Lyons John S, Fernando April D
Center for Innovation in Population Health, College of Public Health, University of Kentucky, Lexington, KY, United States.
Front Psychol. 2023 Jul 11;14:1129197. doi: 10.3389/fpsyg.2023.1129197. eCollection 2023.
Understanding and addressing the impact of adverse life events is an important priority in the design of helping systems. However, creating trauma-informed systems requires efforts to embed effective trauma-informed work in routine practice. This article discusses a model for developing trauma-informed systems using the Transformational Collaborative Outcomes Management (TCOM) framework, a strategy for engineering person-centered care. Person-centered care is naturally congruent with trauma-informed care. We describe the initial stages of implementation of a trauma-informed standardized assessment process to support the sustained evolution of trauma-informed care. Distinguishing between traumatic experiences and traumatic stress is fundamental to an effective trauma-informed system. We describe two sets of analyses-one in a statewide child welfare system and the other in a statewide behavioral health system. These projects found opportunities in the analysis of the detection of traumatic stress based on traumatic experiences to inform practice and policy. Being trauma-informed in child welfare is distinct from being trauma-informed in behavioral health. In child welfare, it appears that a number of children are resilient in the face of traumatic experiences and do not require trauma treatment interventions. However, delayed and missed traumatic stress responses are common. In behavioral health, misses often occur among adolescents, particularly boys, who engage in acting out behavior. Opportunities for the ongoing development of trauma-informed systems using the TCOM framework are discussed.
理解并应对不良生活事件的影响是帮助系统设计中的一项重要优先事项。然而，创建创伤知情系统需要努力将有效的创伤知情工作融入日常实践。本文讨论了一种使用变革性协作成果管理（TCOM）框架开发创伤知情系统的模型，这是一种设计以人为本护理的策略。以人为本的护理与创伤知情护理自然契合。我们描述了创伤知情标准化评估过程实施的初始阶段，以支持创伤知情护理的持续发展。区分创伤经历和创伤应激是有效创伤知情系统的基础。我们描述了两组分析——一组在全州范围的儿童福利系统中，另一组在全州范围的行为健康系统中。这些项目在基于创伤经历对创伤应激检测的分析中发现了为实践和政策提供信息的机会。儿童福利领域的创伤知情与行为健康领域的创伤知情有所不同。在儿童福利领域，似乎许多儿童面对创伤经历时具有复原力，不需要创伤治疗干预。然而，创伤应激反应的延迟和漏诊很常见。在行为健康领域，漏诊经常发生在有外化行为的青少年中，尤其是男孩。本文还讨论了使用TCOM框架持续发展创伤知情系统的机会。
