A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

Abstract

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

Primary Care Providers' Knowledge, Perceptions, and Practice of Trauma-Informed Care in a Public Health Care Setting

“…These cross-sectional results seemingly point to TIC training as a brief, organization-level strategy that not only can enhance the trauma-informed nature of health care provision but also is well-received by providers. Yet, the TIC training literature is in its nascence, and few longitudinal evaluations of TIC trainings for hospital-based health care providers exist 22,37. Ultimately, current findings call for follow-up studies that are methodologically robust and can measure change in trauma-informed practices in a systematic way.…”

“…Yet, the TIC training literature is in its nascence, and few longitudinal evaluations of TIC trainings for hospital-based health care providers exist. 22,37 Ultimately, current findings call for follow-up studies that are methodologically robust and can measure change in trauma-informed practices in a systematic way.…”

“…20 A growing body of work suggests that health care providers' exposure to TIC training programs can effectively enhance their comfort in caring for trauma-exposed patients, knowledge of trauma and PTSD, attitudes toward TIC, use of trauma-informed skills, and overall quality of care. [21][22][23][24] Evidence also suggests TIC training can improve providers' well-being (ie, reduce burnout, secondary trauma) 25,26 and the patient-provider relationship. 27 The current study sought to document the state of TIC provision within primary care at Grady Memorial Hospital, a large safety net health care system located in Atlanta, Georgia that serves predominantly low-income, Black patients with especially high rates of PTSD (>50% lifetime).…”

“…Altogether, the literature suggests that without adequate training, providers may be unaware of best practices or uncertain of how to respond to a trauma disclosure or positive PTSD screen in a trauma-informed manner19 and thus may inadvertently harm trauma-exposed patients 20. A growing body of work suggests that health care providers' exposure to TIC training programs can effectively enhance their comfort in caring for trauma-exposed patients, knowledge of trauma and PTSD, attitudes toward TIC, use of trauma-informed skills, and overall quality of care 21–24. Evidence also suggests TIC training can improve providers' well-being (ie, reduce burnout, secondary trauma)25,26 and the patient-provider relationship 27…”

A practical guide to the trauma-informed physical examination

“…Trauma-informed principles in medical settings have been shown to improve patient satisfaction and the therapeutic care relationship. [23][24][25] Multiple studies have found that completion of TIC physical examination training was associated with positive outcomes for clinicians, such as increased awareness, confidence in abilities, and positive experiences. 13,[26][27][28] The future for TIC is to expand this perspective to an organization as a whole to be transformed into a trauma-responsive workplace.…”