Global autism guidelines for care and workforce education: progress, gaps, and the way forward

(408) Trauma-Informed Care in Undergraduate Medical Education: Results of a Physician-Led Workshop to Improve Clinical Preparedness in Sexual Medicine

There are some unique aspects to providing trauma-informed reproductive care to transgender and nonbinary people, who are affected by minority stress, stigma, and particular forms of trauma; we review the evidence and suggest strategies for the provision of trauma-informed reproductive care to gender minorities. Stigma and minority stress affect the health of transgender and nonbinary (TGNB) people, leading to disparities across a range of outcomes. Barriers to accessing care, including reproductive care, further complicate these health disparities. Interpersonal stigma within the healthcare system, and high rates of physical and sexual violence survivorship, make TGNB people particularly vulnerable to healthcare trauma and poor care. This is particularly true among TGNB people with multiple intersecting marginalized identities. Trauma-informed care provides a framework for medical practitioners to provide safe, holistic, and sensitive care. Scant academic literature discusses trauma-informed reproductive care for TGNB individuals. We present a narrative review of the evidence for trauma-informed reproductive care for TGNB people and suggest potential application and implementation.

Objective: Psychological safety (PS) is essential for health and social care professionals (HSCPs) working in high-stress environments. While much of the existing research focuses on PS within teams, less is known about HSCPs' lived experiences across diverse health and social care settings. This scoping review aims to synthesise the qualitative literature on PS, identifying key barriers and enablers to its development in health and social care workplaces. Methods: A systematic search was conducted across MEDLINE, PsycINFO, Embase, CINAHL, Scopus, Web of Science, and the Cochrane Library, covering a 20-year period (2004-2024). Eligible studies included primary qualitative research exploring HSCPs' experiences of PS. Screening and data extraction were managed using Rayyan. An inductive thematic synthesis approach was applied to identify key patterns in the data. Results: The review identified several enablers and barriers to PS. The main enablers included (1) feeling safe within the team and (2) personal factors, which encompassed professional skills, experience, social support, and self-care. Conversely, key barriers were identified: (1) the normalisation of traumatic incidents, (2) unsupportive team and management structures, (3) organisational constraints, and (4) a lack of knowledge and training on PS. Conclusions: Understanding the enablers and barriers of PS is critical for improving workplace culture, resilience, and wellbeing among HSCPs. These findings provide a foundation for future research and interventions aimed at strengthening PS at individual, team, and organisational levels across diverse health and social care settings. The results also offer valuable insights for informing policies and practice to ultimately enhance both staff wellbeing and patient care quality.

Introduction: Integrated care aims to improve access, quality, and continuity of services for ageing populations and people experiencing chronic conditions. There are several descriptions in the literature recommending training in integrated care for health and social care professionals. One underdeveloped area is a global consensus of the key competencies and a global framework describing what these competencies and models of training look like. This study utilized a consensus building approach (Modified Delphi Study) with global experts with experience in delivering and designing workforce training in integrated care to ascertain which competencies are important to include in the framework and the best ways to implement these competencies. Aims, Objectives, and Methods: The purpose of this study was to analyze the interactions between integrated care education leaders globally to explore what competencies are needed to practice integrated care across a broad range of health and social care settings and to identify the most effective models to implement these competencies. Meticulous and well-informed planning, and the development and implementation of an international competency framework will allow education providers and curriculum developers to incorporate these competencies and proposed models into existing training and curricula. A four-step methodological process was used. First, a potential list of competencies and key features of education and training in integrated care were identified based on a systematic scoping review. Second predefined criteria were used to identify the global panelists with experience in delivering or research in education in integrated care to reach consensus on the level of importance of the competencies and key themes. Thirdly, two anonymous iterative Delphi rounds were conducted followed by analysis and consensus of the results. A key focus of the study was determining how the experts engaged people and community in the delivery and design of the education program. Results and key findings: Components of training needs to include active involvement of people with lived experience of care in the design, delivery, and evaluation of the training. Other components include incorporating models to train health and social care professionals together to work within and across teams. Incorporating advanced collaboration and shared decision-making skills; a focus on comprehensive assessment of patient and family needs and a focus on primary and community care were some of the key findings of this study. Conclusion: Existing competencies and models of training to build capacity for integrated care are not comprehensive and none has been developed through a formal global expert consensus technique. Higher education providers and workplaces may use the results of our study to highlight areas where they need to seek additional expertise, to develop and incorporate new and more advanced competencies into workforce training. Further work is needed to refine and test the competencies to ensure feasibility and usefulness, and to ensure curriculum developers and workplaces are appropriately supported and trained to implement them. The competencies can be used to shape job descriptions, orientation programmes, supervision, performance reviews and to design curricula and training on integrated care.

ABSTRACTWe report the needs and challenges identified by health and social care professionals and service users for robotics and autonomous systems that are of importance to researchers and policymakers. To this end, we held eight workshops in different locations across Cornwall (UK) in which we raised awareness of the applications and opportunities of assistive robots. The 223 participants could interact physically with four robots, watched a multimedia presentation including video and use-case scenarios and then took part in 33 focus groups. Content analysis was carried out based on summaries written by facilitators during the focus groups. The focus groups produced 163 challenges that may have digital solutions including 78 suitable for robotic assistive technology, in three main areas: maintaining independence at home, social isolation, and rurality. Although further research is needed with technology and its implementation, this study shows that health and social care professionals, patients, carers, and students are willing to consider using robotics and autonomous systems in health and social care settings.

Background: Emerging evidence indicates that unresolved trauma is a critical factor influencing sexual health outcomes. However, sexual health care often overlooks trauma’s profound somatic, psychological, and relational effects. Objective: This study explores the integration of trauma-informed care (TIC) into sexual health practice, examining its impact on sexual function, pleasure, body image, and relational intimacy. Methods: A mixed-methods review of peer-reviewed studies, clinical practice insights, and case analyses was conducted. Findings were examined through the lens of trauma theory, somatic healing modalities, and holistic sexual health models. Results: Trauma-informed, somatically attuned approaches improve sexual health outcomes by fostering emotional safety, supporting nervous system regulation, and enhancing embodiment. Culturally responsive interventions further mitigate the impact of intergenerational and systemic trauma on sexual well-being. Conclusions: Trauma-informed sexual health care represents an essential paradigm shift in fostering sustainable healing and sexual empowerment. The findings call for widespread integration of TIC within clinical sexual health interventions.

Investigating the contextual factors and mechanisms associated with implementing Blue Prescription Programmes in health and social care settings: a systematic review using realist synthesis

People seeking reproductive care experience trauma on many levels including personal, structural, in medical care, and in barriers to care. This article reviews key aspects of a Trauma-Informed Care approach in abortion and reproductive healthcare. Experiences of trauma are common and compounding, including systemic trauma, such as racism, sexism, and transphobia. Reproductive healthcare itself traumatizes and re-traumatizes. Trauma Informed Care (TIC) approach to individual abortion care includes maximize patient safety, choice, and privacy. TIC approach to systemic abortion care includes dismantling barriers to care and stigma. The experience of trauma is prevalent, often unrecognized and can be multifactorial, especially for those seeking abortion and contraception care. Reproductive care can create situations or power dynamics that reactivate a trauma experience. History of trauma influences a person's health, relationships, experience, and use of reproductive healthcare, as well as trust in reproductive health recommendations. Laws restricting access to abortion and reproductive health add another layer of trauma and disproportionately affect marginalized groups. Guidelines for Trauma Informed Abortion Care recognize the complexity of trauma in reproductive health experiences and seek to promote safety, empowerment, and healing on individual and systemic levels.

“Tu” or “Vous?”: A European qualitative study of dignity and communication with older people in health and social care settings

Epilepsy is prevalent in 22.2% of the intellectual disability (ID) population, with complexities spanning across health and social care sectors. Minimal research has been conducted to explore the experiences of epilepsy care within social care, despite its significance. Qualitative methodologies, using semi-structured interviews, were used to explore the experiences of health and social care professionals within the United Kingdom and analysed using Braun and Clarke's reflexive thematic analysis framework. Four overarching themes were constructed from 11 interviews a) "It's just not sexy, is it?": Barriers to good epilepsy care, b) "My mission is to make their life better": Facilitators of good epilepsy care, c) "Sometimes they appear frightened": Impact of epilepsy, d) "Epilepsy training as a mandatory": Future of epilepsy care. Fear was the most prevalent emotion described by participants throughout, which was perpetuated by the lack of resources and understanding/awareness, such as training. However, facilitating better epilepsy care for people with ID, can help reduce fear, and promote better wellbeing in all. Participants made recommendations such as mandating epilepsy training, and involving all key stakeholders, including families of people with ID, to improve epilepsy care in the future. Mandating epilepsy training in health and social care settings is beneficial for care delivery and reducing the impact of epilepsy upon families and caregivers. Involving key stakeholders, such as families and caregivers, in all aspects of epilepsy care for people with ID, improves communication, service delivery and quality.

Dementia care: Research and clinical innovation.

BackgroundOver the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnaires used in English-speaking countries but limited their search processes to mental health and public health settings. Our aim was to identify questionnaires used in German-speaking countries measuring the implementation of interventions in public health and health care settings in general and to assess their psychometric properties.MethodsWe searched five different bibliographic databases (from 1985 to August 2017) and used several other search strategies (e.g., reference lists, forward citation) to obtain our data. We assessed the instruments, which were identified in an independent dual review process, using 12 psychometric rating criteria. Finally, we mapped the instruments’ scales and subscales in regard to the constructs of the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcome Framework (IOF).ResultsWe identified 31 unique instruments available for the assessment of implementation science constructs. Hospitals and other health care settings were the ones most often investigated (23 instruments), while education and childcare settings, workplace settings, and community settings lacked published instruments. Internal consistency, face and content validity, usability, and structural validity were the aspects most often described. However, most studies did not report on test-retest reliability, known-groups validity, predictive criterion validity, or responsiveness. Overall, the majority of studies did not reveal high-quality instruments, especially regarding the psychometric criteria internal consistency, structural validity, and criterion validity. In addition, we seldom detected instruments operationalizing the CFIR domains intervention characteristics, outer setting, and process, and the IOF constructs adoption, fidelity, penetration, and sustainability.ConclusionsOverall, a sustained and continuous effort is needed to improve the reliability and validity of existing instruments to new ones. Instruments applicable to the assessment of implementation constructs in public health and community settings are urgently needed.Trial registrationThe systematic review protocol was registered in PROSPERO on October 19, 2017, under the following number: CRD42017075208.

Parental mental illness is a major public health issue and there is growing evidence that family focused practice can improve outcomes for parents and their families. However, few reliable and valid instruments measure mental health and social care professionals' family focused practice. To explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of health and social care professionals. Health and Social Care Professionals (n = 836) in Northern Ireland completed an adapted version of the Family Focused Mental Health Practice Questionnaire. Exploratory factor analysis was used to test the structure of the underlying dimensions in the questionnaire. The results, and theoretical considerations, guided construction of a model that could explain variation in respondents' items. This model was then validated using confirmatory factor analysis. Exploratory factor analysis revealed that solutions including 12 to 16 factors provided a good fit to the data and indicated underlying factors that could be meaningfully interpreted in line with existing literature. From these exploratory analyses, we derived a model that included 14 factors and tested this model with Confirmatory Factor Analysis. The results suggested 12 factors that summarized 46 items that were most optimal in reflecting family focused behaviours and professional and organizational factors. The 12 dimensions identified were meaningful and consistent with substantive theories: furthermore, their inter-correlations were consistent with known professional and organizational processes known to promote or hinder family focused practice. This psychometric evaluation reveals that the scale provides a meaningful measure of professionals' family focused practice within adult mental health and children's services, and the factors that hinder and enable practice in this area. The findings, therefore, support the use of this measure to benchmark and further develop family focused practice in both adult mental health and children's services.

Despite serving patients with especially high rates of trauma exposure and related sequelae, many primary care providers do not receive specialized training in the provision of trauma-informed care (TIC). This study sought to document primary care providers' baseline rates of TIC training and their knowledge, perceptions, and practice of TIC at a large, urban public hospital in the Southeastern United States. Participants (n = 67; 68.7% women; 44.8% white; Mage = 36.7 years, standard deviation [SD]age = 9.8 years) completed an online self-report survey on their TIC training status, trauma-related knowledge, perceptions, and practices, as well as burnout and secondary traumatic stress. Less than half of participants (43.3%) endorsed TIC training exposure. Participants generally had adequate levels of trauma-related knowledge (76.5% of items correct) and favorable perceptions of TIC (endorsed 89.7% of TIC-supportive statements). Most participants (86.6%) endorsed recently using trauma-informed practices, but only 47.8% reported routinely screening for trauma-related disorders. Participants who reported receiving prior TIC training scored better on knowledge items and endorsed recently using more trauma-informed practices than those who did not have training exposure. TIC training status' associations with current screening practices and perceptions of TIC were trending toward significance. TIC training status was not related to burnout, and trained participants reported greater secondary traumatic stress than those without training exposure. Results point to system-wide TIC training as a well-received, translational strategy that can enhance the trauma-informed nature of primary care provision.

Survivors of abuse in care settings have had to fight over many years for their rights for justice. They experienced physical, emotional, and sexual abuse at the hands of individuals, and abuse and neglect because of failures in care systems. At times, some social work and care professionals abused children in their care. Others were complicit in failing to address such abuse. However, social work and social care professionals have also been central in supporting survivors of abuse in care, in bringing offenders to account, and enabling justice processes. The activism and demands of survivors have led to social and governmental responses in a number of countries, including public inquiries, apologies, reparation and redress schemes, and commemorative activity. However, these responses have often been ad hoc and contested. This article will detail the furtherance of justice for survivors of childhood abuse in care in Scotland through the development of a human rights-based model. It will examine the challenges to these developments, particularly in terms of accountability and financial redress. This will be compared to interventions in other countries, including different parts of the UK. Developments in theory and the implications for social work and social care professionals will be highlighted.