Maternal-Child Health Outcomes from Pre- to Post-Implementation of a Trauma-Informed Care Initiative in the Prenatal Care Setting: A Retrospective Study

Racine, Nicole; Ereyi-Osas, Whitney; Killam, Teresa; McDonald, Sheila; Madigan, Sheri

doi:10.3390/children8111061

Cited by 14 publications

(14 citation statements)

References 53 publications

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“…These include addressing healthcare workforce shortages and health infrastructure challenges to alleviate limited clinic interaction time, inadequate physical spaces to reduce privacy issues and support consult-room and triage-level IPV screening respectively. Training healthcare workers using trauma-informed care-based approaches and implementation in ANC settings [ 62 , 67 ] may increase clinicians’ ability to realize the burden of trauma, recognize how all individuals involved with systems, organizations are affected by trauma and respond by putting this knowledge into practice. Providers posited the need to address safety concerns raised by some IPV survivors about retaliatory partner abuse.…”

Section: Discussionmentioning

confidence: 99%

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Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

Anguzu

Cassidy

Beyer

et al. 2022

BMC Health Serv Res

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Background Uganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda. Methods We conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis. Results Participants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse. Conclusions Our findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.

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Section: Discussionmentioning

confidence: 99%

“…Training healthcare workers using trauma-informed care-based approaches and implementation in ANC settings [ 62 , 67 ] may increase clinicians’ ability to realize the burden of trauma, recognize how all individuals involved with systems, organizations are affected by trauma and respond by putting this knowledge into practice.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

Anguzu

Cassidy

Beyer

et al. 2022

BMC Health Serv Res

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“…It is the position of the guest editors of this Special Issue that screening is a necessary and helpful component to a more comprehensive trauma-informed healthcare system. Four papers (Racine et al [ 5 ], Herrero-Roldan et al [ 6 ], Olecka [ 7 ], and Matthew et al [ 8 ]) in this issue were devoted to identifying the benefits of preventing and implementing a trauma-informed approach to care.…”

mentioning

confidence: 99%

“…Limited research exists on TIC approaches implemented within the prenatal care setting. Studies such as Racine et al [ 5 ] have identified some associations between TIC approaches and positive health aspects in infant outcomes. Specifically, as reported in Racine et al [ 5 ], comparing groups receiving standard care versus a TIC approach at two points in time, infants of mothers receiving TIC had significantly fewer adverse birth outcomes.…”

mentioning

confidence: 99%

“…Studies such as Racine et al [ 5 ] have identified some associations between TIC approaches and positive health aspects in infant outcomes. Specifically, as reported in Racine et al [ 5 ], comparing groups receiving standard care versus a TIC approach at two points in time, infants of mothers receiving TIC had significantly fewer adverse birth outcomes. Whether the TIC approach was a direct contributor to these improved outcomes is unknown, but this finding warrants additional investigation.…”

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confidence: 99%

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Introduction to the Special Issue on Adverse Childhood Experiences (ACEs): Prevention, Intervention, and Access to Care

2022

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Adverse childhood experiences: a meta‐analysis of prevalence and moderators among half a million adults in 206 studies

Madigan,

Deneault,

Racine

et al. 2023

World Psychiatry

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Exposure to adverse childhood experiences (ACEs), including maltreatment and family dysfunction, is a major contributor to the global burden of disease and disability. With a large body of international literature on ACEs having emerged over the past 25 years, it is timely to now synthetize the available evidence to estimate the global prevalence of ACEs and, through a series of moderator analyses, determine which populations are at higher risk. We searched studies published between January 1, 1998 and August 5, 2021 in Medline, PsycINFO and Embase. Study inclusion criteria were using the 8‐ or 10‐item ACE Questionnaire (±2 items), reporting the prevalence of ACEs in population samples of adults, and being published in English. The review protocol was registered with PROSPERO (CRD42022348429). In total, 206 studies (208 sample estimates) from 22 countries, with 546,458 adult participants, were included. The pooled prevalence of the five levels of ACEs was: 39.9% (95% CI: 29.8‐49.2) for no ACE; 22.4% (95% CI: 14.1‐30.6) for one ACE; 13.0% (95% CI: 6.5‐19.8) for two ACEs; 8.7% (95% CI: 3.4‐14.5) for three ACEs, and 16.1% (95% CI: 8.9‐23.5) for four or more ACEs. In subsequent moderation analyses, there was strong evidence that the prevalence of 4+ ACEs was higher in populations with a history of a mental health condition (47.5%; 95% CI: 34.4‐60.7) and with substance abuse or addiction (55.2%; 95% CI: 45.5‐64.8), as well as in individuals from low‐income households (40.5%; 95% CI: 32.9‐48.4) and unhoused individuals (59.7%; 95% CI: 56.8‐62.4). There was also good evidence that the prevalence of 4+ ACEs was larger in minoritized racial/ethnic groups, particularly when comparing study estimates in populations identifying as Indigenous/Native American (40.8%; 95% CI: 23.1‐59.8) to those identifying as White (12.1%; 95% CI: 10.2‐14.2) and Asian (5.6%; 95% CI: 2.4‐10.2). Thus, ACEs are common in the general population, but there are disparities in their prevalence. They are among the principal antecedent threats to individual well‐being and, as such, constitute a pressing social issue globally. Both prevention strategies and downstream interventions are needed to reduce the prevalence and mitigate the severity of the effects of ACEs and thereby reduce their deleterious health consequences on future generations.

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Maternal-Child Health Outcomes from Pre- to Post-Implementation of a Trauma-Informed Care Initiative in the Prenatal Care Setting: A Retrospective Study

Cited by 14 publications

References 53 publications

Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

Introduction to the Special Issue on Adverse Childhood Experiences (ACEs): Prevention, Intervention, and Access to Care

Adverse childhood experiences: a meta‐analysis of prevalence and moderators among half a million adults in 206 studies

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