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This paper describes a qualitative study of individual client interviews (n=26) from four social service agencies to understand how clients experience trauma-informed care services and implementation challenges. We used the Fallot & Harris (2009) framework to explore client experiences of the five core concepts of trauma-informed care (safety, trustworthiness, choice, collaboration, and empowerment) using semi-structured interview questions with each client. The four agencies consisted of: refugees (n=4), substance abuse (n=8), older adults (n=12), and maternal/child health (n=2), and the agencies varied in size, service goals, and clientele. The results of the study suggest that clients' experience of these concepts was shaped by the actions of other clients, and these experiences were either mitigated or hindered by actions of the agency employees. Agency policies either supported or enhanced their experiences as well. The results also suggest that it was challenging for agencies to provide for all of the trauma-informed care (TIC) concepts at the same time. We discuss the implications of these findings for social service delivery in a range of agency types. Future research should examine the effects of traumainformed policies on client experiences of each TIC domain.

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This study highlighted how particular intersections of personal characteristics were related to Motivation to Learn (MtL) among adults. MtL is a prerequisite for adult education and training participation. However, little is known about MtL across subpopulations due to several methodological limitations. This study developed a national profile of MtL by key subpopulations that are defined by combinations of age, gender, education level, and literacy proficiency in the United States. Data were obtained from 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted use file (N = 8400). The alignment optimization (AO) method was employed to estimate subpopulation means of a PIAAC-based latent MtL construct. Subpopulations with younger age, greater educational attainment, and higher literacy proficiency showed significantly greater MtL.

Determine mid-term postoperative outcomes among coronavirus disease 2019 (COVID-19)-positive (+) patients compared with those who never tested positive before surgery. Background: COVID-19 is thought to be associated with prohibitively high rates of postoperative complications. However, prior studies have only evaluated 30-day outcomes, and most did not adjust for demographic, clinical, or procedural characteristics. Methods: We analyzed data from surgeries performed at all Veterans Affairs hospitals between March 2020 and 2021. Kaplan-Meier curves compared trends in mortality and Cox proportional hazards models estimated rates of mortality and pulmonary, thrombotic, and septic postoperative complications between patients with a positive preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test [COVID (+)] and propensity score-matched COVID-negative (−) patients. Results: Of 153,741 surgical patients, 4778 COVID (+) were matched to 14,101 COVID (−). COVID (+) status was associated with higher postoperative mortality (P < 0.0001) with a 6-month survival of 94.2% (95% confidence interval: 93.2-95.2) versus 96.0% (95% confidence interval: 95.7.0-96.4) in COVID (−). The highest mortality was in the first 30 postoperative days. Hazards for mortality and postoperative complications in COVID (+) decreased with increasing time between testing COVID (+) and date of surgery. COVID (+) patients undergoing elective surgery had similar rates of mortality, thrombotic and septic complications, but higher rates of pulmonary complications than COVID (−) patients. Conclusions: This is the first report of mid-term outcomes among COVID-19 patients undergoing surgery. COVID-19 is associated with decreased overall and complication-free survival primarily in the early postoperative period, delaying surgery by 5 weeks or more reduces risk of complications. Case urgency has a multiplicative effect on short-term and long-term risk of postoperative mortality and complications.