From Treatment to Healing: Inquiry and Response to Recent and Past Trauma in Adult Health Care

Machtinger, Edward L.; Davis, Katy; Kimberg, Leigh; Khanna, Naina; Cuca, Yvette; Dawson–Rose, Carol; Shumway, Martha; Campbell, Jacquelyn; Lewis‐O’Connor, Annie; Blake, Mary; Blanch, Andrea K.; McCaw, Brigid

doi:10.1016/j.whi.2018.11.003

Cited by 53 publications

(32 citation statements)

References 8 publications

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“…Extensive electronic safety features include a four-digit security personal identification number (PIN), a 'dummy' PIN that redirects to alternate content, and access via web or downloadable app to maximise options. In addition to decision science, myPlan is rooted theoretically in social cognitive theory, 16 empowerment 17 and trauma-informed care, 18 which emphasise safety and empowerment through agency in decision-making and healing. myPlan works to promote long-term support and safety by providing support for (1) defining healthy relationships; (2) safety behaviour, by helping women identify the severity of the violence and potential danger to self and family and providing a set of options; (3) decision-making, via clarifying safety priorities to reduce decisional conflict and enhancing safety preparedness; and (4) healing, via validating messages to counter the culture of victim blaming and stigma, bolster resilience and enable safety behaviour and connection to both formal services (eg, hotline, healthcare providers, advocates) and informal (family/friends, coworkers) networks.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya

et al. 2020

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IntroductionIntimate partner violence (IPV) threatens women’s health and safety globally, yet services remain underdeveloped and inaccessible. Technology-based resources exist, however, few have been adapted and tested in low-resource settings. We evaluate the efficacy of a community-partnered technology solution: culturally and linguistically adapted version of the myPlan app, a tailored safety decision-making and planning intervention, administrated by trained lay professionals.MethodsThis randomised, controlled, participant-blinded superiority trial compares safety-related outcomes at baseline, immediate post intervention and 3-month follow-up among women at risk of and experiencing IPV in Nairobi, Kenya. Women were randomised (1:1 ratio) to: (1) myPlan Kenya (intervention); or (2) standard IPV referrals (control). Primary outcomes were safety preparedness, safety behaviour and IPV; secondary outcomes include resilience, mental health, service utilisation and self-blame.ResultsBetween April 2018 and October 2018, 352 participants (n=177 intervention, n=175 control) were enrolled and randomly assigned; 312 (88.6%, n=157 intervention, n=155 control) were retained at 3 months. Intervention participants demonstrated immediate postintervention improvement in safety preparedness relative to control participants (p=0.001). At 3 months, intervention participants reported increased helpfulness of safety strategies used relative to control participants (p=0.004); IPV reduced in both groups. Among women reporting the highest level of IPV severity, intervention participants had significant increase in resilience (p<0.01) compared with controls, and significantly decreased risk for lethal violence (p<0.01).ConclusionsFacilitated delivery of a technology-based safety intervention appropriately adapted to the context demonstrates promise in improving women’s IPV-related health and safety in a low-resource, urban setting.Trial registration numberPan African Clinical Trial Registry (PACTR201804003321122).

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Section: Bmj Global Healthmentioning

confidence: 99%

Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya

et al. 2020

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“…However, PC residents and OT and PT students much less frequently asked about ACEs and obtained permission to discuss ACEs. Consistent with recommended TI approaches to patient-care, 9 PATH ! training for inquiry and response includes options such as assuming an ACEs history instead of directly asking about ACEs.…”

Section: Discussionmentioning

confidence: 94%

An evaluation of a simulation and video-based training program to address adverse childhood experiences

Miller‐Cribbs

Bragg

Wen³

et al. 2020

Int J Psychiatry Med

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Adverse Childhood Experiences (ACEs) are multiple sources of maltreatment and household dysfunction with tremendous impact on health. A trauma-informed (TI) approach is preferred when working with patients with ACEs. The Professional ACEs-Informed Training for Health© (PATH©) educational program and simulation experience using standardized patients (SP) was developed to help healthcare professionals address ACEs with adults. PATH© is a 3–4 hour curriculum comprised of lecture and discussion, video-based demonstration, simulation experience, and debriefing. It was first developed for primary care (PC) residents in family medicine and internal medicine, and subsequently modified for occupational therapy (OT) and physical therapy (PT) students. This study evaluates a preliminary dataset focusing on PATH© skills of PC residents and OT and PT students during simulation. Recordings of 53 learner-SP encounters from 15 OT and PT students and 38 PC residents were coded using standardized behavioral codes. A subset of ten recordings of PC residents who participated in simulations in the first and fourth year of the training program allowed for evaluation of training outcomes over time. Results showed that medical residents and OT and PT students demonstrated skills during SP encounters congruent with TI training on addressing ACEs with adults, particularly in explaining ACEs, demonstrating empathy, collaborative treatment planning, and stigma reduction. PC residents showed both positive and negative changes in PATH©-specific skills from year 1 to 4 of the training program. This study supports the PATH© model and simulation-based training in preparing clinicians to address ACEs with adults and provides insight into further curriculum improvement.

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“…The omission on the part of the health professional of asking about trauma on intake or during a comprehensive assessment is partly explained by many as having to do with the limits of time and privacy that is common in many healthcare settings and practices. There is also a level of secrecy that is maintained by patients and their healthcare providers (Machtinger et al, 2019). While asking about traumatic experiences is often deferred to mental health specialists, there are at least three problems with this notion.…”

Section: Trauma Assessmentmentioning

confidence: 99%

Understanding Shame as an Obstacle: Toward a Global Perspective

Cummings

Baumann

2021

Nurs Sci Q

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In this paper, the authors suggest that shame is a barrier to many patients’ willingness to disclose their history of trauma to nurses and other members of the healthcare team and that the clinicians participate in this withholding of information because of their experience of vicarious shame. The authors propose that shame and vicarious shame reduce the accuracy of assessment, limit the nurse–patient relationship, and reduce the ability of the healthcare teams to accurately diagnose and treat patients. Shame as a barrier to trauma assessment is also considered in light of the Roy adaptation model and from a global perspective. Implications for education, research, and nursing practice are discussed.

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From Treatment to Healing: Inquiry and Response to Recent and Past Trauma in Adult Health Care

Cited by 53 publications

References 8 publications

Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya

Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya

An evaluation of a simulation and video-based training program to address adverse childhood experiences

Understanding Shame as an Obstacle: Toward a Global Perspective

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