Search Results (33)

The global Black Lives Matter movement and COVID-19 pandemic drew attention to the urgency of addressing entrenched structural dynamics such as racialization, gender, and colonization shaping health inequities for diverse racialized people. Canadian community-based research with racialized immigrant women recognized the need to enhance service provider capacity using a strengths-based activism approach to support client health and wellbeing. In this study, we aimed to understand the impacts of this mental health promotion practice on service providers and strategies to support them. Through purposeful convenience sampling, three focus groups were completed with 19 service providers working in settlement and mental health services in Toronto, Canada. Participants represented varied ethnicities and work experiences; most self-identified as female and racialized, with experiences living as immigrant women in Canada. Postcolonial feminist and critical mental health promotion analysis illuminated organizational and structural dynamics contributing to burnout and vicarious trauma that necessitate a focus on trauma- and violence-informed care. Transformative narratives reflected service provider resilience and activism, which aligned with and challenged mainstream biomedical approaches to mental health promotion. Implications include employing a postcolonial feminist lens to identify meaningful and comprehensive anti-oppression strategies that take colonialism, racialization, gender, and ableism and their intersections into account to decolonize nursing practices. Promoting health equity for diverse racialized women necessitates focused attention and multilevel anti-oppression strategies aligned with critical mental health promotion practices. Full article

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTEs) and developing post-traumatic stress injuries (PTSIs, e.g., depression, anxiety) by the nature of their work. PTSI is also connected to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. There is limited evidence on the cost effectiveness of proactive “prevention” programs aimed at reducing the risk of PTSIs. The purpose of this meta-analysis is to measure the economic effectiveness of proactive PTSI mitigation programs among occupational groups exposed to frequent occupational PPTEs, focusing on the outcomes related to PTSI symptoms, absenteeism, and psychological wellness. Findings from 15 included studies demonstrate that proactive interventions can yield substantial economic and health benefits, with Return On Investment (ROI) values ranging widely from −20% to 3560%. Shorter interventions (≤6 months) often produced higher returns, while longer interventions (>12 months) showed more moderate or negative returns. Notably, the level at which an intervention is targeted significantly affects outcomes—programs aimed at managers, such as the 4 h RESPECT training course, demonstrated a high ROI and broad organizational impact by enhancing leadership support for employee mental health. Sensitivity analyses highlighted significant variability based on the organizational context, program design, and participant characteristics. The majority of proactive interventions successfully reduced psychological distress and enhanced workplace outcomes, although thoughtful consideration of program design and implementation context is essential. Full article

The global mental health workforce is facing a severe crisis marked by burnout, secondary trauma, compassion fatigue, and workforce shortages, with disproportionate effects on marginalized communities. This paper introduces the Integrated Workforce Trauma and Resilience (IWTR) Model, a comprehensive framework to understand and address these interconnected challenges. This study employs a conceptual, documentary analysis approach to examine the challenges faced by mental health workers, particularly trauma, burnout, and workforce shortages. By synthesizing existing qualitative and quantitative studies, the research identifies recurring themes and provides recommendations for policy reform to improve workforce sustainability and equity. Using a thematic synthesis of 75 peer-reviewed articles, conceptual papers, and policy reports published between 2020 and 2025, alongside foundational theoretical works, the IWTR Model integrates five theoretical perspectives: trauma-informed care, Conservation of Resources Theory, Intersectionality Theory, the Job Demands–Resources Model, and Organizational Justice Theory. The analysis identifies three dimensions: the impact of trauma on mental health professionals, organizational and systemic factors influencing workforce retention, and strategies to build resilience through policy and education. The findings reveal how secondary trauma, burnout, and systemic inequities interact to undermine workforce stability and access to care. The IWTR Model emphasizes that individual-level interventions will be insufficient without addressing structural issues, such as workload inequities, lack of leadership diversity, and underfunding. This model offers a roadmap for systemic reforms to strengthen workforce resilience, improve retention, and advance global equity in mental health care systems. Full article

Trauma-informed care is an increasingly trending clinical and organizational approach globally. Multiple guidelines exist on implementing trauma-informed care across healthcare systems, behavioral health programs, academic institutions, and prisons, among other settings. Although many studies have assessed the implementation of trauma-informed care guidelines and the integration of training into curricula for healthcare providers, workforces, and in clinical practice with individuals and communities, there have been no studies previously conducted to date on assessing the existing state of coverage on trauma-informed care across social media to inform future, actionable interventions. This represents a critical gap in research and practice given the increasingly prevalent utilization and accessibility of information online, especially via a multitude of social media platforms. This study is the first to assess the sources, format, and content across one of these social media platforms on YouTube. Content on trauma-informed care was examined through conducting a descriptive, observational study to determine the depth and breadth of content that was widely covered and uncovered across the top 100 widely viewed videos. Findings revealed that most of the content was published by professional, nongovernmental sources. A wide range of resources and strategies was presented on social media for utilizing trauma-informed care across diverse settings on individual and community levels. The five principles of trauma-informed care (safety, trustworthiness, collaboration, empowerment, and choice) were heavily reviewed among the widely viewed videos. A multitude of benefits was presented in terms of implementing trauma-informed care on both micro and macro levels. Social determinants of health were not widely covered but formed some of the stressors and triggers examined among the videos. DEI principles were also scantly covered across the videos. Several clinical and organizational implications are presented. Recommendations to integrate widely covered and uncovered content as targets for intervention in informing future trauma-informed approaches are proposed. Full article

Objectives: Experiences of racial discrimination within the healthcare system are potentially traumatic events (PTEs) that have been associated with lowered perceived trust in healthcare providers, ongoing symptoms of PTSD and depression, and anticipated healthcare avoidance. Based on the BITTEN trauma impact model, we test a pathway such that greater past healthcare discrimination would be associated with anticipated future healthcare avoidance among BIPOC college students. We posited that this direct relationship would be sequentially mediated by healthcare institutional betrayal (HIB) during one’s worst healthcare event and subsequently reduced trust in healthcare. Methods: Our model was tested in a subsample of undergraduate students, all of whom self-identified with at least one minoritized racial or ethnic identity (n = 472). Participants reported on their past experiences with racial discrimination in healthcare. Each then chose and described their worst and/or most traumatic previous healthcare experience. Subsequently, they indicated if this experience included acts of HIB and/or led to medical mistrust. Finally, they reported on the degree to which they anticipated engaging in future healthcare avoidance. Results: Our model explained 31% of the variance in anticipated healthcare avoidance. As hypothesized via BITTEN, greater HIB during one’s worst or most traumatic healthcare experience and resulting mistrust in healthcare sequentially mediated the relationship between past experiences of healthcare racial discrimination and anticipated future healthcare avoidance. However, a direct relationship between racial discrimination in healthcare and anticipated healthcare avoidance was retained. Conclusions: Racial discrimination is a potentially traumatic experience associated with deleterious health outcomes. Current results suggest that healthcare discrimination may drive BIPOC college students’ future healthcare avoidance both directly and through experiencing increased healthcare institutional betrayal during one’s worst healthcare experience and resultant mistrust in healthcare. Due to the crucial role both discrimination and HIB experiences may play in healthcare outcomes, greater organizational adoption of anti-racist trauma-informed healthcare and the enactment of deliberate system-level repair strategies post discrimination and/or HIB is critical. Understanding the interplay of racial discrimination, HIB, and medical mistrust is also likely to help us address and repair system-level factors leading to anticipated healthcare avoidance behavior among BIPOC emerging adults. Full article

Background: The decision of the Joint Federal Committee on the treatment of hip fractures stipulates that proximal femur fractures must be treated within the first 24 h. This leads to organizational and personnel difficulties in day-to-day care. Therefore, we investigated the question at what times of day we operate to maintain this timeline and whether there is a difference in the outcome for the patients according to treatment hours. Methods: Data from the DGU’s “AltersTraumaRegister” from 2016 to 2020 were analyzed. For the analysis, the patients were divided into seven cohorts depending on the time of surgery. Pre-operative, operative, and follow-up data were analyzed. Results: A total of 29,470 patients were included in our study. The results showed that 74% of patients were treated within 24 h. 72% of patients operated on between 0–7 h had pertrochanteric fractures, while 56% of all arthroplasties were performed during normal working hours. In supra-regional trauma centers, significantly fewer operations were performed during normal working hours, while significantly more surgeries were carried out in the late evening and at night (p < 0.001). There were no significant differences in mortality and morbidity between the individual groups. Conclusions: Although we manage to treat most patients within 24 h, only 46% of patients are operated on within normal working hours. In terms of the outcome parameters, this does not appear to be a disadvantage for the patients. Nevertheless, night work and fatigue affect concentration and post-operative results in many areas, as we know. Consequently, patient care during normal working hours within 24 h creates the best possible initial situation for the patient, as significantly more personnel resources are available during normal working hours. The aim should be to create the logistical and personnel requirements for this. Full article

This study explored trauma-informed schools from the perspective of social workers, documenting the reported practices and policies associated with trauma-informed approaches in U.S. schools. Survey data from 538 school social workers were analyzed to investigate the differences in policies and practices between schools identified as trauma informed and not. Logistic regression analyses examined whether the presence of specific school practices and policies was associated with the identification of a school as trauma informed. Of a wide array of programs and policies that may be present in trauma-informed schools, only the presence of trauma training and resources for secondary traumatic stress were key predictors of social workers’ identification of a school as trauma informed. The implementation of trauma training has long been the primary focus of trauma-informed approaches in schools. Should commitment to trauma-informed approaches endure, we recommend moving beyond training and secondary traumatic stress resources to deepen the field’s focus on implementing trauma-informed practices and policies at all organizational levels. We also recommend that future research looks carefully at how some school safety and trauma-informed approaches may be incompatible and the extent to which trauma-informed approaches improve or detract from children’s educational experiences and outcomes. Full article

While the occupational health of sign language interpreters has traditionally focused on physical health, evidence demonstrating mental health concerns is growing and supporting a shift to a more integrated approach. We embarked on a qualitative study to guide the adaptation of a previously developed Total Worker Health^® program to the context of sign language interpreting. Eight unstructured 90-min focus groups were conducted. Interpreters reported occupational safety, health, and well-being concerns and shared their solutions for management. Twenty-seven interpreters participated (aged 53.7 years; 81% female; 85% white). Predominant concerns centered on topics like workplace violence, secondary traumatic stress or vicarious trauma, lack of work–life integration or boundaries, and loss of agency or loss of self. The organizational culture of the field fostered deprioritization of self, oppression, elitism, sexism, and unhealthy relationships with interpreter peers and community members. Physical health remained a contributor, specifically the physical effects of non-physical work, aging, and differences in exposures across interpreting settings but paled in comparison to mental health and organizational culture. Solutions for management included but were not limited to prioritization of jobs, creating safe spaces/communities of supported practice, and exercise. This study supports the evolution of future research, practice, policy, and capacity building aspiring to a more integrated approach. Full article

A cross-disciplinary rapid scoping review was carried out, generally following the PRISMA-SCR protocol to examine historical racial and caste-based discrimination as structural determinants of health disparities in the 21st century. We selected 48 peer-reviewed full-text articles available from the University of Memphis Libraries database search, focusing on three selected case-study countries: the United States (US), Canada, and Nepal. The authors read each article, extracted highlights, and tabulated the thematic contents on structural health disparities attributed to racism or casteism. The results link historical racism/casteism to health disparities occurring in Black and African American, Native American, and other ethnic groups in the US; in Indigenous peoples and other visible minorities in Canada; and in the Dalits of Nepal, a population racialized by caste, grounded on at least four foundational theories explaining structural determinants of health disparities. The evidence from the literature indicates that genetic variations and biological differences (e.g., disease prevalence) occur within and between races/castes for various reasons (e.g., random gene mutations, geographic isolation, and endogamy). However, historical races/castes as socio-cultural constructs have no inherently exclusive basis of biological differences. Disregarding genetic discrimination based on pseudo-scientific theories, genetic testing is a valuable scientific means to achieve the better health of the populations. Epigenetic changes (e.g., weathering—the early aging of racialized women) due to the DNA methylation of genes among racialized populations are markers of intergenerational trauma due to racial/caste discrimination. Likewise, chronic stresses resulting from intergenerational racial/caste discrimination cause an “allostatic load”, characterized by an imbalance of neuronal and hormonal dysfunction, leading to occurrences of chronic diseases (e.g., hypertension, diabetes, and mental health) at disproportionate rates among racialized populations. Major areas identified for reparative policy changes and interventions for eliminating the health impacts of racism/casteism include areas of issues on health disparity research, organizational structures, programs and processes, racial justice in population health, cultural trauma, equitable healthcare system, and genetic discrimination. Full article

Trauma-informed care (TIC) is a comprehensive approach that focuses on the whole individual. It acknowledges the experiences and symptoms of trauma and their impact on health. TIC prioritizes physical and emotional safety through a relationship of trust that supports patient choice and empowerment. It provides a safe and respectful healing environment that considers specific needs while promoting a greater sense of well-being, patient engagement, and partnership in the treatment process. Given the prevalence of trauma, this descriptive cross-sectional study examined the attitudes and perspectives of U.S. physicians (N = 179; 67% males; 84% White; 43% aged 56–65) in providing trauma-informed care using an anonymous 29-item online survey administered by Reaction Data. Findings showed that 16% (n = 18) of physicians estimated that >50% of their patients have a history of trauma. Commonly perceived barriers to providing TIC were resource/time/administrative constraints, provider stress, limited awareness of the right provider to refer patients who experienced trauma, and inadequate TIC emphasis in medical education/training. Expanding physicians’ knowledge base of trauma through training and organizational policy/support is crucial in enhancing their TIC competence, particularly in caring for patients with complex care needs whose social determinants increase their risk of exposure to adverse experiences that carry lasting physical and psychological effects. Full article

A thread of trauma weaves throughout the U.S. criminal legal system, beginning with individual childhood experiences that are situated within families, communities, and systems that are embedded in structural oppression, thereby increasing the risk of initial and subsequent traumas. The criminal legal system, where individuals who experience prior trauma are more likely to be system-involved, exposes racial minority youths especially to further trauma. This thread also impacts criminal legal system professionals who bear witness to the indirect trauma of victims and people who have harmed, which is often manifested in secondary and vicarious trauma symptoms, while may also cause them to grapple with their own prior trauma. The author offers a critical theory of trauma based on Bronfenbrenner’s ecological framework, first by examining select scholarly research on individual-, relationship-, community-, and system-level trauma, including trauma within the criminal legal system. The system is then examined through the lens of critical race theory, which both explains the persistence of oppression within the system and provides a path to reform by centering on the lived experiences of those most impacted. The author then applies the concepts of secondary and vicarious trauma, psychological safety, and institutional betrayal to explore original research on the impacts of working sex crimes on prosecutors. Finally, implications for system- and organizational-level change and recommendations for future research are offered, including the meaningful engagement of individuals with lived experiences in the development, implementation, and evaluation of victim-centered, trauma-informed, and culturally responsive programs and services. Full article

This study explores the relationship between staff rejection sensitivity (a psychological concept grounded in histories of loss and trauma) and organizational attachment among mental health agencies transitioning to Trauma-Informed Care (TIC), which is currently outside the focus of most research. Specifically, this study examines: (1) whether staff rejection sensitivity predicts organizational attachment; (2) whether staff turnover intentions account for the association between rejection sensitivity and organizational attachment; and (3) whether those associations hold once taking into account staff demographic factors (gender, race and ethnicity, education, and income)? Around 180 frontline workers in three Northeastern U.S. mental health agencies responded to surveys collected between 2016 and 2019 using the organizational attachment, rejection sensitivity and turnover intention measures, and their previous TIC training experience. Rejection sensitivity was significantly associated with organizational attachment (β = −0.39, p < 0.001), accounting for 6% of its variance in organizational attachment. The relationship between these variables retained significance, and staff education significantly predicted organizational attachment, with higher education predicting lower levels of organizational attachment (β = −0.15, p < 0.05), accounting for 22% of its variance. This study concludes that TIC transitioning mental health agencies’ staff with a higher rejection sensitivity are more likely to express lower organizational attachment and higher intent-to-turnover. Full article

The COVID-19 pandemic drew public attention to the essential work and vulnerability of low-income Latina immigrants. Less recognized were the ways immigrant community organizations mobilized under exceptional conditions to provide immediate support to their communities while continuing to work toward durable systematic change. This paper analyzes the approach of Mujeres Unidas y Activas (MUA) in the San Francisco Bay Area. Over three decades, MUA developed an organizing model that builds transformative relationships among peers and provides direct services and leadership development for civic engagement. MUA has a long history of research collaborations and self-study aligned with critical community-engaged research methods and values. In 2019, MUA formed a research team of its leaders and academics to analyze the impact of their model. Since data collection occurred between March 2020 and December 2022, the research also documented the organization’s response to COVID-19. This paper argues that specific organizational values and practices of liderazgo, apoyo, and confianza (leadership, support, and trust) proved to be particularly powerful resources for sustaining individuals and community work through the pandemic, enabling women who have experienced multiple forms of structural violence to perceive themselves as capable of healing themselves and their communities while working to address root causes of trauma and inequity. Full article

In 2018, the International Classification of Diseases (ICD-11) established a novel nosographic category within the stress-specific disorders known as complex post-traumatic stress disorder (C-PTSD). Characterized by distinctive clinical attributes and a limited response to conventional PTSD treatments, C-PTSD has prompted the reconsideration of care methods. Our study’s purpose was to explore the intricate factors shaping the care pathways for individuals suffering from C-PTSD. We used a grounded theorization technique involving professionals across a range of specialized French psychotraumatology institutions. The resulting comprehensive theoretical model offers valuable insights into the constitution mechanisms of these pathways, helping elucidate the varying care options. Interestingly, we found that differences in clinical perspectives were determined by the care provider’s viewpoint on clinical guidelines, screening tools, and treatment options, but also by structural and organizational factors. The distinctive dynamics and interrelationships identified in our research reveal potential areas of focus for incorporating C-PTSD care more effectively into specialized French trauma centers. This investigation offers a path toward improved understanding and management of C-PTSD, ultimately advancing patient outcomes. Full article

Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X² = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains. Full article