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.

项目摘要创伤对生活人员的身心健康的高流行和相关的负面影响艾滋病毒及其参与艾滋病毒护理（即保留，病毒抑制）强调了需要在初级艾滋病毒护理中系统地解决创伤。创伤信息护理（TIC）是基于证据的涉及理解，识别和应对创伤影响的治疗框架。证据从其他环境中表明，抽动可以改善患者的预后，提高员工的士气，并且是成本 - 有效的。近年来，HRSA和NIH呼吁创伤性艾滋病毒系统，但有限研究了促进在艾滋病毒护理环境中实施TIC所需的策略。在预先实施研究，以评估影响采用和实施TIC的因素美国艾滋病毒流行病（DHHS地区IV）的Ryan White资助的HIV诊所（RWC），我们发现大多数提供商/员工认为TIC适合RWC，并进行了一些创伤和推荐设备方案，但培训创伤和与创伤幸存者合作和缺乏员工支持的方法对于管理与创伤幸存者合作的情感损失是限制采用抽动的重要因素。重要的是，实施顾问的抽动培训和使用（此处称为实施促进）是被确定为促进RWC中的TIC实施的潜在策略，包括员工的实施支持。在交互式系统框架的指导下，我们具有TIC专业知识的Emory团队将在与Emory公共卫生培训和技术援助（Emory Centers）的合作 RWC制定和试点测试两种实施策略（TIC培训和促进）（TI-Staff支持实践，例如汇报，自我保健等））关于提供者和诊所级实施以及患者的效力结果。目的包括：1）开发受创伤的艾滋病毒护理培训和实施促进通过剧院测试的迭代反馈，以量身定制员工的支持实践，与RWC员工/提供者/管理员的方法，以告知内容，剂量，强度和交付以优化 RWC的有效性； 2）使用修改后的AIM 1中制定的两个实施策略 Delphi方法是建立关于与RWC利益相关者在DHHS地区IV的内容和交付的共识优化各种RWC的使用； 3）试行并进行混合方法评估精制实施策略对提供商和诊所级实施的初步有效性亚特兰大大都会的两个大批量RWC的结果。这项研究的结果将为未来的混合类型提供信息 2效力实施试验，检查了集中交付TIC培训和促进的影响关于TIC的实施和患者HIV的有效性结果，并对循证驱动反应高级呼吁将TIC集成到HIV初级保健服务中。