Integrating Trauma Screening and Management at HIV Care Initiation: Current practices and future directions Público
Schiff, Julia (Spring 2018)
Published
Abstract
Introduction: The high prevalence of trauma and its negative effects on health and medical outcomes among HIV-infected populations highlight the need for integration of trauma services into HIV care. This study aims to fill a gap in knowledge regarding current practices of trauma screening and referrals in the context of HIV care initiation in an urban, resource-limited HIV care setting.
Methods: From March 2017-March 2018, as part of a parent study that aimed to understand how to best implement trauma-informed care into HIV services, surveys with providers (n=14), staff (n=17), and patients (n=63), direct observations of the multistep clinic intake process and hospital-to-clinic intake process, and reviews of intake forms in patient charts (n=69) were conducted to explore the extent to which trauma screening and associated referrals routinely occur at care initiation.
Results: Surveys suggested that major center strengths in trauma screening and referral included screening for substance abuse, screening in a private setting, and explaining why questions are being asked; major gaps included asking about previous head trauma, histories of combat violence, and screening for histories of community violence and comprehensive family needs. Direct observations of clinic and hospital-to-clinic intake indicated that while no formal screening for trauma occurs as part of clinic initiation, patients are screened for needs related to effects of trauma including mental health, substance abuse, legal aid, and case management through a standardized intake form; specific trauma screening occurs in case management. Upon chart review, 58/69 patient charts had at least one intake form, 17 had more than one form; 26/58 patients qualified for case management. Of the 26 who qualified, 16 were referred, 1 person declined, and 9 had no documented referral.
Conclusions: This study demonstrates a gap in standardized trauma-specific screening and referral to trauma-specific support services at HIV care initiation. Future efforts should focus on integrating trauma-specific screening and referrals into the HIV care enrollment process and incorporating additional trauma-informed practices, so that this important barrier to retention in care and adherence to antiretroviral therapy can be addressed early on.
Table of Contents
Chapter I: Introduction................................................................................ 1
Background of Problem....................................................................................1
Problem Statement ............................................................................................2
Significance ...........................................................................................................5
Purpose of Study .................................................................................................6
Chapter II: Literature Review.....................................................................7
The burden of trauma among HIV-infected individuals ....................7
Why are HIV and trauma syndemic?........................................................10
The effect of trauma on the health of HIV-positive individuals ...12
Trauma specific interventions ...................................................................18
Support for trauma-informed HIV care ..................................................20
Trauma-informed HIV care approach suggested by Brezing ........22
HIV care initiation process ..........................................................................23
Site Background ...............................................................................................27
Chapter III: Manuscript.............................................................................31
Abstract .................................................................................................34
Introduction.........................................................................................36
Methods ................................................................................................41
Parent Study Overview ..................................................................41
Overview of Thesis Sub-study.....................................................42
Data Collection ..................................................................................43
Observation of Intake and Care Initiation Process ..43
Needs Assessment .................................................................45
Chart Review for Screening Documents.......................47
Results ..................................................................................................49
Observation of Intake and Care Initiation Process ...........49
Needs Assessment Results for Screening and Initiation.57
Chart Review for Screening Documents ...............................61
Discussion ..........................................................................................64
Strengths and Limitations ..........................................................68
Recommendations .........................................................................69
Conclusion..........................................................................................71
References .........................................................................................73
Tables and Figures ..........................................................................75
Chapter IV: Conclusion and Recommendations.............................86
References .........................................................................................89
Appendix.............................................................................................95
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Palavra-chave | |
| Committee Chair / Thesis Advisor | |
| Partnering Agencies |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Integrating Trauma Screening and Management at HIV Care Initiation: Current practices and future directions () | 2018-04-20 12:15:06 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|