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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:BackgroundDigital interventions readily permit data capture of participant engagement with them. If future interventions are intended to be more interactive, tailored, or a useful resource offered to users, it may be valuable to examine such data. One module available in a digital alcohol intervention recently tested in a randomised control trial offered participants the opportunity to self-author prompts that were sent to them by a text message at a time of their choosing. This study thus aimed to evaluate these self-authored prompts to increase knowledge on how individuals negotiate behaviour change and assess whether intervention content can be improved in the future.MethodsThe self-authored prompts were evaluated qualitatively using a combination of content and thematic analysis. The identified themes and subcategories are exemplified using anonymized quotes, and the frequency that each identified theme was coded for among the prompts was calculated. Associations between baseline characteristics and the odds of authoring a prompt at all, as well as a prompt within each theme, were investigated using logistic regression.ResultsFive themes were identified (Encouragement Style, Level of Awareness, Reminders of reasons to reduce/quit, Strategies to reduce/quit, and Timescale), all with several subcategories. The prompts module was more likely to be used by women and older individuals, as well as those for whom reducing alcohol consumption was perceived as important, or who felt they had the know-how to do so. Participants who had immediate access to the support tool (intervention group) were more than twice as likely to author a prompt (OR = 2.36; probability of association > 99%) compared to those with 4-month delayed access (control group).ConclusionsIndividuals who engaged with the prompts module showed evidence of using the information provided in the support tool in an active way, with several showing goal setting and making plans to change their drinking behaviour. Individuals also used this opportunity to remind themselves of personal and specific reasons they wanted to change their drinking, as well as to encourage themselves to do so.

Project description:BackgroundFalls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success.ObjectiveThis study aims to evaluate a behavior theory-informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children.MethodsParents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention.ResultsA total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention.ConclusionsThis study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app.

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.

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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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