Impact of an attachment- and trauma-informed training intervention for social care professionals

The importance of trauma-informed care (TIC) within residential aged care (RAC) settings has been increasingly recognised. TIC would ensure that older people who have experienced trauma over their lifetime have their needs better understood and accommodated. This scoping review examined the extent to which TIC has been applied within RAC settings. A scoping review was conducted according to Cochrane recommendations and the PRISMA-ScR checklist. A systematic search of six databases (Embase, Emcare, CENTRAL, CINAHL, PsychInfo and Medline) was performed in July 2022 and March 2023 and peer-reviewed primary research, in English and involved RAC staff or residents (aged 65years and over) providing or receiving TIC were eligible for inclusion. Studies focused on trauma intervention, assessment, screening, or treatment were excluded. Thematic synthesis was performed to extract themes relating to trauma-informed practice, barriers and enablers to TIC, and outcomes from the application of TIC approaches. Five articles were included. There was little evidence of the implementation of TIC interventions in RAC settings. Only one study examined the application of a TIC framework in a RAC setting. However, there was some evidence that approaches that consider resident's experience of trauma have emerged from practice experience and been used in RAC as an extension of person-centred care. Whilst trauma-informed approaches to resident care are emerging through practice experience, and despite policy recommendations to do so, there is little evidence that formal TIC interventions or frameworks have been applied to RAC internationally. This study highlights a gap in research and practice and makes several recommendations for further research and implementation of TIC in RAC.

This article describes the process of integrating trauma-informed behavioral health practices into a pediatric primary care clinic serving low-income and minority families while facing barriers of financial, staffing, and time limitations common to many community healthcare clinics. By using an iterative approach to evaluate each step of the implementation process, the goal was to establish a feasible system in which primary care providers take the lead in addressing traumatic stress. This article describes (1) the process of implementing trauma-informed care into a pediatric primary care clinic, (2) the facilitators and challenges of implementation, and (3) the impact of this implementation process at patient, provider, and community levels. Given the importance of trauma-informed care, especially for families who lack access to quality care, the authors conceptualize this paper as a guide for others attempting to integrate best behavioral health practices into pediatric clinics while working with limited resources.

Cumulative traumatic migration experiences are compounded by escalating chronic distress related to the current sociopolitical climate for refugee and immigrant children and families. The aim of this open trial was to conduct a preliminary evaluation of You're Not Alone, a rapidly mounted, strengths-based, community-focused capacity building training initiative for stakeholders interacting with refugee and immigrant children and families in the Chicago area. Trainings, based on Trauma-Informed Care (TIC) and psychological first aid frameworks, adapted education and universal health promotion strategies for population-specific chronic traumatic stress. Two groups of participants (N = 948), who attended either mandatory (n = 659 educators) or voluntary (n = 289 community stakeholders) trainings, completed surveys at pretraining, post-training, and 6-week follow-up. Outcome indices included participant satisfaction, acceptability of training model, and changes in knowledge, attitudes, and behaviors. Over 90% of participants reported satisfaction and acceptability of trainings. For educators, hierarchical linear modeling analyses demonstrated significant increases in trauma knowledge, refugee and immigrant-specific knowledge, positive attitudes toward TIC over time, and a decrease in negative attitudes toward immigrants. Over 95% of participants indicated that they learned and intended to use new strategies to help serve refugee and immigrant children and families. At follow-up, over 80% of those who completed the survey had utilized at least one strategy, and over 55% indicated that they were using resources that they learned about in the training. This study demonstrates that capacity-building trainings swiftly developed and disseminated to community stakeholders can produce positive change in knowledge, attitudes, and practices. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological trauma can have a significant impact on mental and physical health, and interpersonal relationships. Many physicians report discomfort addressing psychological trauma in the context of health care visits, and few training opportunities exist for health care trainees to learn about the relationship between trauma and health. The aim of this project was to develop and implement an educational curriculum to teach medical and nursing trainees about trauma-informed primary care. We expanded upon pilot data from a brief interdisciplinary intervention to train medical residents in trauma-informed primary care at a Veterans Affairs hospital. We generated a trauma-informed care curriculum involving five 1-hour didactic sessions, 10-minute group reflection regarding patient interactions prior to each didactic session, and optional patient care observation and feedback. The curriculum aligned with internal medicine (n=16) and nurse practitioner (n=5) interprofessional primary care education sessions during the 2017/18 academic year. The curriculum was feasible and associated with increased self-reported knowledge, attitudes and practice around trauma-informed care. Free text feedback indicated that residents found the topic important, appreciated a skills-based approach and valued experiential educational activities. Training residents in trauma-informed care results in improved knowledge, attitudes and practices in caring for patients with psychological trauma. Residents appreciated both experiential and skills-based exercises. Next steps include continued exploration of using direct observation and feedback, and examining effects of training on patient outcomes (e.g. satisfaction with care).

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 TIC education for clinicians has not been well examined. To remedy this, the authors conducted a multidisciplinary, scoping literature review to discern best practices for 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 Published International Literature on Traumatic Stress database. Two independent reviewers screened 1,824 abstracts and excluded 1,697. After assessing 127 full-text articles, they excluded 76 based on predefined exclusion criteria; subsequently, they identified 4 additional articles through hand searching. Results: Fifty-five studies met inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma, responding to disclosures, defining trauma, and understanding trauma’s impact on health. Forty-seven of the studies included curricular evaluations, most commonly pre- and postsurveys. A minority used only postsurveys or a retrospective pre–post survey. The most common survey items included confidence in TIC skills, training content knowledge, participant demographics, and attitudes regarding the importance of TIC. Discussion: Future curricula should include applying a foundational lens of cultural humility, understanding the impacts of marginalization and oppression on individual and collective experiences of trauma, interprofessional collaboration, and incorporating survivors’ voices in education. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care providers. Significance: Although medical school curricula are increasingly including TIC education, best practices in TIC curricula have not been developed. This scoping review lays the groundwork for evidence-based strategies for the design, implementation, and evaluation of TIC curricula in the health professions.

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. 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. 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%]). 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.

Improving health outcomes for IPV-exposed women living with HIV.

Trauma exposure is associated with a host of biopsychosocial effects, including premature mortality, compromised physical/mental health, substance misuse, and addiction; 90% of American adults report at least one significant lifetime traumatic incident. Disparate trauma exposure among people with physical disabilities, lower socioeconomic status, rural residence, and/or racial/ethnic minority status creates a strong rationale supporting trauma-informed care (TIC) in promoting health equity. Although physical therapist (PT) practice, education, and research do not routinely integrate TIC, public health needs and the opportunity to advance health equity compel greater professional involvement in addressing trauma and its impact on overall wellness. This perspective describes (1) the biopsychosocial impact of trauma; (2) screening and assessment of trauma exposure and its impact; (3) TIC in physical therapy practice; (4) the impact of unaddressed trauma; and 5) TIC in physical therapy education, research, and advocacy. Physical therapy professionals should apply this information to address the gap in trauma-informed care for individuals, families, groups, and communities.

Attitudes towards trauma-informed care in residential out-of-home care

Due to the pervasiveness of trauma, it is likely that many children and families seen in pediatric health settings have incurred traumatic experiences. These experiences can lead to a variety of negative medical, psychological, and social health outcomes. Therefore, a provider's focus on supporting resilience is integral. The use of trauma-informed care (TIC) is one way providers can work toward promoting a family's resilience. TIC is considered an organizational, attitudinal shift to understanding the broad impacts of trauma. This shift can contribute to changes in policies and procedures to make each system more welcoming to all those accessing the health system. This review will discuss the current pervasiveness of trauma, its associated impacts, the importance of TIC, and practical applications of TIC based on guiding principles provided by the Substance Abuse and Mental Health Services Administration. [Pediatr Ann. 2024;53(8):e299-e304.].

The importance of trauma-informed care (TIC) is now recognized across most health and human service systems. Providers are calling for concrete examples of what TIC means in practice and how to create more trauma-informed organizations. However, much of the current understanding about implementation rests on principles and values rather than specific recommendations for action. This paper addresses this gap based on observations during the provision of technical assistance over the past decade in fields like mental health and addictions, juvenile justice, child welfare, healthcare, housing, and education. Focusing on the infrastructure for making change (the TIC workgroup), assessment and planning, and the early stages of implementation, the authors discuss barriers and challenges that are commonly encountered, strategies that have proven effective in addressing barriers, and specific action steps that can help sustain momentum for the longer term.

Objectives: This study investigates the application of Trauma-Informed Care (TIC) for military veterans, particularly those with trauma-related experiences, emphasizing conflict management and therapeutic communication. It focuses on addressing the unique needs of adolescent and older veterans to improve mental health outcomes and facilitate smoother transitions to civilian life. Method: The research examines TIC’s effectiveness in enhancing veterans' emotional regulation, collaborative problem-solving, and interpersonal conflict management skills. It emphasizes therapeutic communication techniques such as active listening and reflective statements to foster trust and support veterans in exploring their emotions safely. Results: TIC helps adolescent veterans, who often struggle with emotional expression, and older veterans, who may have repressed emotions over time, in managing conflicts and understanding their trauma. Therapeutic communication under TIC builds trust between veterans and healthcare providers, facilitating open emotional expression. However, barriers, including limited TIC training for healthcare providers, rigid care structures, and organizational constraints, impede effective implementation. Discussion: While TIC provides a promising framework for supporting veterans, its success relies on overcoming institutional challenges. Expanding training, restructuring healthcare models, and fostering an organizational culture that prioritizes trauma-sensitive care are critical steps to fully integrating TIC. Addressing these challenges could significantly improve mental health outcomes for adolescent and older veterans, promoting resilience and facilitating successful reintegration into civilian life.

Expressed emotion (EE) is a measure of family emotional climate found to be predictive of symptom levels in a range of psychiatric, medical, and developmental disorders, including autism. Employing data from 104 mothers of children with autism, this study examines the Autism-Specific Five Minute Speech Sample (AFMSS), a modified EE coding system based on the widely used Five Minute Speech Sample (Magana et al., 1986). With the exception of one EE component, emotional over-involvement, the revised coding system demonstrated adequate internal consistency and good to excellent inter-rater and code-recode reliability. It also demonstrated acceptable validity, based on its significant correlations with factors linked to EE in previous research. Regression analyses also indicated AFMSS-EE to be a significant predictor of child social competence, but not child problem behaviors. While further testing is required, the AFMSS appears to be a useful method of assessing EE within the context of parenting children with autism and related disorders.

Family expressed emotion (EE), a measure of emotional overinvolvement (EOI) and criticism (CRIT), is predictive of relapses and poor treatment outcomes among adults experiencing a range of psychopathology and may predict outcomes among youth with mood disorders. Although it is typically measured by an individual interview with a family member, EE is thought to index family processes and, therefore, should be reflected in family interactional behavior. We examined the association between maternal EE and interactional behavior in a sample of mothers and their 8-12-year-old children. Mother-child dyads participated in three video-recorded interaction tasks--two problem-solving tasks and one planning-fun-activity task. Maternal EE was measured by the Five Minute Speech Sample, and mothers were classified as CRIT, EOI, or low EE. Maternal interactional behavior was coded using the Living in Family Environments coding system. Repeated measures analyses of variance were used to test the hypothesis that both maternal EE and the type of task would predict maternal interactional behavior. On average, maternal critical behavior increased from the first to the second problem-solving task and decreased during the planning-fun-activity task. Mothers high in CRIT showed greater relative frequencies of critical behavior as compared to mothers high in EOI or mothers low in EE. The results suggest that maternal CRIT, as assessed by the Five Minute Speech Sample, is significantly associated with observed maternal critical behavior.

Introduction: Mounting evidence indicates that early life trauma is highly prevalent and associated with adverse health outcomes later in life. However, primary care providers report lacking the training to effectively address trauma encountered in daily practice. There is a paucity of research describing the implementation and evaluation of trauma-informed care (TIC) curricula within Graduate Medical Education.Methods: We piloted a three-hour TIC workshop facilitated by a community-based psychologist expert to assess the feasibility and impact of TIC training on Internal Medicine (IM) residents’ knowledge, attitudes and skills related to TIC. Participants were a subset of IM residents in a health-equity-focused curricular pathway in the University of Colorado IM Residency. Residents completed anonymous surveys one week before and after the workshop, and a final survey 10 weeks later. Residents who did not participate in the workshop completed a similar baseline survey (control group). Data were analyzed using matched pair T-tests.Results: Fourteen of 20 residents (70%) who participated in the pilot workshop completed the initial survey. Of these, 10 (71%) completed the first post-workshop survey, and seven (50%) completed the final survey. We observed significant improvements in residents’ self-reported knowledge, attitudes and skills related to TIC. The majority of residents in the control group reported a desire for TIC training.Conclusions: TIC is an important curricular gap in IM training. A single, brief TIC workshop was feasible and was associated with improved self-reported knowledge, attitudes and skills among IM residents.