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A mixed methods exploratory assessment of the usefulness of Baltimore City Health Department's trauma-informed care training intervention.

ABSTRACT: Youth exposure to trauma is a significant public health problem in the United States, particularly in urban areas. Although trauma-informed care (TIC) training of service providers to address this challenge is increasing nationwide, we lack empirical evidence regarding the feasibility and acceptability of cross-organizational TIC training, including perspectives of training participants. The purpose of our study was to evaluate participating service providers' self-reported changes in knowledge about trauma, attitudes toward traumatized individuals, and beliefs in their capacity to provide referrals to trauma services after completion of the TIC intervention. Intervention participants represented a range of service sectors, including government health and education agencies, social services, law enforcement, as well as nonprofits. Participants completed a pre-post quantitative survey assessing TIC-related knowledge, attitudes, and beliefs (N = 88). A subset of participants was interviewed using a semistructured interview format (n = 16). Mixed methods were used to evaluate the intervention's impact on participants' knowledge about trauma and to understand participants' experience in the training. Quantitative results revealed significant improvements in TIC-related knowledge and attitudes. Five themes emerged from qualitative analysis of interviews: the intervention provided a framework for understanding TIC; useful lessons were learned from other participants; there was a need for outreach to upper-level management; real-life applicability was lacking; and guidance regarding next steps was wanting. Study findings suggest the training may be a starting point for enhancing service providers' capacity to address traumatized youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

SUBMITTER: Damian AJ

PROVIDER: S-EPMC6397786 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A mixed methods exploratory assessment of the usefulness of Baltimore City Health Department's trauma-informed care training intervention.

Damian April Joy AJ Mendelson Tamar T Bowie Janice J Gallo Joseph J JJ

The American journal of orthopsychiatry 20180903 2

Youth exposure to trauma is a significant public health problem in the United States, particularly in urban areas. Although trauma-informed care (TIC) training of service providers to address this challenge is increasing nationwide, we lack empirical evidence regarding the feasibility and acceptability of cross-organizational TIC training, including perspectives of training participants. The purpose of our study was to evaluate participating service providers' self-reported changes in knowledge ...[more]

PMID: 30179025

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Project description:ObjectivesSexual and physical trauma and substance use are intersecting risks for HIV among young women. This study assesses the feasibility, acceptability and preliminary effects of a novel trauma-informed substance use and sexual risk reduction intervention for young South African women.DesignA single arm feasibility test and qualitative interviews of participants.ParticipantsSixty women, between 18 and 25 years of age, who reported trauma exposure, substance use and recent condom-less sex were recruited. Twenty participants were randomly selected for qualitative interviews.InterventionA six-session group-based intervention.Main outcome measuresWe examined the proportion of women who provided consent, completed counselling and were retained in the study. Qualitative interviews explored intervention acceptability. Preliminary effects of the intervention on substance use, mental health (depression, psychological distress and trauma symptoms) and sexual risk outcomes (STI symptoms, number of partners and condomless sex) were explored.ResultsOf the 66 eligible women, 91% were enrolled. Intervention completion rates were low; 35% attended all sessions. On average, participants attended four sessions (M=3.8, SD=1.3). A 93% follow-up rate was achieved at the 3-month endpoint. In this single group design, reductions in the proportion of participants who tested positive for methamphetamine, cannabis and methaqualone were observed at the 3-month endpoint. Symptoms of depression, psychological distress and trauma; number of STI symptoms; and number of sexual partners also decreased. Outcomes were similar for participants who completed up to four and those who completed five or more sessions. Participants thought the intervention was highly beneficial and proposed modifications to enhance acceptability.ConclusionsThis novel intervention seems acceptable and holds potential benefits for trauma-exposed women who use substances. Truncating the intervention may enhance the likelihood of its implementation. The efficacy of the intervention for improving substance use, sexual risk and mental health outcomes requires testing in a controlled design.

Project description:IntroductionExposure to different types of psychological trauma may lead to a range of adverse effects on trauma survivors, including poor mental and physical health, economic, social and cognitive functioning outcomes. Trauma-informed (TI) approaches to care are defined as a service system grounded in and directed by an understanding of how trauma affects the survivors' neurological, biological, physiological and social development. TI service system involves training of all staff, service improvements and sometimes screening for trauma experiences. The UK started incorporating TI approaches into the National Health Service. While policies recommend it, the evidence base for TI approaches to healthcare is not well established. We aim to conduct a systematic review to synthesise evidence on TI approaches in primary and community mental healthcare globally.Methods and analysisWe will undertake a systematic search for primary studies in Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, websites of organisations involved in the development and implementation of TI approaches in healthcare, and databases of thesis and dissertation. Included studies will be in English published between 1990 and February 2020. Two reviewers will independently perform study selection with data extraction and quality appraisal undertaken by one reviewer and checked for accuracy by a second reviewer. A results-based convergent synthesis will be conducted where quantitative (narratively) and qualitative (thematically) evidence will be analysed separately and then integrated using another method of synthesis. We set up a trauma survivor group and a professional group to consult throughout this review.Ethics and disseminationThere is no requirement for ethical approval for this systematic review as no empirical data will be collected. The findings will be disseminated through a peer-reviewed publication, scientific and practitioner conferences, and policy briefings targeted at local and national policy makers.Prospero registration numberCRD42020164752.

Project description:Background:Adoption of responsive trauma-informed practices by staff in hospital-based paediatric care may help mitigate downstream costs associated with treatment delivery due to reduced pain and distress for children and care providers, improved health-related quality of life and increased satisfaction with care. A web-based education intervention (termed Responsive CARE) was developed to build self-efficacy of staff in a paediatric medical setting. This protocol paper describes a feasibility study (including preliminary effectiveness) of the implementation of Responsive CARE in a tertiary, outpatient burn clinical setting. Methods:A pre-post, mixed methods design will be employed. Children and caregivers attending hospital for change of burn wound dressings or burn scar management during the 3-month control or 3-month intervention period will be eligible, with follow-up to 6-months post-baseline. All children and caregiver/s will receive "standard care" including burn interventions focused on wound healing, scar management, itch management (both pharmacological and non-pharmacological), counselling, age-appropriate procedural support and burn rehabilitation. Health professional participants will be those involved in the management of children with burns during the study period or their senior managers. Health professional participants who attend a weekly educational clinical meeting will be invited to complete the intervention during a 1-month timeframe between the control and intervention period (or upon their commencement in burn outpatients during the intervention period) using an individualised log-in process. A purposive sample of caregivers and health professionals will be sought for participation in semi-structured interviews. Qualitative data will be analysed using Framework analysis. Feasibility will be evaluated via interviews, digital records of intervention usage and technical assistance logs. The primary outcome measures of effectiveness (pain, itch and distress) will be measured using self-report or behavioural observation. Quantitative data will primarily be analysed descriptively and using generalised linear models. Discussion:This study will provide insights into factors that impact upon the feasibility of a web-based trauma-informed care education intervention in a clinical practice setting. This knowledge may support other education approaches within healthcare settings related to improving and supporting patients to reduce the risk of healthcare interactions that result in paediatric medical traumatic stress.

Project description:BackgroundOffice workers typically sit for most of the workday, which has been linked to physical and mental ill-health and premature death. This mixed-methods study sought to identify barriers and facilitators to reducing sitting and increasing standing among office workers who received an intervention prototype (the 'ReSiT [Reducing Sitting Time] Study'). The intervention comprised a sit-stand workstation and tailored advice to enhance motivation, capability and opportunity to displace sitting with standing.MethodsTwenty-nine UK university office workers (aged ?18y, working ?3?days per week, most time spent at a seated desk) participated in a 13-week uncontrolled study. They were initially monitored for one-week. In a subsequent face-to-face consultation, participants received sitting time feedback from a prior one-week monitoring period, and selected from a set of tailored sitting-reduction techniques. Quantitative data comprising sitting, standing and stepping time, which were objectively monitored for 7 consecutive days across three post-intervention timepoints, were descriptively analysed. Qualitative data, from semi-structured interviews conducted at 1, 6 and 12-weeks post-intervention, were thematically analysed.ResultsCompared to baseline, mean sitting time decreased at weeks 1, 6 and 12 by 49.7mins, 118.2mins, and 109.7mins respectively. Despite prior concerns about colleagues' reactions to standing, many reported encouragement from others, and standing could be equally conducive to social interaction or creating private, personal space. Some perceived less cognitively-demanding tasks to be more conducive to standing, though some found standing offered a valued break from challenging tasks. Participants prioritised workload over sitting reduction and were more likely to stand after rather than during work task completion. Temporary context changes, such as holidays, threatened to derail newfound routines.ConclusionsOur findings emphasise the importance of understanding workers' mental representations of their work, and the social functions of sitting and standing in the workplace. Workplace intervention developers should incorporate a pre-intervention sitting time monitoring period, encourage workers to identify personally meaningful tasks and cues for standing, and build organisational support for sitting-reduction. We will use these insights to refine our intervention for self-administered delivery.Trial registrationISRCTN29395780 (registered 21 November 2016).

Project description:Dogs play an important role in our society as companions and work partners, and proper training of these dogs is pivotal. For companion dogs, training helps preventing or managing dog behavioral problems-the most frequently cited reason for relinquishing and euthanasia, and it promotes successful dog-human relationships and thus maximizes benefits humans derive from bonding with dogs. For working dogs, training is crucial for them to successfully accomplish their jobs. Dog training methods range widely from those using predominantly aversive stimuli (aversive methods), to those combining aversive and rewarding stimuli (mixed methods) and those focusing on the use of rewards (reward methods). The use of aversive stimuli in training is highly controversial and several veterinary and animal protection organizations have recommended a ban on pinch collars, e-collars and other techniques that induce fear or pain in dogs, on the grounds that such methods compromise dog welfare. At the same time, training methods based on the use of rewards are claimed to be more humane and equally or more effective than aversive or mixed methods. This important discussion, however, has not always been based in solid scientific evidence. Although there is growing scientific evidence that training with aversive stimuli has a negative impact on dog welfare, the scientific literature on the efficacy and efficiency of the different methodologies is scarce and inconsistent. Hence, the goal of the current study is to investigate the efficacy and efficiency of different dog training methods. To that end, we will apply different dog training methods in a population of working dogs and evaluate the outcome after a period of training. The use of working dogs will allow for a rigorous experimental design and control, with randomization of treatments. Military (n = 10) and police (n = 20) dogs will be pseudo-randomly allocated to two groups. One group will be trained to perform a set of tasks (food refusal, interrupted recall, dumbbell retrieval and placing items in a basket) using reward methods and the other group will be trained for the same tasks using mixed methods. Later, the dogs will perform a standardized test where they will be required to perform the trained behaviors. The reliability of the behaviors and the time taken to learn them will be assessed in order to evaluate the efficacy and efficiency, respectively, of the different training methods. This study will be performed in collaboration with the Portuguese Army and with the Portuguese Public Security Police (PSP) and integrated with their dog training programs.

Project description:BackgroundFemale genital mutilation/cutting (FGM/C) is a complex and deeply rooted sociocultural custom that is innately entrenched in the lives of those who continue its practice despite the physical and psychological dangers it perpetrates. FGM/C is considered a significant independent risk factor for adverse maternal and fetal outcomes in pregnancy and childbirth. Several studies in high-income countries have explored the experiences and needs of women with FGM/C as well as the knowledge of the health professionals, particularly midwives and nurses, who care for them. However, to date, no studies have evaluated the implementation of education for health professionals in high-income countries to meet the specific needs of women with FGM/C.ObjectiveThis study aims to explore the impact of an FGM/C education program for midwives and nurses as informed by the experiences of women with FGM/C accessing maternity, gynecological, and sexual health services in South Australia.MethodsThis study will adopt a three-phase, exploratory sequential mixed methods design. Phase 1 will involve the exploration of women with FGM/C views and experiences accessing maternity and gynecological (including sexual health) services in South Australia. The findings from phase 1 will inform phase 2: the development of an educational program for midwives and nurses on the health and cultural needs of women with FGM/C. Phase 3 will involve the evaluation of the program by measuring midwives' and nurses' changes in knowledge, attitude, and practice immediately before and after the education as well as 4 months after completing the program. Phase 1 of this study has been approved by the Women's and Children's Health Network human research ethics committee (ID number 2021/HRE00156) and the University of South Australia human research ethics committee (ID number 204096).ResultsPhase 1 will commence in August 2021, with the interpretation of findings being undertaken by November 2021. Phase 2 will be developed and facilitated by February 2022, and the final phase of this study will begin in March 2022. This study is expected to be completed by February 2023.ConclusionsThe findings of this research will provide insight into the development and evaluation of education programs for midwives and nurses that includes collaboration with women from culturally and linguistically diverse backgrounds to address the specific cultural and health needs of communities.International registered report identifier (irrid)PRR1-10.2196/32911.

Project description:BACKGROUND:Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of telemedicine training in undergraduate medical education. OBJECTIVE:The aim of this review was to collect and outline the current experiences and learnings that have been generated as medical schools have sought to implement telemedicine capacity-building into undergraduate medical education. METHODS:We performed a mixed-methods review, starting with a literature review via Scopus, tracking with Excel, and an email outreach effort utilizing telemedicine curriculum data gathered by the Liaison Committee on Medical Education. This outreach included 70 institutions and yielded 7 interviews, 4 peer-reviewed research papers, 6 online documents, and 3 completed survey responses. RESULTS:There is an emerging, rich international body of learning being generated in the field of telemedicine training in undergraduate medical education. The integration of telemedicine-based lessons, ethics case-studies, clinical rotations, and even teleassessments are being found to offer great value for medical schools and their students. Most medical students find such training to be a valuable component of their preclinical and clinical education for a variety of reasons, which include fostering greater familiarity with telemedicine and increased comfort with applying telemedical approaches in their future careers. CONCLUSIONS:These competencies are increasingly important in tackling the challenges facing health care in the 21st century, and further implementation of telemedicine curricula into undergraduate medical education is highly merited.

Project description:Introduction: The efficacy of high-intensity interval training (HIIT) for improving markers of physical fitness and cardiometabolic health is promising. The workplace is one non-laboratory setting where the effectiveness of HIIT could be explored. The aim of this study was to undertake a mixed-methods exploratory pilot trial of a workplace HIIT intervention named Brief Exercise at Work (BE@Work). Methods: Fifty-four healthy employees (mean ± standard deviation [SD] age 46 ± 10 years) from two workplaces in Northeast England were allocated to 8 weeks of thrice-weekly workplace HIIT based on boxing, stair climbing and stepping, comprising 4-7 60 s high-intensity intervals interspersed with 75 s rest (n = 30), or a no-intervention control (n = 24). The primary outcome was the change SD of predicted maximal oxygen consumption (VO2max). Markers of physical fitness, cardiometabolic health and mental well-being were also measured at baseline and follow-up. Participant perceptions of the intervention were explored in post-intervention focus groups (n = 9). Results: Mean (±SD) session attendance was 82% (±15%). Mean peak heart rate across the intervention was 87% of age-predicted maximal heart rate with a within- and between-subject SD of 5.5% and 3.7%, respectively. The SD of changes in predicted VO2max was 6.6 mL·kg-1·min-1 across both groups, which can be used to inform sample size estimations for a future full trial. The control-adjusted mean increase (95% confidence interval) in predicted VO2max was 3.9 (-0.2 to 8.1) mL·kg-1·min-1, corresponding to a Cohen's D of 0.47. We also observed preliminary evidence of small to moderate effects in favour of the intervention group for non-dominant leg extensor muscle power, markers of health-related quality of life, well-being and perceived stress and small to moderate effects in favour of the controls in perceived pain, physical activity and high-density lipoprotein cholesterol. During HIIT, focus group participants reported physiological responses they perceived as unpleasant or tiring (e.g., breathlessness, local muscular fatigue), but also that they felt alert and energised afterwards. Conclusion: The findings of this exploratory pilot trial support the implementation of a definitive randomised controlled trial to quantify the effectiveness of a workplace HIIT intervention.

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A mixed methods exploratory assessment of the usefulness of Baltimore City Health Department's trauma-informed care training intervention.

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A mixed methods exploratory assessment of the usefulness of Baltimore City Health Department's trauma-informed care training intervention.

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