Principles Of Trauma-informed Care Research Articles

Histories of trauma: A qualitative analysis of lifetime traumatic experiences among emergency department patients.

Emergency medicine clinicians are excellent at identifying and treating physical trauma as a chief complaint, but are often unaware of patients' previous experiences of trauma. The purpose of this study was to describe emergency department (ED) patients' lifetime experiences of trauma. The investigative team used framework analysis to examine 1,282 participants' open-ended responses to the Vera Institute's Trafficking Victim Identification Tool questions. Of these, 204 participants were found to have experienced at least one form of trauma; none of these participants were assessed positive for a human trafficking experience. From 204 participants, 343 instances of trauma were recorded and analyzed. Of the 204 patient-participants who reported trauma, 96 experienced one form of trauma and 108 experienced two or more. Three major themes emerged: work trauma (experiences of trauma originating in the workplace), coercion (being manipulated into activities), and trauma connections (some forms of trauma were commonly experienced with other kinds of trauma). A fourth, less prominent, theme was disclosure as witness (participants witnessing trauma). ED patients have experienced many forms of lifetime trauma and, in this study, were willing to share about their experiences while in the acute care setting. Given the common experience of trauma among the ED patients in this investigation, more work is needed to examine if and how trauma-informed care principles should be employed in the ED. Additionally, the ED may be an underutilized data source for researchers seeking participants with experiences of trauma and/or a point of connection for trauma survivors to be linked to trauma care services.

A Pilot Study on the Awareness and Knowledge of Adverse Childhood Experiences Science and Trauma-informed Care among Medical School Students.

Childhood trauma is widespread and contributes to clinical, behavioral, and social health consequences. Despite more than 2 decades of research from the Centers for Disease Control and Prevention-Kaiser Adverse Childhood Experiences (ACEs) Study, ACEs science is still not fully integrated into medical school curricula. Therefore, we conducted a pilot study to assess the level of awareness about ACEs and trauma-informed care (TIC) curricula among medical students. A cross-sectional study was conducted at the Medical College of Georgia using a sample of convenience. Enrolled first-, second-, and third-year students were invited to complete a survey during the Spring 2020 semester. A total of 194 students responded to specific questions about training on and knowledge of ACEs and principles of TIC. The majority of students (80%) indicated they heard of the ACEs Study, and 70% reported they received information about ACEs. Regarding TIC, findings indicated less knowledge on cultural context related to stress and trauma. In addition, first-year students were less likely to know about TIC principles than third-year students. This preliminary study is the first of its kind in the state of Georgia, where recent surveillance data indicate that 60% of adults have experienced at least one ACE. Given that ACEs are widespread, effective educational practices to increase knowledge about ACEs science, and skills to carry out TIC practices may benefit future practicing physicians by introducing ACEs in the first-year curriculum.

Trauma-Informed Care in Child Health Systems.

Trauma-Informed Care in Child Health Systems.

Adverse childhood experiences and trauma informed care: treating the whole patient with a more complete osteopathic approach.

In 1998, a seminal study identified a strong connection between participants' exposures to adverse childhood experiences (ACEs) and the development of risk factors for serious health conditions later in life. More than two decades later, leaders in both policy and health care professions now appreciate the impact of social determinants of health, including the enormous societal costs incurred by deleterious experiences, and recognize that treating illness begins with prevention in early childhood. The trauma informed care (TIC) model offers a treatment approach that lends consideration to the traumatic experiences that impact a given patient and allows for more complete treatment by their physician. Delivering care under the TIC model encourages trauma identification, early intervention, system level awareness and policy change, and avoiding retraumatization in the therapeutic setting. Various programs across the country seek to employ these methods at the community, state, and federal level. Several programs aimed at introducing medical students to these principles have contributed to an incorporation of TIC within the physician pipeline. In this Commentary, the author proposes an expansion of the Tenets of Osteopathic Medicine with a fifth principle-considering the implications of a patient's past formative experiences, their present life circumstances, and their future prospects-as a vehicle for instilling TIC principles ubiquitously throughout osteopathic medical training to develop physicians who treat the whole person more completely and are better equipped to manage this public health crisis.

Implementation of Trauma-Informed Healthcare

Trauma that is rooted in extremely stressful events is an important factor affecting human health. Patients who have experienced trauma may present in a variety of different ways in healthcare settings. One of these ways is the exhibiting of strong emotional or behavioral reactions triggered by traumatic memories. Caring for patients affected by known or unknown trauma is a significant challenge for healthcare providers. The core of trauma-informed care includes understanding trauma; respecting, empathizing and responding to the needs and reactions of patients with trauma; and providing care in a manner that prevents re-traumatization. In this article, the impact of trauma on overall health is introduced followed by a presentation of trauma triggers in the healthcare context, underscoring the importance of prioritizing care for patients with a history of trauma. Lastly, the concept and principles of trauma-informed care are incorporated into healthcare practice, providing specific, practical application strategies for healthcare providers to use in clinical settings. Trauma-informed healthcare practice relies on healthcare providers and organizations working together. The principles include the self-awareness and self-care of healthcare providers, awareness of the patient's trauma reaction, ensuring patient safety, building trust and transparency in care, working collaboratively with the patient and the healthcare team, and providing choices and empowerment during the care process. This article provides a reference to healthcare providers for providing friendly and high-quality care to patients with trauma.

Implementing Trauma-Informed Strategies for Mothers of Infants with Neonatal Abstinence Syndrome.

To improve outcomes of infants with neonatal abstinence syndrome (NAS) by implementing an evidence-based approach to care. An interdisciplinary team developed and implemented an educational module about the elements and principles of trauma-informed care (TIC) and standardized education on NAS for mothers with substance use disorder (SUD). The team collaborated with community behavioral health professionals to secure the services of a certified recovery specialist. Primary outcome measures of average length of stay (LOS) and admissions to special care nursery (SCN) for NAS infants were analyzed. Following health care team education on TIC and implementation of the standardized NAS brochure, average LOS decreased significantly from 6.5 to 5.1 days from baseline period (January-December 2019) to the implementation period (February-June 2020; p = 0.03). There was no difference in SCN admission from the baseline period (February-June 2019) to the implementation period (February-June 2020). Referrals to certified recovery specialists did not change. Education on the impact of trauma on new mothers with SUD can promote collaboration between them and the neonatal team. Standardizing education for new mothers of infants with NAS can help to engage families of infants with NAS and improve clinical outcomes.

Examining Veterans’ Interactions with the UK Social Security System through a Trauma-Informed Lens

AbstractThis paper uses the principles of trauma-informed care – safety, collaboration, choice, trustworthiness, and respect – to reflect on the quality of veterans’ treatment within the UK social security system. Drawing upon new data from qualitative longitudinal research with veterans in four geographical locations across England, UK, it explores their experiences within the social security system, highlighting specific issues relating to their interactions with the Work Capability Assessment (WCA) but also the conditionality inherent within the UK benefits system. Overall, it is evident that there is a lack of understanding of the impact of trauma on people’s psychosocial functioning and, as a result, veterans are treated in ways which are variously perceived as disrespectful, unfair or disempowering and in some cases exacerbate existing mental health problems. We propose that the application of trauma-informed care principles to the UK social security system could improve interactions within this system and avoid re-traumatising those experiencing on-going or unresolved trauma. The paradigm of trauma-informed care has been used internationally to examine health, homelessness, prison and childcare services, but ours is the first exploration of its application to the delivery of social security.

Education in Trauma-Informed Care in Maternity Settings Can Promote Mental Health During the COVID-19 Pandemic

Globally, the pandemic has adversely affected many people’s mental health, including pregnant women and clinicians who provide maternity care, and threatens to develop into a mental health pandemic. Trauma-informed care is a framework that takes into account the effect that past trauma can have on current behavior and the ability to cope and can help to minimize retraumatization during health care encounters. The purpose of this article is to highlight the pressing need for perinatal clinicians, including nurses, midwives, physicians, doulas, nurse leaders, and nurse administrators, to be educated about the principles of trauma-informed care so that they can support the mental health of pregnant women, themselves, and members of the care team during the pandemic.

Trauma-Informed Children's Ministry: a Qualitative Descriptive Study.

Over half of American children will experience at least one traumatic event, and nearly one in six will experience four or more events. These traumatic events affect children's physical and mental health throughout their lives. Consequently, organizations which serve children, including local religious congregations, are urged to adopt the principles of trauma-informed care. The purpose of this study was to describe specific ways in which trauma-informed principles are applied by church children's ministries. We gathered interview, focus group, and observational data from nine different children's ministries that were previously identified as being exceptionally inclusive and supportive. Interview participants included nine children's pastors, 17 children's ministry volunteers, and 38 individuals across 14 families. Focus group participants included 20 children ages 7 to 13. Data were analyzed using qualitative descriptive methodology using both a deductive and inductive approach. Drawing from prior literature, we deductively categorized the values (preparation, awareness, collaboration, and transparency) and goals (that children feel safe, regulated, connected, and valued) of trauma-informed children's ministries. Results. Results inductively identify and describe specific ways in which each of these values and goals were applied in the children's ministry context. Our results reveal that churches have the potential to be places of healing for children who have experienced trauma. Moreover, although many of these trauma-informed practices in a children's ministry context are similar to a school context, there are important differences that make children's church a unique context for care. We highlight the implications for children's ministries.

Developing Advisory Boards within Community-based Participatory Approaches to Improve Mental Health among Refugee Communities.

Community-based participatory approaches to research and intervention with ethnically and racially diverse minority groups demonstrate great promise to address health disparities. Refugees as a group have experienced a disproportionate amount of trauma, experience on-going resettlement and acculturative stressors, and have been shown to be at a heightened risk for psychological distress. This article aims to extend current knowledge by examining best practices for use of community advisory boards (CABs) and youth advisory boards (YABs) to achieve mental health equity among refugee communities. In order to improve outcomes in refugee communities, public health and mental health research and interventions should aim to engage refugees as active partners on advisory boards. Employing trauma-informed care principles through cultural humility, authentic engagement and power-sharing, recognition of the stigma of mental illness and mental health care, respect for community norms and preferences, and acknowledgement of acculturative and generational differences within refugee communities epitomize best practices in establishing and maintaining meaningful community advisory boards. Inclusion of trauma-informed CABs community adult and YABs in refugee mental health research and interventions ensures that the work is relevant and meaningful to those who are intended to benefit from these efforts.

Teaching Trauma-Informed Care: A Symposium for Medical Students.

A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.

Trauma-Informed Care Principles and Practices at a Residential Facility for Adolescent Girls

Trauma-Informed Care Principles and Practices at a Residential Facility for Adolescent Girls

Health Care in the Age of Mass Incarceration: A Selective Course for Medical Students in Their Preclinical Years.

IntroductionWhile medical school curricula increasingly address health disparities, content regarding health care for persons impacted by incarceration is a persistent and notable gap. There is a high burden of disease among incarcerated populations, and health care challenges continue postincarceration. We developed a course to introduce medical students to the current landscape of mass incarceration in the US and implications for health and health care delivery to people impacted by this system.MethodsWe developed a 3.5-hour elective course taken by 19 first-year medical students in its first year and 20 students in its second. The course utilized lecture, case-based discussion, and guest speaker modalities to introduce students to the history of mass incarceration, health care delivery within the carceral system, and challenges in accessing care during and following incarceration.ResultsStudents received two surveys after completing the course. In the first, 100% of respondents reported outstanding, excellent, or good levels of satisfaction with various elective components, including organization, learning activities, and student discussion. The second found significant increases in knowledge about mass incarceration and incarceration health issues, in addition to significant increases in interest in advocating or providing health care for incarcerated populations.DiscussionGiven current mass incarceration practices, students will encounter patients impacted by this system. This elective course sought to better prepare students to effectively care for these patients. We were limited by time availability, and future directions include incorporating a standardized patient exercise, trauma-informed care principles, and providers working within the carceral system.

Reaching consensus on the principles of trauma-informed care in early intervention psychosis services: A Delphi study.

AimThe current study sought to conceptualize and reach consensus on the principles of trauma‐informed care in early intervention psychosis services.MethodsA three‐phase Delphi method was employed in this study. Experts included researchers, service providers and Experts by Experience in the area of early intervention in psychosis. In the initial qualitative phase, an expert panel (n = 57) shared their views on the constituents of trauma‐informed care in early intervention psychosis services. Thematic analysis led to the generation of statement items. The expert panel was asked to rate the extent to which each statement item was an essential principle of trauma‐informed care, leading to consensus of endorsed principles.ResultsQualitative analysis of the first phase data led to the identification of 185 distinct statements which were compiled into an online questionnaire for the panel to rate in Phase 2. The Phase 2 questionnaire was completed by 42 experts, with the endorsement of seven principles. In Phase 3, the panel were invited to re‐rate 24 statements. This phase was completed by 39 panel members, with the acceptance of a further nine principles. Consensus was achieved resulting in the endorsement of 16 essential principles of trauma‐informed care.ConclusionsThe study offers novel understanding of the conceptualisation of trauma‐informed care in early intervention services and suggests principles which are widely agreed by experts in the field. The recommendations may inform the adoption of consistently delivered trauma‐informed care in early interventions in psychosis and facilitate the evaluation and development of services.

A Universal, Trauma-Informed Approach to Pediatric Hospital Medicine.

Olivia, a 13-year-old neurologically intact patient with cerebral palsy, arrived from a routine abdominal procedure screaming in pain. The medical team was baffled as to why she experienced such agony despite receiving copious doses of morphine. We spoke with her adoptive parents to obtain more history. They revealed long-standing physical and sexual abuse before Olivia’s adoption 6 years ago and noted extreme distress to all medical procedures and prolonged surgical healing time. Although her parents hoped to give her a better life and ensure she received appropriate care for her condition, they felt helpless that Olivia was at risk for retraumatization (reexperiencing posttraumatic symptoms from her original traumas) each time she came to the hospital. The amplification of pain and delayed medical recovery secondary to a history of psychological trauma and adverse childhood experiences (ACEs) is well recognized.1–3 Health care institutions are aware of the need for the integration of trauma-informed care into practice, yet they struggle to find the right approach. Although screening for ACEs has been widely adopted as a trauma-informed practice, there are multiple concerns with ACEs screening, including operating from a deficit- versus strength-based model, risk for traumatization from screening, and limited follow-up resources.4 ACEs scores also do not fully capture trauma and posttraumatic stress symptoms, which may be better predictors of negative outcomes than ACEs alone. Many organizations have now implemented the Substance Abuse and Mental Health Services Administration guidelines of educating clinicians on realizing …

Interactive Case-Based Childhood Adversity and Trauma-Informed Care Electronic Modules for Pediatric Primary Care.

IntroductionTraining health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited.MethodsFour computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.ResultsOverall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.DiscussionA trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Trauma Talks: Exploring Personal Narratives of Trauma-Informed Care through Podcasting

Trauma Talks: Rising from the Ashes is a podcast series developed by The Institute on Trauma and Trauma-Informed Care (ITTIC). The series aims to present a variety of personal audio narratives that explore how trauma-informed care (TIC) intersects with individual experiences of healing and connection following traumatic events. The operationalization of TIC principles in the interviewing process is illustrated throughout, and a qualitative analysis is presented, exploring how podcast guests experienced these principles in practice. Justification for the creation of a podcast series illuminating TIC is outlined, and implications for social work educators on the use of podcasting is discussed. Podcasting is ultimately highlighted as a useful product and tool to harness technology for social good and provide guidance toward manifesting TIC.

Psychometric Evaluation of the TIC Grade, a Self-Report Measure to Assess Youth Perceptions of the Quality of Trauma-Informed Care They Received.

Agencies and clinical practices are beginning to provide trauma-informed care (TIC) to their clients. However, there are no measures to assess clients' perceptions of and satisfaction with the TIC care they have received. A 20-item questionnaire, the TIC Grade, was developed, based on the National Center for Trauma-Informed Care principles of TIC, to assess the patient or client perception of the TIC provided in settings that serve adolescents and emerging adults. The goal of this project was to evaluate the psychometric properties of the TIC Grade instrument and to make recommendations for use of the full measure and its short form-an overall letter grade. The TIC Grade questionnaire was administered to youth over the age of 18 years from four community partners providing care to vulnerable young adults. Potential participants were offered questionnaires at the end of their visit. Those interested in participating left their completed anonymous questionnaire in a locked box to maintain confidentiality. Questionnaires were collected from 100 respondents; 95 were complete enough to include in analyses for psychometric evaluation. The findings of this project support the reliability and usability of the 20-item TIC Grade measure to assess youth's perceptions of the quality of TIC they received. This TIC-specific, behaviorally worded client report measure can assist service delivery organizations to assess their success at implementing TIC and to identify areas where further staff training and support are needed.

Factors distinguishing veterans participating in supported education services from veterans on campus: Evidence supporting modifiable intervention targets.

The purpose of this study was to identify specific and modifiable supported education (SEd) service needs for the veteran population. To do so, we compared veterans participating in SEd services to other veterans on campus with respect to service-related challenges, community reintegration, and academic-related challenges. Identifying independent factors that distinguish veterans receiving SEd services from other veterans on campus may help operationalize interventions that target the unique challenges in this vulnerable population. This study used an exploratory cross-sectional design. We used logistic regression on 410 veterans attending college. Models tested whether sociodemographic characteristics (e.g., age), service-related challenges (e.g., combat exposure), academic-related challenges (e.g., academic self-efficacy), and aspects of community reintegration (e.g., employment status) distinguished veterans receiving SEd services (n = 94) from veterans on campus (n = 316). Veterans who reported (a) more severe combat exposure, (b) more severe posttraumatic stress disorder (PTSD) symptoms, (c) service-related mild traumatic brain injury (mTBI), (d) lower levels of academic self-efficacy, and (e) no paid employment were more likely to participate in SEd services. This study established several factors that distinguished veterans receiving SEd services from veterans on campus. Findings indicate that SEd education services for veterans should: (a) apply principles of trauma-informed care, (b) mitigate the influence of PTSD and/or mTBI upon academic success and community reintegration, (c) promote academic self-efficacy, and (d) integrate principles of supported employment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Supporting Face-to-Face Birth Family Contact after Adoption from Care: Learning for Trauma-Sensitive Practice

Abstract There are recent calls to consider face-to-face birth family contact for more children adopted from care. Given that the threshold for this authoritative intervention is significant harm, post-adoption contact should be sensitive to the possible impact of early childhood trauma, and be adequately supported. This article draws on adopters’ reports of face-to-face contact with birth relatives, and their evaluation of social work support to suggest an approach to practice informed by principles of trauma-informed care. Twenty-six adoptive parents participated in focus groups, and seventy-three completed a web-based questionnaire, all from Northern Ireland where face-to-face post-adoption contact is expected. Findings are structured thematically around principles of trauma-informed care: trusting relationships; physical and emotional safety; choice and control; and narrative coherence. Most families had a social worker attending contact, and help with practical arrangements. Less common but important practices included: deliberate consideration of children’s perspectives; safeguarding their emotional well-being; and facilitating communication outside of visits. Findings suggest that visits are a context in which trauma-effects may surface, and social workers supporting contact should be sensitive to this possibility. This article suggests a systemic approach to helping all parties prepare for, manage and de-brief after contact, attending to both adult-to-adult and adult–child interactions.