Trauma informed care

创伤知情护理

基本信息

批准号：
10700149
负责人：
Ameeta Shivdas Kalokhe
金额：
$ 23.48万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-07 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10700149
关键词：
Acquired Immunodeficiency Syndrome Address Adherence Administrator Adoption Age Attitude Behavior Caring Child Abuse Clinic Collaborations Consensus Continuity of Patient Care Data Dose Effectiveness Emotional Epidemic Evaluation Evidence based treatment Feedback Focus Groups Funding Future Guidelines HIV HIV diagnosis Health Health Promotion High Prevalence Hybrids Individual Interactive Systems Framework Interview Job Satisfaction Literature Low income Medicaid Mental Health Methodology Methods Morale Opportunistic Infections Outcome Patient-Focused Outcomes Patients Persons Primary Care Process Protocols documentation Provider Public Health Education Publishing Recording of previous events Reporting Research Self Care Self Efficacy Service setting Services Sexual abuse Site Social Work Source Surveys Survivors System Testing Training Trauma Uninsured United States Health Resources and Services Administration United States National Institutes of Health Viral Woman Work antiretroviral therapy behavioral health burnout care providers comorbidity cost effective effectiveness outcome effectiveness/implementation trial ethnic minority ethnic minority population experience falls federal poverty level implementation facilitation implementation outcomes implementation strategy implementation study improved informant innovation intimate partner violence men mortality organizational structure physical abuse physical conditioning pilot test primary care services racial minority referral services response screening screening guidelines substance use transgender trauma exposure

项目摘要

PROJECT SUMMARY The high prevalence and associated negative impact of trauma on the mental and physical health of people living with HIV and their engagement in HIV care (i.e., retention, viral suppression) underscore the need for systematically addressing trauma within primary HIV care. Trauma-informed care (TIC) is an evidence-based treatment framework that involves understanding, recognizing, and responding to the effects of trauma. Evidence from other settings demonstrates that TIC improves patient outcomes, increases staff morale, and is cost- effective. In recent years, WHO, HRSA, and NIH have called for trauma-informed HIV systems, yet limited research exists on the strategies needed to facilitate TIC implementation in HIV care settings. In a pre- implementation study to assess TIC provision and factors influencing adoption and implementation of TIC in Ryan White-funded HIV Clinics (RWCs) at the epicenter of the US HIV epidemic (DHHS Region IV), we found that most providers/staff felt that TIC was appropriate for RWCs and had some trauma screening and referral protocols in place, but training on trauma and methods for working with trauma survivors and lack of staff support for managing the emotional toll of working with trauma survivors were salient factors limiting TIC adoption. Importantly, TIC training and use of an implementation advisor (herein called implementation facilitation) were identified as potential strategies for facilitating TIC implementation in RWCs, including implementation of staff support. Guided by the Interactive Systems Framework, our Emory team with expertise in TIC will work in collaboration with The Emory Centers for Public Health Training and Technical Assistance (Emory Centers) and RWCs to develop and pilot test two implementation strategies (TIC training and facilitation (of TI-staff support practices, e.g. debriefings, selfcare, etc.)) on provider- and clinic-level implementation and patient effectiveness outcomes. The aims include: 1) to develop trauma-informed HIV care trainings and an implementation facilitation process to tailor staff support practices to clinic-specific needs, with iterative feedback via theater testing methodology with RWC staff/providers/administrators to inform content, dose, intensity and delivery to optimize effectiveness for RWCs; 2) to refine the two implementation strategies developed in Aim 1 using a modified Delphi method to build consensus on content and delivery with RWC stakeholders across the DHHS Region IV to optimize use across a diversity of RWCs; and 3) to pilot and perform a mixed-methods evaluation of the preliminary effectiveness of the refined implementation strategies on provider- and clinic-level implementation outcomes at two high-volume RWCs in Metro Atlanta. The results of this study will inform a future Hybrid Type 2 effectiveness-implementation trial examining the impact of centralized delivery of TIC training and facilitation on TIC implementation and patient HIV effectiveness outcomes and enable an evidence-driven response to the high-level calls for integration of TIC into HIV primary care services.

项目概要创伤的高患病率及其对人们身心健康的相关负面影响艾滋病毒感染者及其对艾滋病毒护理的参与（即保留、病毒抑制）强调了系统地解决初级艾滋病毒护理中的创伤。创伤知情护理 (TIC) 是一种基于证据的治疗涉及理解、识别和应对创伤影响的治疗框架。证据来自其他环境的结果表明 TIC 可以改善患者的治疗效果，提高员工士气，并且成本低廉有效的。近年来，世卫组织、HRSA 和 NIH 呼吁建立创伤知情艾滋病毒系统，但仍有限现有关于促进艾滋病毒护理机构中 TIC 实施所需策略的研究。在预评估 TIC 规定以及影响 TIC 采用和实施的因素的实施研究我们发现 Ryan White 资助的 HIV 诊所 (RWC) 位于美国 HIV 流行中心（DHHS IV 区）大多数提供者/工作人员认为 TIC 适合 RWC，并进行了一些创伤筛查和转诊协议已到位，但有关创伤和创伤幸存者工作方法的培训以及缺乏工作人员支持管理创伤幸存者工作中的情感损失是限制 TIC 采用的显着因素。重要的是，TIC 培训和实施顾问的使用（本文称为实施促进）被确定为促进 RWC 中 TIC 实施的潜在战略，包括实施工作人员支持。在交互式系统框架的指导下，我们具有 TIC 专业知识的埃默里团队将在与埃默里公共卫生培训和技术援助中心（埃默里中心）合作， RWC 制定并试点测试两项实施战略（TIC 培训和促进（TI 工作人员支持）实践，例如关于提供者和诊所层面的实施和患者有效性的汇报、自我护理等））结果。目标包括： 1) 开展创伤知情的艾滋病毒护理培训并促进实施根据诊所特定需求定制员工支持实践的流程，并通过剧院测试进行迭代反馈与 RWC 工作人员/提供者/管理员合作的方法，告知内容、剂量、强度和交付以进行优化 RWC 的有效性； 2) 使用修改后的方法完善目标 1 中制定的两种实施策略德尔菲方法与 DHHS 第四区的 RWC 利益相关者就内容和交付达成共识优化各种 RWC 的使用； 3) 试点并进行混合方法评估提供者和诊所层面实施细化实施战略的初步成效亚特兰大都会区两场高容量 RWC 的成果。这项研究的结果将为未来的混合型提供信息 2 有效性实施试验，检验集中提供 TIC 培训和便利的影响 TIC 实施和患者 HIV 有效性结果，并能够对高层呼吁将 TIC 纳入艾滋病初级保健服务。