Browsing by Subject "Trauma-informed care"
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Item Open Access Building a Trauma-Informed Foster Care System: Giving Foster Parents the Tools to Help Children Heal(2019-04) Giordano, GiannaThe Adverse Childhood Experiences Study, which shows a correlation between exposure to childhood adversity and negative health outcomes such as heart disease, cancer, and lower life expectancy, makes a compelling argument for why we need to pay attention to childhood trauma. Despite the fact that all children in foster care have had at least one adverse childhood experience, the emerging scientific body of knowledge on childhood trauma has not yet produced major changes in the policies and practices of state foster care systems. One of the reasons that key actors in state foster care systems have not yet acted on recent information about trauma is they lack concrete skills on how to use this information to help children. This thesis seeks to address the gap between information and action amongst foster parents, who spend the most time with children and therefore have many opportunities to use trauma information to help children heal. Through a qualitative analysis of interviews with and survey responses from foster parents and staff at child welfare agencies in four counties in North Carolina, this study provides insight on the strengths and shortcomings of current foster parent training in North Carolina, essential skills foster parents need to work with children who have experienced trauma, and barriers to equipping foster parents with these tools. The results demonstrate that child welfare agencies in North Carolina must equip foster parents with a skill set of communication skills, sensory-based regulation strategies, and discipline techniques, and, above all, treat foster parents as critical actors in children’s healing processes.Item Open Access Flying Blind? Implementing a Trauma-Informed Care Approach in the Treatment of Trafficking Survivors(2018-12-05) Downey, CaraMillions of people are exploited for labor or sex throughout the world. Governments and non-profit organizations have increasingly explored how to best help trafficking survivors overcome their adversity through services such as counseling, job assistance, financial assistance, family reunification, and housing. However, there are few evidence-based practices for how to best care for trafficking survivors due to transitory contact between survivors and care providers, a lack of organizational capacity for research, and the need to not withhold potentially beneficial treatment from any survivor. In 2018, the United States Office to Monitor and Combat Trafficking in Persons suggested that one best practice is using trauma-informed care (TIC) due to survivors’ likelihood of having experienced complex trauma. This study examines 18 anti-trafficking organization employees’ perceptions and use of TIC in the treatment of trafficking survivors through interviews. A meta-analysis of research about the best practices of meeting the mental health needs of survivors shows in what ways providers using TIC to meet survivors’ mental health needs are not flying blind, but rather using evidence-based practices. A meta-analysis of research about the mental health needs of trafficking survivors is used to further develop providers’ understanding of survivors’ mental health needs and identify areas for further research.Item Open Access Healthcare Experiences, Needs, and Strategies of Survivors of Violence(2018) Reeves, Elizabeth AnneThe long-term and multi-faceted consequences of trauma are well documented and health conditions associated with traumatic life events are often those that benefit from early and regular attention from a healthcare provider. However, for many trauma-exposed women, seeking out and receiving healthcare is associated with physical and psychological intrusions that are linked to their traumatic experiences. Implementing trauma-informed care, based in knowledge and understanding of trauma that sensitively meets the needs of survivors, is an effective way to improve trauma survivors’ healthcare experiences. However, implementing such changes in practice to improve care for survivors is often made difficult by the current prevailing characteristics of patient-provider relationships and the U.S. healthcare system. Further, relying on providers to change practice is a disempowering position for survivors; supporting survivors to advocate for their needs within healthcare interactions and the healthcare system could be an efficient, effective and empowering solution to attaining widespread trauma-informed care.
This dissertation addresses current knowledge deficits through: 1) description and comparison of lifetime trauma exposure among community-based women from diverse locations and backgrounds; 2) examination of existing trauma-informed care practices for survivors of physical and sexual violence; and 3) descriptions of the healthcare experiences, needs, and strategies of female survivors of physical and sexual violence with regard to navigating healthcare experiences, provider interactions, and the healthcare system. A descriptive, correlational analysis and a synthesis of current literature were used to address the first and second research aims. Original qualitative interview and participatory Photovoice studies were conducted to address the third research aim.
Findings from the statistical analysis of trauma exposure among four community-based samples of women in Colombia, Hong Kong, and the United States indicate that trauma exposure is more similar than different and that trauma and its effects are pervasive in the lives of women across diverse locations. The synthesis of literature elucidates five thematic elements of trauma-informed care including: sensitive and universal screening, provider-patient relationships, minimizing distress, maximizing autonomy, and providing appropriate collaboration and referral. Findings from the qualitative interview and participatory Photovoice studies highlight imbalances in power dynamics and lack of mutual belief and trust as the most significant challenges to positive provider-patient relationships and healthcare experiences. These findings also indicate that survivors of violence use a variety of strategies to navigate healthcare encounters in the face of system-, agency- and provider-level barriers to positive healthcare experiences.
This dissertation adds to existing evidence on trauma exposure and trauma-informed care, and data on the engagement behaviors and healthcare strategies of survivors of violence addresses substantive gaps in the literature. Further, these findings generate useful frameworks and foundations for future research to continue to explore survivors’ healthcare desires, provider-survivor relationships, and provider- and survivor-led interventions to support the implementation of trauma-informed care.