Principles Of Trauma-informed Care Research Articles

Implications of Occupation-Based Trauma-Informed Care for Gun Violence Survivors: A Mixed-Methodology Study

Abstract Date Presented 03/31/2022 With the prevalence of gun violence in the United States, and as health care providers in a variety of settings with people of all demographics, OT practitioners are very likely to encounter clients who have experienced trauma from a gun-related incident. This presentation will provide comprehensive resources about occupation-based trauma-informed care ( TIC) for gun violence survivors. It will discuss the six guiding principles of TIC and mental health of gun violence survivors, viewed through the lens of OT. Primary Author and Speaker: Manisha Sheth Additional Authors and Speakers: Sara Macaluso, Grace Agnes, Tatevick Sargsyan, Kristen Galvez

Applying shared decision-making to screening for trauma and adversity in youth

Youth who have experienced adverse childhood experiences (ACEs) or trauma are at risk for negative outcomes that may be lessened by adversity screening and prevention efforts. However, experts and consumers do not universally embrace adversity screening efforts. Despite significant support for widespread adversity screening, and many guidelines on how to conduct such screening, successful implementation has lagged behind enthusiasm. This paper outlines the challenges of adversity screening and then proposes applying the shared decision-making (SDM) model to improve adversity screening by increasing youths' 1) engagement in adversity screening if doing so is appropriate for them, and 2) disclosure of honest information during screens. Using an SDM approach honors youth preferences and perspectives, which simultaneously accomplishes a third overarching goal: aligning adversity screening with the principles of trauma-informed care.

A Trauma-informed Approach to Postpartum Care.

Distressing or traumatic perinatal experiences and adverse health outcomes can lead to particularly challenging postpartum experiences for patients and families. By adopting a trauma-informed care approach, the health care team can provide much-needed support, prevent additional harm, and promote healing. We propose practical communication, behavioral, and procedural considerations for integrating trauma-informed care principles into routine postpartum care, with attention to populations that have been marginalized. We see postpartum care as a critical component of holistic patient recovery and an opportunity to facilitate posttraumatic growth so that all families can thrive.

Trauma-Informed Care on CAMHS ID Unit. Case Study of a Child with Neurodevelopmental Disorder and Self-Injurious Behaviour

AimsCrystal House is a specialist CAMHS ID inpatient 5-bedded unit based in the Kingswood Centre, North West London - for children aged between 13 and 18 years with primary diagnosis of Intellectual Disabilities with or without additional concerns that warrant admission to hospital for purpose of assessment and management. Reporting this case, we wanted to highlight complexities of management of children presenting with neurodevelopmental conditions and history of trauma.MethodsThis is a case of a fourteen-year-old girl with established diagnoses of Moderate Intellectual Disability, Childhood Autism, Foetal Alcohol Syndrome and childhood trauma. She was admitted to our CAMHS ID Assessment and Treatment Unit with a nine- year history of self-injurious behaviour, suicidal ideation and voice-hearing experiences – after failed treatment in the community and in-patient treatment (including under restrictions of long-term segregation) on generic CAMHS unit. Her current treatment includes a person-centred Trauma- Informed Positive Behaviour Support Plan; individual and family therapy psychology sessions based on the principles of trauma-informed care and consultation with staff on trauma-informed care. She also undertook ADHD assessment, and we are in the process of optimising ADHD medication.ResultsTrauma-Informed Positive Behaviour Support Plan was a new concept for the team. Therefore, this was supported by training and consultations with staff. The latter was introduced to create a psychologically oriented environment using trauma-informed care principals and helping the team understand what trauma means and how it affects the individual. ADHD assessment confirmed the diagnosis of ADHD which was followed by optimising ADHD medication.ConclusionSystemic and a person-centred approach is used for this child with concerning presentation and history of neurodevelopmental disorder and childhood trauma.

The Trauma-Informed Ethical Decision-Making Model: An Integrative Framework

The prevalence of Adverse Childhood Experiences, and recent increase in stress during the COVID-19 crisis necessitates the practice of trauma-informed care in counseling. When addressing ethical concerns that emerge during counseling, attention to the principles of trauma-informed care is of critical importance. The purpose of this conceptual piece is to propose a Trauma-informed Ethical Decision-making Model that integrates trauma-informed standards (SAMHSA, 2014), with the proposed Principles of Trauma-informed Practice, and Kitchener and Anderson’s (2011) ethical decision-making model. This Trauma-informed Ethical Decision-making Model may provide counselors, particularly counselors-in-training, with a framework for addressing ethical concerns with client survivors of trauma. The framework may also provide counselor educators with a framework to support the development of curriculum regarding trauma-informed practice and ethical decision-making.

Peer-to-Peer Trauma-Informed Training for Surgical Residents Facilitated by Psychiatry Residents.

This article describes the implementation of trauma-informed care (TIC) didactic training, using a novel, interdisciplinary peer-to-peer teaching model to improve confidence surrounding trauma-informed practices in a surgical residency program. Eight psychiatry residents and two medical students with a background in psychological trauma and TIC and an interest in medical education were recruited to participate in three 2-hour "train the trainer" sessions led by a national expert in TIC. Eight psychiatry residents and two medical students subsequently developed and delivered the initial TIC training to 29 surgical interns. Training included the neurobiology of psychological trauma, principles of trauma-informed care, and developing trauma-informed curricula. Surgical interns reported significantly improved understanding of the physiology of trauma, knowledge of TIC approaches, and confidence and comfort with TIC and practices. Among surgical interns, understanding of the physiology of the fear response increased from 3.36 to 3.85 (p = 0.03). Knowledge of the neurobiology of trauma improved between pre- and post-training surveys (2.71 to 3.64, p = 0.006). Surgery interns also expressed an improved understanding of the connection between fear, trauma, and aggression (3.08 to 4.23, p = 0.002) from pre- to post-training surveys. Post-training knowledge of trauma-informed approaches increased from 2.57 to 4.71 (p < 0.001) and confidence in delivering TIC on the wards increased from 2.79 to 4.64 (p < 0.001). This TIC curriculum delivered via a peer-to-peer training model presents an effective way to improve comfort and confidence surrounding TIC practices and approaches in a surgical residency training program.

Trauma and resettlement: lessons learned from a mental health screening and treatment programme for Syrian refugees in the UK

Resettlement schemes can offer refugees an opportunity to rebuild their lives and to heal from loss and trauma. Mental health services in host countries may have an important role to play in aiding refugees in this journey to recovery. However, facilitating the process of healing for refugees raises challenges for mental health services working within Western medicalised settings. Recovery and wellbeing for resettled refugees also depends upon an interaction of variables at a wider systemic level, that go beyond the direct remit of mental health services. Based on the experience of delivering a mental health screening and treatment programme for resettled Syrian refugees in the UK over a 5-year period, this paper reflects on these challenges and suggests that future resettlement schemes in the UK be designed in accordance with the principles of trauma-informed care. This means putting safety, trust, choice, collaboration, empowerment and respect for inclusion and diversity at the core of the services provided for resettled refugees.

Toward Trauma-Informed Pedagogy: An Intersectional Analysis of Pimping in Medical Education.

Increased awareness of the role of power and privilege in medical education demands reevaluation and critical reflection on the role of pimping, both in name and practice. The authors use an intersectional approach to explore the ways in which the term pimping is rooted in sexist, racist, and classist stereotypes. In using this term to describe a pedagogical approach rooted in hierarchical power and stark knowledge differentials, the medical community intentionally or unintentionally reinforces racist stereotypes, acts of carceral violence, gender-based violence, and harmful ways of referring to sex work. The authors suggest drawing on principles of trauma-informed care, often considered solely in the context of clinical care, as a means of engaging in transformative pedagogy. Embracing such a trauma-informed, transformative pedagogical approach can help dismantle entrenched hierarchies and create a liberatory learning environment grounded in knowledge cocreation and reimagination of teacher-learner binaries. Decentralization of power in teaching relationships can further empower trainees to become active knowledge partners alongside educators, encouraging shared responsibility, trust, and empathy in learning spaces.

Applying the principles of trauma-informed care in intellectual disability services

Applying the principles of trauma-informed care in intellectual disability services

Establishing Trauma-Informed Primary Care: Qualitative Guidance from Patients and Staff in an Urban Healthcare Clinic.

Patients present to primary care clinics with a variety of experiences, including exposure to adverse childhood experiences (ACEs) and other social determinants of health. The pervasive impact of early adversity on later healthcare outcomes has resulted in the development of trauma-informed care principles that can be applied to healthcare settings. The primary aim of this study is to improve understanding of patient and staff experiences within a trauma-informed urban healthcare setting to guide considerations and recommendations when implementing such a model. A phenomenologic approach was taken using an interpretivist paradigm to collect qualitative data by conducting patient and staff focus groups. The following themes were identified: the communal experience of significant trauma, lack of continuity of care and time for each appointment, the importance of a sense of community and standardization and normalization of asking about trauma, development of social support networks, and creating a safe and non-judgmental healthcare space. Based on findings, considerations for implementing a trauma-informed healthcare model are provided.

Trauma involving violation of trust and mental health help seeking among homeless adults

ABSTRACT Objective Lack of trust in others is a barrier to mental health help seeking and may be a consequence of trauma exposure, which is highly prevalent among people who experience homelessness. This study examined the association between trauma involving violation of trust and mental health help seeking. Method This study was a secondary analysis of data collected for a randomised controlled trial comparing a 3-year homelessness intervention with standard service provision. The sample included trauma-exposed adults with a history of chronic homelessness in Melbourne (N = 73). Participants identified their worst lifetime trauma and indicated whether someone they knew and trusted was responsible for that event. The primary outcome was 12-month formal mental health help seeking. Results Controlling for randomisation and baseline posttraumatic stress disorder symptom severity, participants whose worst trauma involved violation of trust reported, on average, 4.34 times as many visits to an outpatient service (e.g., hospital, mental health facility, alcohol and other drug service) as those whose worst trauma did not involve a violation of trust, p = .002. Conclusions Contrary to expectation, chronically homeless adults whose worst trauma involved violation of trust sought outpatient care more than those whose worst trauma did not involve violation of trust. Mental health professionals should adopt a trauma-informed approach and be aware that trauma exposure may influence help seeking among people who experience chronic homelessness. Key Points What is already known about this topic: Chronically homeless adults have high rates of trauma exposure, trauma-related mental health disorders, and unmet mental health care needs. People experiencing homelessness face multiple barriers to accessing mental health care, and qualitative studies have found feelings of mistrust may be one such barrier. In the general population, interpersonal trauma, particularly trauma involving betrayal, is associated with reduced trust in others, including physicians and health care systems. What this topic adds: Over 12 months, greater outpatient service use was reported by chronically homeless adults whose worst trauma involved violation of trust compared to those whose worst trauma did not involve violation of trust. The violation of trust group included a higher percentage of Aboriginal persons, and a higher percentage of participants whose worst trauma occurred in childhood compared to the no violation of trust group. Mental health professionals, such as psychologists, should apply trauma-informed care principles when providing mental health care for chronically homeless adults.

Parent Experience of Hypoxic-Ischemic Encephalopathy and Hypothermia: A Call for Trauma Informed Care.

Therapeutic hypothermia (TH) is the standard treatment for hypoxic-ischemic encephalopathy (HIE). We surveyed parents of infants treated with TH about their experiences of communication and parental involvement in the neonatal intensive care unit (NICU). A 29-question anonymous survey was posted on a parent support (web site: https://www.hopeforhie.org ) and sent to members via e-mail. Responses from open-ended questions were analyzed using thematic analysis. A total of 165 respondents completed the survey and 108 (66%) infants were treated with TH. 79 (48%) respondents were dissatisfied/neutral regarding the quality of communication in the NICU, whereas 127 (77%) were satisfied/greatly satisfied with the quality of parental involvement in the NICU. Six themes were identified as follows: (1) setting for communication: parents preferred face to face meetings with clinicians; (2) content and clarity of language: parents valued clear language (use of layman's terms) and being explicitly told the medical diagnosis of HIE; (3) immediate and longitudinal emotional support: parents required support from clinicians to process the trauma of the birth experience and hypothermia treatment; (4) clinician time and scheduling: parents valued the ability to join rounds and other major conversations about infant care; (5) valuing the parent role: parents desired being actively involved in rounds, care times, and decision-making; (6) physical presence and touch: parents valued being physically present and touching their baby; this presence was limited by the novel coronavirus disease 2019 (COVID-19)-related restrictions. We highlight stakeholder views on parent involvement and parent-clinician communication in the NICU and note significant overlap with principles of trauma informed care: safety (physical and psychological), trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, and voice and choice. We propose that a greater understanding and implementation of these principles may allow the medical team to more effectively communicate with and involve parents in the care of infants with HIE in the NICU. · Parents of infants with HIE experience trauma both from the birth and the hypothermia treatment.. · Transparent communication and encouraging parental involvement can ameliorate this trauma..

COVID-19 on an acute psychiatric unit: an interdisciplinary, trauma-informed response

Purpose There is a high prevalence of trauma among mental health clients, with risk of re-traumatisation when admitted to a Department of Psychiatry (DoP) (Kimberg and Wheeler, 2019). The COVID-19 pandemic poses challenges to therapy service operations in DoPs, with infection control measures impacting opportunities for therapeutic and social engagement. A trauma-informed care (TIC) lens was used when adapting services in Tallaght University Hospital DoP in response to COVID-19. Design/methodology/approach An interdisciplinary approach was taken to adapt therapy services during early stages of the pandemic. Changes were informed by TIC principles to minimise re-traumatisation while maintaining high-quality services. Changes included expansion of the therapeutic activity programme, changes to groups, addition of COVID-19-specific groups and increased awareness of communication support needs. Findings The early response to the pandemic, combined with the focus on TIC, resulted in continued, effective therapy services and positive client feedback. With clients’ involvement in their care enhanced, Individual Care Planning goals were achieved through group interventions. Originality/value The COVID-19 pandemic brought unprecedented changes to mental health services. This paper highlights a response to unique challenges brought by COVID-19 on a DoP.

Integrating trauma-informed care into clinical practice with trafficked persons.

Trauma-informed care (TIC) as practiced within anti-human trafficking work is still in its early stages, and there is a significant need for specific guidelines concerning how to apply TIC principles along various phases of behavioral health care. Thus, the goals of this article are to (1) provide an overview of the framework of TIC; (2) identify and summarize the literature that specifically highlights the clinical application of TIC principles; and (3) contribute to the existing literature by providing some examples of integrating TIC principles into patient-clinician interactions with trafficked patients. The authors' hope is that mental health providers will reference the provided script examples to help improve patient-provider interactions and to develop better rapport and trust between providers and trafficked persons.

Prevalence and Impact of Adverse Childhood Experiences in an Interdisciplinary, School-Based Pediatric Clinic.

This study's purpose was to ascertain the prevalence of adverse childhood experiences (ACEs) in a pediatric population and their connection to other health history information. Using health history data, a retrospective, descriptive study was undertaken with 1,028 children seen at a school-based, interprofessional clinic over 1 academic year. Nearly 58% of children had at least one ACE, and 9.5% had four or more, similar to the prevalence of ACEs in adults reported in the original study by Felitti et al. (1998). With increasing ACEs, children had higher rates of intrauterine drug exposure, intensive care on delivery, homelessness, substance abuse, behavioral problems, mental illness, learning difficulties, and weight issues. Because ACEs are prevalent among children, pediatric providers should use trauma-informed care principles and teach and model a loving and supportive adult presence in children's lives.

Using feminist theory as a research method in the examination of trauma-informed care in a non-profit organisation

The purpose of this qualitative study was to gather information about the experiences of staff at a non-profit agency in the United States as the organisation transitioned towards the implementation of trauma-informed care (TIC). In non-profit organisations, TIC (that is, safety, trustworthiness, choice, collaboration and empowerment) enhances the wellbeing of employees and clients by acknowledging the impact of trauma and reducing the risk of retraumatisation. Feminist theory was utilised to inform this study to empower participants to voice their experiences and to analyse the organisation’s commitment to the principles of TIC. Four focus groups were conducted (N = 17 participants in total) and all participants reported that the organisational culture was moving in a positive direction. Even in the early stages of the implementation of TIC, management reported feeling empowered and supported by the organisation; however, many participants noted that significant work will need to continue to enhance the emotional safety and empowerment of direct-line workers.

Advancing Child Trauma Screening Practices

Child trauma screening practices have advanced considerably as child-serving systems have increasingly incorporated early identification and intervention into trauma-informed models of care. While research points to the necessity of screening practices that attend to a child’s developmental capacities, cultural background, relational strengths, contextual details surrounding the traumatic experience, and complex trauma considerations, many of these features remain absent in common brief screening measures used in practice. Pictorial screening measures may offer an innovative opportunity to address attentional concerns and developmental capacities of young and complexly traumatized children, yet are understudied in this area. The purpose of this paper is threefold: 1) highlight areas for expansion within current brief trauma screening models, 2) propose an evidence-informed framework for a pictorial complex trauma screening tool for children, and 3) offer implementation considerations for piloting the proposed screening tool. Piloting and implementation considerations address the importance of cognitive interviewing, cultural sensitivity, development of a companion response and referral protocol, and embedding principles of trauma-informed care in the training and implementation process.

Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective.

Forensic nurses engaged in medicolegal death investigations experience trauma-induced responses in responding to, investigating, and documenting sudden unexpected deaths. The trauma of these repeated experiences often results in diminished performance, job dissatisfaction, and burnout. The principles of trauma-informed care are not new but have not been incorporated into death investigation practices. When coupled with medicolegal death investigation procedures, application of these principles can help to alleviate distress for forensic nurses, colleagues, and decedents of concerned families. This case series illustrates how the principles of trauma-informed care can be implemented to enhance communication, deescalate emotional or threatening situations, and prevent retraumatization in the context of medicolegal death investigations.

Using Principles of Trauma-Informed Care to Address Structural Racism in Psychiatric Care.

Using Principles of Trauma-Informed Care to Address Structural Racism in Psychiatric Care.

Terapia zorientowana na traumę w placówkach ochrony zdrowia

Odkrycie powszechności przeżyć traumatycznych w życiu ludzi było początkiem rozwoju badań nad wpływem różnego rodzaju urazów na stan zdrowia społeczeństwa. Pierwsze badania korelacji między występowaniem doświadczeń traumatycznych w dzieciństwie (ACE) a miarą dolegliwości zdrowia fizycznego i psychicznego w późniejszym wieku wskazało na znaczenie urazów w rozwoju człowieka. Z powodu istotnego wpływu traumy na zdrowie stwierdzono, że żadna pomoc osobom, które doświadczyły urazów, nie może prowadzić do retraumatyzacji. W tym celu określono podstawowe zasady działania dowolnej placówki ochrony zdrowia zorientowanej na traumę (TIC). W pracy przedstawiono sześć podstawowych zasad TIC oraz metody ich zastosowania w celu stworzenia bezpiecznego miejsca pomocy ofiarom traumy. Oprócz specjalnych warunków, jakim powinien podlegać ośrodek TIC, w pracy przedstawiono również wyniki badań dotyczących różnych obrazów zapisu traumy w świadomości człowieka. Uznano, że odmienność zapisu powinna mieć znaczenie w wyborze odpowiednich podejść terapeutycznych.