Brown Leslie Lauren, Wilkins Megan Leigh, Pichon Latrice Crystal, Stewart Jamie Lynn, Sales Jessica McDermott, Audet Carolyn Marie, Hill Samantha Veronica, Pettit April Christine
Meharry Medical College School of Medicine.
St Jude Children's Research Hospital.
Res Sq. 2023 Aug 14:rs.3.rs-3234952. doi: 10.21203/rs.3.rs-3234952/v1.
Trauma-Informed Care (TIC) is an evidence-based approach for improving health outcomes by providing systematic, trauma- sensitive and -responsive care. Because TIC adoption varies by setting and population, Implementation Science (IS) is particularly well-suited to guide roll-out efforts. Process Mapping (PM) is an IS model for creating shared visual depictions of systems as to identify rate-limiting steps of intervention adoption, but guidance on to apply PM to guide TIC adoption is lacking. Authors of this study aimed to develop a novel method for conducting TIC-focused PM.
A real-life TIC implementation study is presented to show how TIC-focused PM was conducted in the case example of a pediatric HIV clinic in a Southern urban area with a high burden of psychological trauma among youth with HIV. A five-phase PM model was applied to evince clinic standards of care, including Preparation, planning and process identification; Data and information gathering; Map generation; Analysis; and Taking it forward. Practices and conditions from four TIC domains were assessed, including Trauma responsive services; Practices of inclusivity, safety, and wellness; Training and sustaining trauma responsiveness; and Cultural responsiveness.
The TIC-focused PM method indicated the case clinic provided limited and non-systematic patient trauma screening, assessment, and interventions; limited efforts to promote professional quality of life and elicit and integrate patient experiences and preferences for care; no ongoing efforts to train and prepare workforce for trauma- sensitive or -responsive care; and no clinic-specific efforts to promote diversity, equity, and inclusion for patients and personnel.
Principles and constructs of resilience-focused TIC were synthesized with a five-phase PM model to generate a baseline depiction of TIC in a pediatric HIV clinic. Results will inform the implementation of TIC in the clinic. Future champions may follow the TIC-focused PM model to guide context-tailored TIC adoption.
创伤知情护理（TIC）是一种基于证据的方法，通过提供系统的、对创伤敏感且有响应的护理来改善健康结果。由于TIC的采用因环境和人群而异，实施科学（IS）特别适合指导推广工作。流程映射（PM）是一种IS模型，用于创建系统的共享可视化描述，以识别干预采用的限速步骤，但缺乏关于如何应用PM来指导TIC采用的指导。本研究的作者旨在开发一种针对TIC的PM新方法。
介绍了一项实际的TIC实施研究，以展示在南部城市地区一家儿科艾滋病毒诊所的案例中，如何进行针对TIC的PM，该地区艾滋病毒感染青年中存在高心理创伤负担。应用一个五阶段的PM模型来展示诊所的护理标准，包括准备、规划和流程识别；数据和信息收集；地图生成；分析；以及推进。评估了四个TIC领域的实践和条件，包括创伤响应服务；包容性、安全性和健康实践；培训和维持创伤响应能力；以及文化响应能力。
针对TIC的PM方法表明，该案例诊所提供的患者创伤筛查、评估和干预有限且不系统；在促进职业生活质量以及引出和整合患者的护理体验和偏好方面的努力有限；没有持续努力培训和使工作人员为创伤敏感或有响应的护理做好准备；并且没有针对诊所的努力来促进患者和工作人员的多样性、公平性和包容性。
以复原力为重点的TIC的原则和结构与一个五阶段的PM模型相结合，以生成一家儿科艾滋病毒诊所TIC的基线描述。结果将为该诊所TIC的实施提供信息。未来的倡导者可以遵循针对TIC的PM模型来指导根据具体情况量身定制的TIC采用。
