMID: 31505136 DOI: 10.2105/ajph.2019.305193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To understand changes in behavioral health services utilization and expenditures before and after natural disaster with an adult Medicaid population affected by the Baton Rouge, Louisiana-area flood (August 2016).Methods. We examined de-identified behavioral health claims data for Medicaid-insured adults in the affected region for 10 months before and after flooding (October 2015-June 2017). This constituted 273 233 provider claims for 22 196 individuals. Claims data included patient gender, behavioral health diagnoses, treatment dates, and costs. We made adjustments for Medicaid expansion by using monthly enrollment data.Results. Overall, most male patient behavioral health care visits were for substance use disorders (33.6%) and most female patient behavioral health care visits were for depression-related disorders (30%). Both diagnostic categories increased after the flood by 66% and 44%, respectively. Expansion accounted for a 4% increase in claims. Postflood claims reflected 8% to 10% higher costs.Conclusions. Greater amounts of behavioral health care services were sought in all 10 months of the postflood study period. We observed gender differences in use of services and diagnoses. Behavioral health care services following natural disasters must be extended longer than traditionally expected, with consideration for specific population needs.
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Affiliation(s)
- Stephen W Phillippi
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Kaylin Beiter
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Casey L Thomas
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Olivia K Sugarman
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Ashley Wennerstrom
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Kenneth B Wells
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Edward Trapido
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
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