The landscape of trauma informed care in community-based HIV service organizations in the United States south

Ali, Samira; Stanton, Megan C.; McCormick, Katie A.; Reif, Susan

doi:10.1080/09540121.2022.2079599

Cited by 7 publications

(17 citation statements)

References 24 publications

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“…While 83% of sampled Ryan White clinics in the Southeastern U.S. report providing mental health care on-site, 21 75% of HIV-focused CBOs in the Southern U.S. report insufficient community mental health services, and only 43% report having routine procedures for patient trauma screening. 28 Our findings appear to be consistent with national, 20 regional, 28 and local findings, with the latter findings also indicating the need to improve the quality of mental health services in the catchment area. 31 Moreover, consistent with TIC literature, 21 , 28 , 36 , 39 we observed significant interest in TIC adoption within a workforce who have received little TIC training.…”

Section: Discussionsupporting

confidence: 86%

“… 28 Our findings appear to be consistent with national, 20 regional, 28 and local findings, with the latter findings also indicating the need to improve the quality of mental health services in the catchment area. 31 Moreover, consistent with TIC literature, 21 , 28 , 36 , 39 we observed significant interest in TIC adoption within a workforce who have received little TIC training. These results underscore the need for carrying out the summit recommendation to create a shared communication system to facilitate networking, referrals, and training.…”

Section: Discussionsupporting

confidence: 86%

“…The observed need for systematic efforts to engage community members or end-users as collaborative designers of services and policies is similar to that observed in other Southern CBO spaces. 28 A recent quantitative study in the region showed a high rate of personnel reported working in systems in which patients are invited to share their thoughts, ideas, and experiences; 39 our findings suggest future TIC research should assess whether feedback is systematic or informal, and whether feedback results are utilized to improve services. Overall, the limited systematic efforts to elicit and integrate patient experiences present a barrier to providing patient-centered care.…”

Section: Discussionmentioning

confidence: 78%

“…40 – 41 While one-third of HIV care personnel report high levels of burnout, 21 only one-third of CBOs address personnel vicarious trauma. 28 This represents a critical omission given the trauma burden experienced by PWH, and the documented likelihood for vicarious trauma among HIV care personnel. 42 While wellness campaigns excluding mental health have not improved clinical outcomes for staff, 43 – 44 those including mental health support have been associated with reductions in stress, anxiety, and depression and improvements in well-being.…”

Section: Discussionmentioning

confidence: 99%

“… 5 However, no studies have explored how cultural responsiveness explicitly relates to TIC. Finally, few studies document TIC implementation in Southern community-based HIV Organizations (CBOs) 28 or across city-wide HIV care networks. To address these gaps, we applied a CBPR approach to conduct pre-implementation stage research to develop a data-driven plan for implementing TIC across a city-wide HIV care network in the Southern U.S.…”

Section: Introductionmentioning

confidence: 99%

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Community-based participatory research to guide adoption of culturally responsive trauma-informed HIV care throughout Nashville, Tennessee

Brown,

Perkins,

Acuña

et al. 2023

Preprint

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Background: Psychological trauma is a highly prevalent driver of poor health among people with HIV (PWH) in the Southern United States (U.S.). Trauma-informed care (TIC) has potential to advance national Ending the HIV Epidemic (EHE) goals, but formative research is needed to tailor TIC implementation to complex and interdependent HIV networks. Methods: We applied a community-based participatory research (CBPR) approach to iteratively engage personnel from high volume HIV care institutions in Nashville, Tennessee. Current practices and potential implementation determinants were identified through participatory process mapping (PM) and key informant interviews. The Consolidated Framework for Implementation Research (CFIR) was applied to deductively code interview data. Personnel attending a dissemination summit developed a network-wide implementation plan. Results: Data were collected with personnel from five institutions (e.g., community-based organizations, primary care clinics, public health department), for PM (n=48), interviews (n=35), and the summit (n=17). Results suggest there are limited trauma screenings, assessments, and services across the network. Relevant Characteristics of Individuals included a trauma-sensitive workforce committed to continuous learning and TIC adoption. Relevant Inner Setting Factors were networks and communications, with strong tension for change, high compatibility with TIC, and need for advancing cultural responsiveness. Relevant Outer Setting Factors included patient needs and resources and cosmopolitanism, with need for better leveraged mental health services. Relevant Process domains were champions and leadership, with need to diversify championship among leaders. Relevant Intervention Characteristics included relative advantage and complexity, with need for personnel wellness initiatives and increased engagement with the community as service designers. Four recommendations included development of shared communication systems, personnel wellness campaigns, routine evaluations to inform practices, and culturally responsive care initiatives. Conclusion: Modifiable TIC determinants were identified, and a community-created implementation plan was developed to guide adoption. Future research will focus on city-wide implementation and strengthening pre-implementation research in other settings.

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