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Background and Objectives: Greater lifetime exposure to psychological trauma correlates with a higher number of health comorbidities and negative health outcomes. However, physicians often are not specifically trained in how to care for patients with trauma, especially in acute care settings. Our objective was to identify implemented trauma-informed care (TIC) training protocols for emergency and/or trauma service physicians that have both sufficient detail that they can be adapted and outcome data indicating positive impact.Methods: We conducted a comprehensive literature search in MEDLINE (Ovid), Scopus, PsycInfo, Web of Science, Cochrane Library, Ebsco’s Academic Search Premier, and MedEdPORTAL. Inclusion criteria were EM and trauma service clinicians (medical doctors, physician assistants and nurse practitioners, residents), adult and/or pediatric patients, and training evaluation. Evaluation was based on the Kirkpatrick Model.Results: We screened 2,280 unique articles and identified two different training protocols. Results demonstrated the training included patient-centered communication and interprofessional collaboration. One curriculum demonstrated that targeted outcomes were due to the training (Level 4). Both curricula received overall positive reactions (Level 1) and illustrated behavioral change (Level 3). Neither were found to specifically illustrate learning due to the training (Level 2).Conclusion: Study findings from our review show a paucity of published TIC training protocols that demonstrate positive impact and are described sufficiently to be adopted broadly. Current training protocols demonstrated an increasing comfort level with the TIC approach, integration into current practices, and referrals to trauma intervention specialists.

Purpose: Children with behavioral issues in residential care settings have high rates of trauma, with a range of trauma experiences such as abuse and neglect, issues with attachment, and multiple disruptions in placements. Staff in these settings should have an understanding of trauma, its impact, and how to engage in trauma-informed practice. The purpose of this study was to examine whether a trauma-informed training, developed specifically based on the identified needs of a residential group care facility, had an impact on future staff attitudes and behaviors. Materials and methods: A 3-h training was delivered by the researchers. Three identical sessions were provided to all 48 staff, regardless of education and role, across a 3-day period. Prior to the training, staff were given a pretest survey measuring components of trauma-informed (TI) practice that indicated how often the staff members engaged in TI practice. Thirty days later, the same participants completed a posttest survey to gauge if the training had an impact on their subsequent attitudes and behavior. Results: There were improvements in many of the trauma-informed practice areas on the posttest survey. T-test analysis revealed five trauma-informed practice areas had improvements that were statistically significant from the pretest survey. Discussion: The findings present the opportunity for recommendations for trauma-informed training development and delivery, as well as providing implications for the field of social work. Conclusion: This study demonstrates the feasibility of administering a trauma-informed training program and observing relatively rapid improvements in future attitudes and behavior among staff. [ABSTRACT FROM AUTHOR]

This paper reports the findings of a critical qualitative study on trauma-informed teaching of English as a second language (ESL) at Australian universities. Post-traumatic stress affects verbal learning, yet most ESL teachers do not receive training in trauma-informed teaching. The field has suffered from a dearth of empirical studies and absence of student voice. This study used a validated tool to measure the post-traumatic stress of 39 participants, including international students and former refugees. Twenty of these completed semi-structured interviews about the ESL learning environment, based on a framework of trauma-informed principles. Data were analysed using critical, qualitative methods through a trauma-informed lens. A major theme in the findings was the importance of ESL teachers' understanding of students. Within this theme, four sub-themes are explored: personal engagement and attention, acceptance and understanding of the learner role, understanding the lives of students outside the classroom and an understanding of students' cultures. [ABSTRACT FROM AUTHOR]

The high prevalence of trauma among people with HIV (PWH) and its negative impact on HIV outcomes underscore the need for Ryan White-funded HIV clinics (RWCs) to implement trauma-informed care (TIC) inclusive of crisis prevention and response. As part of a mixed-methods study of TIC practices employed by RWCs, we conducted qualitative interviews with 36 administrators, providers, and staff from Southeastern RWCs exploring crisis prevention and response strategies. Interviews were guided by the Substance Abuse and Mental Health Services Administration TIC framework and analyzed using a framework-driven, qualitative thematic approach. Crisis prevention strategies included: using electronic medical records to identify patients at risk for experiencing crisis, peer navigators to help patients bypass clinic public spaces, protocols to ensure perpetrator-victim pairs were not concurrently scheduled, and social workers to help patients identify crisis triggers and develop safety plans, plus dedicating safe spaces for patients with extensive trauma histories. Crisis response included patient referral to onsite and community crisis intake, trauma support, and mental health services and having onsite security personnel and alarm systems. Several participants requested additional training in response protocols. Study findings highlight the need for RW network-wide TIC training and sharing of best practices in crisis prevention and response. [ABSTRACT FROM AUTHOR]

Interpersonal violence (IPV) recognition is vital to patient-centered care. Previous educational efforts have incorporated IPV into undergraduate medical education in the form of standardized patient encounters and IPV screening and awareness, but no semester-long elective that offers an intersectional approach to trauma-informed care and incorporates local advocacy groups and resources currently exists. The aim of this elective was to address the gap in IPV education in current medical school curricula and equip first-year medical students with the skills and knowledge of trauma-informed approaches in healthcare settings. We implemented a Trauma and Violence Informed Care (TVIC) elective for first-year medical students at the University of Colorado School of Medicine during Fall 2022. Seventeen first-year medical students enrolled in the elective. In this 13-week program, students met twice weekly for 1 hour sessions consisting of lectures, group discussions and role-playing activities. Learning objectives addressed IPV, intersectionality, mandatory reporting, survivors' rights and resources, and vicarious trauma. To assess course impact, surveys with Likert scale and free-response questions were distributed. Responses were analyzed using paired T-tests and content analysis. All students completed the surveys. There was significant difference (p < 0.05) in student comfort and knowledge for the following topics: Skills & Abilities, Intersectionality, Resources, System Based Processes, and Course Logistics. A TVIC elective positively impacts medical student comfort and skills around IPV patient care. More educational efforts are needed to address this curricular gap. [ABSTRACT FROM AUTHOR]

Emotional neglect (EN), characterized by a lack of emotional attunement in childhood, leads to deficits in emotion regulation, increase in self-criticism, and poor mental health outcomes including depression, anxiety, and substance use disorders. Treatment for adults that experienced childhood emotional neglect is necessary, but not sufficiently studied. Self-criticism can be treated with Compassion Focused Therapy (CFT), but the impacts of EN require additional focus on regulating the autonomic nervous system. This practice advance utilizes trauma-informed care and polyvagal theory to augment CFT using a four-pronged approach. This includes the role of the therapist and the therapeutic relationship, assessment and identification of EN, client psychoeducation on the influence of EN on the mind and body, and integration of self-regulation and self-compassion activities. This multi-modal intervention can reduce the debilitating effects of EN for individuals, their loved ones, and the behavioral health systems that support them. [ABSTRACT FROM AUTHOR]

This paper introduces the special issue of the journal on trauma-informed care in forensic settings. We consider the contributions of each of the papers, followed by a discussion of the complexities of work in this area. We conclude by proposing three general principles that can be used to guide the ongoing development of trauma-informed forensic practice. [ABSTRACT FROM AUTHOR]

The prevalence of trauma within secure forensic populations is widely acknowledged, yet the implementation of trauma-informed care (TIC) in secure forensic settings (SFS) remains in its infancy. This qualitative study delves into the perceptions and experiences of healthcare professionals (HCPs) adopting a TIC framework in SFS, examining associated barriers and facilitators. 15 participants engaged in semi-structured interviews, and results underwent thematic analysis, yielding five overarching themes and 15 sub-themes. Themes identified include: 1) understanding the TIC experience in SFS, 2) organizational and personal barriers in TIC implementation, 3) facilitators and reflections on TIC benefits, 4) barriers to specific TIC practices, and 5) practical recommendations. Participants emphasized the prevalent nature of trauma in SFS and underscored the perceived advantages of creating spaces for reflection and emotional well-being. Interviewees explored the impact of organizational culture, the demands of frontline roles and training accessibility. Practice implications highlight the need to involve key stakeholders (staff and SUs) in decision making and in assessing the feasibility of implementing TIC. SFS should prioritize TIC by addressing training needs, allocating time for TIC in supervision, providing specialist support for trauma-informed clinical work, and ensuring dedicated spaces for reflection. While the study highlights the power of incorporating HCP perspectives, limitations arise from findings drawn from a single forensic service, emphasizing the importance of further replication. This research contributes valuable insights into advancing trauma-informed care practices within secure forensic settings. [ABSTRACT FROM AUTHOR]

Within forensic populations, exposure to traumatic experiences is high. These experiences are associated with multiple mental and physical health problems later in life. Forensic services would therefore ideally adopt a trauma-informed approach. The aim of this scoping review is to identify trauma-informed training or education for staff within forensic mental health care. A database search of English or Dutch language articles from PubMed, PsycINFO, Embase, Scopus and Web of Science was performed. Researchers reviewed 6,386 articles and nine were included for final analysis, all in justice-involved youth populations. Results show that training in trauma-informed care may facilitate the relationship between staff members and residents and create safer treatment units. Besides this, a reduction in post-traumatic stress symptoms and greater clinical improvement in depression, anxiety, hope and optimism among justice-involved youth was noted. Trauma-informed staff training may also lead to a decrease in incidents taking place as well as a decrease in use of restraints and seclusion. [ABSTRACT FROM AUTHOR]

The suite of cognitive-emotional symptoms that one experiences while subject to registration and/or community supervision for a sexual offence has recently been conceptualized as Post-Conviction Traumatic Stress (PCTS). In the current study, we present a thematic analysis of transcription data extracted from focus groups with 22 men in treatment for sexual offending. We first describe the main sources of their trauma (e.g. allegation, arrest, court, conviction, jail, prison, parole/probation, and registration). Next, we examine their reported manifestations of symptoms contained in the DSM-5 criteria for Post-Traumatic Stress Disorder (PTSD). All the men described at least one symptom, and many endorsed symptoms in all four criteria categories. Commonly described indicators of PCTS included intrusive memories of the arrest; avoidance of certain people, situations, and environmental cues; negative thoughts about themselves and the future; hyperarousal triggered by reminders of arrest or prison; and fear of being re-arrested for a violation of probation or registration. Finally, implications for trauma-informed practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Since 2015, women's prisons across England have been working toward providing trauma-informed care (TIC) given the high rates of psychological trauma in the prison population. Research into TIC in prisons has been limited to date. This qualitative study explored the perceptions of 35 prison officers from two English women's prisons about their experiences of providing TIC, including the role of training. Four main themes were identified using thematic analysis: Creating trauma-informed settings was noted as a dynamic process, complicated by prisons being triggering environments for women. Prison officers described attempting to negotiate the power (im)balance between them and women in prison, to allow them to nurture positive relationships with them. Operational practices reportedly regularly undermined these efforts by reinforcing the power differential. Staff also observed variable and limited capacity and opportunities for TIC, further reducing the ability to create settings conducive to TIC. These findings have important implications for women's prisons, including the need to review and revise TIC training for new and existing staff; prioritize staff well-being and support, and improve recruitment processes to develop a staff group with the aptitude and skill to deliver TIC. [ABSTRACT FROM AUTHOR]

In the current case study, we evaluated synchronous reinforcement (SSR) as an intervention to increase self-feeding for a 5-year-old male diagnosed with ASD and a pediatric feeding disorder who also had a history of trauma. Synchronous reinforcement is a schedule of covariation where reinforcement is delivered continuously contingent on responding. Synchronous reinforcement has not been previously reported in the literature in a feeding context. A benefit of reinforcement-based procedures, such as SSR, is that they may align with recommendations for trauma-informed care by preventing or limiting the necessity of physical guidance procedures for those with a history of physical trauma. This is of particular significance given children with disabilities are more likely to experience traumatic events and abuse. We demonstrated that SSR was an effective intervention for increasing self-feeding, as well as methods for fading SSR as a treatment component. We discuss the potential for SSR as a trauma-informed approach, and the importance of caregiver collaboration and programming for generalization. [ABSTRACT FROM AUTHOR]

• Under-resourced families experience high trauma rates, which can affect learning. • TRiEE aimed to build capacity for trauma- and resilience-informed services. • Children in TRiEE centers showed large developmental gains. • Trauma-informed services are important for advancing early education equity. Enhancing access to high-quality early childhood education (ECE) represents one promising pathway toward reducing the disparities in school-related outcomes for children from under-resourced and minoritized communities. In this paper we describe the Trauma- and Resilience-informed Early Enrichment (TRiEE) initiative, an innovative community schools (CS) approach to ECE that was designed to bolster the capacity of public pre-K programs to provide holistic, family-centered, and trauma-informed services. As such, TRiEE features the integration of trained psychiatric social workers (PSWs) into one public school district's set of early education centers (EECs). We hypothesized that this approach to ECE could be positively associated with the acquisition of key skills that are foundational to children's school readiness. Student-level de-identified administrative data, drawn from the Desired Results Developmental Profile (DRDP), was obtained from twenty-four TRiEE-affiliated EECs in a large, urban public school district over the course of three academic years. Results from mixed-effects models showed that students at sites actively implementing TRiEE demonstrated significantly greater rates of improvement in socio-emotional, cognitive, and physical outcomes (all p < 0.05) in comparison to children participating in sites which were not yet actively implementing TRiEE. [ABSTRACT FROM AUTHOR]

Community-based programs serve a critical need for vulnerable youth and families. In recent years, researchers and practitioners have urged programs to adopt a trauma-informed care (TIC) approach to address adversity in young people's lives. The purpose of this article is to describe the implementation and outcomes of the Trauma Ambassador (TA) Program, a pilot youth leadership program guided by a community-university partnership that utilized a TIC approach in an underserved East North Philadelphia neighborhood. Fourteen youth engaged in interactive trainings to build their understanding of trauma and develop practical tools to support encounters with individuals with trauma histories. Focus groups and individual interviews were conducted to better understand program implementation and outcomes. Rich data emerged that identifies a myriad of ways that youth and their community might benefit from a program like the one described. The program successfully impacted participants, as TAs recognized their own trauma and were motivated to help others who may have trauma histories. This program provided quality youth development experiences, particularly with respect to trauma-informed care, and results support taking a holistic, healing-centered approach to foster well-being for youth and adult mentors. [ABSTRACT FROM AUTHOR]

Although reentry programming has grown, little is known about the process of developing reentry programming that utilizes peer support. Peer support is commonly utilized along side evidence-based practices in other service delivery areas (e.g., mental health), and is increasingly used during reentry, yet little is known about whether this practice is effective at reducing recidivism. This study examines a Smart Reentry program in an urban, Midwestern city. Drawing on 18 interviews with peer guides and family support specialists across two time points, and program participants at one time point, the authors examine the challenges and strengths related to staff training and development, program culture, and participant engagement. Results demonstrate the strengths of a family-centered model of reentry programing, and the challenges of working with the department of correction staff and paraprofessional peer guides within a professional environment. Suggestions are offered for programming utilizing similar models of paraprofessionals. [ABSTRACT FROM AUTHOR]

Road traffic injuries (RTIs) are a pressing public health concern in India, leading to a rise in injury‐related deaths, hospitalizations, and disabilities. India accounts for a significant portion of the world's fatal traffic accidents, with two‐wheelers being involved in the majority of these accidents. The impact of non‐fatal injuries on individuals extends beyond the bodily consequences of the injury and includes both the physical and psychological dimensions of the injury. The literature indicates the need for policy cascades and implementation framework for the prevention of road traffic injury. This study aimed to investigate the post‐RTI experiences and challenges faced by college students who experienced road traffic injury during their college life by using a qualitative research approach in Madurai district, Tamil Nadu, India. The study found that college students who experienced RTIs faced a wide range of physical, emotional, and social difficulties. The study highlights the need for a more comprehensive and holistic approach to RTI prevention that takes into account the complex interplay of individual, environmental, and societal factors that contribute to RTIs. The study also underscores the urgent need to improve the quality and availability of healthcare and rehabilitation services for RTI survivors. [ABSTRACT FROM AUTHOR]

In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodResultsConclusionWorldwide, the numbers of refugees and displaced people being exposed to traumatic and inhumane experiences are escalating, resulting in an enhanced need for appropriate psychological management of trauma in this at-risk group. This study explores therapists’ perspectives on and preparedness for supporting adult refugees with trauma-related interventions.Therapists (N = 17), with varying ranges of experiences supporting adult refugee clients, were recruited nationally, and participated in semi-structured interviews, exploring their experiences and preparedness for therapeutically supporting refugee clients with trauma-related interventions. Data were analyzed using reflexive thematic analysis. A Patient Public Involvement (PPI) approach was embedded within this study.Five major themes were developed throughout the analysis: (i) Therapists’ Fears and Apprehensions in Meeting Client Complexities, (ii) Preparation and Support for Competency Development, (iii) Adjusting Preconceptions of the Nature of Therapeutic Work, (iv) Humanity Within the Therapeutic Relationship, and (v) Balancing Therapeutic Meaningfulness and Hardships.Therapist training must reflect trauma-informed care and inter-cultural awareness to allow therapists to feel better prepared within mainstream and specialist services. Further, therapists’ well-being needs to be prioritized to prevent vicarious trauma, burn-out and ultimately, improve interventions for clients. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodsResultsConclusionsIn 2018, HIV prevalence among transgender women of color in the USA was 14.11%, with similar severe trends observed in Canada. This highlights the persistent challenge of HIV/AIDS in both countries, particularly for transgender sex workers of color (TSWOC), who face significant barriers to accessing crucial HIV/AIDS care services due to stigma, systemic discrimination, and biased healthcare practices. To address these issues, a scoping review was undertaken to explore the specific barriers to HIV/AIDS care experienced by TSWOC in the United States and Canada.After various database searches (MEDLINE, PubMed, and Google Scholar) using the PRISMA-ScR methodology, 47 studies were extracted. Studies were then screened on Covidence by using the set inclusion and exclusion criteria. After screening, fifteen studies met the criteria.The results were thematically organized using an intersectionality-grounded socio-ecological model. Results revealed individual-level challenges of internalized stigma, interpersonal issues with biased healthcare providers, and community-level problems such as lack of support and enduring stigma. Notable structural barriers, consistent across studies, included homelessness, economic marginalization, and institutional transphobia. Institutionalized cisnormativity in healthcare was also found to exacerbate these challenges.The findings underscore a feedback loop intensifying HIV/AIDS burdens within TSWOC due to intersecting stigmas and structural disparities. The review advocates for trans-specific and trans-inclusive HIV/AIDS services to address unique challenges, emphasizing the imperative for holistic, trauma-informed HIV care for this underserved population. [ABSTRACT FROM AUTHOR]

Background: Exposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners' perspectives on trauma-informed primary care. Methods: Eight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis. Results: 13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment. Conclusions: This review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses. [ABSTRACT FROM AUTHOR]

Events such as the COVID-19 pandemic and the war in Ukraine have increased people's awareness of mental health issues. Psychological trauma impacts patients in the acute care setting through physical and mental health presentations. Trauma is a public health issue crossing all socioeconomic groups and is related to social determinants of health. Trauma-informed care (TIC) is an evidence-based approach to providing care. TIC is within the scope of nursing practice and improves outcomes for patients. However, there is a lack of standard terms or practices within healthcare. Additionally, there is superficial acknowledgment of the need for TIC at the local or national level regarding policy. Nurses need to adopt TIC into practice and advocate for policy change to improve the health and lives of those seeking care. [ABSTRACT FROM AUTHOR]

Background: Women in the sex trade encounter significant challenges in obtaining reproductive healthcare. Reports of reproductive healthcare for women in the sex trade center on the prevention and termination of pregnancies, yet most women in the sex trade globally experience full term pregnancies and bear children. This study aimed to explore barriers and enabling factors to providing reproductive healthcare for women in the sex trade in Israel. Methods: We conducted a qualitative study utilizing a grounded theory method. Data were collected through semi-structured interviews, conducted between June 2021 and July 2022. Interviews were conducted with practitioners in healthcare settings (n = 20), practitioners in social services settings (n = 15), and women in the sex trade who received reproductive health care-related medical services (n = 13) in Israel. The interviews were audiotaped, transcribed, and thematically analyzed. Results: The findings indicated a multilayered structure of healthcare system-related factors and women-related factors. Stigma was noted as a multidimensional barrier, reflected in service providers' attitude towards women in the sex trade, impairing the patient-provider relationship and impeding women's help-seeking. However, the creation of a relationship of trust between the women and healthcare providers enabled better health outcomes. Conclusions: Based on the findings, we propose recommendations for designing and implementing reproductive healthcare services for women in the sex trade. The recommendations offer to (a) include women with lived experiences in planning and providing reproductive healthcare services, (b) adopt a trauma-informed approach, (c) emphasize nonjudgmental care, (d) train healthcare providers to reduce stigma and bias, and (e) enhance the affordability of health services for women experiencing marginalization. [ABSTRACT FROM AUTHOR]

Trauma-informed care and practice was developed over 20 years ago and is emerging as a way of working for the police, in corrections and courts, and broader contexts such as health and education services. I started my criminal justice career with South Australia Police in 2001. It was not until 2014 that I first heard the term “trauma-informed,” which was regarding victim services. Back then, it was unclear how it might be applied in practice. Soon after, I was appointed to the Parole Board of South Australia in 2015. As a Parole Board member, I have interviewed more than 1,000 adults, many with chronic offending histories and most with trauma histories. In this paper, I draw from local case studies and apply the SAMHSA (2014) trauma-informed practice framework to explore “trauma-informed” policing. Trauma is understood to mean the impact of adversity (i.e., potentially traumatic events and experiences) on an individual’s functioning and well-being. I outline the ABCs of a trauma-informed policing response: (A) trauma-informed policing requires an agenda, (B) trauma-informed policing is broad, and (C) trauma-informed policing is compassionate. Without the ABCs of trauma-informed policing, police responses may be, at best, well-intentioned good practice, but they should not be considered to be trauma-informed. [ABSTRACT FROM AUTHOR]

In this article, the authors explore the early integration of trauma-informed policing into the training of police recruits in Tasmania since 2023. Trauma-informed policing is an approach that recognizes the psychological, emotional, and physical impact of trauma on individuals and supports a more compassionate and empathetic response from law enforcement at various stages of the policing process. Additionally, it emphasizes the importance of mental health and well-being for officers themselves. A quick perusal of scholarly and grey literature seemed to identify a gap in training materials specifically designed for police recruits. This preliminary exercise led to a more thorough systematic literature review, which revealed the same. With a lack of consolidated materials for police training, a tailored curriculum was co-designed between the University of Tasmania, Tasmania Police, and experts in the field. The training aims to equip recruits with knowledge to recognize signs of trauma, understand its effects on behaviour, and respond appropriately. The survey evaluation of all training conducted in 2023 received a 70.8% response rate and indicated significant satisfaction with the training. After presenting the results of this evaluation, the authors discussed the benefits of trauma-informed policing training while acknowledging the challenges of implementation. However, in the Tasmanian context, strong police leadership support, a long-standing academic partnership, and a whole-of-government endorsement of trauma-informed practices provide a conducive environment for this initiative. Overall, the integration of trauma-informed principles into police training in Tasmania represents a significant step towards more empathetic, effective, and resilient policing, with potential for broader application and ongoing development. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the interRAI Trauma-Informed Care (TIC) training program based on evidence-informed Collaborative Action Plans. Focus groups and the Attitude Related Trauma-Informed Care (ARTIC) questionnaire addressed clinicians' and mental health professionals' attitudes toward the application of TIC with their child and youth clients. An explanatory sequential design was conducted. In total, 105 clinicians and mental health professionals who participated in a 4-hour, in-person or virtual TIC training, two comprehensive seminars, and 28 trauma-informed training web-based modules completed the ARTIC questionnaire. Researchers conducted seven focus groups with clinicians/participants (N = 23) to discuss the views and effectiveness of the interRAI TIC educational training modules. To quantitatively measure the change of attitudes towards TIC, descriptive statistical analysis was completed using the means and standard deviation of the ARTIC scores at the initial time point, the follow-up time point, and the difference between scores at both time points. Paired sample t-tests were conducted on both the overall score and each of the subscales in each of the three samples (total sample, online subsample, and hybrid subsample). A thematic analysis was conducted to generate qualitative findings from the focus groups. Findings from the quantitative and qualitative analyses suggest that the interRAI TIC training provided clinicians with an improved sense of knowledge and ability to apply trauma-informed care planning with their clients. [ABSTRACT FROM AUTHOR]

Trauma-informed care (TIC) is a relatively new topic in the Estonian child protection system, but it has become the particular focus of substitute care. The Estonian child protection system focuses on protecting children from maltreatment, and neglects the adult carers' right to adequate information about the child's trauma experience. This makes trauma-informed care vague. This article is based on focus groups conducted for a wider study that aims to develop the basis for a TIC training course for foster parents and staff members working as direct caregivers in residential substitute care. The foster parents and staff members participated in four focus groups, with special attention on their experiences with TIC. The participants eagerly shared their experiences, and thematic narrative analysis was used during the data analysis. The central theme of the participants' stories was the need for information about the child's traumatic past. The findings indicate that a complex interplay exists between the needs of children entering substitute care and the capacity of the foster parents and residential care staff to meet those needs. It is complicated for a child to heal from trauma if the child's past is hidden from their carers. This could result in re-traumatisation and hinder the child from making sense of past trauma. Estonia's child protection system needs greater awareness of the impact of trauma on the child's behaviour and how to help the child heal. This is directly connected to the need for clear and precise information, which is one of the basic rights of the child. [ABSTRACT FROM AUTHOR]

Recognition that schools should be responsive to children who are impacted by adversity and trauma is burgeoning internationally. However, consensus regarding the necessary components of a trauma-informed school is lacking. This research developed expert-informed and internationally relevant best-practice trauma-informed principles for schools. A four-phase methodology included (i) identification of school-relevant trauma-informed practice programs, (ii) inductive thematic analysis of the main concepts underlying programs, (iii) phrasing of draft Principles and (iv) Principle revision and finalisation via a two-round Delphi survey with international experts. Excellent agreement by experts on the importance of all Principles was achieved (round 1 ≥ 86.4%, 2 ≥ 92.3%). The final 'International Trauma-Informed Practice Principles for Schools' (ITIPPS) include four Overarching (A–D) and 10 Practice Principles (1–10). Summarised, these include that the school: (A) is student focussed; (B) models compassion and generosity; (C) is understanding and responsive; (D) incorporates recognition of their First Nations peoples in the school's ethos: (1) prioritises safety and wellbeing; (2) models positive relationships; (3) provides a positive culture and connects; (4) consults and collaborates; (5) supports vulnerable students; (6) teaches social and emotional learning; (7) provides trauma-informed practice training; (8) is predictable yet flexible; (9) identifies and nurtures strengths and (10) reflects, changes and grows. The ITIPPS provide clear guidance for education sectors, schools and other settings about appropriate learning environments for children and young people impacted by trauma. Research is now underway in Western Australian schools to pilot test the feasibility and impact of using the ITIPPS within a framework (thoughtfulschools.org.au) to establish trauma-informed schools. [ABSTRACT FROM AUTHOR]

AIM This research aimed to uncover elements of a comprehensive, trauma-informed (TI) multidisciplinary health professions simulation framework to improve the delivery of care to traumatized patients. BACKGROUND Trauma is a pervasive public health problem requiring a TI approach. Simulation is an evidence-based teaching strategy that advances knowledge and clinical reasoning. There is a lack of scientifically based simulation education models addressing the delivery of TI care for the health professions. METHOD A Delphi study utilizing a panel of experts was conducted to identify the most critical elements of a simulation framework. RESULTS Phase one identified 10 content areas and 111 subcontent areas. Phase two analysis revealed 99 percent of the 111 subcontent areas achieved expert consensus. CONCLUSION This Delphi study provides the first scientifically based framework to guide the development of a comprehensive, TI, multidisciplinary simulation framework to recognize trauma survivors and subsequently display concern and respect. [ABSTRACT FROM AUTHOR]

Aim: To describe the implementation of a trauma‐informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW. Design: Discussion paper. Data Sources: Evidence gathered from a literature search (2008–2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews. Discussion: The literature highlights the high prevalence of trauma in patients following COVID‐19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma‐informed model of care was implemented. Conclusion: Reconceptualizing COVID‐19 as a 'collective trauma' can help healthcare workers understand the needs of post‐COVID patients and enable them to respond empathetically. A trauma‐informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic. Implications for Nursing and Patient Care: Frontline healthcare workers, particularly nurses, are well positioned to implement trauma‐informed care due to their high‐level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided. Impact: The COVID‐19 pandemic has led to adverse physical and mental health outcomes for many.Trauma‐informed care is a way to promote reengagement with the healthcare system in this group.Post COVID patients globally may benefit from this approach, as it aims to build trust and independence. Patient or Public Contribution: Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post‐COVID patient. [ABSTRACT FROM AUTHOR]

Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes. [ABSTRACT FROM AUTHOR]

This article explores the Quality of Provider Interaction (QPI) within maternity care, spotlighting its crucial role in positive childbirth experiences. It emphasizes the need for trust-based relationships between women and their care providers, a necessity amplified by the profound neurohormonal sensitivities experienced during labor. Drawing from the 'Optimizing the birth environment' COST DEVOTION CA18211 Working Group, this article aims to provide insights and stimulate discussion on how to mitigate birth trauma and improve childbirth experiences. The study evolved through discussions on QPI, engagement with the group, a review of COST Action research, and conference contributions, leading to essential recommendations. From our dialogue and evaluation of existing literature, we identified four pivotal aspects critical to enhancing QPI: 1) Empathy and emotional availability, 2) Trauma-informed maternity care, 3) Integrating woman-centered individual and institutional attitudes, and 4) Empowering language use. We examine how these elements influence women's emotional and psychological well-being throughout childbirth and beyond, underscoring their critical contribution. This article proposes a framework to improve maternity care by enhancing the Quality of Provider Interaction (QPI). It offers practical recommendations for refining care protocols and language guidelines, emphasizing the importance of respectful, secure birthing environments. Adopting care models that prioritize high-quality provider interactions is crucial for the well-being of women and their families. [ABSTRACT FROM AUTHOR]

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Child maltreatment affects millions globally across all economic levels. Despite its prevalence, comparative research and internationally comparable data are limited due to varied definitions, methodologies, and reporting systems. This narrative review aims to compare child maltreatment trends in the U.S. and Japan, highlighting the roles of sociocultural factors. Through a literature review and analysis of national data since 1990, the study estimates maltreatment and fatality rates in both countries. Findings suggest an increase in Japan's reported maltreatment cases, likely attributable to legislative changes and heightened public awareness, while the U.S. appears to show a decline, potentially linked to improved mental health services and socioeconomic advancements. In both nations, mothers are predominantly identified as perpetrators, with sociocultural factors influencing maltreatment types and rates. Japan faces challenges in accurately measuring maltreatment due to reporting inconsistencies and mental health stigma. Despite a higher victimization rate, Japan reports significantly fewer fatalities than the U.S., with the fatality rate in the U.S. being approximately 9 times higher than in Japan. This contrast underscores the critical role of healthcare access and mental health support. The review advocates for international efforts to standardize maltreatment definitions and reporting, suggesting the adoption of trauma-informed care and comprehensive healthcare access as effective strategies. [ABSTRACT FROM AUTHOR]

Background: There is an intricate relationship between the mind and the body in experiences of health and wellbeing. This can result in complexity of both symptom presentation and experience. Although the contribution of life trauma to illness experience is well described, this is not always fully recognised or addressed in healthcare encounters. Negotiating effective and acceptable trauma-informed conversations can be difficult for clinicians and patients. Aim: To explore the experience of primary care practitioners caring for women through a trauma-informed care lens. Design and setting: Qualitative study in the general practice setting of England, with reflections from representatives of a group with lived experience of trauma. Method: This was a secondary thematic analysis of 46 qualitative interviews conducted online/by telephone to explore primary care practitioners' experiences of supporting women's health needs in general practice, alongside consultation with representatives of a lived-experience group to contextualise the findings. Results: Four themes were constructed: 'you prioritise physical symptoms because you don't want to miss something'; you do not want to alienate people by saying the wrong thing; the system needs to support trauma-informed care; and delivering trauma-informed care takes work that can have an impact on practitioners. Conclusion: Primary care practitioners are aware of the difficulties in discussing the interface between trauma and illness with patients, and request support and guidance in how to negotiate this supportively. Lack of support for practitioners moves the focus of trauma-informed care from a whole-systems approach towards individual clinician–patient interactions. [ABSTRACT FROM AUTHOR]

Analysis of in‐depth interviews with eight district court judges in North Carolina revealed over 40 practices that judges can adopt to become more trauma‐informed in their work. These practices map onto SAMHSA's framework for a trauma‐informed approach, demonstrating that abstract principles can translate into concrete actions in the courtroom setting. Analysis revealed an additional core principle of trauma‐informed judicial practice—Rehabilitation and Healing—and several areas where judges can deepen their commitment to trauma‐informed care—engagement with peer support programming; greater attention to cultural, historical, and gender issues; and application of trauma‐informed practice in adult criminal court. [ABSTRACT FROM AUTHOR]

Abstract Background Exposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners’ perspectives on trauma-informed primary care. Methods Eight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis. Results 13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment. Conclusions This review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses.

Given the potential for retraumatization among survivors of sexual violence engaged in research, we aimed to provide pertinent knowledge and exemplification of the integration of trauma-informed practice to research with survivors. Grounded in trauma-informed care, we discuss the need for trauma-informed research, drawing upon experiences and data from a longitudinal case-control study on sexual violence. Through trauma-informed research settings, we can improve research experiences for survivors of sexual violence, as demonstrated by positive experiences of participants in The THRIVE Study. By meeting the needs of survivors, researchers can increase participation while maximizing the research quality and advancement of research.

While clinical practitioners have long recognized the importance of trauma-informed models of care, geographies of care scholars have been slow to engage with and address trauma in its methodologies for better understanding environments that support, or hinder, care for people. Marrying the conceptual contributions of geographies of care, trauma geographies, and geographies of addiction, this paper aims to advance the inquiry of trauma-informed spaces of care. Drawing on the example of the homeless substance user, we present a novel theoretical imperative for considering trauma on both an individual and collective level for advancing spatial interventions for healing in spaces of care. [ABSTRACT FROM AUTHOR]

The lived experiences of marginalised consumers are relatively absent in the marketing canon. In this article, we propose layering a trauma-informed approach onto the qualitative research methodologies of depth-interviewing and collaging to enhance the voices of marginalised consumers. Although marketing researchers are trained to consider potential risks to research participants, little formal guidance exists on how to negotiate the research space when the phenomenon of interest involves or intersects with consumer marginalisation. Application of a trauma-informed approach (TIA) not only offers a path toward effective methodologies to better understand the lived experiences of marginalised consumers, but also provides a method to amplify their voices. Adopting a TIA approach ensuring informants' physical and emotional safety can build trust, engage informants in the research process, and encourage open, honest responses among marginalised consumers who often feel disenfranchised in the marketplace. [ABSTRACT FROM AUTHOR]

Trauma-informed care (TIC) benefits to service users and providers are increasingly acknowledged across various health and social care settings. TIC can potentially increase service user engagement, prolong shelter placements, and lessen staff vicarious trauma and burnout. However, studies documenting staff experiences and/or the implementation of TIC are scarce. This limitation has prompted calls for more grounded and applied research into trauma-informed practice, tracking implementation in practice, staff perceptions, barriers, and organisational change. This study aims to address this gap and is an ecological, mixed-methods evaluation of the efficacy of TIC training in a female-only homeless shelter. Quantitative data included 132 incident reports during the first yearly quarters pre- and post-training, hypothesising post-training reductions in incident numbers and severity. Using expansive thematic analysis, semi-structured interviews with six shelter staff (n = 6) explored employee views of TIC relative to trauma understanding, incident management, and integration in practice. Findings revealed a marginal increase in incident numbers and a statistically significant reduction in incident severity post-TIC with a 50% reduction in calls to emergency medical services (EMS). Participant accounts of working practice pre- and post-TIC uncovered increased trauma understanding, increased confidence and competence, healing relationships, and enhanced self-care. Findings are discussed with reference to Substance Abuse and Mental Health Services Administration (SAMHSA)’s (2014) trauma-informed framework and Yatchmenoff et al’s. (2017) core questions in evaluating TIC. While these results are significant as one of the first evaluations of TIC training in Ireland, limitations and implications for future research and practice are considered.

Background Major depression (MD) is a prevalent and disabling condition in Chile, with most cases being treated at the primary care level. In Chilean primary care, the authors have identified key factors associated with more complex presentations of MD and a poorer prognosis, such as a history of childhood trauma, suicidality, and comorbidities. These findings underscore the need for a multidimensional, trauma-informed, and interprofessional approach to the treatment of depression. Methods This protocol is a two-arm, single-blinded, cluster RCT to compare the effectiveness of a collaborative multidimensional approach for depression (CMAD) versus usual care to treat MD in primary care clinics in Chile. In total, 394 depressed adults from 18 to 65 years of age in twelve clinics located in Chile’s Maule Region will be consented to participate in the study. Patients and care teams from each clinic will be randomized to the intervention or to the control arm. Interprofessional teams in the intervention arm will attend 27 hours of didactic and active learning sessions focused on clinical competences to effectively engage, treat and follow up patients with the factors associated to the complex presentation of MD. Team in the control arm will receive 27 didactic sessions on current clinical guidelines for MD. Patients of both arms will be blindly assessed at baseline, three months, and six months. The primary outcome will be the reduction in depressive symptoms, with secondary outcomes including improvements in anxiety symptoms, interpersonal and social functioning, and treatment adherence. Discussion This protocol proposes the evaluation of an intervention designed to improve depression symptoms by enhancing the clinical competencies of primary care teams. These competencies are structured around collaborative care and trauma-informed practices. Trial registration NCT05016388, registered on 16 August 2021 at ClinicalTrials.gov.

People in prisons have high levels of trauma exposure throughout their lives. Presentations are often complex, with a high prevalence of PTSD and CPTSD and other mental health comorbidities. Prisons themselves can be stressful and traumatising environments. There are challenges in the delivery of effective treatments for PTSD and CPTSD. There is a need for the development of effective clinical pathways for these conditions that are embedded within trauma-informed organisational approaches. Responding to this need, this report is the result of a multidisciplinary expert consensus meeting and review of the research literature on PTSD, CPTSD, associated comorbidities and optimal approaches to trauma-informed practice. The group consisted of 24 expert representatives from psychology, psychiatry, healthcare, academia, social care and Welsh Government. The meeting commenced with presentations on various aspects of the clinical pathway for PTSD and complex PTSD in prisons, and of applications of trauma-informed practice within prisons. Small sub-groups then provided practical recommendations and solutions relevant to their assigned topic. Findings were presented to all meeting attendees for another round of discussion and debate, until consensus was reached. The resulting recommendations provide guidance to improve identification, treatment and support for people living in prison who have experienced trauma. [ABSTRACT FROM AUTHOR]

The adoption of trauma-informed practices in schools is a significant and growing area of school reform efforts. It has been assumed that professional development aimed at influencing teacher attitudes toward trauma-informed care in schools is an important first step in adopting trauma-informed practices and improving student and school outcomes. However, there are gaps in the literature assessing the impact of trauma-informed professional development on teacher attitudes toward trauma-informed care, and there is little evidence linking changes in teacher attitudes to changes in practices. This exploratory study assessed teacher responses to a year-long pilot program providing intensive professional development and consultation on trauma-informed practices in one urban elementary school in the U.S. Southwest. Findings raise questions about the impact of professional development on teacher attitudes and subsequent changes to practice. [ABSTRACT FROM AUTHOR]

This article discusses the relationship between developmental trauma and violence, arguing that trauma is often overlooked in discussions about violence and mental illness. The authors conducted a literature review and found that early exposure to trauma is a significant risk factor for psychiatric disorders and violence. They propose the reintroduction of developmental trauma disorder (DTD) to better understand the unique implications of childhood trauma. The article emphasizes the need for trauma-informed care and the development of tailored service models for at-risk individuals. It also highlights the potential misdiagnosis of developmental trauma as other conditions and the long-lasting effects it can have on children. The article suggests trauma-informed care, peer support, and digital mental health interventions as potential treatment practices. It concludes by emphasizing the importance of accurate diagnosis and individualized treatment strategies for developmental trauma. [Extracted from the article]

The integration of trauma-informed and ethical frameworks in qualitative research concerning survivors of gender-based violence (GBV) within displaced communities is critical. These individuals often bear the weight of traumatic experiences compounded by displacement and associated hardships. Adopting a trauma-informed approach establishes a safe environment, prioritizing survivors' well-being and respecting their agency and narratives, thereby fostering trust and reducing re-traumatization risks. Ethical considerations ensure the dignity, rights, and cultural sensitivities of participants are upheld, contributing to rigorous and humane research. This integration amplifies survivors' voices and experiences, enhancing understanding and empathy. Trauma-informed approaches acknowledge the likelihood of trauma in individuals' lives and prioritize safety without aiming to treat symptoms. Proficient interviewing skills aim to improve comfort, safety, and recall without avoiding challenging questions. Integration of trauma-informed principles across all interview phases is crucial, particularly for individuals experiencing various traumas simultaneously, such as displacement, violence, and ongoing conflict. Drawing from the authors' experiences and existing literature, this paper advocates for a compassionate and empowering shift in qualitative research methodologies to better engage with survivors of trauma and GBV within displaced communities. [ABSTRACT FROM AUTHOR]

Youth involved in the child welfare system need creative ways to meet their needs. One type of active group intervention, adventure therapy, is currently gaining momentum as an additional support for youth with trauma histories. The Ohio Adventure Therapy Coalition (OATC) developed an implementation model to support youth workers in facilitating adventure therapy groups across the state with a focus on trauma-informed care and involving providers in a parallel process, so they can personally understand the process of adventure therapy. A pilot study collected data from youth, parents and providers looking at overall mental health functioning and trauma symptoms. Overall, youth reported significant improvements in overall mental health functioning, while parents reported significant overall improvements as well as improvements on five subscales as measured by the Youth Outcomes Questionnaire. Providers reported significant decreases in youth trauma symptoms, behavioral and emotional needs and risk behaviors as captured by the CANS. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a pervasive, worldwide public health concern. Risk of IPV may elevate during the perinatal period, increasing maternal and fetal health risks. Trauma- and violence-informed care shows promise among interventions addressing associated mental health sequelae. As a secondary analysis, the purpose of this study was to employ a qualitative arts-based exploration to better understand pregnant women's experiences of trauma and violence-informed perinatal care in the context of IPV. Using an arts-based qualitative methodology, different art forms were used to analyze, interpret, and report data, resulting in a layered exploration to represent phenomena. From this, four themes were reflected in four poetic pieces: Black Deep Corners, Triggering my Thoughts, Breaking through the Brokenness, and Now Perfectly Imperfect. Nine pieces of visual art were created reflecting these themes, creating a layered, embodied, artistic way to empathically explore and translate phenomena. [ABSTRACT FROM AUTHOR]