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The concept of equity recognizes historical and current barriers and promotes thriving for veterinary teams and people and animals in the community. Veterinary medicine lacks sociodemographic diversity; veterinarians and other team members who identify with systemically excluded groups offer valuable contributions but are at risk of workplace discrimination. Client families who face barriers for financial and other reasons are at risk of poor animal health and welfare outcomes, including separation from their animals. This article is part one of 2 articles reviewing how the concept of equity applies and could transform well-being in companion animal veterinary practice in North America.

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This practitioner essay will discuss the evidence base for an Australian trauma-informed kickboxing program, The Fight Back Project. We share key differences and adjustments while delivering this program in the Salvadoran context. We consider practitioner assumptions and limitations when transferring trauma-informed practice principles from the Global North to the Central American setting, and the criticality of gender-responsive adaptations. Drawing from existing research on the benefits of trauma-informed martial arts as a form of physical exercise, we describe the collaborative development and implementation of a trauma-informed kickboxing program alongside a local, community-led organization.

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Justice-involved youth have high rates of mental health symptoms and diagnoses. Unaddressed mental health needs are associated with exposure to adversity and trauma, as well as unidentified or mislabeled symptoms that may be present early in life. Justice-involved youth disproportionately come from low-income families and minoritized populations. Community-based interventions that address family and community factors associated with justice involvement are key to improving mental health and life trajectory outcomes for youth. Policies and interventions that address unmet educational needs, support families, and promote early identification of youth in need of social, educational, and mental health services are reviewed.

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Pediatric mental health needs are currently on the rise across all levels of care. The COVID-19 pandemic accentuated concerns within our mental health system, not only for those requiring care, but also for care providers. One particular area of concern is access to care for those that require acute care or crisis stabilization (eg, emergency department visits or stays on crisis stabilization units). The Attachment, Regulation, and Competency (ARC) approach, a flexible trauma-informed treatment framework, provides equitable and effective treatments for youth as well as systems to support health care professionals caring for these youth. Trauma-informed care, particularly that which incorporates restorative practices, increases equity for racially and ethnically minoritized youth and informs the creation of upstream, midstream, and downstream policy interventions.

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Forced displacement can expose youth to unimaginable levels of traumatic life events. We discuss how home-based, school-based, and community-based services can be strategically situated to address the psychological sequelae of such events. Given the systemic challenges that refugee youth face when establishing trust in their new environments, are often from collectivist cultural backgrounds, espouse stigma towards professional help seeking, and must prioritize accessing services for their basic needs, these types of settings can be particularly relevant. In the administration of such services, we advocate for an intentional approach to addressing basic needs as well as using cultural brokers, validated measures, and family- and school-based interventions.

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This article discusses the tensions around trauma-informed narratives and mind-body practices, which may obscure social inequalities. We present the evaluation of community yoga programs and explore how trauma-informed yoga can be part of the healing process of women subject to interlocking systems of oppression. The study showed how the sociocultural location of participants shaped their engagement with normative yoga discourses and practices. Yoga was perceived as a practice that improved the sense of healing and well-being, and created relational spaces during COVID-19. The article also discusses the value of embodied self-inquiry as an intersectional feminist tool for researchers and practitioners.

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Events such as the COVID-19 pandemic and the war in Ukraine have increased people's awareness of mental health issues. Psychological trauma impacts patients in the acute care setting through physical and mental health presentations. Trauma is a public health issue crossing all socioeconomic groups and is related to social determinants of health. Trauma-informed care (TIC) is an evidence-based approach to providing care. TIC is within the scope of nursing practice and improves outcomes for patients. However, there is a lack of standard terms or practices within healthcare. Additionally, there is superficial acknowledgment of the need for TIC at the local or national level regarding policy. Nurses need to adopt TIC into practice and advocate for policy change to improve the health and lives of those seeking care.

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PURPOSE: Children with behavioral issues in residential care settings have high rates of trauma, with a range of trauma experiences such as abuse and neglect, issues with attachment, and multiple disruptions in placements. Staff in these settings should have an understanding of trauma, its impact, and how to engage in trauma-informed practice.The purpose of this study was to examine whether a trauma-informed training, developed specifically based on the identified needs of a residential group care facility, had an impact on future staff attitudes and behaviors. MATERIALS AND METHODS: A 3-h training was delivered by the researchers. Three identical sessions were provided to all 48 staff, regardless of education and role, across a 3-day period. Prior to the training, staff were given a pretest survey measuring components of trauma-informed (TI) practice that indicated how often the staff members engaged in TI practice. Thirty days later, the same participants completed a posttest survey to gauge if the training had an impact on their subsequent attitudes and behavior. RESULTS: There were improvements in many of the trauma-informed practice areas on the posttest survey. T-test analysis revealed five trauma-informed practice areas had improvements that were statistically significant from the pretest survey. DISCUSSION: The findings present the opportunity for recommendations for trauma-informed training development and delivery, as well as providing implications for the field of social work. CONCLUSION: This study demonstrates the feasibility of administering a trauma-informed training program and observing relatively rapid improvements in future attitudes and behavior among staff.

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The concept of equity recognizes historical and current barriers and promotes thriving for veterinary teams and people and animals in the community. It is possible to design equitable workplace systems to prevent and respond to harm using learnings from human medicine and the social sciences. These systems are grounded in the principles of health equity and must incorporate both formal policies and intentional cultivation of supportive culture and relationships. This article is part 2 of 2 articles reviewing how the concept of equity applies and could transform well-being in companion animal veterinary practice in North America.

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In response to communities where individuals experience both disproportionate numbers of Adverse childhood experiences (ACEs) and other health inequities, narrative change has emerged as a powerful tool to change how ACEs are viewed and addressed by communities. The special issue presents a set of papers examining efforts to use narrative change to address ACEs. In this commentary, we offer reflections on the introduction and three articles of the special issue and point to future considerations for implementation and impact of community narrative initiatives. For example, we assert that to prevent and address the outcomes of ACEs such as substance use and mental health problems, communities need to include and amplify the voices of those with lived experience during decision-making about policy. We also espouse using research models of resilience in communities as a way to further uptake of narrative change strategies in the literature on ACEs and health disparities in communities. Using trauma-informed outcomes and measures are also critical to measure how narrative change can move the needle to promote health equity.

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BACKGROUND: Exposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners' perspectives on trauma-informed primary care. METHODS: Eight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis. RESULTS: 13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment. CONCLUSIONS: This review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses.

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BACKGROUND: Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample. PARTICIPANTS AND SETTING: Medical records of children with child welfare involvement with at least one behavioral health condition (i.e., mental, behavioral or neurodevelopmental disorder, ICD-10 F01-F99) between 1/1/2018-12/31/2021 were extracted from a large, academic hospital system. METHODS: Behavioral health complexity was categorized as non-chronic, non-complex chronic, or complex chronic using the Pediatric Medical Complexity Algorithm. Partial proportional logistic regression models adjusted for age, sex, race/ethnicity, caregiver type, and physical health complexity generated odds of behavioral health complexity by maltreatment type (physical abuse, sexual abuse, neglect) and maltreatment combinations. RESULTS: The analytic sample included 3992 participants (mean age 7.6 (Standard Deviation, 5.0) 44 % female, 29 % white, 32 % black, 22 % Hispanic). Participants who experienced physical abuse (Odds Ratio [OR]: 1.79, 95 % Confidence Interval [CI]: 1.10-2.91), or neglect (OR: 1.69, 95 % CI: 1.38-2.07) were more likely to have increasing behavioral health complexity versus those without maltreatment. Participants with both physical abuse and neglect were over twice as likely (OR: 2.44, 95 % CI: 1.88-3.16) to have increasing behavioral health complexity versus those who did not experience maltreatment. CONCLUSION: Results emphasize the differential impacts of maltreatment and polyvictimization exposures on behavioral health complexity among children with child welfare involvement that can guide risk assessment and clinical care.

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Child maltreatment affects millions globally across all economic levels. Despite its prevalence, comparative research and internationally comparable data are limited due to varied definitions, methodologies, and reporting systems. This narrative review aims to compare child maltreatment trends in the U.S. and Japan, highlighting the roles of sociocultural factors. Through a literature review and analysis of national data since 1990, the study estimates maltreatment and fatality rates in both countries. Findings suggest an increase in Japan's reported maltreatment cases, likely attributable to legislative changes and heightened public awareness, while the U.S. appears to show a decline, potentially linked to improved mental health services and socioeconomic advancements. In both nations, mothers are predominantly identified as perpetrators, with sociocultural factors influencing maltreatment types and rates. Japan faces challenges in accurately measuring maltreatment due to reporting inconsistencies and mental health stigma. Despite a higher victimization rate, Japan reports significantly fewer fatalities than the U.S., with the fatality rate in the U.S. being approximately 9 times higher than in Japan. This contrast underscores the critical role of healthcare access and mental health support. The review advocates for international efforts to standardize maltreatment definitions and reporting, suggesting the adoption of trauma-informed care and comprehensive healthcare access as effective strategies.

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BACKGROUND: The literature on trauma-informed care practices (TIC) indicates that this framework is beneficial for young people, carers, and staff. However, a significant gap in the literature and practice is the absence of psychometrically sound scales to measure carer adherence to TIC principles. Emerging evidence suggests that TIC practices shift carer attitudes and beliefs, which mediate positive outcomes for both carers and young people. OBJECTIVE: To develop a theoretically comprehensive and psychometrically sound measure of carer TIC beliefs using Rasch methodology. PARTICIPANTS AND SETTING: Active carers (N = 719, M = 43 years, SD = 10.7 years) from online support groups in Australia, Canada, the United States of America, the United Kingdom, and the Republic of Ireland completed the questionnaire online. METHODS: Based on previous research (e.g., limitations of the Trauma-Informed Belief Scale-Brief [TIBS-B]; Beehag, Dryer, et al., 2023a) and a scoping review of the TIC literature (Beehag, 2023), 61 candidate items were created that covered the three main characteristics of carer-related TIC theory (i.e., beliefs on TIC strategies to manage trauma symptoms, beliefs on the impact of adverse childhood experiences (ACE), and beliefs on the importance of self-care/reflection). The resulting data was subjected to Rasch analyses. RESULTS: Following analyses and minor modifications, a 35-item version of the questionnaire was confirmed, which fitted the Rasch model and demonstrated unidimensionality, reasonable targeting, and sound internal consistency reliability (Person Separation Index = 0.81). CONCLUSIONS: The TIBS-C is a psychometrically sound measure of child welfare carer TIC beliefs. Future studies are needed to provide further evidence of its validity (e.g., predictive validity), reliability (e.g., test-retest reliability) and clinical utility.

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BACKGROUND: Children and young people (CYP) in contact with child welfare services are at high risk of developing mental health problems. There is a paucity of evidenced-based preventative interventions provided to this population. OBJECTIVE: This project worked in partnership with CYP, their parents/caregivers and the professionals who support them to co-produce a preventative mental health intervention for CYP in contact with child welfare services. PARTICIPANTS AND SETTING: We recruited a purposive sample of CYP in contact with child welfare services (n = 23), parents/caregivers (n = 18) and practitioners working within child welfare services and mental health services (n = 25) from the North East of England and convened co-production workshops (n = 4). METHODS: This project followed the established principles for intervention development, applying the six steps to quality intervention development (6SQUID) approach. The mixed method research consisted of four work packages with continuous engagement of stakeholders throughout the project. These were: a systematic review of reviews; focus groups with practitioners; interviews with parents/caregivers and CYP; co-production workshops. RESULTS: We identified that the primary risk factor affecting CYP in contact with child welfare services is the experience of childhood adversity. The quality of relationships that the CYP experiences with both their parent/caregivers and the professionals involved in their care are considered to be the main factors amenable to change. CONCLUSIONS: We found that a trauma-informed, activity-based intervention with an embedded family-focused component provided to CYP who have experienced adversity is most likely to prevent mental health problems in those in contact with child welfare services.

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This paper assesses literature regarding the sexual and reproductive healthcare (SRH) needs of resettled refugee women who experienced gender-based violence (GBV) and trauma-informed care (TIC) principles utilized among SRH service providers. A systematic search identified relevant studies published between 2000 and 2021; no articles found reflected both SRH and TIC principles among refugee women. The search was therefore separated into two aims: to review the literature about SRH needs for refugee women in resettlement countries who experienced GBV (Aim 1) and to examine the use of TIC principles in SRH care among women who experienced GBV (Aim 2). Thematic analysis of the articles identified key themes. Twenty-six articles were included in the analysis across both aims (Aim 1 = 8, Aim 2 = 18). Aim 1 articles shared three factors shaping the SRH needs of resettled refugee women: the centrality of violence and trauma; structural barriers to SRH care; and actions, practices, and resources for service providers. Aim 2 articles illustrated seven key principles of TIC used in SRH service provision, such as empowerment; trauma-specific services and integrated care; connection; safety; collaboration; identity culture and context; and trustworthiness. Resettled refugee women's experiences of violence necessitate trauma-informed SRH health care. While there is limited peer-reviewed literature regarding TIC-SRH care for refugee women, the findings regarding the SRH needs of refugee women and the findings regarding the implementation of TIC in SRH collectively frame recommendations for how SRH can be infused with TIC. An example from practice, in the form of the Refugee Women's Health Clinic, is included as an exemplar of TIC SRH principles in action for the health of resettled refugee women who have survived gendered violence.

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Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.

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Obstetrics and gynecology hospitalists play a vital role in reducing maternal morbidity and mortality by providing immediate access to obstetric care, especially in emergencies. Their presence in hospitals ensures timely interventions and expert management, contributing to better outcomes for mothers and babies. This proactive approach can extend beyond hospital walls through education, advocacy, and community outreach initiatives aimed at improving maternal health across diverse settings.

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BACKGROUND: Labor trafficking of registered nurses (RNs) in the USA impedes justice by denying inalienable human rights and equal economic opportunities. Nursing shortages in developed countries, poverty, social upheaval, and government actions influence migration, as do other factors related to determinants of health. Migrant RNs are visa workers, displaced, refugees, immigrants, or asylum seekers. Labor traffickers target vulnerable migrant RNs seeking employment outside their home country. Unlike ethical recruiters, traffickers lure migrant RNs into indentured contracts in work environments that result in health-threatening conditions, long shifts, and exorbitant fines that threaten families with financial retribution. PURPOSE: The purpose of the paper is to raise awareness. METHODS: Authors explain the background of influences and nuances in migrant RN labor trafficking. DISCUSSION: Identifying labor traffickers' deceitful, coercive, fraudulent, and illegal methods, assist organizational approaches for establishing Total Worker Health, trauma-informed care, coordinated community response, and No Door Closed actions when wanting to mitigate or eradicate labor trafficking of migrant RNs.

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Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic's importance and intention to translate knowledge into practice.