Trauma-informed Care Training Research Articles

Enhancing Mental Health Outcomes for Adolescent and Older Veterans through Conflict Management and Therapeutic Communication Strategies in Trauma-Informed Care

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.

Feasibility and Impact of Trauma-Informed Care Training in Internal Medicine Residency: A Pilot Study.

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.

Women’s experiences of restrictive interventions within inpatient mental health services: A qualitative investigation

Restrictive interventions (RI), such as physical restraint, seclusion, and rapid tranquilization, can have negative psychological effects on service users; however, there has been little investigation regarding their effects on women. The aim of this paper was to explore women's experiences of RI within UK inpatient mental health services. Twenty women accessing inpatient mental health services participated in semi-structured interviews. Using thematic analysis (TA), three primary themes were reported from women's experiences: (1) powerlessness, (2) dehumanization, and (3) relationships and communication. Clinical recommendations included ensuring gender-awareness and trauma-informed care training is mandatory for all mental health staff, for RI training to include awareness of gender differences, and for policies to be reviewed with regard to women being invasively searched and ensuring sanitary products are safely available for women within seclusion. Directions for future research include investigating the experiences of RI for women from minority ethnic groups and exploring important moderators and mediators in the relationship between RI and re-traumatization for women.

Trauma-informed care training with HIV and related community service workers: Short and long term effects on attitudes.

Although the experience of trauma is a widespread, global phenomenon, individuals living with HIV, who are two-spirit, lesbian, gay, bisexual, transgender, queer+ (2SLGBTQ+), who use injection drugs, and/or who have marginalized status, are disproportionately affected (Harris & Fallot, 2006; Hopper, Bassuk, & Olivet, 2009; Seedat, 2012). The need for trauma competent service provision, meaning integrating psychoeducation about trauma, and knowledge of its prevalence, impact, and outcomes, is clear. Numerous HIV service and affiliated agencies in Ontario requested a Trauma-Informed Care workshop for their staff and volunteers, and the current project reports on the outcomes of this workshop. There were 150 community, health, and social service providers in the HIV, hepatitis C, LGBTQ, harm reduction, and related sectors who participated in a full- or half-day Trauma-Informed Care workshop. Participants completed the Attitudes Related to Trauma-Informed Care scale (ARTIC-10) at preworkshop, postworkshop, and at 6-month follow-up, as well as a brief phone interview. There was a significant increase in ARTIC scores, indicating more favorable attitudes toward trauma-informed care, from preworkshop (M = 58.01, SE = 0.64) to postworkshop (M = 61.73, SE = 0.67), M = -3.72, BCa 95% confidence interval [-4.65, -2.82], t(149) = -7.79, p < .001, resulting in a medium-sized effect, d = 0.48. These gains were maintained at follow-up. Results were complemented by participant interviews. These results demonstrate that a brief workshop on Trauma-Informed Care can improve attitudes relatively quickly, that are generally maintained over time, creating a trauma-informed environment for clients. Future directions include assessing client outcomes as they may relate to changes in provider attitudes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trauma-informed attitudes in residential treatment settings: Staff, child and youth factors predicting adoption, maintenance and change over time

BackgroundLittle is known about the benefits of implementing trauma-informed care (TIC) training programs for child welfare workers serving in out-of-home treatment settings, or about how staff, child and youth characteristics affect adoption of favorable attitudes towards TIC. ObjectiveThis study aimed to understand how attitudes towards TIC changed over time for child welfare workers receiving training and monthly supervision sessions. Participants and settingChild welfare workers (n = 429) serving juveniles mandated to protection or offender units (ages = 3–20 years), across 11 child protection agencies in Quebec, Canada. MethodsParticipants completed the ARTIC-35 at pre-training, 6 months post-training, and 1 year follow-up. Multilevel mixed effect regression models were fit to examine outcomes for all subscales. ResultsParticipants reported small improvements in attitudes towards TIC at post-training and 1 year follow-up for subscales related to problematic child/youth behavior (β = 0.23–0.32, p's < 0.001). Multilevel modeling revealed that age group (adolescent), unit gender (boys) and legal mandate (offender) predicted higher pre-training TIC ratings for staff in management versus frontline positions across three subscales related to problematic child/youth behavior (β = 0.77–0.93, p's < 0.05) and two subscales related to trauma work and support needs (β = 0.66/0.84, p's < 0.05). ConclusionsResults extend previous research demonstrating an association between TIC training and improved attitudes towards TIC over time, and highlight specific contexts in which frontline staff may experience more difficulty applying TIC-based principles than colleagues in management positions.

Evaluating trauma informed care training for services supporting individuals experiencing homelessness and multiple disadvantage

Purpose Implementing trauma informed care (TIC) for individuals facing homelessness and multiple disadvantage is proposed to help both service users and staff work effectively and therapeutically together. However, the effectiveness of implementing TIC via training is debatable. This study aims to explore the effects of a four-day TIC and psychologically informed environments training package in such services. Design/methodology/approach The analysis explores the effect of this training on the degree of TIC as measured by the TICOMETER, a psychometrically robust organisational measure of TIC. The study examines group and individual level changes from before training and again at six-month and one-year follow-up time-points. Findings At the group level analysis, three of the five TICOMETER domains (knowledge and skills, relationships, and policies and procedures) were higher when compared to pre-training scores. The remaining two domains (service delivery and respect) did not improve. Individual-level analysis showed some participants’ scores decreased following training. Overall, the training appeared to modestly improve the degree of TIC as measured by the TICOMETER and these effects were sustained at one-year follow-up. Research limitations/implications Findings are limited by the design and low response rates at follow-up. Practical implications Training is necessary but not sufficient for the implementation of TIC and needs to be complemented with wider organisational and system-level changes. Originality/value This paper is the first UK study to use the TICOMETER.

Patterns of Change in Restraints, Seclusions and Time-outs over the Implementation of Trauma-informed Staff Training Programs in Residential Care for Children and Youth

ABSTRACT Trauma-informed care (TIC) is receiving growing interest and support as a promising approach to reducing the use of restrictive measures (restraints, seclusions and time-outs) in children and youth living in residential care. In this study, we aimed to compare the use of restrictive measures prior to and following the implementation of a TIC staff training initiative in 44 residential units for children and youth and to explore differences between units and type of measures used. Patterns of change in monthly use of restrictive measures 6 months before and 12 months after the training were compared using growth curve models. Restraints, seclusions and time-outs decreased by 41.82%, 19.91%, and 48.15%, respectively, over a year following the training. Despite these important declines, trajectories of restrictive measures did not change significantly from pre- to post-training when holding the TIC training against stringent criteria. Nonetheless, some units’ characteristics were associated with successful changes. Results are promising, but not conclusive about the ability of this TIC training to produce changes in trajectories of restrictive measures, at least in the first year of implementation. This study highlights the need for rigorous statistical models in further studies to ensure accurate empirical evaluation of TIC staff training programs.

Educational Practices for Providers of Trauma-Informed Care: A Scoping Review

BackgroundAs more is learned about trauma and the ways in which trauma informed care (TIC) is provided, it is important to explore the education and training offered to those individuals who provide TIC. PurposeThis scoping review examined training provided to individuals who interact with persons aged birth to 21 years old who have experienced or are experiencing trauma. MethodThe researchers searched six databases and identified 16 peer-reviewed articles in the areas of medicine/nursing, social work, and education published from 2012 to 2019 that met inclusion criteria. DiscussionAlthough most training protocols had a similar foundation, the findings from this review suggested that trauma informed care training practices vary across disciplines. ConclusionsAs training approaches varied greatly across disciplines, a conclusion on best practice guidelines cannot be stated for the professional environments.

Psychiatric hospital nurses' attitudes towards trauma-informed care.

Accessible SummaryWhat is known on the subject? Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service‐users. Care delivered with this awareness is known as trauma‐informed care (TIC).There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in‐depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. What this paper adds to existing knowledge? MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work‐related traumas which interfere with their ability to provide TIC. What are the implications for practice? Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well‐being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long‐term clients. This would benefit service‐users by ensuring MHNs are more trauma‐informed. More research on attitudes towards TIC among MHNs is needed. IntroductionQuantitative studies exploring trauma‐informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used.AimTo examine nurses' TIC attitudes at a psychiatric hospital.MethodA mixed‐method design was used. One hundred and thirty‐six MHNs completed the Attitudes Related to Trauma‐Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used.ResultsMHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale “Causes” were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes “Awareness,” “Unhealthy boundaries” and “Inhibition” emerged from qualitative analysis.DiscussionChallenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long‐term clients on the cycle of perpetuated trauma identified by previous research and MHNs work‐related traumas.Implications for practiceIdentified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.

Targeting Causes of Burnout in Residency: An Innovative Approach Used at Hennepin Healthcare.

Rates of burnout are high in physicians in the United States. While others have reported on the success of burnout-reduction strategies on practicing physicians and residents, few strategies have approached the problem longitudinally in residents. From 2014 to 2019, the authors used a previously developed survey to assess factors related to resident burnout, including sleep, personal time, professional fulfillment, effects on relationships, program recognition, and peer support. At Hennepin Healthcare, a safety-net hospital in Minneapolis, Minnesota, the authors created a reproducible process for collecting data from internal medicine residents annually, and for using evidence-based conceptual frameworks to develop a continuous improvement method to address worklife across training years. Interventions included jeopardy coverage for essential life events, a newsletter celebrating resident achievements, removal of after-hours consult pager call, an extra day off for senior residents on the wards, and care packages distributed to night teams. Annually from 2014 to 2019, 40/66 (60.6%) to 62/73 residents (84.9%) completed the survey (average response rate was 72.1% over 6 years). Survey results were shared with residents in multiple formats, and feedback was requested, demonstrating that burnout reduction is a priority for program leadership. High professional fulfillment scores were documented every year. Self-reported rates of burnout were between 25% and 35%. Significant improvements were seen in perception of empathy, sleep impairment, and peer support. The authors developed a plan for minimizing burnout, which includes the following evidence-based domains: workload, control, balance in effort and reward, work-life balance, fairness, values, support, gender equity, moral distress, and moral injury. Additional interventions include protected time for didactics, trauma-informed care training, and addressing workplace racism. The authors aspire to achieve an integrated culture of well-being for residents and faculty; foster an efficient, effective, and fair learning environment; and reduce-and ultimately eliminate-burnout.

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.

Social Work Training and Readiness for Trauma-Informed Care in Nursing Homes

Most adults have experienced traumatic events (SAMHSA, 2017). Late-life traumas may compound upon trauma histories (Maschi, et al., 2013), accentuating the risks confronting older adults. Per CMS’ updated Requirements for Participation, nursing homes (NHs) must implement trauma-informed care (TIC) approaches, effective November 2019. Many NHs do not staff Masters of Social Work (MSWs), despite their expertise in providing mental health care. Notwithstanding, employed MSWs feel unprepared to help their NHs implement TIC. This presentation discusses findings from a national survey of NH social service directors (N = 932). Results showed 71% (n = 650) reported moderate to strong interest in TIC training. A Kruskal-Wallis H test revealed a statistically significant difference in TIC training interest χ2(1) = 43.690, p < .001, such that MSWs reported higher interest (M = 486.47) than non-MSWs (M = 375.23). There was no difference between those with and without a Bachelor of Social Work.

Educational Innovation for Gun Violence in the US

Gun violence remains a public health issue that continues to affect tens, perhaps hundreds, of thousands of Americans annually. 1 Hink A.B. Bonne S. Levy M. et al. Firearm injury research and epidemiology: a review of the data, their limitations, and how trauma centers can improve firearm injury research. J Trauma Acute Care Surg. 2019; 87: 678-689 Crossref Scopus (11) Google Scholar Within the community of trauma surgeons, increased effort and attention has been turned to the opportunities surgeons have for prevention of firearm injury and the humanistic care of trauma patients. 2 Kuhls D.A. Campbell B.T. Burke P.A. et al. Survey of American College of Surgeons Committee on trauma members on firearm injury: consensus and opportunities. J Trauma Acute Care Surg. 2017; 82: 877-886 Crossref PubMed Scopus (30) Google Scholar ,3 Bulger E.M. Kuhls D.A. Campbell B.T. et al. Proceedings from the Medical Summit on Firearm Injury Prevention: a public health approach to reduce death and disability in the US. J Am Coll Surg. 2019; 229: 415-430.e12 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Integrated into this approach has been attention to the social determinants of health that affect firearm injury risk, trauma informed care training, and improved technical skills for managing complex penetrating trauma. 4 Kim D. Social determinants of health in relation to firearm-related homicides in the United States: a nationwide multilevel cross-sectional study. PLoS Med. 2019; 16e1002978 Crossref Scopus (14) Google Scholar , 5 Rowhani-Rahbar A. Quistberg D.A. Morgan E.R. et al. Income inequality and firearm homicide in the US: a county-level cohort study. Inj Prev. 2019; 25: i25-i30 Crossref PubMed Scopus (13) Google Scholar , 6 Brenner M. Inaba K. Aiolfi A. et al. Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy in select patients with hemorrhagic shock: early results from the American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry. J Am Coll Surg. 2018; 226: 730-740 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar , 7 Ordonez C.A. Rodriguez F. Parra M. et al. Resuscitative endovascular balloon of the aorta is feasible in penetrating chest trauma with major hemorrhage: proposal of a new institutional deployment algorithm. J Trauma Acute Care Surg. 2020; 89: 311-319 Crossref Scopus (15) Google Scholar , 8 Garcia A.F. Manzano-Nunez R. Orlas C.P. et al. Association of resuscitative endovascular balloon occlusion of the aorta (REBOA) and mortality in penetrating trauma patients. Eur J Trauma Emerg Surg. 2020 Apr 16; ([Epub ahead of print]) Crossref Scopus (8) Google Scholar

Trauma-Informed Care Training for Educators: Some Preliminary Evidence

A report of the findings of two studies conducted on the training of educators on trauma-informed care (TIC) is presented in this article. With one sample ( N = 552), Study 1 results indicated that both full-day and half-day training resulted in improved scores on attitudes regarding TIC. There were no significant differences in pre-training and post-training scores across those who received half-day and full-day training. With a second sample ( N = 159), Study 2 examined whether four middle schools within one school district with varying amounts of prior TIC training would differ in scores on the Attitudes Related to Trauma-Informed Care (ARTIC-35) scale before receiving this TIC training. A one-way ANOVA indicated significantly higher scores on the ARTIC-35 in schools that had received prior TIC training compared with those that had not. Overall, the results of both studies advance the understanding of TIC in schools.

Home visiting: A lifeline for families during the COVID-19 pandemic

Home visiting: A lifeline for families during the COVID-19 pandemic

An evaluation of trauma informed care training package delivered to youth justice colleagues

An evaluation of trauma informed care training package delivered to youth justice colleagues

Trauma Informed Care Training in Ob/Gyn Residency Programs [26G

INTRODUCTION: One in six American women experience sexual abuse in their lifetime, which pre-disposes a large percentage of our patients to post-traumatic stress disorder. Patients report being re-traumatized when undergoing exams during childbirth and routine Ob/Gyn visits. Very little is known about whether Ob/Gyn physicians are trained to care for patients who have experienced trauma. METHODS: This study was a cross-sectional survey administered to program directors at all US and Canadian Ob/Gyn Residency programs in September of 2019. RESULTS: At this time, 58 out of 241 (24%) program directors have responded to the survey and represent all ACOG districts. Over 20% of programs have formal training that occurs every year, 63.8% have had some training occur in the past though not on a regular basis, and 15.5% have never had any training. When asked about the primary barrier to providing this training, 27.6% of respondents cited the lack of facilitators to teach it, followed by lack of time within the residency curriculum (17.2%). About 30% of respondents are satisfied with the current training provided at their program. All respondents agree that Ob/Gyn residents need to be trained in trauma informed care, 60.3% believe it should be a CREOG educational objective, and 88% would be somewhat or extremely likely to implement a training program specifically designed for Ob/Gyn residents if one became available. CONCLUSION: Most Ob/Gyn residency programs are providing some training on the care of patients who have experienced trauma, however respondents in our sample are largely unsatisfied with how this occurs.

Capacity Building for Refugee Mental Health in Resettlement: Implementation and Evaluation of Cross-Cultural Trauma-Informed Care Training.

Refugee mental health needs are heightened during resettlement but are often neglected due to challenges in service provision, including lack of opportunities for building capacity and partnership among providers. We developed and implemented culturally-responsive refugee mental health training, called Cross-Cultural Trauma-Informed Care (CC-TIC) training. We evaluated CC-TIC, using a free listing and semi-structured retrospective pre- and post-training evaluation with five localities in two states in the U.S. The results showed significant improvement in providers’ knowledge of trauma impacts, cultural expressions of trauma/stress-related symptoms, and culturally-responsive trauma-informed care. Trauma-informed care specific to refugee resettlement was regarded as the most helpful topic and community partnership building as the most requested area for future training. This study emphasizes that culturally-responsive trauma-informed approaches can help bridge gaps between mental health care and resettlement services and promote exchanges of knowledge and expertise to build collaborative care and community partnership.

Effects of Trauma-informed Care Training on Healthcare Providers Caring for Victims of Human Trafficking

Objective: The purpose of this study is to analyze the impact of trauma-informed care training on the practice of dental, optometry, and mental health providers caring for victims of human trafficking. Methods: A mixed method approach was used, including pre-post surveys and one focus group discussion. Results: The dental, optometry, and mental health provider participants reported a greater awareness of human trafficking and greater knowledge of how to approach and care for the victims in a trauma- informed way. Conclusion: Continued training on the provision of trauma-informed care for victims of human trafficking is necessary for dentists, optometrists, and mental health professionals serving in health clinics in a university located in the southeast United States.

Effectiveness of 1-day trauma-informed care training programme on attitudes in psychiatric hospitals: A pre-post study.

Many patients in mental health settings are likely to have histories of interpersonal traumatic experiences. Mental health providers are recommended to adopt trauma-informed care (TIC) to ensure sensitivity and responsiveness to the impact of trauma on patients. However, few studies have examined the effectiveness of a TIC training programme using standardized measures with follow-up assessments. The aim of the study was to evaluate the effects of a TIC training programme on attitudes towards TIC in mental health professionals. The study involved a pre-post design with 3-month follow-up assessments conducted between March and June 2018. In total, 65 mental health professionals from 29 psychiatric hospitals in Tokyo and its suburban prefectures participated in the study. Mental health professionals participated in a 1-day programme consisting of a 3.5-hour lecture and 1-hour group discussion. Development of favourable attitudes towards TIC was the primary outcome, as assessed by using the Attitude Related Trauma-Informed Care scale. The majority of participants were women (86%), and the mean age was 42.2years. The mean score of the Attitude Related Trauma-Informed Care scale scores increased significantly from 5.1 during pre-training to 5.5 immediately after training (mean difference: 0.4; 95% confidence interval: 0.3-0.5) and 5.4 after 3months (mean difference: 0.3; 95% confidence interval: 0.2-0.4). Furthermore, half of the participants claimed to have implemented TIC practice in daily clinical settings at the 3-month follow-up. These results suggested that this brief TIC training programme improved attitudes towards TIC practice significantly.