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Elisseou S, Shamaskin-Garroway A, Kopstick AJ, Potter J, Weil A, Gundacker C, Moreland-Capuia A. Leading Organizations From Burnout to Trauma-Informed Resilience: A Vital Paradigm Shift. Perm J 2024; 28:198-205. [PMID: 38332699 PMCID: PMC10940251 DOI: 10.7812/tpp/23.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Sadie Elisseou
- Department of Medicine, VA Boston Health Care System, Harvard Medical School, and Boston University School of Medicine, Boston, MA, USA
| | - Andrea Shamaskin-Garroway
- Departments of Psychiatry and Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Avi Joshua Kopstick
- Division of Pediatric Critical Care Medicine, Texas Tech University Health Sciences Center El Paso, Lubbock, TX, USA
| | - Jennifer Potter
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amy Weil
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Constance Gundacker
- Department of Pediatrics—General and Community, Medical College of Wisconsin, Milwaukee, WI, USA
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Mangus AR, Webb EK, Bar-Halpern M, Ravichandran C, Ressler KJ, Moreland-Capuia A. Training for Lasting Change: Trauma-Informed Training Results in Improved and Sustained Individual and Organizational Knowledge, Attitudes, and Policies. J Clin Psychiatry 2023; 84:23m14904. [PMID: 37916942 DOI: 10.4088/jcp.23m14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Objective: Trauma-informed care (TIC) trainings seek to improve individual and organizational recognition and care to individuals who have experienced trauma. However, whether TIC trainings result in long-term changes to an organization's policies and practices remains unclear. This article describes the effectiveness of a workshop designed to train professionals across disciplines in understanding and implementing TIC in their work and workplace. Methods: Between July 2021 and May 2022, participants completed a 2-day (approximately 12 hours) training in TIC that included didactics on cultural responsivity, the biological effects of trauma, the components of TIC, and how to deploy TIC within their organization. Prior to the training, participants completed a previously validated survey, the Survey for Trauma-Informed Systems Change, which evaluated their pre-training (T0) competency in TIC and the level of TIC within their organization. Within 48 hours following the training, participants completed a post-survey (T1). To evaluate the longer-term impact of the training, participants repeated the post-survey at 6 months post-training (T2). Results: Over a 1-year period, 598 individuals (78% women, 20% men; mean age = 45.5 years) received training in TIC. There was a significant increase between the T0 survey and the T1 post-survey in self-assessed knowledge and attitudes; systemwide knowledge and attitudes; training, support, interaction, and environment; and awareness of cultural background at work (P values < .001), but not safety and acceptance at work (P = .06). Open-ended qualitative responses on the T2 survey, which probed what specific policies and/or practices had been modified within the participant's organization, revealed improvement in several key themes (training, policy, and communication). Conclusions: This unique trauma-informed didactic training resulted isn persistent quantitative and qualitative change within individuals and organizations. Most notably, the training yielded greater confidence in utilizing TIC practices and systemic change at the organizational level. The results suggest that a 2-day training in TIC can transform organizational training, policy, and communications.
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Affiliation(s)
- Alexandra R Mangus
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - E Kate Webb
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Miri Bar-Halpern
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Ravichandran
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Lurie Center for Autism, Lexington, Massachusetts
| | - Kerry J Ressler
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alisha Moreland-Capuia
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Corresponding Author: Alisha Moreland-Capuia, MD, McLean Hospital, 115 Mill St, Belmont, MA 02478
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Buxton H, Marr MC, Hernandez A, Vijanderan J, Brasel K, Cook M, Moreland-Capuia A. Peer-to-Peer Trauma-Informed Training for Surgical Residents Facilitated by Psychiatry Residents. Acad Psychiatry 2023; 47:59-62. [PMID: 35579850 PMCID: PMC9669278 DOI: 10.1007/s40596-022-01648-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/05/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE This article describes the implementation of trauma-informed care (TIC) didactic training, using a novel, interdisciplinary peer-to-peer teaching model to improve confidence surrounding trauma-informed practices in a surgical residency program. METHODS Eight psychiatry residents and two medical students with a background in psychological trauma and TIC and an interest in medical education were recruited to participate in three 2-hour "train the trainer" sessions led by a national expert in TIC. Eight psychiatry residents and two medical students subsequently developed and delivered the initial TIC training to 29 surgical interns. Training included the neurobiology of psychological trauma, principles of trauma-informed care, and developing trauma-informed curricula. RESULTS Surgical interns reported significantly improved understanding of the physiology of trauma, knowledge of TIC approaches, and confidence and comfort with TIC and practices. Among surgical interns, understanding of the physiology of the fear response increased from 3.36 to 3.85 (p = 0.03). Knowledge of the neurobiology of trauma improved between pre- and post-training surveys (2.71 to 3.64, p = 0.006). Surgery interns also expressed an improved understanding of the connection between fear, trauma, and aggression (3.08 to 4.23, p = 0.002) from pre- to post-training surveys. Post-training knowledge of trauma-informed approaches increased from 2.57 to 4.71 (p < 0.001) and confidence in delivering TIC on the wards increased from 2.79 to 4.64 (p < 0.001). CONCLUSION This TIC curriculum delivered via a peer-to-peer training model presents an effective way to improve comfort and confidence surrounding TIC practices and approaches in a surgical residency training program.
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Affiliation(s)
| | - Mollie C Marr
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Karen Brasel
- Oregon Health & Science University, Portland, OR, USA
| | | | - Alisha Moreland-Capuia
- Oregon Health & Science University, Portland, OR, USA.
- McLean Hospital/Harvard Medical School, Belmont, MA, USA.
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Moreland-Capuia A, Dumornay NM, Mangus A, Ravichandran C, Greenfield SF, Ressler KJ. Establishing and validating a survey for trauma-informed, culturally responsive change across multiple systems. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Abstract
Aim
The purpose of the present study was to establish and validate the Survey for Trauma-Informed Systems Change (STISC), a measure of culturally responsive trauma-informed care (TIC) and services that can be administered to professionals in any field or industry.
Subject/methods
The current study with 262 respondents from judicial, healthcare, political, non-profit, and for-profit settings examined the internal consistency reliability and factor structure of the STISC.
Results
A total of 262 respondents from various industries accessed the pre-training survey. Seven of the 59 items were reassigned to alternate subscales and three subscales were merged following correlation analysis. Internal consistency reliability for subscales based on the final item assignments was good or excellent (lower 95% confidence limits for hierarchical omega ≥ 0.85). The root mean square error of approximation estimate for the confirmatory factor analysis based on final item assignments was acceptable (0.073; 90% CI 0.71, 0.76). Neither the comparative fit index value of 0.76 nor the Tucker–Lewis fit index value of 0.75 approached conventional thresholds for acceptable fit.
Conclusion
Given the absence of a validated alternative, this study supports use of the STISC tool to measure the degree of an individual’s trauma-informed knowledge and positive attitudes toward trauma-informed systems change, as well as trauma-informed practices in the workplace. Further study and refinement will aim to determine whether the STISC survey is sensitive to change, which will provide stronger support for the survey’s potential usefulness as a cost-effective method of standardizing trauma-informed systems change programs across multiple fields and industries.
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Dumornay NM, Finegold KE, Chablani A, Elkins L, Krouch S, Baldwin M, Youn SJ, Marques L, Ressler KJ, Moreland-Capuia A. Improved emotion regulation following a trauma-informed CBT-based intervention associates with reduced risk for recidivism in justice-involved emerging adults. Front Psychiatry 2022; 13:951429. [PMID: 36276328 PMCID: PMC9579430 DOI: 10.3389/fpsyt.2022.951429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Male youth who have been involved in the juvenile legal system have disproportionate rates of trauma and violence exposure. Many justice-involved youth have untreated mental illness, with an estimated 66% of young men who are incarcerated meeting criteria for at least one mental health disorder, including posttraumatic stress disorder (PTSD), depression, and substance abuse. While Cognitive Behavioral Therapy (CBT) approaches are considered among effective evidence-based treatments for addressing and treating behavioral and emotional difficulties, male youth with a history of incarceration and youth who are at risk for (re)incarceration, violence, emotion dysregulation, and trauma face significant barriers in accessing these services. METHODS Roca, Inc. (Roca), an internationally recognized organization moving the needle on urban violence by working relentlessly with young people at the center of violence in Massachusetts and Maryland, employs a trauma-informed CBT-based skills curriculum and approach in their intervention model, to improve youths' educational, employment, parenting, and life skills opportunities, while decreasing risk for recidivism, addressing trauma and increasing skills for emotion regulation. The aim of this analysis was to assess the effectiveness of Roca's trauma-informed CBT skills curriculum on youths' emotional and behavioral outcomes. We analyzed data from over 300 participating emerging adult men from four sites in Massachusetts and one site in Baltimore, Maryland who had at least three series of data collection across multiple skills-based sessions. RESULTS We found improvements in outcomes in overall mean scores related to decreased distress about employment and education, as are expected with standard intervention approaches for justice-involved youth. Participants who show improvement in emotion regulation across engagement (approximately half the cohort), were found to have significant improvements in distress related to relationship and family functioning and self-care, and decreased substance use, along with other outcomes compared to those participants with less improvement in emotion regulation. Furthermore, improvement in different aspects of emotion regulation were associated with improved relationships, life distress, substance use, and improved prosocial thinking. CONCLUSIONS Together, these data suggest that adding mental health support and skills training, such as with trauma-informed CBT models, to programs for justice-involved youth may lead to significant improvements in functioning, quality of life, and mental health outcomes.
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Affiliation(s)
- Nathalie M Dumornay
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Institute of Child Development, University of Minnesota, Minneapolis, MN, United States
| | - Katherine E Finegold
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,School and Child Clinical Psychology, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Soo Jeong Youn
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kerry J Ressler
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Alisha Moreland-Capuia
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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