Provider Perspectives on the Gaps in Knowledge, Skills, and Resources Necessary for Delivery of Trauma-Informed HIV Care: Implications for Future Curriculum Development Público

Abstract

Background: Trauma-informed care has been an increasingly developed area of research over the past several decades. There is a significant need for trauma-informed care training that is specific to HIV care providers due to the high levels of trauma experienced by people living with HIV and the impact on their HIV outcomes. Few studies have assessed provider gaps in skills and knowledge in provision of trauma-informed care.

Methods: This thesis focuses on the qualitative study of a larger mix-methods study among providers and staff of Ryan White HIV Clinics in the Southeastern United States. Twelve in-depth interviews were conducted with HIV care providers, examining their perceptions of gaps in knowledge and skills to effectively provide trauma-informed care, factors influencing prioritization of implementation of trauma-informed care training, and preferences for content and delivery of training. Interviews were conducted and recorded via Zoom. All twelve interviews were then coded and analyzed, using thematic analysis.

Results: The study found that HIV care providers would like to see trauma-informed care curriculum implemented into medical education curricula and clinical training, in addition to re-training for practicing providers. Providers would also like to see trainings delivered by subject-matter experts. Providers are particularly interested in population specific trauma-informed care training, as well as trauma-informed care training that focusses on not re-triggering or re-traumatizing a patient.

Conclusions: The study provides critical insight into the content and delivery of trauma-informed care training for HIV care providers. Future research should pilot and evaluate implementation of such trauma-informed care training and examine effects on providing trauma-informed HIV care to people living with HIV. Furthermore, trauma-informed care trainings should be piloted and subsequently added to medical training.

Table of Contents

CHAPTER ONE: INTRODUCTION 1

CHAPTER TWO: LITERATURE REVIEW 3

Trauma: Definitions 3

Trauma Experience Among People Living with HIV 4

Trauma: Effects on Health 5

Trauma Among Providers and Staff 5

Trauma: Safeguards 6

Trauma-Informed Care: A Framework for Addressing Trauma Among Patients, Providers, and Staff 7

Trauma-Informed Care: The Evolving Role of the Clinic and Providers 10

Trauma-Informed Care: Present Make-Up/Delivery 11

Trauma-Informed Care: Integration into HIV Clinics 13

Ryan White HIV Primary Clinics: Ideal Settings for Implementation of Trauma-Informed Care 15

Trauma-Informed Care: Need for Trauma-Informed Care training of HIV Care Providers 16

A Need to Understand Gaps in Provider Knowledge and Skills to Inform Training of Providers 17

CHAPTER THREE: MANUSCRIPT 20

Abstract 20

Background: 20

Introduction 21

Methods 22

Study Overview: 22

Study Setting: 23

Participants: 24

Table 1 25

Data Collection: 26

Ethics: 27

Data Management: 27

Data Analysis 28

Results 28

Participant Characteristics 28

Existing Knowledge of Trauma-Informed Care & Trauma-Informed Care Trainings 29

Perceived Priority of Trauma-Informed Care Training 32

Factors Influencing Implementation of Trauma-Informed Care Training 34

Preferences of Trauma-Informed Care Training 36

Discussion 39

CHAPTER FOUR: CONCLUSIONS AND RECOMMENDATIONS 42

REFERENCES 44

APPENDICES 48

In-depth Interview Guide 48

CFIR Codebook 56

SAMHSA Codebook 69

About this Master's Thesis

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• 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, Mental Health Health Sciences, Public Health Education Health Sciences, Public Health
Palavra-chave	Trauma-Informed Care Trauma-Informed Care Curriculum Trauma-Informed Care Training Ryan White HIV
Committee Chair / Thesis Advisor	Ameeta Kalokhe MD, MSc, Emory University

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