Physician Perspectives on the Implementation of a Trauma Informed Care Initiative in the Maternity Care Setting
PDF

Keywords

trauma-informed care
adverse childhood experiences
pregnancy
primary care
qualitative

How to Cite

HuartsonK., HillT., KillamT., KellyM., & RacineN. (2022). Physician Perspectives on the Implementation of a Trauma Informed Care Initiative in the Maternity Care Setting. International Journal of Child and Adolescent Resilience, 9(1), 205-215. https://doi.org/10.54488/ijcar.2022.313

Abstract

Objectives: To explore the barriers and facilitators from the perspective of family physicians on the implementation of a pilot trauma-informed care (TIC) initiative to promote resilience, with particular emphasis on asking about adverse childhood experiences (ACEs), in a maternity care clinic.
Methods: Using an exploratory qualitative design, in-depth semi-structured interviews were conducted with family physicians who were practicing in a maternity clinic in a large Canadian city. Interviews were audio-recorded and transcribed verbatim. Transcripts were reviewed by three coders and themes were extracted using thematic analysis.
Results: The analysis of 10 interviews yielded six thematic domains. Three domains pertained to perceived barriers to obtaining an ACEs history including: (1) concern about time management, (2) initial lack of physician comfort with TIC, and (3) cultural limitations of using the ACEs questionnaire. Three themes pertained to perceived facilitators of obtaining an ACEs history including: (1) the importance of a physician champion, (2) a supportive and flexible clinic environment, and (3) improved patient-physician relationships.
Implications: In the context of a broader TIC initiative within a maternity care setting, asking patients about ACEs was generally perceived positively by physicians. Ensuring a supportive clinic environment and adequate staff training may be critical factors that contribute to successful implementation. Future research focused on diverse physician experiences in different settings are needed.

https://doi.org/10.54488/ijcar.2022.313
PDF

References

Ahmad, S. I., Rudd, K. L., LeWinn, K. Z., Mason, W. A., Murphy, L., Juarez, P. D., Karr, C. J., Sathyanarayana, S., Tylavsky, F. A., & Bush, N. R. (2021). Maternal childhood trauma and prenatal stressors are associated with child behavioral health. Journal of Developmental Origins of Health and Disease, 13(4), 483-493. https://doi.org/10.1017/S2040174421000581

Ashby, B. D., Ehmer, A. C., & Scott, S. M. (2019). Trauma-informed care in a patient-centered medical home for adolescent mothers and their children. Psychological Services, 16(1), 67-74. https://doi.org/10.1037/ser0000315

Bowlus, A., McKenna, K., Day, T., & Wright, D. (2003). The economic costs and consequences of child abuse in Canada: Report to the law commission of Canada. https://cwrp.ca/sites/default/files/publications/en/Report-Economic_Cost_Child_AbuseEN.pdf

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide. SAGE.

Cooke, J. E., Racine, N., Pador, P., & Madigan, S. (2021). Maternal adverse childhood experiences and child behavior problems: A systematic review. Pediatrics, 148(3). https://doi.org/10.1542/peds.2020-044131

Cuthbert, C., & Seng, J. (2015). What is trauma informed care and why is it important? In J. Seng & J. Taylor (Eds.), Trauma informed care in the perinatal period (pp. 13-23). Dunedin Academic Press.

Farrow, V. A., Bosch, J., Crawford, J. N., Snead, C., & Schulkin, J. (2018). Screening for history of childhood abuse: Beliefs, practice patterns, and barriers among obstetrician-gynecologists. Women's Health Issues, 28(6), 559-568. https://doi.org/10.1016/j.whi.2018.09.001

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventative Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Finkelhor, D. (2018). Screening for adverse childhood experiences (ACEs): Cautions and suggestions. Child Abuse & Neglect, 85, 174-179. https://doi.org/10.1016/j.chiabu.2017.07.016

Flanagan, T., Alabaster, A., McCaw, B., Stoller, N., Watson, C., & Young-Wolff, K. C. (2018). Feasibility and acceptability of screening for adverse childhood experiences in prenatal care. Journal of Women's Health, 27(7), 903-911. https://doi.org/10.1089/jwh.2017.6649

Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. Lancet, 373(9657), 68-81. https://doi.org/10.1016/S0140-6736(08)61706-7

Gokhale, P., Young, M. R., Williams, M. N., Reid, S. N., Tom, L. S., O'Brian, C. A., & Simon, M. A. (2020). Refining trauma-informed perinatal care for urban prenatal care patients with multiple lifetime traumatic exposures: A qualitative study. Journal of Midwifery & Women's Health, 65(2), 224-230. https://doi.org/10.1111/jmwh.13063

Hall, S., White, A., Ballas, J., Saxton, S. N., Dempsey, A., & Saxer, K. (2021). Education in trauma-informed care in maternity settings can promote mental health during the COVID-19 pandemic. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(3), 340-351. https://doi.org/10.1016/j.jogn.2020.12.005

Kern, A., Frederickson, A., Hebert, M., Bernier, A., Frappier, J. Y., & Langevin, R. (2022). Exploring the relationships between child maltreatment and risk factors for pregnancy complications. Journal of Obstetrics and Gynaecology Canada, 44(5), 496-502. https://doi.org/10.1016/j.jogc.2021.11.013

Kim, S. S., Kaplowitz, S., & Johnston, M. V. (2004). The effects of physician empathy on patient satisfaction and compliance. Evaluation & Health Professions, 27(3), 237-251. https://doi.org/10.1177/0163278704267037

MacKinnon, A. L. B., S., Killam, T., Lacombe, C., & Zumwalk, K. (2021). Enhancing Mental health in primary care: A program to incorporate mental health screening and trauma history taking into clinical practice [Manuscript submitted for publication]. Department of Psychology, University of Calgary.

Madigan, S., Wade, M., Plamondon, A., Maguire, J. L., & Jenkins, J. M. (2017). Maternal adverse childhood experience and infant health: Biomedical and psychosocial risks as intermediary mechanisms. The Journal of Pediatrics, 187, 282-289. https://doi.org/10.1016/j.jpeds.2017.04.052

McLennan, J. D., MacMillan, H. L., & Afifi, T. O. (2020). Questioning the use of adverse childhood experiences (ACEs) questionnaires. Child Abuse & Neglect, 101, Article 104331. https://doi.org/10.1016/j.chiabu.2019.104331

McLennan, J. D., MacMillan, H. L., Afifi, T. O., McTavish, J., Gonzalez, A., & Waddell, C. (2019). Routine ACEs screening is not recommended. Paediatrics & Child Health, 24(4), 272-273. https://doi.org/10.1093/pch/pxz042

Merrick, J. S., Narayan, A. J., DePasquale, C. E., & Masten, A. S. (2019). Benevolent childhood experiences (BCEs) in homeless parents: A validation and replication study. Journal of Family Psychology, 33(4), 493-498. https://doi.org/10.1037/fam0000521

Mersky, J. P., & Lee, C. T. P. (2019). Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC Pregnancy Childbirth, 19(1), Article 387. https://doi.org/10.1186/s12884-019-2560-8

Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect, 37(11), 917-925. https://doi.org/10.1016/j.chiabu.2013.07.011

Muzik, M., Ads, M., Bonham, C., Rosenblum, K. L., Broderick, A., & Kirk, R. (2013). Perspectives on trauma-informed care from mothers with a history of childhood maltreatment: A qualitative study. Child Abuse & Neglect, 37(12), 1215-1224. https://doi.org/10.1016/j.chiabu.2013.07.014

Olsen, J. M., Galloway, E. G., & Guthman, P. L. (2021). Exploring women's perspectives on prenatal screening for adverse childhood experiences. Public Health Nursing, 38(6), 997-1008. https://doi.org/10.1111/phn.12956

Purkey, E., Patel, R., Beckett, T., & Mathieu, F. (2018). Primary care experiences of women with a history of childhood trauma and chronic disease: Trauma-informed care approach. Canadian Family Physician, 64(3), 204-211. https://www.ncbi.nlm.nih.gov/pubmed/29540391

Racine, N., Ereyi-Osas, W., Killam, T., McDonald, S., & Madigan, S. (2021). Maternal-child health outcomes from pre- to post-implementation of a trauma-informed care initiative in the prenatal care setting: A retrospective study. Children, 8(11), Article 1061. https://doi.org/10.3390/children8111061

Racine, N., Killam, T., & Madigan, S. (2019). Trauma-informed care as a universal precaution: Beyond the adverse childhood experiences questionnaire. JAMA Pediatrics, 174(1), 5-6. https://doi.org/10.1001/jamapediatrics.2019.3866

Racine, N., Plamondon, A., Madigan, S., McDonald, S., & Tough, S. (2018). Maternal adverse childhood experiences and infant development. Pediatrics, 141(4), Article e20172495. https://doi.org/10.1542/peds.2017-2495

Racine, N., Zumwalt, K., McDonald, S., Tough, S., & Madigan, S. (2020). Perinatal depression: The role of maternal adverse childhood experiences and social support. Journal of Affective Disorders, 263, 576-581. https://doi.org/10.1016/j.jad.2019.11.030

Seng, J. (2015). Why trauma informed care in the perinatal period? In J. Seng & J. Taylor (Eds.), Trauma informed care in the perinatal period (pp. 1-12). Dunedin Academic Press.

Sperlich, M., Seng, J., Rowe, H., Fisher, J., Cuthbert, C., & Taylor, J. (2017). A cycles-breaking framework to disrupt intergenerational patterns of maltreatment and vulnerability during the childbearing year. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3), 378-389. https://doi.org/10.1016/j.jogn.2016.11.017

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. (SMA) 14-4884). https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf

Tink, W., Tink, J. C., Turin, T. C., & Kelly, M. (2017). Adverse childhood experiences: Survey of resident practice, knowledge, and attitude. Family Medicine, 49(1), 7-13. https://www.ncbi.nlm.nih.gov/pubmed/28166574

Weinreb, L., Savageau, J. A., Candib, L. M., Reed, G. W., Fletcher, K. E., & Hargraves, J. L. (2010). Screening for childhood trauma in adult primary care patients: A cross-sectional survey. Primary Care Companion to the Journal of Clinical Psychiatry, 12(6), e1-e10. https://doi.org/10.4088/PCC.10m00950blu