Enhancing Capacity of Ryan White Clinic to Provide Trauma-Informed HIV Care: Iterative Development of a Healing-Centered Training Curriculum Restricted; Files Only

Abstract

Background: HIV care often intersects with trauma, posing complex challenges for patients and providers. Research highlights the prevalence of trauma among people living with HIV (PLWH) and its adverse effects on HIV and other health outcomes. Trauma-informed care (TIC) principles offer promise in addressing these challenges but face barriers to implementation in HIV clinic settings, in part due to gaps in training and workforce development. This thesis thus proposes to develop a tailored TIC training program for Ryan White-funded HIV clinics (RWCs) to  enhance their capacity to support patients with trauma histories and ultimately improve patient health outcomes.

Methods: The curriculum development was led by a multidisciplinary team, including researchers  and clinicians specializing in behavioral science, trauma, and HIV care, and experts in training and technical assistance for RWCs. Training content and facilitation strategies were informed by review of qualitative interviews from a mixed-methods study on TIC implementation across RWCs in the Southeastern US. A framework for the curriculum was derived from the Substance Abuse and Mental Health Services Administration Concept of Trauma-Informed Care. Curriculum development included collaborative brainstorming, case study development, and iterative refinement through advisory group feedback from local RWCs. A facilitator's guide was created to support standardized training delivery and ensure an impactful learning experience.

Results: The thesis delivers a comprehensive, highly participatory training curriculum consisting of six modules aimed at fostering a healing-centered care (HCC) approach within RWCs. Modules focus on building cohesive clinic culture, prioritizing staff well-being, providing trauma-informed care to patients, and emphasizing the role of physical environments in promoting healing through case studies, reflections, and group exercises. Detailed session drafts are included in Appendix 1, providing practical guidance for training facilitators and participants.

Discussion: The developed curriculum equips RWCs with TIC training to enhance their capacity in providing supportive healing-centered HIV care. Lessons learned highlight a shift from TIC to the more empowering HCC approach, prioritizing actionable activities, and focusing on staff well-being. Next steps involve refining the curriculum and piloting before potential large-scale trials. Successful implementation could significantly improve patient outcomes and inform policy development within Ryan White programs.

Table of Contents

Table of Contents

CHAPTER I: INTRODUCTION 1

CHAPTER II: LITERATURE REVIEW 6

What is Trauma? 7

Trauma and People Living with HIV 7

Epidemiology of People Living with HIV and Trauma 7

Trauma and HIV Care Engagement: Antiretroviral Adherence and Retention in Care 8

HIV Care and Implications for Providers and Staff 10

Trauma Informed Care (TIC) 12

What is Trauma Informed Care? 12

Trauma Informed Care in HIV Settings 14

Barriers & Facilitators to Integrating Trauma Informed Care in HIV Settings 15

Existing Trauma Informed Care Trainings in HIV Settings 16

Conclusion 17

CHAPTER III: METHODS 18

Training Development Team 18

Preliminary Research 19

Curriculum Development 21

Developing the Facilitator's Guide 22

CHAPTER IV: RESULTS 24

Overall Structure of Modules 24

Table 1: Overall Structure of Modules 24

Module 1: Introduction 25

Module 2: Care for Clinic Culture 25

Module 3: Care for Self 26

Module 4: Care for Staff Support 26

Module 5: Care for Others 26

Module 6: Care for Environment & Closing 27

CHAPTER V: DISCUSSION & PUBLIC HEALTH IMPLICATIONS 29

Lessons Learned During Development 29

Shift from Trauma Informed Care to Healing-Centered Care 29

Prioritization of Actionable Activities & Sustainability 30

Strengths and Limitations 31

Strengths 31

Limitations 33

Next Steps 33

Public Health Implications 34

Implications for Program and Practice 34

Implications for Research 35

Implications for Policy 36

REFERENCES 37

APPENDIX 1: PROVIDING TRAUMA-INFORMED CARE USING A HEALING-CENTERED APPROACH IN RYAN WHITE CLINICS 48

Healing-Centered Care Session One: Introduction to Healing-Centered Care 49

Healing-Centered Care Session Two: Healing-Centered Care in the Clinic Culture 55

Healing-Centered Care Session Three: Healing-Centered Care for Self 60

Healing-Centered Care Session Four: Healing-Centered Care for Staff Support 68

Healing-Centered Care Session Five: Healing-Centered Care for Others 72

Healing-Centered Care Session Six: Healing-Centered Care for Environment, and Closing 79

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Curriculum HIV Trauma Informed Care TIC Training
Committee Chair / Thesis Advisor	Ameeta Kalokhe, Emory University

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