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Hall D, Smiley Y, Slovin A, Manget J, Bost JE, Chokshi B. Applying a Trauma-Informed Lens to Challenging Adolescent Encounters: A Faculty Development Session for Pediatricians. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11408. [PMID: 38957524 PMCID: PMC11219089 DOI: 10.15766/mep_2374-8265.11408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/29/2024] [Indexed: 07/04/2024]
Abstract
Introduction Patient encounters perceived to be challenging are common and contribute to both suboptimal patient health outcomes and provider burnout. A trauma-informed care (TIC) approach to these encounters is critical, as many of the characteristics associated with challenging patient encounters can be linked to a history of trauma exposure. Methods Our team created and delivered a 1-hour synchronous virtual session intended to bolster provider knowledge of TIC principles and their application to challenging adolescent encounters. Participants were all faculty and staff engaged in pediatric primary care at an urban academic center, including physicians, nurse practitioners, psychologists, and social workers. The content was rooted in adult learning principles and included didactic components anchored to case-based learning with facilitated group discussions and opportunities for reflection. We used paired pre- and postsession self-assessments of provider knowledge, confidence, and practice related to TIC using Likert-scale and free-text questions. Descriptive statistics and a paired t test were used to determine the impact of the session on these metrics. Results In 24 paired surveys, there were statistically significant increases (p ≤ .001) in participant perceived knowledge, confidence, and practice, with 100% of participants having a statistically significant improvement in one or more of these domains. There were also strongly positive Likert-scale and free-text responses regarding content relevance and delivery. Discussion We demonstrate that a brief session can create improvement in pediatric providers' perceived knowledge about the application of TIC principles to challenging adolescent encounters as well as confidence in their ability to put these into practice.
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Affiliation(s)
- Deborah Hall
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Yael Smiley
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Ariella Slovin
- Instructor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Jaytoya Manget
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - James E. Bost
- Research Division Chief, Center for Translational Research, Children's National Hospital; Associate Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Binny Chokshi
- Associate Professor, Division of Military Child and Family Research, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
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Burton ET, Moore JM, Vidmar AP, Chaves E, Cason-Wilkerson R, Novick MB, Fernandez C, Tucker JM. Assessment of Adverse Childhood Experiences and Social Determinants of Health: A Survey of Practices in Pediatric Weight Management Programs. Child Obes 2023. [PMID: 38133550 DOI: 10.1089/chi.2023.0152] [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: 12/23/2023]
Abstract
Introduction: Adverse childhood experiences (ACEs) and social determinants of health (SDoH) are associated with increased incidence of pediatric obesity. Recent literature highlights an imperative need to assess ACEs and SDoH among youth and families with obesity to identify those individuals requiring targeted interventions. The primary objective of the present study was to examine the frequency, methodology, and barriers in evaluation of ACEs and SDoH within pediatric weight management programs (PWMPs). Methods: Invitations were e-mailed to a comprehensive directory of 92 PWMPs in the United States with a link to complete an electronic survey. Results: Forty-one PWMPs from 26 states completed the survey. Assessment of one or more ACEs and SDoH was common and typically took place during the initial patient visit by the psychologist or medical practitioner through unstructured conversations. Reported barriers to assessment included lack of time to assess and to follow-up, lack of clinic protocols, and inadequate referral resources. Programs offering bariatric surgery and those with embedded mental health clinicians reported fewer barriers to ACEs/SDoH referral resources, while family-based and healthy lifestyle-focused programs perceived more barriers related to insufficient support staff and time to follow-up with families. Conclusions: Most PWMPs assess a subset of ACEs and SDoH; however, approaches to assessment vary, are often unstructured, and several barriers remain to optimizing assessment and follow-up. Future research should evaluate standardized ACEs/SDoH assessment protocols, ideal workflow, and their impact on obesity treatment and related health outcomes.
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Affiliation(s)
- E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jaime M Moore
- Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alaina P Vidmar
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Eileen Chaves
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rochelle Cason-Wilkerson
- Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marsha B Novick
- Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Cristina Fernandez
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jared M Tucker
- Health Optimization Services, Helen Devos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
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McBain RK, Levin JS, Matthews S, Qureshi N, Long D, Schickedanz AB, Gilgoff R, Kotz K, Slavich GM, Eberhart NK. The effect of adverse childhood experience training, screening, and response in primary care: a systematic review. EClinicalMedicine 2023; 65:102282. [PMID: 38106557 PMCID: PMC10725064 DOI: 10.1016/j.eclinm.2023.102282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 12/19/2023] Open
Abstract
Background Adverse childhood experiences (ACEs) can have harmful, long-term health effects. Although primary care providers (PCPs) could help mitigate these effects, no studies have reviewed the impacts of ACE training, screening, and response in primary care. Methods This systematic review searched four electronic databases (PubMed, Web of Science, APA PsycInfo, CINAHL) for peer-reviewed articles on ACE training, screening, and/or response in primary care published between Jan 1, 1998, and May 31, 2023. Searches were limited to primary research articles in the primary care setting that reported provider-related outcomes (knowledge, confidence, screening behavior, clinical care) and/or patient-related outcomes (satisfaction, referral engagement, health outcomes). Summary data were extracted from published reports. Findings Of 6532 records, 58 met inclusion criteria. Fifty-two reported provider-related outcomes; 21 reported patient-related outcomes. 50 included pediatric populations, 12 included adults. A majority discussed screening interventions (n = 40). Equal numbers (n = 25) discussed training and clinical response interventions. Strength of evidence (SOE) was generally low, especially for adult studies. This was due to reliance on observational evidence, small samples, and self-report measures for heterogeneous outcomes. Exceptions with moderate SOE included the effect of training interventions on provider confidence/self-efficacy and the effect of screening interventions on screening uptake and patient satisfaction. Interpretation Primary care represents a potentially strategic setting for addressing ACEs, but evidence on patient- and provider-related outcomes remains scarce. Funding The California Department of Health Care Services and the Office of the California Surgeon General.
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Affiliation(s)
- Ryan K. McBain
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Division of Healthcare Delivery, RAND Corporation, Washington, DC, USA
| | - Jonathan S. Levin
- Division of Healthcare Delivery, RAND Corporation, Washington, DC, USA
| | - Samantha Matthews
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
| | - Nabeel Qureshi
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
| | - Dayna Long
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Adam B. Schickedanz
- Department of Pediatrics, David Geffen School of Medicine and Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Rachel Gilgoff
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, CA, USA
| | - Krista Kotz
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nicole K. Eberhart
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
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Manning A, Weingard M, Fabricius J, French A, Sendak M, Davis N. Be ExPeRT (Behavioral Health Expansion in Pediatric Residency Training): A Case-Based Seminar. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11326. [PMID: 37534018 PMCID: PMC10392710 DOI: 10.15766/mep_2374-8265.11326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/08/2023] [Indexed: 08/04/2023]
Abstract
Introduction Pediatric residents report behavioral or mental health (B/MH) assessment and treatment as a training gap and often feel ill-equipped to address these issues in clinical practice. We developed a novel interactive training program to improve resident confidence in managing common pediatric B/MH conditions. Methods The Be ExPeRT curriculum comprised a half-day interactive seminar on attention deficit hyperactivity disorder, anxiety, depression, and suicidality followed by monthly case-based discussions. Content included didactic material, role-play, and case discussion. The training was optional and open to pediatric or combined medicine-pediatrics trainees. Results Twenty-three residents (70% female) participated in four separate seminars over 2 years. Of the participants attending the seminars, 17 (74%) completed the presurvey, and 16 (70%) completed the postsurvey. Statistically significant improvement was noted in comfort treating major depressive disorder (41% pre, 94% post, p = .002), suicide risk (29% pre, 94% post, p < .001), and anxiety (24% pre, 94% post, p < .001) following program participation. Twelve (75%) of the 16 participants completing the survey rated the training in the top 5%-10% with respect to other resident learning experiences. Discussion We developed this curriculum to enhance trainee knowledge and comfort in addressing common pediatric B/MH conditions in primary care. Significant improvement was noted in self-reported comfort in treating major depressive disorder, suicide risk, and anxiety, and the program was well received. The curriculum can be adapted for use in any training program for primary care providers to provide B/MH education that may be lacking or supplement existing programming.
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Affiliation(s)
- Alison Manning
- Assistant Professor and Clinician Educator, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
| | - Matthew Weingard
- Assistant Professor, Division of Pediatric Behavioral Health, Department of Pediatrics, University of Utah and Intermountain Primary Children's Hospital
| | - Jacqueline Fabricius
- Pediatric Rheumatology Fellow, Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Alexis French
- Medical Instructor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Mya Sendak
- Consulting Associate, Department of Pediatrics, Duke University School of Medicine
| | - Naomi Davis
- Assistant Professor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
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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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Thang C, Kucaj S, Forkey H, Lopez N, Ocampo A, Inkelas M, Wilhalme H, Szilagyi M. Training Pediatric Interns to be Trauma-Responsive Providers by Adapting a National Evidence-Informed Curriculum for Pediatricians. Acad Pediatr 2023; 23:219-221. [PMID: 35259547 PMCID: PMC10376929 DOI: 10.1016/j.acap.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Christine Thang
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif.
| | - Samantha Kucaj
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
| | - Heather Forkey
- Child Protection Program and Foster Children Evaluation Services and Department of Pediatrics (H Forkey), University of Massachusetts Memorial Children's Medical Center, Worcester, Mass
| | - Nathalie Lopez
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
| | - Andrea Ocampo
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
| | - Moira Inkelas
- Fielding School of Public Health (M Inkelas), University of California at Los Angeles, Los Angeles, Calif
| | - Holly Wilhalme
- Department of Medicine Statistics Core (H Wilhalme), University of California Los Angeles, Los Angeles, Calif
| | - Moira Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
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Szoko N, Ragunanthan B, Radovic A, Garrison JL, Torres O. Antiracist Curriculum Implementation for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231162986. [PMID: 37123077 PMCID: PMC10134181 DOI: 10.1177/23821205231162986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents. Methods In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation. Results Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy. Conclusion We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Nicholas Szoko, Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Avenue, Second Floor, Pittsburgh PA, 15213, USA.
| | | | - Ana Radovic
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L. Garrison
- Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Orquidia Torres
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Treme J, Quick C. Integrating Adverse Childhood Experiences Into Undergraduate Nursing Curriculum: A Scoping Review. J Nurs Educ 2022; 61:673-678. [PMID: 36475994 DOI: 10.3928/01484834-20221003-01] [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: 12/12/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are traumatic events occurring in childhood that can have severe effects on health throughout the life span. Quality nursing care includes the knowledge and skills to recognize patients who were exposed to ACEs and respond appropriately. METHOD A scoping review of the literature was conducted as the foundation for implementing ACEs into baccalaureate nursing curricula. RESULTS A total of 22 articles were examined and included 15 research studies, two literature reviews, one quality improvement project, and four discussion articles. The literature reflects a prevalence for case-based ACEs content and the importance of student safety measures during content implementation. CONCLUSION Knowledge derived from this review can assist nursing educators to integrate ACEs education into baccalaureate nursing curricula and identify research areas for further investigation. [J Nurs Educ. 2022;61(12):673-678.].
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Stout J, Martin AI. Trauma-Informed Care in the Classroom: Our Experience with a Content Warning in a Medical School Course. MEDICAL SCIENCE EDUCATOR 2022; 32:711-718. [PMID: 35818610 PMCID: PMC9270545 DOI: 10.1007/s40670-022-01559-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 06/03/2023]
Abstract
Trauma is now recognized as a common human experience that has consequences, including adverse effects on learning outcomes. Principles of trauma-informed care include awareness of the impact of trauma and use of strategies to prevent retraumatization. While well-described in medical and mental health care, these principles have been inconsistently applied in the medical education classroom. Content warnings can be part of a trauma-informed classroom approach that notifies learners about potentially distressing topics, allows individuals to employ self-care, and seeks to resist retraumatization. This article describes our experience integrating a content warning about reproductive topics in a second-year medical school course. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01559-0.
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Affiliation(s)
- Julianne Stout
- Veterinary Administration Department, Indiana University School of Medicine-West Lafayette, Purdue University, 715 Clinic Drive Suite 2069, West Lafayette, IN 47907 USA
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Steen M, Raynor J, Baldwin CD, Jee SH. Child Adversity and Trauma-Informed Care Teaching Interventions: A Systematic Review. Pediatrics 2022; 149:184788. [PMID: 35165742 DOI: 10.1542/peds.2021-051174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Health professionals need training to provide trauma-informed care (TIC) for children with adverse childhood experiences (ACEs), which can affect short- and long-term health. We summarize and evaluate published curricula for health professionals on ACEs and TIC. METHODS We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PsychInfo, and MedEdPORTAL through January 2021. Studies meeting the following criteria were included: Described teaching interventions on ACEs, TIC, and child abuse and maltreatment; included health care providers or trainees as learners; were written in English; included an abstract; and described a curriculum and evaluation. We reviewed 2264 abstracts, abstracted data from 79 studies, and selected 51 studies for qualitative synthesis. RESULTS Studies focused on ACEs/TIC (27), child abuse (14), domestic/intimate partner violence (6), and child maltreatment/parental physical punishment (4). Among these 51 studies, 43 were published since 2010. Learners included a mix of health professionals (34) and students (17). Duration, content, and quality of the 51 curricula were highly variable. An analysis of 10 exemplar curricula on ACEs and/or TIC revealed high and very high quality for methods and moderate to very high quality for curriculum evaluation, suggesting that they may be good models for other educational programs. Four of the 10 exemplars used randomized controlled trials to evaluate efficacy. Studies were limited to English language and subject to publication bias. CONCLUSIONS ACEs and TIC are increasingly relevant to teaching health professionals, especially pediatricians, and related teaching curricula offer good examples for other programs.
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Affiliation(s)
| | - Jennifer Raynor
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, New York
| | | | - Sandra H Jee
- Division of General Pediatrics, Department of Pediatrics.,Center for Community Health and Prevention, Rochester, New York
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Lloyd MC, Ratner J, La Charite J, Ortiz R, Tackett S, Feldman L, Solomon BS, Shilkofski N. Addressing Trauma and Building Resilience in Children and Families: Standardized Patient Cases for Pediatric Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11193. [PMID: 34820511 PMCID: PMC8592119 DOI: 10.15766/mep_2374-8265.11193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) and trauma are common and can negatively impact children's health. Standardized patient (SP) learning may provide trainees with knowledge and skills to screen for and manage ACEs, apply trauma-informed care approaches, and teach resilience strategies. METHODS With content experts, we developed three SP cases based on common clinical encounters, as well as didactic and debriefing materials. Case 1 focused on somatic symptoms in an adolescent with ACEs, case 2 focused on an ACE disclosure by a parent, and case 3 focused on de-escalation. The workshop required facilitators, SPs, simulation exam room and meeting space, and audiovisual equipment. It lasted 4 hours and included an orientation (1 hour), the three SP cases (totaling 2 hours), and group debriefing (1 hour). RESULTS We conducted five identical workshops with 22 pediatric residents. Participants responded favorably to case fidelity and applicability to their clinical work. Resident mean self-assessment scores improved significantly from baseline. Specifically, we assessed comfort with inquiring about and discussing ACEs, explaining the health impacts of trauma, identifying protective factors, resilience counseling, and de-escalation. Over 90% of responses indicated that residents were likely to apply what they had learned to their clinical practice. DISCUSSION These findings demonstrate that our SP cases were well received and suggest that such curricula can help pediatric residents feel more prepared to address trauma and promote resilience. Future work will assess these outcomes, as well as behavior change, in a larger sample to further substantiate these promising findings.
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Affiliation(s)
- M. Cooper Lloyd
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Jessica Ratner
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Jaime La Charite
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Robin Ortiz
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Sean Tackett
- Associate Professor, Department of Medicine, Johns Hopkins Bayview Medical Center and Johns Hopkins University School of Medicine; Core Faculty, Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine
| | - Leonard Feldman
- Associate Professor, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Barry S. Solomon
- Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Nicole Shilkofski
- Associate Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
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Collins K, Spice C, Ingraham BC, Al Achkar M. Family Medicine Resident Knowledge of Adverse Childhood Experiences. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2021; 5:13. [PMID: 33860168 DOI: 10.22454/primer.2021.971170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction Exposure to adverse childhood experiences (ACEs) has been associated with poor health in adulthood. Primary care providers can provide more appropriate medical care and intervene if they ask patients about ACEs. The purpose of this study is to determine existing knowledge and attitudes about ACEs among family medicine residents within the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region. Methods Researchers developed a nine-question survey to assess family medicine residents' knowledge and attitudes about ACEs, and their comfort level in addressing ACEs. The survey was distributed to 540 residents in 22 family medicine residency programs in the WWAMI region. Results Most residents reported they had some (32%) or moderate (35%) knowledge of the ACEs study. However, 30% reported no knowledge of the ACEs study, and very few (3%) reported significant knowledge. Of 117 respondents reporting at least some prior knowledge of ACEs, 42% had first heard about ACEs during residency. The ACEs topics that respondents felt least comfortable addressing during a patient encounter were a patient's personal history of sexual abuse (75%) and witnessing physical abuse (47%). Most residents (84%) indicated that they would like to see ACEs integrated into their residency curriculum. Discussion This study demonstrates a gap in residency training on the topic of ACEs in family medicine residencies within the WWAMI region. Residents are uncomfortable addressing ACEs with patients but are receptive to learning about this topic. More teaching about ACEs can increase residents' comfort level with addressing these topics in the primary care setting.
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Chokshi B, Walsh K, Dooley D, Falusi O, Deyton L, Beers L. Teaching Trauma-Informed Care: A Symposium for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11061. [PMID: 33409358 PMCID: PMC7780743 DOI: 10.15766/mep_2374-8265.11061] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/11/2020] [Indexed: 06/03/2023]
Abstract
INTRODUCTION A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. METHODS We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. RESULTS The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. DISCUSSION A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.
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Affiliation(s)
- Binny Chokshi
- Pediatrician and Co-Medical Director Healthy Generations, Children's National Hospital; Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Kimberly Walsh
- Clinical Research Coordinator, Children's National Hospital
| | - Danielle Dooley
- Pediatrician and Medical Director of Community Affairs and Population Health, Child Health Advocacy Institute, Children's National Hospital; Assistant Professor of Pediatrics and Co-Course Director, Patients Populations and Systems, George Washington University School of Medicine and Health Sciences
| | - Olanrewaju Falusi
- Pediatrician and Medical Director Advocacy Education, Child Health Advocacy Institute, Children's National Hospital; Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lawrence Deyton
- Senior Associate Dean of Clinical Public Health, Murdock Head Professor of Medicine and Health Policy, and Professor of Medicine, George Washington University School of Medicine and Health Sciences
| | - Lee Beers
- Pediatrician and Medical Director for Municipal and Regional Affairs, Child Health Advocacy Institute, Children's National Hospital; Co-Director Early Childhood Innovation Network, Children's National Hospital; Associate Professor of Pediatrics, George Washington University School of Medicine and Health Sciences
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Chokshi B, Chen KLD, Beers L. Interactive Case-Based Childhood Adversity and Trauma-Informed Care Electronic Modules for Pediatric Primary Care. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10990. [PMID: 33094156 PMCID: PMC7549390 DOI: 10.15766/mep_2374-8265.10990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/18/2020] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Training health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited. METHODS Four computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules. RESULTS Overall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience. DISCUSSION A trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.
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Affiliation(s)
- Binny Chokshi
- General Pediatrician, Children's National Health System; Assistant Professor, Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Kuan-Lung Daniel Chen
- Senior Researcher, Building Community Resilience, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University
| | - Lee Beers
- General Pediatrician, Children's National Health System; Medical Director of Community Health and Advocacy, Child Health Advocacy Institute; Associate Professor, Department of Pediatrics, George Washington University School of Medicine and Health Sciences
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Onigu-Otite E, Idicula S. Introducing ACEs (Adverse Childhood Experiences) and Resilience to First-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10964. [PMID: 32964120 PMCID: PMC7499813 DOI: 10.15766/mep_2374-8265.10964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are associated with negative mental and physical health outcomes and predictive of higher sociodemographic risk. Introducing ACEs into undergraduate medical education is key to prevention, early recognition, and intervention. METHODS In a 1-hour lecture, held live and viewed online, we delivered a condensed introduction to ACEs to first-year medical students. Live-classroom participants completed pre-/postsession questionnaires self-assessing their knowledge of 10 content areas on a 5-point Likert scale. We analyzed quantitative data to determine mean scores and differences. We synthesized qualitative data obtained from feedback. RESULTS One hundred twenty-four students, including 32 live-classroom attendees and 92 online viewers, participated in this activity. Self-assessment scores increased in all content areas measured, with a mean increase of 1.5 (p < .0001). The most significant increases occurred in identifying household dysfunction as ACEs (increase of 2.3), calculating an ACE score (increase of 2.2), differentiating between child abuse acts of commission and omission (increase of 1.9), describing resilience (increase of 1.7), and recognizing the link between ACEs and chronic medical conditions (increase of 1.4). Participants found the lecture informative, appreciating the use of the case illustrating how ACEs impact health and an interactive slide on the risks conferred by cumulative ACEs. Learners welcomed the positive message of resilience. DISCUSSION Introducing ACEs in medical student education is feasible. Educating the next generation of health providers on ACEs while highlighting prevention and resilience and teaching trauma-informed care is crucial. This lecture can be readily incorporated into medical student curricula.
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Affiliation(s)
- Edore Onigu-Otite
- Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Associate Course Director, Behavioral Sciences Foundations Course, School of Medicine, Baylor College of Medicine
- Corresponding author:
| | - Sindhu Idicula
- Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Course Director, Behavioral Sciences Foundations Course, School of Medicine, Baylor College of Medicine
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Ghastine L, Kerlek AJ, Kopechek JA. Childhood Sexual Abuse: A Call to Action in Pediatric Primary Care. Pediatrics 2020; 146:peds.2019-3327. [PMID: 32753372 DOI: 10.1542/peds.2019-3327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lea Ghastine
- College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Anna J Kerlek
- College of Medicine, The Ohio State University, Columbus, Ohio; and.,Nationwide Children's Hospital, Columbus, Ohio
| | - Jack A Kopechek
- College of Medicine, The Ohio State University, Columbus, Ohio; and.,Nationwide Children's Hospital, Columbus, Ohio
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