Trauma informed care

项目摘要 创伤的高发生率及其对生活在世界各地的人的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）强调需要 在艾滋病毒初级护理中系统地处理创伤问题。创伤知情护理（TIC）是一种基于证据的 治疗框架，包括理解，识别和应对创伤的影响。证据 从其他设置表明，TIC改善病人的结果，提高工作人员的士气，是成本- 有效近年来，WHO、HRSA和NIH呼吁建立创伤知情的艾滋病毒系统， 目前正在研究促进在艾滋病毒护理环境中实施TIC所需的战略。在一个前- 实施研究以评估旅游业议会提供服务及影响采纳和实施旅游业议会的因素， 我们发现，Ryan White资助的位于美国艾滋病流行中心（DHHS第四区）的艾滋病诊所（RWC） 大多数提供者/工作人员认为TIC适合RWC，并有一些创伤筛查和转诊 制定了程序，但提供了关于创伤和创伤幸存者工作方法的培训，而且缺乏工作人员的支持 管理与创伤幸存者一起工作的情感代价是限制TIC采用的突出因素。 重要的是，TIC培训和使用执行顾问（以下称为执行促进） 被确定为促进农村妇女委员会执行TIC的潜在战略，包括执行工作人员 支持.在交互式系统框架的指导下，我们在TIC方面具有专业知识的埃默里团队将在以下方面开展工作： 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将制定并试点测试两项实施策略（TI培训和促进（TI员工支持） 实践，例如汇报、自我护理等））提供者和诊所层面的实施和患者的有效性 结果。其目的包括：1）制定创伤知情的艾滋病毒护理培训和实施便利 根据诊所特定需求定制员工支持实践的流程，并通过战区测试提供迭代反馈 与RWC工作人员/提供者/管理员一起使用的方法，以告知内容、剂量、强度和输送， 2）改进目标1中制定的两项实施战略， 采用德尔菲法与DHHS第四区域的RWC利益相关者就内容和交付达成共识 优化各种RWC的使用;以及3）试点和执行混合方法评估， 改进后的执行战略在提供者和诊所一级的执行工作的初步成效 在亚特兰大市区的两个高容量RWC的结果。这项研究的结果将告知未来的混合型 2项有效性-实施试验，检查集中提供议会培训和促进的影响 关于TIC实施和患者艾滋病毒有效性结果，并能够对 高级别呼吁将TIC纳入艾滋病毒初级保健服务。

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.