Screening for Adverse Childhood Experiences in Primary Care: A Quality Improvement Project

Bryant, Charnita; VanGraafeiland, Brigit

doi:10.1016/j.pedhc.2019.09.001

Cited by 24 publications

(36 citation statements)

References 7 publications

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“…The resulting 19 articles, with two conference abstracts, 21,22 were examined in-depth to determine the participants, mode and length of training, topics, and evaluation methods and results. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] We identified 17 different curricula in the 19 articles included for final analysis. The two articles by Green et al discuss the same curriculum, but evaluate different outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Trainings were taught by a mixture of health professionals including TIC experts, clinical psychologists, social workers, physicians, and nurses. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Continued on next page)…”

Section: Resultsmentioning

confidence: 99%

“…[23][24][25][26][27][28][29][30][31] Two educational curricula were adapted from prior curricula, while the remainder were created from a variety of sources, including Substance Abuse and Mental Health Services Administration principles, 4 the American Academy of Pediatrics Trauma Toolbox for Primary Care, 40 guidelines from the American Psychological Association, 41 evidence-based literature, and expert feedback. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Bursch et al adapted the "Families OverComing Under Stress" resiliency training program (a strength-based, trauma-informed training program for deployed military personnel) for use with medical residents. 25 Green et al adapted the Risking Connection curriculum (a strength-based training program for helping people who have been hurt in interpersonal relationships, previously used in mental health, congregate care, faith-based, and medical facilities) for use with primary care residents, advanced practice providers, and physicians.…”

Section: Impact Of Training On Overall Practicementioning

confidence: 99%

“…23,24 Utilizing the TIC pyramid by Raja et al 2015 as a framework to extract TIC training topics from articles, 19 the majority of the curricula covered topics related to universal trauma precautions; 71% (12/17) covered topics related to patient-centered communication and care [22][23][24][25][26]28,[30][31][32][33][34][35]38,39 and 94% (16/17) covered topics related to understanding the health effects of trauma. [21][22][23][24][25][27][28][29][30][31][32][33][34][35][36][37][38] The only curriculum that did not cover topics related to understanding the health effects of trauma was Shamaskin-Garroway et al, which focused on patient-centered communication skills. 26 Shamaskin-Garroway et al expanded on their initial pilot to include background teaching about trauma in their extended trauma-informed primary care curriculum.…”

Section: Impact Of Training On Overall Practicementioning

confidence: 99%

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

Gundacker

Barry

Laurent

et al. 2021

Fam Med

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Impact Of Training On Overall Practicementioning

confidence: 99%

Section: Impact Of Training On Overall Practicementioning

confidence: 99%

See 2 more Smart Citations

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

Gundacker

Barry

Laurent

et al. 2021

Fam Med

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“…Quality improvement is viewed by the NHS as a good model to improve care and outcomes for service users, by training staff in quality improvement engages clinicians in change (Bryant and VanGraafeiland, 2019) but there needs to be staff engagement within quality improvement (McGilloway and Donelly, 1999). There are several tools that can be applied to quality improvement (WHO, 2005; O’Sullivan et al , 2019) but for this project, the Plan, Do, Study, Act (PDSA) cycle was chosen because it has four clear stages that enable clinical projects to be evaluated: Plan. Do. Study. Act. …”

Section: Methodsmentioning

confidence: 99%

When policy fails try something different integrated practice improve outcomes for dual diagnosis co-occurring service users accessing mental health services

Dugmore

Bauweraerts

2021

DAT

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Purpose This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings. Design/methodology/approach In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model. These changes were: • Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients. • To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services. • Introduction of substance misuse workers as team members on acute mental health and rehab wards. • Group Substance Misuse programmes. Findings Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances. Originality/value Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.

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Parental Preferences for Mental Health Screening of Youths From a Multinational Survey

et al. 2023

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ImportanceScreening youths for mental disorders may assist in prevention, promote early identification, and be associated with reduced related lifetime impairment and distress.ObjectiveTo assess parents’ and caregivers’ comfort with and preferences for pediatric mental health screening and factors associated with these preferences.Design, Setting, and ParticipantsThis survey study used an online survey available from July 11 to 14, 2021, through Prolific Academic. Analyses were conducted from November 2021 to November 2022. The survey was administered to English-speaking parents and caregivers in the US, UK, Canada, and 16 other countries who were aged 21 years or older and had at least 1 child aged 5 to 21 years living at home.Main Outcomes and MeasuresThe main outcomes were parental preferences regarding content, implementation, and review of the findings of pediatric mental health screening. Parental comfort with screening topics was reported on a 6-point Likert scale with 6 indicating highest comfort. Mixed-effects logistic regression models were used to evaluate factors associated with parental comfort levels.ResultsOf 1200 survey responses requested, data were collected from 1136 participants (94.7%). The final sample meeting the inclusion criteria comprised 972 parents and caregivers aged 21 to 65 years (mean [SD] age, 39.4 [6.9] years; 606 [62.3%] female). A total of 631 participants (64.9%) supported annual mental health screening for their child, and 872 (89.7%) preferred reviewing the screening results with professional staff (eg, physicians). Participants reported significantly decreased comfort with child self-report compared with parent-report screening assessments (b = −0.278; SE = 0.009; P &lt; .001), although they were generally comfortable with both options. Despite slight variations based on country of residence, screening topic, and child’s age, participants were generally comfortable discussing all 21 screening topics on the survey. The greatest comfort was with sleep problems (mean [SE] score, 5.30 [0.03]); the least comfort was with firearms (mean [SE] score, 4.71 [0.05]), gender identity (mean [SE] score, 4.68 [0.05]), suicidality (mean [SE] score, 4.62 [0.05]), and substance use or abuse (mean [SE] score, 4.78 [0.05]).Conclusions and RelevanceIn this survey study of parents and caregivers, parent-reported and child self-reported mental health screening in primary care settings was supported by the majority of the sample, although comfort levels differed according to various factors (eg, screening topic). Participants preferred to discuss screening results with professional health care staff. In addition to parental need for expert guidance, the study findings highlight the growing awareness of child mental health needs and the importance of addressing mental health concerns early via regular mental health screenings.

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Screening for Adverse Childhood Experiences in Primary Care: A Quality Improvement Project

Cited by 24 publications

References 7 publications

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

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

When policy fails try something different integrated practice improve outcomes for dual diagnosis co-occurring service users accessing mental health services

Parental Preferences for Mental Health Screening of Youths From a Multinational Survey

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