Trauma-Informed Obstetric Care: Development and Implementation of a Stakeholder-Informed Toolkit for Obstetric Providers and Patients

项目总结/摘要 许多孕妇都经历过创伤，这会使围产期护理压力大， 与怀孕有关的健康风险。然而，产科提供者可以修改程序， 减轻患者的痛苦，增强患者的控制感和安全感。虽然产科医生经常照顾 在创伤幸存者中，大多数人没有接受过创伤知情护理（TIC）的培训。此外，没有关于 TIC工具和干预措施在产科中的可行性、适当性或可接受性。目标 拟议的K23项目的一个主要目标是开发第一个由产妇知情的产科TIC工具包， 治疗方案，临床医生培训，创伤和暴力筛查工具，以及其他帮助 产科提供者除了识别和提供支持外，还将TIC实践应用于所有临床互动 为创伤幸存者准备的产科TIC干预工具包（OB-TIC）将与主要的 利益相关者（孕妇和产后患者、护士、医生和管理人员），以确保 可行的、可接受的、适当的、具有成本效益的和临床有用的。目前的做法和偏好将是 与利益相关者进行定性访谈，这将为OB-TIC的发展提供信息， 与社区利益相关者工作组合作。将进行OB-TIC的试点实施试验， 在两个产科门诊进行，以收集真实世界的数据，为最终干预提供信息 该工具包将在未来的研究（R 01）中进行更大规模的测试。K23奖将促进 候选人向侧重于改善妇女福祉的独立研究职业过渡 通过创伤知情的围产期保健和实施科学，这是直接符合 NICHD妊娠和围产期优先事项“改善妇女的健康之前，期间和之后 怀孕”迄今为止，候选人的培训重点是发展围产期的临床专业知识， 行为医学，产科，围产期应激和行为干预的研究经验， 压力和歧视。K23奖将为1）实施科学的培训提供受保护的时间 方法侧重于制定利益攸关方知情的干预措施， 实证干预; 2）定性研究方法， 实施科学和以残疾人为基础干预发展; 3） 产科，这将为OB-TIC提供知识基础。每个主要培训领域的专家将 除了专门的讲习班和教学之外，还提供个人辅导。在K23计划中， 奖，候选人将是一个研究科学家在米里亚姆医院和助理教授在布朗 大学这种环境充满了创新和协作，将加强候选人的培训 并促进他们的研究目标。作为K23奖项的一部分，所获得的指导和技能将为 候选人寻求资金的R 01集中在随机对照试验OB-TIC。

PROJECT SUMMARY/ABSTRACT Many pregnant women have experienced trauma, which can make perinatal care stressful and increase the risk of pregnancy-related health conditions. However, obstetric providers can modify procedures to reduce distress and enhance patients’ sense of control and safety. Although obstetric providers frequently care for trauma survivors, most are not trained in trauma-informed care (TIC). Additionally, there are no data on feasibility, appropriateness, or acceptability of TIC tools and interventions in the context of obstetrics. The goal of the proposed K23 project is to develop the first, stakeholder-informed obstetric TIC toolkit composed of treatment protocols, clinician training, trauma and violence screening tools, and other resources to help obstetric providers apply TIC practices to all clinical interactions in addition to identifying and providing support for trauma survivors. The obstetric TIC intervention toolkit (OB-TIC) will be developed in collaboration with key stakeholders (pregnant and postpartum patients, nurses, physicians, and administrators) to ensure that it is feasible, acceptable, appropriate, cost-effective, and clinically useful. Current practices and preferences will be characterized in qualitative interviews with stakeholders which will inform the development of OB-TIC in collaboration with a community working group of stakeholders. A pilot implementation trial of OB-TIC will be conducted in two outpatient obstetrics clinics to gather real-world data that will inform the final intervention toolkit, which will be tested on a larger scale in future (R01) studies. The K23 award will facilitate the candidate’s transition towards an independent research career focused on improving the well-being of women through trauma-informed perinatal healthcare and implementation science, which is directly in line with the NICHD pregnancy and perinatology priority of “improving the health of women before, during, and after pregnancy.” To date, the candidate’s training has focused on developing clinical expertise in perinatal behavioral medicine, and research experience in obstetrics, perinatal stress, and behavioral interventions for stress and discrimination. The K23 award will provide protected time for training in 1) implementation science methodology focused on the development of stakeholder informed interventions and scale-up and spread of evidence-based interventions; 2) qualitative research methodology, a foundational component of implementation science and stakeholder-based intervention development; 3) and trauma-informed care in obstetrics, which will provide a knowledge base for OB-TIC. Experts in each of the key training domains will provide individual mentorship in addition to specialized workshops and didactics. During the proposed K23 award, the candidate will be a Research Scientist at The Miriam Hospital and an Assistant Professor at Brown University. This environment is rich with innovation and collaboration and will enhance the candidate’s training and facilitate their research goals. The mentorship and skills gained as part of this K23 award, will prepare the candidate to pursue funding for an R01 focused on a randomized controlled trial of OB-TIC.