Trauma-Informed Care in a Patient-Centered Medical Home for Adolescent Mothers and Their Children
Trauma-Informed Care in a Patient-Centered Medical Home for Adolescent Mothers and Their Children
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DOI：
10.1037/ser0000315
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发表时间：
2019-02-01
影响因子：
2.3
通讯作者：
Scott, Stephen M.
中科院分区：
文献类型：
--
作者：
Ashby, Bethany D.;Ehmer, Amelia C.;Scott, Stephen M.
与未做母亲的少女相比，未成年母亲遭受创伤和虐待的比例更高，患精神疾病的风险也更大，这使她们成为特别脆弱的群体，并使她们感到得不到医疗服务提供者的支持或与之结盟。有童年虐待史的妇女面临产科并发症的增加;她们的婴儿出生体重低、发育和智力迟缓以及行为问题的风险增加。创伤知情护理在精神卫生环境中已变得普遍;然而，这种模式并没有普遍应用于其他环境，如以患者为中心的医疗之家（PCMH）。科罗拉多青少年产妇方案（CAMP）是一个产科和儿科医疗之家，为怀孕和养育22岁以下的少女及其子女提供服务，位于科罗拉多儿童医院内。随着行为健康到CAMP的整合，并考虑到文献中报道的青少年母亲中创伤史的流行，使用药物滥用和精神卫生服务管理局的创伤知情方法的六个关键原则，对临床护理进行了方案和操作上的改变。数据显示，近30%的参与者报告了创伤史。在纳入创伤知情原则后，患者的产前预约率显着提高（p <0.001），低出生体重儿的比例显着降低（p = 0.02）。未来的程序变化和长期的评估结果，这种创伤知情的方法在PCMH也进行了讨论。
Adolescent mothers experience higher rates of trauma and abuse, as well as increased risks for mental health disorders, compared to adolescent girls who are not mothers, making them a particularly vulnerable population and contributing to them feeling less supported by or allied with their medical provider. Women with a history of childhood abuse face increased rates of obstetric complications; their infants are at increased risk for low birthweight, developmental and intellectual delays, and behavioral problems. Trauma-informed care has become widespread in mental health settings; however, this model has not been as commonly applied to other settings, such as patient-centered medical homes (PCMHs). The Colorado Adolescent Maternity Program (CAMP) is an obstetric and pediatric medical home for pregnant and parenting adolescent girls through age 22 and their children located within Children's Hospital Colorado. With the integration of behavioral health into CAMP, and given the prevalence of trauma histories among adolescent mothers reported in the literature, programmatic and operational changes to clinical care were made using the Substance Abuse and Mental Health Services Administration's six key principles of a trauma-informed approach. Data showed that nearly 30% of participants reported a history of trauma. Following the inclusion of trauma-informed principles, patients had significantly higher rates of attendance at prenatal appointments (p < .001) and significantly lower rates of low birthweight babies (p = .02). Future programmatic changes and long-term assessment outcomes of this trauma-informed approach in a PCMH are also discussed.