Understanding staff- and system-level contextual factors relevant to trauma-informed care implementation.

Objective: Trauma-informed care (TIC) is increasingly used to address and prevent adverse childhood experiences. However, research on the implementation process of TIC has lagged, limiting its impact and sustainability. The goal of this two-study project was to provide a summary of staff- and system-level contextual factors relevant to TIC implementation. Method: Study 1 was a secondary data analysis of survey data from 760 staff members from human services, health, and education practice settings familiar with TIC. Independent-samples t tests were used to evaluate differences between lower- and higher-implementing organizations on staff- and system-level TIC implementation drivers. These drivers were then coded using the Consolidated Framework for Implementation Research (CFIR). Study 2 was a content analysis of the empirical literature on TIC. Study 2 produced information on the staff- and system-level facilitators of and barriers to TIC implementation, which were then also coded using the CFIR. Results: Study 1 suggested that the attributes of the individuals implementing TIC and the implementation climate of the organization played the most central roles. Study 2 identified available resources and the strength and quality of the evidence underpinning the intervention as important contextual factors for TIC implementation. Conclusion: This study used a well-established framework, the CFIR, to elucidate key contextual factors related to the successful implementation of TIC, with the goal of informing the efforts of researchers, practitioners, and policymakers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The implementation and effect of trauma-informed care within residential youth services in rural Canada: A mixed methods case study.

OBJECTIVE: The prevalence and associated risks of trauma have led youth-serving institutions to adopt trauma-informed care (TIC). A limited research base has linked TIC with improved outcomes. Associations between TIC and vicarious traumatization (VT) are even less commonly studied. The purpose of this case study is to evaluate the implementation and effect of TIC within 1 residential youth services division in rural Canada using the curriculum-based Risking Connection (RC; Saakvitne et al., 2001) and Restorative Approach (RA; Wilcox, 2012) trauma training programs, with a focus on VT. METHOD: We used an explanatory sequential mixed methods design and a participatory action research approach to evaluate the implementation and effect of RC and RA. Study 1, the quantitative program evaluation, used a prepost design to evaluate the effect of RC and RA on staff. Study 2, the qualitative study, used participant observations and interviews to develop a deeper understanding the quantitative findings. RESULTS: This study replicated previous findings that RC improves attitudes favorable to TIC but found that staff experience of VT increased after TIC training. Qualitative findings suggested that the division was successfully implementing TIC and that increased awareness and discussion of VT were potentially responsible for increases in VT scores. CONCLUSIONS: This case study documents improvements in staff attitudes favorable to TIC post-RC and RA and presents an in-depth analysis of TIC implementation. The study also highlights the complicated relationship between TIC implementation and staff experience of VT. Finally, this study provides a blueprint for conducting program evaluations of TIC. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Dietary methionine restriction enhances metabolic flexibility and increases uncoupled respiration in both fed and fasted states.

Dietary methionine restriction (MR) is a mimetic of chronic dietary restriction (DR) in the sense that MR increases rodent longevity, but without food restriction. We report here that MR also persistently increases total energy expenditure (EE) and limits fat deposition despite increasing weight-specific food consumption. In Fischer 344 (F344) rats consuming control or MR diets for 3, 9, and 20 mo, mean EE was 1.5-fold higher in MR vs. control rats, primarily due to higher EE during the night at all ages. The day-to-night transition produced a twofold higher heat increment of feeding (3.0 degrees C vs. 1.5 degrees C) in MR vs. controls and an exaggerated increase in respiratory quotient (RQ) to values greater than 1, indicative of the interconversion of glucose to lipid by de novo lipogenesis. The simultaneous inhibition of glucose utilization and shift to fat oxidation during the day was also more complete in MR (RQ approximately 0.75) vs. controls (RQ approximately 0.85). Dietary MR produced a rapid and persistent increase in uncoupling protein 1 expression in brown (BAT) and white adipose tissue (WAT) in conjunction with decreased leptin and increased adiponectin levels in serum, suggesting that remodeling of the metabolic and endocrine function of adipose tissue may have an important role in the overall increase in EE. We conclude that the hyperphagic response to dietary MR is matched to a coordinated increase in uncoupled respiration, suggesting the engagement of a nutrient-sensing mechanism, which compensates for limited methionine through integrated effects on energy homeostasis.