Perceived lack of training moderates relationship between healthcare providers’ personality and sense of efficacy in trauma-informed care

ABSTRACT

Background and Objectives: Medical patients often have trauma histories that are not routinely assessed, which can adversely affect health outcomes. Despite growing awareness of this issue, there is limited understanding of factors that influence provider competency in trauma-informed care (TIC). The study examined healthcare providers’ personality traits in relation to their sense of TIC efficacy, taking into account perceived barriers to TIC and professional quality of life.

Study Design: The study used cross-sectional survey methods to examine our central hypothesis that provider personality traits and perceived barriers to TIC would be associated with TIC-efficacy, and to explore interactions among study variables.

Methods: Survey data were collected from 172 healthcare providers examining TIC knowledge, TIC-efficacy, perceived barriers to TIC, personality traits, and professional quality of life.

Results: TIC-efficacy was positively correlated with “intellectence/openness” and inversely correlated with “neuroticism” and perceived lack of training as a barrier. “Intellectence/openness” interacted with perceived lack of training to predict TIC-efficacy, suggesting that providers with lower “intellectence/openness” report greater TIC-efficacy when lack of training is not perceived as a barrier.

Conclusions: Provider personality traits and perceived barriers to TIC appear related to providers’ TIC-efficacy. Implications for overcoming barriers to TIC through training and implementation are discussed.     

Physical Abuse in U.S. Children: Risk Factors and Deficiencies in Referrals to Support Services

More than 600,000 U.S. children are reported for physical abuse annually. Risk factors are proposed in the literature, but a comprehensive, national assessment of risk factors and support services has not been conducted. An analysis of national data from the National Child Abuse and Neglect Dataset revealed that domestic violence, parental alcohol and drug use, prior child abuse and neglect, public assistance receipt, and child behavior problems are associated with higher odds of substantiated physical abuse reports, compared to unsubstantiated reports. Most families, however, failed to receive relevant support services for any of these risk factors. Screening by physicians, child protection workers, and others for these risk factors could help identify children at increased risk for physical abuse and inform prevention efforts and support-service provision.     

Secret-Keeping Behaviors in Black and White Children as a Function of Interviewer Race,Racial Identity,and Risk for Abuse

Summary

The tendency for children to keep the secret of child abuse is an important practical impediment to adequate research, prevention, assessment, and treatment. While some studies have established that children will readily keep adult secrets, few have investigated the predictors of ease of disclosure. In this research, race of the interviewer requesting the secret strongly affected disclosure, with Black children particularly showing an unwillingness to disclose a negative secret to a different race interviewer. Children at high risk for sexual abuse (as assessed by the Finkelhor checklist) also were more likely to keep the secret.     

Evaluation of a Trauma-Informed School Intervention with Girls in a Residential Facility School: Student Perceptions of School Environment

In response to the high nationwide prevalence of psychological trauma among court-involved youth who have been exposed to abuse and neglect and the associated far-reaching adverse consequences, there are calls to develop a trauma-informed workforce across the various systems (child welfare, juvenile justice, mental health, and education) designed to serve this population. We describe a pilot test of a modified version of the Heart of Teaching and Learning (HTL) curriculum, an intervention designed to increase trauma-informed practices in education settings. This program was implemented in a public charter school that exclusively serves court-involved youth placed in residential treatment. The intervention was associated with decreases in trauma symptoms experienced by youth. Because student perceptions of teachers were high both before and after implementation of the curriculum, no statistically significant changes were observed. The article concludes with a discussion of the ways in which the curriculum can be used to help prepare a national education workforce capable of implementing trauma-informed evidence-based practices in school settings.     

Domestic Violence

Summary

In this paper, the authors outline their experience in incorporating a curriculum on domestic violence into an urban family practice residency program. Based on the concept that in order to successfully develop such a curriculum, it is necessary to address the “culture of the organization,” joint educational strategies that in-elude resident education as well as faculty development were considered. A research question was designed to inquire as to the difference in the level of knowledge about domestic violence in family practice faculty as compared to residents prior to the introduction of educational strategies. The authors describe curriculum goals and objectives and outline specific teaching methods as well as the evaluation instrument utilized in the study to measure actual difference in knowledge between faculty and residents about domestic violence with a focus specifically on spousal abuse. Their conclusions point to the need for an educational strategy that includes emphasis on the faculty-resident interface which utilizes both traditional and non-traditional integrated formats in order to successfully train residents in the identification and treatment of domestic violence.     

Research Concerning Wife Abuse

SUMMARY

Violence toward women has been declared a public health epidemic. To date, research on battered women in medical settings has focused primarily on incidence and prevalence and on identification of risk markers. Such research also has elucidated low rates of battered women identified in medical settings, as well as barriers to such identification. Methods of training physicians to identify and help battered women are described in the present article. The unique role of psychologists and other mental health professionals in designing and evaluating such programs is discussed.     

Chaos and Trauma in the Lives of Adolescent Females with Antisocial Behavior and Delinquency

Summary

Female adolescents entering the juvenile justice system have complex and serious problems in multiple areas of adjustment. Literature is reviewed on the prevalence and form of antisocial behavior in girls and on the long-term implications of such problems in adolescence. Risk factor characteristics, including family fragmentation, physical and sexual trauma, mental health problems, official arrest and self-report offending histories of a population of girls referred for out-of-home placement because of repeated and chronic juvenile offending are presented. In addition, with the exception of sexual trauma histories, these sample characteristics are compared to a similar sample of chronically offending boys. A treatment approach is described and pilot data are presented on its feasibility. Implications for designing empirically-based, gender-related treatment models are discussed.     

Editorial

The aim was to investigate organizational impact on working conditions and to explore the associations between sector, different types of organizational change, and working conditions. A strategic selection was made of representative staff members from 72 work sites. Data pertaining to organizational factors were collected from managers, and to working conditions from employees. Multilevel analyses were performed, with 10 aspects of self-reported and expert assessed psychosocial and ergonomic/physical working conditions as the dependent variables, and patterns of organizational change and sector as the explanatory variables. The results showed that the variance in working conditions was significantly attributed to organizational level (16?–?65% of the variance), and that both the pattern of change and the sector were important. Organizations that had not undergone change provided the best work conditions. The “standardizing” and “market-adjusting” patterns of change had deleterious effects, while the “lean” and “centralizing” patterns led to dual outcomes. Organizational change was perceived as having more negative consequences in the public sector than in the private sector. The results indicate that organizational change contributes to increased differentiation of working conditions, as different types of changes congregate in specific areas of the labour market and affect groups of employees differently.     

An extraordinary ordinariness

Counselling psychology in the UK has evolved from the disciplines of psychology, sociology and philosophy, but more slowly than its counterpart in the USA. Counselling psychologists, it is argued, have the skills and training to integrate good practice with rigorous research. Expertise in rigorous research methods, both quantitative and qualitative, and skill in identifying new paradigms, make the interface between practice and research in counselling psychology an especially fruitful area for study.     

Ways to independence

Much research attests to the beneficial effects of equine interventions on physical development and ability. However, less is known about the possible psychological benefits of horse activities, such as therapeutic riding or interactions with horses. Although there is public consensus that horses can have psychological benefits, it is an under-researched area and conclusions are largely based on anecdotal data. The little empirical evidence that is available about the efficacy of equine-assisted interventions on psychological outcomes tends to be mixed and is often difficult to interpret due to the lack of rigorous research designs. The purpose of this review was to examine the current state of the literature regarding the psychological effects of equine-assisted interventions, and to make recommendations for future research. Findings from this review suggest that equine-assisted interventions hold much promise, particularly in terms of child/adolescent social and behavioural issues, and perhaps adult affective disorders. However, the current state of the literature does not allow us to definitively conclude that equine-assisted interventions are efficacious. Well-designed randomised controlled trials are greatly needed in this area, as it is an appreciation of the need to standardise and document equine-assisted interventions and outcomes in future research.