Training Hospital Personnel in Trauma-Informed Care: Assessing an Interprofessional Workshop With Patients as Teachers.

OBJECTIVE: Trauma-informed care (TIC) and violence intervention programs (VIPs) facilitate psychosocial healing and reduce injury recidivism for children and families affected by community violence. To integrate a VIP into 2 Level 1 Pediatric Trauma Centers, an educational initiative was developed and co-taught by pediatricians and former patients. The primary aim was to increase provider-driven patient referrals to the VIP. A secondary aim was to improve all participants' comfort levels in 5 areas of TIC. METHODS: Referrals to the VIP from 2014 to 2018 were tracked and analyzed. A curriculum based on Five Points of TIC was developed and offered to interprofessional groups of hospital employees. Pediatricians and former patients recovering from violent injury facilitated the workshops. Twenty-two workshops were attended by 318 providers and hospital staff members from 2015 to 2018. Pre- and postworkshop surveys asked participants to rate their comfort levels with 5 areas of TIC. RESULTS: Provider-driven patient identification increased from 34.8% to 86.8% over the study period. For the entire cohort, participants' self-assessment of comfort levels with TIC improved by 21% (P < .001), with medical students' scores improving the most (24%). Residents were less likely to complete the workshop than fellows or attendings (P = .03). CONCLUSIONS: This novel curriculum was associated with a change in practice patterns, as well as a closer relationship between the VIP and pediatric hospital systems. All professional groups experienced an improvement in comfort levels with the Five Points of TIC. Future study on information retention and other patient care-related outcomes is needed.

Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns' experiences.

OBJECTIVE: Tubal sterilization remains one of the most commonly requested contraceptive methods in the United States. Catholic hospital policy prohibits all sterilizations, but this ban is not uniformly enforced. We conducted this study to assess obstetrician-gynecologists' beliefs and experiences with tubal ligation in Catholic hospitals. STUDY DESIGN: We interviewed 31 obstetrician-gynecologists geographically dispersed throughout the US who responded to a national survey and agreed to be contacted for a follow-up interview or who were referred by colleagues from the survey sample. Twenty-seven had experienced working in a Catholic hospital. Interviews were open ended and guided by a semistructured instrument. Transcripts were thematically analyzed. RESULTS: Obstetrician-gynecologists disagreed with strict prohibition of sterilizations, especially when denying a tubal ligation placed the patient at increased medical risk. Cesarean delivery in Catholic hospitals raised frustration for obstetrician-gynecologists when the hospital prohibited a simultaneous tubal ligation and, thus, sent the patient for an unnecessary subsequent surgery. Obstetrician-gynecologists described some hospitals allowing tubal ligations in limited circumstances, but these workarounds were vulnerable to changes in enforcement. Some obstetrician-gynecologists reported that Catholic policy posed greater barriers for low-income patients and those with insurance restrictions. CONCLUSION: Obstetrician-gynecologists working in Catholic hospitals in this study did not share the Church's beliefs on sterilization. Research to understand patients' experiences and knowledge of their sterilization options is warranted in order to promote women's autonomy and minimize risk of harm. IMPLICATIONS STATEMENT: Tubal sterilization, even when medically indicated or in conjunction with cesarean delivery, is severely restricted for women delivering in Catholic hospitals. For women whose only access to hospital care is at a Catholic institution, religious policies can prevent them from receiving a desired sterilization and place them at risk for future undesired pregnancy.

Secondary migration and relocation among African refugee families in the United States.

The purpose of this study was to understand the secondary migration and relocation of African refugees resettled in the United States. Secondary migration refers to moves out of state, while relocation refers to moves within state. Of 73 recently resettled refugee families from Burundi and Liberia followed for 1 year through ethnographic interviews and observations, 13 instances of secondary migration and 9 instances of relocation were identified. A family ecodevelopmental framework was applied to address: Who moved again, why, and with what consequences? How did moving again impact family risk and protective factors? How might policies, researchers, and practitioners better manage refugees moving again? Findings indicated that families undertook secondary migration principally for employment, affordable housing, family reunification, and to feel more at home. Families relocated primarily for affordable housing. Parents reported that secondary migration and relocation enhanced family stability. Youth reported disruption to both schooling and attachments with peers and community. In conclusion, secondary migration and relocation were family efforts to enhance family and community protective resources and to mitigate shortcomings in resettlement conditions. Policymakers could provide newly resettled refugees jobs, better housing and family reunification. Practitioners could devise ways to better engage and support those families who consider moving.

Identification and evaluation of mental health and psychosocial preparedness resources from the Centers for Public Health Preparedness.

An exemplar group of disaster mental health subject matter experts was formed as part of the CDC Center for Public Health Preparedness program to develop a "toolkit" of relevant CPHP disaster mental health training and education curricula and resources. The group developed a charter, compiled relevant CPHP training materials, developed an objective review template, and collectively reviewed the assembled resources. Curricular reviews were presented at a March 2005 meeting where an asset matrix was developed to categorize and compare the training and education curricula and resources. This article describes findings and next steps for toolkit development and refinement. Some recommendations for the toolkit identified thus far are to develop standardized disaster mental health nomenclature, add training exercises to the array of CPHP training and education resources, develop disaster mental health competencies for public health workers, add more advanced trainings to the current repertoire, and add resources to the toolkit during the coming years. The group also plans to disseminate the mental health/psychosocial preparedness toolkit to practice partners engaged in training disaster response personnel.

Competency mapping and analysis for public health preparedness training initiatives.

Competency-based education and assessment initiatives have been completed in a number of health care and health management professions during the past decade. In addition, several competency specification endeavors have been similarly undertaken in relation to the field of public health, including the development of the Council on Linkages between Academia and Public Health Practice competency model and the initial competency modeling Delphi survey completed by the Association of Schools of Public Health. All of these organizations have subsequently had to address the many challenges and barriers to the dissemination and integration of their models into specific educational and professional development practices. As previously addressed by many researchers in the field of competency modeling and deployment, understanding and acceptance of competency-based systems are formidable goals, often rife with controversy. This article describes the processes undertaken by The University of Michigan Center for Public Health Preparedness to integrate competency-based learning and assessment in educational and training initiatives with its many community partners.