Barriers and Facilitators to Providing Trauma Informed Care at a Large Urban HIV Treatment Center in the Southeastern United States: Perceptions from the Clinic Staff and Providers Pubblico

Abstract

INTRODUCTION: The high prevalence of trauma and its impact on health and health-promoting behaviors among populations living with HIV underscore the need to integrate trauma informed care into HIV treatment. To date, there are no published studies of staff and provider’s assessment of trauma-informed HIV care implementation in high-volume, resource constrained treatment contexts.

METHODS: Between March-August 2017, semi-structured interviews (n=19) and surveys (n=31) were conducted among staff and providers at a large, urban HIV treatment center predominately serving uninsured, low-socioeconomic patients in the southern US to identify strengths and gaps in the center’s trauma-informed care (TIC) practices. The survey assessed the presence of 8 SAMSHA identified TIC domains: training and education, work force development, patient engagement, cross sector collaboration, physical environment, open/respectful communication towards patients, trauma screening/ follow up, and offering trauma-specific interventions/services. Subsequently, the interviews explored barriers to and facilitators of TIC.

RESULTS: Surveys identified treatment center (TC) strengths in the domains of open and respectful communication and offering services and trauma-specific interventions. Identified TC weaknesses were in the domains of trauma training and education and workforce development. Interviews highlighted the benefit of being a comprehensive clinic which allows patients to be connected to many onsite services related to trauma care. Participants described a lack of knowledge of available resources for trauma survivors and inconsistent screening throughout the clinics as a significant barrier to TIC. Many participants expressed a divisiveness between the clinics and employee levels, highlighting the need for better workplace collaboration and feedback practices and more support from administration to improve employee satisfaction.

CONCLUSIONS: Providers and staff highlighted many strengths and gaps in the TIC practices of the TC. We put forth recommendations that build upon center strengths and address the identified barriers to facilitate the creation of a multilevel implementation strategy to integrate TIC into the HIV services provided. If successfully adapted, the TC could serve as a HIV-TIC model for other high-volume, resource-constrained HIV clinics.

Table of Contents

Table of Contents

CHAPTER 1: LITERATURE REVIEW.......................................................................1

1.1 People Living with HIV (PLH) and Trauma.............................................................1

1.2 Trauma Informed Care......................................................................................7

1.3 Barriers to Patient Engagement in HIV Care.........................................................10

1.4 Study Setting..................................................................................................12

1.5 Study Aims.....................................................................................................13

CHAPTER 2: MANUSCRIPT.......................................................................................15

2.1 Abstract..........................................................................................................15

2.2 Introduction.....................................................................................................16

2.3 Methodology.....................................................................................................18

2.4 Results.............................................................................................................20

Table 1: Characteristics of study participants stratified by clinic/department (n=50)............................................................................................................21

Table 2: TIC assessment survey items evaluating trauma training and education..............v..........................................................................................22

Table 3: TIC assessment survey items evaluating work force development.....................................................................................................26

Table 4: TIC assessment survey items evaluating patient engagement and involvement......................................................................................................30

Table 5: TIC assessment survey items evaluating cross sector collaboration.....................................................................................................32

Table 6: TIC assessment survey items evaluating physical environment.....................................................................................................37

Table 7: TIC assessment survey items evaluating open and respectful communication toward patients.................................................................................................39

Table 8: TIC assessment survey items evaluating trauma screening and follow up...................................................................................................................41

Table 9: TIC assessment survey items evaluating the offering of services and trauma-specific interventions.........................................................................................47

2.5 Discussion........................................................................................................53

2.6 Limitations........................................................................................................60

CHAPTER 3: CONCLUSION AND RECOMMENDATIONS............................................61

3.1 Conclusion........................................................................................................61

3.2 Recommendations..............................................................................................61

REFERENCES..........................................................................................................63

APPENDIX 1: Recruitment Strategy..........................................................................67

Table 10: Projected Recruitment Strategy.............................................................67

Table 11: Final Recruitment Accrual......................................................................67

APPENDIX 2: Semi-structured Survey Instraument.....................................................68

APPENDIX 3: In-Depth Interview Guide.....................................................................79

APPENDIX 4: Qualitative Interview Codebook.............................................................83

 

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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
Parola chiave	Barriers Facilitators Trauma Informed Care TIC HIV
Committee Chair / Thesis Advisor	Kahloke, Ameeta, Emory University
Partnering Agencies	Hospital or other health care provider

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