Implementation of trauma-informed care and trauma-responsive services in clinical settings: a latent class regression analysis

Frontiers in Psychiatry

Psychiatry

Kaitlin N. Piper¹  Jessica M. Sales¹  Katherine M. Anderson¹  Ameeta S. Kalokhe² 

[1] Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States;Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States;Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States;

关键词: trauma-informed care;    Ryan White HIV/AIDS clinics;    HIV/AIDS;    latent class analysis;    implementation science;   

DOI  :  10.3389/fpsyt.2023.1214054

 received in 2023-05-03, accepted in 2023-09-21,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionEngagement and retention in health care is vital to sustained health among people living with HIV (PLWH), yet clinical environments can deter health-seeking behavior, particularly for survivors of interpersonal violence. PLWH face disproportionate rates of interpersonal violence; clinical interactions can provoke a re-experiencing of the sequalae of trauma from violence, called re-traumatization. Trauma-informed care (TIC) is a strengths-based approach to case that minimizes potential triggers of re-traumatization and promotes patient empowerment, increasing acceptability of care. Yet, Ryan White HIV/AIDS clinics, at which over 50% of PLWH received care, have struggled to IMPLEMENT TIC. In this analysis, we sought to (1) identify unique sub-groups of HIV clinics based on clinical attributes (i.e., resources, leadership, culture, climate, access to knowledge about trauma-informed care) and (2) assess relationships between sub-group membership and degree of implementation of TIC and trauma-responsive services offered.MethodsA total of 317 participants from 47 Ryan White Federally-funded HIV/AIDS clinics completed a quantitative survey between December 2019 and April 2020. Questions included assessment of inner setting constructs from the Consolidated Framework for Implementation Research (CFIR), perceived level of TIC implementation, and trauma-responsive services offered by each respondent’s clinic. We employed latent class analysis to identify four sub-groups of clinics with unique inner setting profiles: Weak Inner Setting (n = 124, 39.1%), Siloed and Resource Scarce (n = 80, 25.2%), Low Communication (n = 49, 15.5%), and Robust Inner Robust (n = 64, 20.2%). We used multilevel regressions to predict degree of TIC implementation and provision of trauma-responsive services.ResultsResults demonstrate that clinics can be distinctly classified by inner setting characteristics. Further, inner setting robustness is associated with a higher degree of TIC implementation, wherein classes with resources (Robust Inner Setting, Low Communication) are associated with significantly higher odds reporting early stages of implementation or active implementation compared to Weak class membership. Resourced class membership is also associated with availability of twice as many trauma-responsive services compared to Weak class membership.DiscussionAssessment of CFIR inner setting constructs may reveal modifiable implementation setting attributes key to implementing TIC and trauma-responsive services in clinical settings. Introduction.

【 授权许可】

Unknown   
Copyright © 2023 Anderson, Piper, Kalokhe and Sales.