Principles Of Trauma-informed Care Research Articles

Competency in trauma-informed care: Empowering advanced practice registered nursing students to adopt a trauma-informed approach during routine health assessment

BackgroundNurses need competency in trauma-informed care (TIC) to create supportive environments that encourage patient engagement and treatment adherence. Increased demand for TIC in nursing practice requires improved approaches to competency evaluation. AimThis study aimed to evaluate the competency of advanced practice registered nursing (APRN) students in implementing TIC principles, utilizing a rubric tailored for simulation-based learning within an advanced health assessment course. DesignEmploying a non-experimental, observational approach, this project utilized a quantitative, rubric-based assessment to analyze video-recorded simulations and rate competency in implementation of TIC principles. Setting and participantsThe study included 64 graduate-level APRN students enrolled in a mandatory advanced health assessment course at a large midwestern university in the United States. MethodsThe study assessed student competency in implementing seven TIC principles within a simulation-based experience (SBE), using a scale ranging from 1 (novice) to 5 (expert). ResultsWhile a few students demonstrated competency at, or above, level 3 in certain TIC principles, the overall average competency rating remained below 3. This outcome aligns with expectations for novice APRN students. Notably, the principles of communication and safety showed the highest average competency levels. ConclusionsFindings revealed that most students were at a novice competency level, struggling with implementation of TIC principles. This highlights the imperative for nurse educators to incorporate a variety of educational activities into the curriculum. Integrating TIC content into didactic lectures, providing formative assessment opportunities, and conducting post-lecture SBEs are recommended strategies to enhance TIC competency among APRN students, thereby equipping them with the essential skills to deliver exemplary care to trauma survivors.

Training Nurses in Trauma-Informed Care to Address Workplace Violence in Inpatient Settings.

Frontline workers in psychiatric facilities are exposed to considerable risks of verbal and physical assaults, with 40% to 65% of mental health nurses experiencing violence in the workplace. The goal of this pilot study was to assess the readiness and motivation for adopting trauma-informed care (TIC) to address workplace violence in an acute care psychiatric hospital. A pre-post quality improvement study was conducted in two pilot units of a 274-bed acute care psychiatric hospital, involving a discussion-based seminar and a practical exercise. Surveys assessed participants' readiness and motivation posttraining. Sixty-eight staff members completed part 1 training, with 63 (92.6%) reporting being prepared to use TIC principles afterward. All 14 staff members (100%) who completed part 1 and part 2 training reported being motivated to apply the TIC model after the intervention. The results show that TIC training may impact self-reported strategies for reducing workplace violence. Education in trauma-informed care may prove to be beneficial in providing nurses with the necessary skills to effectively implement TIC principles in their daily practices. [J Contin Educ Nurs. 2024;55(10):472-478.].

Implementing an obstetric sepsis bundle in a large academic hospital system

For the purposes of this review, obstetric sepsis refers to sepsis (from all causes, including non-obstetric such as pneumonia) in pregnant or postpartum patients, which was previously described as maternal sepsis. Obstetric sepsis poses a significant threat to pregnant, birthing, and postpartum individuals, contributing prominently to maternal mortality and morbidity despite being largely preventable1. In response to identified gaps in sepsis management, particularly the lack of specific protocols tailored to obstetric populations, New York-Presbyterian undertook a system-wide initiative to implement a comprehensive sepsis bundle. This initiative included the development of new criteria for identifying sepsis in obstetric patients, the creation of electronic medical record (EMR) alerts aligned with obstetric-specific indicators, and the establishment of a structured sepsis management algorithm.The project involved collaboration across eight hospital campuses within the New York-Presbyterian system, aiming to standardize and improve the early recognition and treatment of sepsis in maternal care. Key components included rigorous data analysis to select appropriate sepsis criteria, simulation-based training to familiarize clinical teams with the new algorithm, and continuous refinement of alert systems to mitigate alarm fatigue and enhance responsiveness.Post-implementation evaluation revealed a significant reduction in preventable morbidity related to sepsis, accompanied by the identification of additional gaps in fever and chorioamnionitis management. These findings prompted the development of new clinical guidelines to further enhance patient safety. Challenges encountered included adapting sepsis criteria to balance sensitivity and specificity, as well as integrating trauma-informed care principles into clinical practice.This project underscores the effectiveness of tailored quality improvement efforts in maternal health, emphasizing the critical role of proactive interventions in enhancing patient outcomes and safety within obstetric settings. Ongoing efforts focus on monitoring process metrics through a dedicated sepsis dashboard and advancing education on trauma-informed care principles, highlighting the continued commitment to sustained improvement in maternal health outcomes.

Sexual and Reproductive Healthcare Needs of Refugee Women Exposed to Gender-Based Violence: The Case for Trauma-Informed Care in Resettlement Contexts.

This paper assesses literature regarding the sexual and reproductive healthcare (SRH) needs of resettled refugee women who experienced gender-based violence (GBV) and trauma-informed care (TIC) principles utilized among SRH service providers. A systematic search identified relevant studies published between 2000 and 2021; no articles found reflected both SRH and TIC principles among refugee women. The search was therefore separated into two aims: to review the literature about SRH needs for refugee women in resettlement countries who experienced GBV (Aim 1) and to examine the use of TIC principles in SRH care among women who experienced GBV (Aim 2). Thematic analysis of the articles identified key themes. Twenty-six articles were included in the analysis across both aims (Aim 1 = 8, Aim 2 = 18). Aim 1 articles shared three factors shaping the SRH needs of resettled refugee women: the centrality of violence and trauma; structural barriers to SRH care; and actions, practices, and resources for service providers. Aim 2 articles illustrated seven key principles of TIC used in SRH service provision, such as empowerment; trauma-specific services and integrated care; connection; safety; collaboration; identity culture and context; and trustworthiness. Resettled refugee women's experiences of violence necessitate trauma-informed SRH health care. While there is limited peer-reviewed literature regarding TIC-SRH care for refugee women, the findings regarding the SRH needs of refugee women and the findings regarding the implementation of TIC in SRH collectively frame recommendations for how SRH can be infused with TIC. An example from practice, in the form of the Refugee Women's Health Clinic, is included as an exemplar of TIC SRH principles in action for the health of resettled refugee women who have survived gendered violence.

Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis.

The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers. To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement. A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline. A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play. Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.

Lived experiences of transgender and nonbinary people in the perioperative context: a qualitative study.

Transgender and nonbinary (TNB) people experience obstacles that create barriers to accessing health care, including stigmatization and health inequities. Our intention was to describe the lived experiences of TNB patients and identify potential gaps in the education of health care professionals. We conducted a qualitative descriptive study influenced by phenomenology by interviewing with TNB adults who underwent surgery in Canada within the previous 5 years. We recruited participants using purposeful and snowball sampling via online social networking sites. Audio recordings were transcribed. Two authors coded the transcripts and derived the themes. We interviewed 21 participants, with a median interview duration of 49 minutes. Participants described positive and negative health care encounters that led to stress, confusion, and feelings of vulnerability. Major themes included having to justify their need for health care in the face of structural discrimination; fear and previous traumatic experiences; community as a source of support and information; and the impact of interactions with health care professionals. Participants detailed barriers to accessing care, struggled to participate in shared decision-making, and desired trauma-informed care principles; they described strength in community and positive interactions with health care professionals, although barriers to accessing gender-affirming care often overshadowed other aspects of the perioperative experience. Additional research, increased education for health care professionals, and policy changes are necessary to improve access to competent care for TNB people.

A Pilot Survey of Pediatric Occupational and Physical Therapy Providers’ Confidence, Attitudes, Barriers, and Education Regarding Trauma-Informed Care

Aim Trauma-informed care (TIC) is a strengths-based organizational approach which recognizes the prevalence and impact of trauma on an individual’s neurological, sensorimotor, and emotional responses and development. There is limited research on pediatric occupational therapy providers’ (OTPs) and physical therapy providers’ (PTPs) perceptions on incorporating TIC into their practice. This pilot study aims to describe the confidence, attitudes, barriers, and education of pediatric OTPs and PTPs regarding TIC. Method OTPs and PTPs (n = 87) working in pediatric settings in the U.S. completed an electronic survey regarding their perceptions of TIC. Results OTPs reported higher confidence in TIC compared to PTPs. Most participants reported favorable attitudes toward TIC, yet no statistical significance was identified between the two professions’ overall attitudes toward TIC. Collectively, participants reported lack of time and training as barriers. There was a statistically significant difference between how the two professions rated competency, training, and concern over clients’ retraumatization. There was significant association between years of professional experience and TIC education. Conclusion Preliminary findings indicate an overall agreement of OTPs and PTPs with principles of TIC and common barriers to TIC practice. There are implications to further integrate opportunities for TIC training into foundational education and professional practice.

Moving beyond the 'PPG': co-production and inclusion health.

We frequently fail to meaningfully incorporate patient voice in the development of health services, in particular the voices of those who are most disadvantaged. To share learning from a co-production project to improve primary care experience for those with multiple disadvantage and lived experience of trauma. We formed a collective of women (Bridging Gaps). Group members had lived experience of poverty, mental health challenges, addictions, homelessness, and sexual exploitation. Other members were researchers, GPs, and members of a third-sector organisation. We worked alongside local GPs to change how services were delivered. We collected interviews (n = 9), ethnographic data from group meetings (n = 3), and reflective notes from group members (n = 19). Data on our process were analysed using a framework approach drawn from the principles of trauma-informed care. We highlight the challenges for those with multiple disadvantages and trauma experience to meaningfully and safely engage in traditional Patient Participation Group (PPG) models. True co-production of services requires adequate resources and close collaborative working with local community organisations. Groups must be facilitated by those with relevant experience and the ability to both notice and manage power dynamics within the room. With sufficient support, co-production models have potential to empower group participants and improve health services. Partnership working between GPs, the third sector, and other organisations is vital. This can allow GPs to benefit from the expertise of those with relevant lived experience in tackling health inequalities.

An evaluation of a Trauma-Informed Reflective Practice Group for NHS CAMHS staff

We know more about trauma – and its long-term impact – than ever before. This has led to a demand for services to better recognise the needs of trauma survivors in order to avoid re-traumatisation – a recognition that care needs to be ‘Tmuma-Infimied’. But, making the system-wide shift from ‘what is wrong with you?’ to ‘what has happened to you?’ is no small feat. As such, it is acknowledged that there needs to be effective ways to support staff to deliver competent trauma-informed care. The use of reflective practice is gaining increasing recognition as an exciting opportunity to align the principles of trauma-informed care with day-to-day clinical practice. This article presents the results of an evaluation of a Trauma-Informed Reflective Practice group pilot for staff working in an NHS CAMHS setting. Semi-structured interviews were undertaken to explore their experiences. Thematic analysis was used to analyse the interview data. Five themes emerged relating to trauma-informed care:-Learning from the voice of lived experience, Translating Knowledge into Practice, Sharing is Caring, Growing in Confidence and Looking to the Future. The results suggest that trauma-informed group reflective practice can pay dividends in terms of supporting trauma-informed care. To build on the findings from this small-scale study, further research is recommended to investigate the impact of trauma-informed reflective practice.

Trauma-Informed Healthcare Leadership? Evidence and opportunities from interviews with leaders during COVID-19

BackgroundCOVID-19 impacted the mental health of healthcare workers, who endured pressures as they provided care during a prolonged crisis. We aimed to explore whether and how a Trauma-Informed Care (TIC) approach was reflected in qualitative perspectives from healthcare leaders of their experience during COVID-19 (2020–2021).MethodsSemi-structured interviews with healthcare leaders from four institutions were conducted. Data analysis consisted of four stages informed by interpretative phenomenological analysis: 1) deductive coding using TIC assumptions, 2) inductive thematic analysis of coded excerpts, 3) keyword-in-context coding of full transcripts for 6 TIC principles with integration into prior inductive themes, and 4) interpretation of themes through 6 TIC principles (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and awareness of cultural, historical, and gender issues).ResultsThe actions of leaders (n = 28) that were reported as successful and supportive responses to the COVID-19 pandemic or else missed opportunities reflected core principles of Trauma-Informed Care. To promote safety, leaders reported affirmative efforts to protect staff by providing appropriate physical protection, and enhanced psychological safety by providing channels for communication about emotional well-being. To promote trustworthiness and transparency, leaders listened to their staff, shared current COVID-19 information, and increased frequency of meetings to disseminate accurate information. To promote mutual support, strategies included wellness check-ins, sharing uplifting stories, affirming common goals, articulating fears, and leading by example. Examples of empowerment included: making time and adjusting modalities for flexible communication; naming challenges outside of the hospital; and functioning as a channel for complaints.Reported missed opportunities included needing more dedicated time and space for healthcare employees to process emotions, failures in leadership managing their own anxiety, and needing better support for middle managers. Awareness of the TIC principle of cultural, historical, and gender issues was largely absent. Results informed the nascent Trauma-Informed Healthcare Leadership (TIHL) framework.ConclusionsWe propose the Trauma-Informed Healthcare Leadership framework as a useful schema for action and analysis. This approach yields recommendations for healthcare leaders including creating designated spaces for emotional processing, and establishing consistent check-ins that reference personal and professional well-being.

Advancing Clinical Decision Making Through Trauma-Informed Care in Pediatric Hearing Health Care

Purpose: Adverse childhood experiences affect early brain development and future health outcomes. The principles of trauma-informed care (TIC) incorporate safety, screening, understanding context, avoiding retraumatization, and discharge planning to provide optimal care for patients and families. Secondary traumatic stress is the trauma providers' experience when serving patients and families who have experienced trauma. The purpose of this article is to examine the impact of trauma, investigate the principles of TIC, and identify the ways to implement it in hearing health care. Conclusions: Providers working with children and families who have experienced trauma should be trained to provide a trauma-informed approach and learn the signs, symptoms, and risks of secondary traumatic stress. To improve the quality of care for children with hearing loss who have experienced trauma, their adverse experiences must be considered with trauma-informed techniques incorporated into the hearing health care model of care.

Trauma-Informed Care as a Universal Precaution: A Brief, Case-Based, Educational Primer Featuring Role-Playing and Individual Self-Reflection Exercises.

Despite its growing popularity, the implementation of Trauma-Informed Care (TIC) in standard medical practices remains insufficient. A workshop, featuring role-playing scenarios and individual self-reflection exercises, was developed to enhance compassion among health care providers. The workshop was created by a multidisciplinary team of community pediatricians, pediatric intensivists, psychologists, and palliative care physicians, was structured around key elements and principles of TIC, and was based on actual patient encounters. The 90-minute session included didactics, role-playing, writing and self-reflection exercises, and large-group debriefings, and it was presented at two academic meetings. It is currently available as an open-sourced, freely accessible website. The workshop was attended by individuals with varying levels of training and experience. Of approximated 80 participants, 39 responded to surveys about baseline knowledge and workshop satisfaction, and 24 completed self-perceived pre- and postknowledge surveys. Nearly 90% had limited prior exposure to TIC. All rated the workshop highly, with no significant differences based on workshop facilitation. Nearly 95% felt that they learned something that would impact their day-to-day practices. Self-perceived pre-post knowledge showed statistically significant improvements. This workshop is feasible and can potentially increase health care professionals' capacity to care, decrease moral injury, and alleviate burnout from difficult cases.

The Value of Student Voice and Choice: A Guide for Trauma-Informed Participatory Action Research in the University Setting

Many college and university students live with the effects of trauma, and more research is needed around trauma-informed practices in higher education. It is important that this research represents the needs and interests of students and that it be conducted in a way that is appropriate and safe for trauma survivors. We describe the process of forming a vertically integrated, interdisciplinary Participatory Action Research (PAR) team of students and faculty dedicated to creating a trauma-informed learning environment on a university campus and argue that PAR and Trauma-Informed Care (TIC) practices provide important and complementary frameworks for inclusive, just, and community-responsive research. We describe how this research team embodied core PAR values of collaboration, incorporation of local knowledge, eclecticism and diversity, case orientation, emergent process, and linking scientific understanding to social action, along with the TIC commitments of trauma awareness, safety, choice and empowerment, and strengths-based orientation. We describe lessons learned by the team and provide recommendations for researchers who seek to incorporate both PAR and TIC principles into their work on trauma and education. Central lessons learned from this process highlighted the importance of 1) establishing and maintaining psychological safety, 2) speaking openly about trauma, and 3) privileging responsiveness to the difficulty of working with trauma while living through ongoing global stressors. Specific recommendations include 1) lead with values, 2) acknowledge and attend to context, 3) recognize that defining trauma is controversial, 4) model courageous conversations, 5) emphasize responsiveness and care, and 6) teach strategies for managing painful emotions.

Implementing trauma-informed care practices in the workplace: a descriptive phenomenological study

The effects of trauma are becoming more prevalent in the clinical setting, which has helped generate conversations about being more trauma-informed and providing trauma-informed care services. The principles centered around trauma-informed care could be applied to a person’s everyday life, including the work setting with the goal of creating a more trauma-informed environment for all employees. This qualitative descriptive phenomenological study aimed to investigate what trauma-informed care principles are needed in the workplace from the employee perspective to create a more trauma-informed environment. The survey instrument used in this study was a modified version of Fallot and Harris’s (2011) consumer satisfaction survey in their published article Creating Cultures of Trauma-Informed Care: A Self-Assessment and Planning Protocol. The instrument contained 13 questions, with each core question having an optional secondary question requesting additional details about the participants’ responses. The tool was categorized into four sections: safety, trustworthiness, choice and collaboration, and empowerment. Ninety participants accessed the survey through SurveyMonkey Audience, but four did not meet the criteria to participate and exited the study. The researcher was left with 86 completed surveys. The qualitative analytical tool Quirkos was employed to help analyze the data and generate themes. The category that produced the most themes was empowerment. Employees want to be viewed as a person rather than a resource to get the job done. Likewise, participants wanted to be valued and have their voices heard. To push this conversation forward, future researchers should conduct interviews face-to-face to produce more in-depth findings.

Navigating the Roadmap for Trauma-Informed Medical Education: Application of Undergraduate Medical Education Competencies.

Trauma is common in the United States, increases risk of long-term adverse health effects, and individuals who experience it often find seeking medical care difficult. Trauma-informed care (TIC) builds trust and fosters healing relationships between clinicians and patients; however medical education has lacked consistent training in TIC. Using recently published competencies for undergraduate medical education (UME), this manuscript provides curricular examples across 8 domains to assist faculty in developing educational content. The authors identified published curricula for each of the 8 competency domains using a published search strategy and publicly available database. Inclusion criteria were published works focused on UME in the United States; abstracts and curricula not focused on UME were excluded. The authors used a consensus-based process to review 15 eligible curricula for mapping with the competencies. Of 15 published UME curricula, 11 met criteria and exemplify each of the 8 UME competency domains. Most of the available curricula fall into the Knowledge for Practice and Patient Care domains. Most were offered in the first 2 years of medical school. Competency-based medical education for TIC is new, and most current educational offerings are foundational in nature. Additional innovation is needed in the competency domains of Professionalism, Systems-Based Practice, Interprofessional Collaboration, and Personal/Professional Development. This manuscript offers a set of curricular examples that can be used to aid efforts at implementing TIC competencies in UME; future work must focus on improving assessment methods and developmental sequencing as more students are exposed to TIC principles.

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Childhood maltreatment and association with trajectories of depressive symptoms among older adults: a longitudinal study in China

Objectives Childhood maltreatment has long-lasting effects on mental health. Existing evidence suggests that trajectories of depressive symptoms vary among individuals; however, little is known about how childhood maltreatment shapes these trajectory patterns. Therefore, this study investigated the impacts of childhood maltreatment on eight-year depressive trajectories among Chinese older adults. Method Five waves of longitudinal data from the China Health and Retirement Longitudinal Study were utilized. Growth Mixture Modelling was performed to identify distinct trajectories of depressive symptoms, and multinomial logistic regression was conducted to explore the associations between these trajectories and childhood maltreatment. Results Four trajectories of depressive symptoms were identified: the ‘no symptoms’ class (61.83%), the ‘increasing symptoms’ class (14.49%), the ‘decreasing symptoms’ class (16.44%), and the ‘chronic symptoms’ class (7.24%). Older adults who experienced childhood physical abuse were more likely to be in the ‘chronic symptoms’ class than in the ‘no symptoms’ class, whereas emotional neglect did not show a significant association with three problematic trajectories. Conclusion This study provides empirical evidence that childhood physical abuse increases the likelihood of developing chronic depressive symptoms in later life. To mitigate this risk, it is crucial to institute comprehensive treatment plans that incorporate trauma-informed care principles, employ evidence-based therapies specifically designed to address the long-term effects of abuse, and prioritize regular screening and assessment of mental health among older adults.

Reflective supervision as a vehicle for trauma-informed organizational change in early childhood education settings

ABSTRACT While reflective supervision and trauma-informed care are often implemented separately within early care and education (ECE) settings, there is meaningful intersection between these two approaches that may support ongoing efforts to support young children who have experienced trauma. The current study presents secondary analysis of qualitative data from three focus groups with 11 ECE supervisors who attended a reflective supervision training, paired with reflective consultation. ECE supervisors who engaged in a reflective supervision training noted shifts in experience and practice that intersect with Substance Abuse and Mental Health Services Administration (SAMHSA’s) six principles of trauma-informed care: 1) safety, 2) trustworthiness and transparency, 3) peer support, 4) collaboration and mutuality, 5) empowerment, voice, and choice, and 6) cultural, historical, and gender issues. Reflective supervision may serve as an effective tool for organizations to invest in trauma-informed care, which creates a space for teachers to engage in relational learning. This investment can lead to enhanced support for young children, especially those who have experienced trauma.

Are Function-Based Interventions for Students with Emotional/Behavioral Disorders Trauma Informed? A Systematic Review.

Students with emotional/behavioral disorders (EBD) commonly engage in both externalizing and internalizing behaviors-a behavioral profile that has been connected to childhood trauma. Although the efficacy of function-based interventions for students with EBD has been documented, the extent to which these interventions align with principles of trauma-informed care (TIC) is unknown. We conducted a systematic review of function-based intervention studies for students with EBD to evaluate whether and how these interventions incorporated critical elements of TIC. We identified 56 articles that met the eligibility criteria and used an iterative process to identify intervention practices consistent with each of six pillars of TIC, then evaluated the extent to which interventions in the study sample incorporated these practices. Despite identifying 45 function-based intervention practices aligned with pillars of TIC, we found most of these practices were absent in most interventions. We identified teaching skills, building healthy relationships, and including family, culture, and community as three pillars of TIC that warrant more attention when developing function-based interventions for students with EBD. For pillars of TIC that lack a strong empirical foundation in behavior analysis, we point to related literatures and disciplines with potential to inform next steps in behavior analytic research and practice.