Improving Communication Between Primary Care Providers and Their Trauma Patients

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Improving Communication between Primary Care Providers and their Trauma Patients Abstract Trauma, especially interpersonal violence, is associated with a variety of emotional complaints, anxiety and depressive disorders, and interpersonal problems, as well as increased medical morbidity, decreased preventive care, and increased costs to the health care system. Yet trauma-related problems have not received sufficient attention in training of providers or in primary care settings, and providers feel unprepared to work with these patients. The proposed research utilizes the R34 mechanism to adapt and pilot test a theory- based practical approach to working productively with trauma survivors, the Risking Connection curriculum, to be appropriate for primary care providers (PCPs) serving low-income and minority patients. The following aims are proposed: 1) To adapt an existing manual and training curriculum on working therapeutically with trauma survivors to be appropriate for primary care providers. Risking Connection (RC) is a theory-based practical approach to teaching service providers how to work with trauma survivors in a variety of settings, with a focus on growth-promoting and healing relationships. The process of adaptation includes multiple modifications informed by the expert team's experiences, extensive input of PCPs, and the vetting of the curriculum to patients. 2) To evaluate initial acceptability of the curriculum and associated materials. This aim includes the early piloting of the training curriculum with 16 PCPs, and qualitative investigations of its feasibility and acceptability. It also focuses on clarifying the theory-linked areas in which the curriculum is likely to affect provider behavior and patient evaluations and outcomes. 3) To implement a controlled study of the adapted training in PCPs in regional safety-net clinical sites. Four groups of eight PCPs each will be randomized to training or wait-list (delay) conditions; the waitlist groups will be trained after reassessment following delay. Outcomes will be assessed at baseline and after training for trained and control groups, and the delay group will be assessed again after training. The primary outcomes will consist of codes of independent raters, based on taped visits to the PCPs by standardized/simulated patients (SPs) in areas that link theoretically with the RC training. Secondary outcomes include acceptability and feasibility of the intervention to the providers, provider self-assessments of learned skills, ratings of the providers' skills by the SPs after their visit, ratings of a subset of the visits using discourse analysis, and the short-term impact on a subset of PCPs' actual patients. Follow-up of some providers for as long as 18 months will explore the extent of sustained gains in the target behaviors. The long-term goal of the research program is to support PCPs by providing them with multiple strategies to address the physical and mental health complaints of their patients, with follow-on research addressed to sustainability and patient outcomes. The research will complement other interventions that our Center for Trauma and the Community is developing for low-income patients, their providers, and the safety-net systems of care in which they are treated. Narrative The proposed research program aims to adapt and pilot test a curriculum for primary care providers (PCPs) to help them work more productively with trauma survivors. We plan to: (1) adapt an existing manual and training curriculum on working therapeutically with trauma survivors to be appropriate for PCPs, (2) evaluate initial acceptability of the curriculum and material to providers and patients; and (3) conduct a controlled study of the adapted training, all with a focus on providers serving low-income populations. Providing PCPs with multiple strategies to address the physical and mental health complaints of their patients will improve primary care for vulnerable populations.