Trauma-Informed Care for Violently Injured Patients in the Emergency Department

Fischer, Kyle; Bakes, Katherine; Corbin, Theodore J.; Fein, Joel A.; Harris, Erica; James, Thea; Melzer-Lange, Marlene

doi:10.1016/j.annemergmed.2018.10.018

Cited by 68 publications

(56 citation statements)

References 52 publications

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“…Given the prevalence of ACE exposure among males and females in this urban ED sample, the findings underscore the importance of ED staff providing traumainformed care. This approach takes into consideration the lived experience of past and present psychological and physical trauma in patients' lives, and how the patient may perceive and react to medical care (25,44). Briefly, the trauma-informed care approach encompasses trauma awareness and acknowledgment; safety and trustworthiness; choice, control, and collaboration; strengthsbased and skills-building care; and cultural, historical, and gender issues (44).…”

Section: Discussionmentioning

confidence: 99%

“…Second, most patients seeking non-emergency care at urban EDs are Medicaid recipients, uninsured or underinsured and not likely to have a primary care provider or may not access health care otherwise (23,24). Consistent with the importance of providing trauma-informed care (25,26), having more information on ACE and substance use outcomes could help inform the design of effective screening, brief interventions, and referral to treatment (SBIRT) approaches to alcohol, tobacco, and other drug use among ED patients (27).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

Cunradi

Caetano

Alter

et al. 2020

The American Journal of Drug and Alcohol Abuse

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Background: Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment. Objectives: To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males. Methods: Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome. Results: One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females' cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males' separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes. Conclusion: ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

Cunradi

Caetano

Alter

et al. 2020

The American Journal of Drug and Alcohol Abuse

View full text Add to dashboard Cite

show abstract

“…It is well known that health care professionals are not immune to the mental health effects of traumatic events. 7 , 8 , 9 – 10 But the psychological impact associated with delivering health care is not relegated to discrete traumatic events such as terrorism or similar.…”

Section: Discussionmentioning

confidence: 99%

“…And unlike discrete but traumatic events, such as 9/11 7 , 9 pandemics of this magnitude are uncommon in the experience of United States, and even internationally, where outbreaks of infectious diseases, wars, civil strife, and natural disasters are more common. 7 , 8 , 9 , 10 , 11 , 12 , 13. , 14 , 15.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 mental health considerations for health care workers and Patients: A brief overview

McFee¹

2020

Disease-a-Month

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“…This does not account for trauma associated with the resettlement process. ED-specific approaches of trauma-informed care have been suggested for violently injured patients who have been injured due to violence and are treated in the ED; and some components may be applicable to refugee populations 15. While more research is needed to establish trauma-informed models of care for refugees in the ED, providers should acknowledge a patient’s history of trauma, ongoing signs and symptoms, and avoid practices that may result in retraumatization.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Accessing Acute Care for Newly Arrived Refugees

Zeidan

Khatri

Munyikwa

et al. 2019

WestJEM

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Over the past decade, the number of refugees arriving in the United States (U.S.) has increased dramatically. Refugees arrive with unmet health needs and may face barriers when seeking care. However, little is known about how refugees perceive and access care when acutely ill. The goal of this study was to understand barriers to access of acute care by newly arrived refugees, and identify potential improvements from refugees and resettlement agencies. Methods: This was an in-depth, qualitative interview study of refugees and employees from refugee resettlement and post-resettlement agencies in a city in the Northeast U.S. Interviews were audiotaped, transcribed, and coded independently by two investigators. Interviews were conducted until thematic saturation was reached. We analyzed transcripts using a modified grounded theory approach. Results: Interviews were completed with 16 refugees and 12 employees from refugee resettlement/post-resettlement agencies. Participants reported several barriers to accessing acute care including challenges understanding the U.S. healthcare system, difficulty scheduling timely outpatient acute care visits, significant language barriers in all acute care settings, and confusion over the intricacies of health insurance. The novelty and complexity of the U.S. healthcare system drives refugees to resettlement agencies for assistance. Resettlement agency employees express concern with directing refugees to appropriate levels of care and report challenges obtaining timely access to sick visits. While receiving emergency department (ED) care, refugees experience communication barriers due to limitations in consistent interpretation services. Conclusion: Refugees face multiple barriers when accessing acute care. Interventions in the ED, outpatient settings, and in resettlement agencies, have the potential to reduce barriers to care. Examples could include interpretation services that allow for clinic phone scheduling and easier access to interpreter services within the ED. Additionally, extending the Refugee Medical Assistance program may limit gaps in insurance coverage and avoid insurance-related barriers to seeking care. [

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Trauma-Informed Care for Violently Injured Patients in the Emergency Department

Cited by 68 publications

References 52 publications

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

COVID-19 mental health considerations for health care workers and Patients: A brief overview

Barriers to Accessing Acute Care for Newly Arrived Refugees

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