Comparison of Outcomes Between Professions Following an Interprofessional Continuing Education Program to Enhance Trauma Care for Children

Figures & data

Table 1. Childhood trauma ECHO series didactic topics by session.

Session	Didactic Topic	Session	Didactic Topic
1	What is Trauma?	12	Culture, Race, and Equity Part II: A School Perspective
2	Screening and Assessments	13	Culture, Race, and Equity Part III: A School Perspective
3	Screening for Resilience	14	Current Impact of COVID and How to Address It
4	Trauma-Informed Schools	15	Neurodivergence
5	Collaboration with Schools	16	LGBTQ+ Youth
6	Traumatic Grief	17	Immigrants, Refugees, and Homelessness
7	Foundations for Family Engagement	18	Cultural Humility
8	Practical Strategies for Family Engagement	19	Suicidality and Self-Harm: Part I
9	Secondary Traumatic Stress, Compassion, Fatigue, and Burnout: Part I	20	Suicidality and Self-Harm: Part II
10	Secondary Traumatic Stress, Compassion, Fatigue, and Burnout: Part II	21	Substance Use
11	Culture, Race, and Equity Part I: An Overview	22	Collaborating with Child Protective Services

Table 2. Childhood trauma ECHO series learning objectives.

Learning Objectives
1. Utilise evidence-based strategies to assess, support, and treat individuals experiencing trauma in paediatric and adolescent populations.
2. Use effective communication techniques with patients, families, and schools in a virtual environment.
3. Implement self-care strategies to combat burnout, compassion fatigue, and trauma in practice.
4. Apply best practice approaches to develop a trauma-informed work climate and teaching environment.
5. Demonstrate awareness of the impact that justice, equity, diversity, and inclusion have on trauma patients and their families.

Table 3. Childhood Trauma ECHO survey statements by domain.

Domain	Scale	Statements Assessed
Knowledge	5-point Likert scale: 1=No knowledge 2=Minimal knowledge 3=Basic knowledge 4=Adequate knowledge 5=Superior knowledge	Tools to screen and assess patients/clients/students for the side effects of trauma. Best practices to treat patients/clients/students experiencing side effects from trauma. Patient/Client/Student and Family engagement communication techniques. Best practices to develop a trauma-informed work climate. A justice, equity, diversity, and inclusion approach to care.
Self-Efficacy	5-point Likert scale: 1=Not at all confident 2=Slightly confident 3=Moderately confident 4=Very confident 5=Completely confident	My ability to use trauma-informed treatment best practices Communicating effectively with patients/clients/students and their families.
Skills	5-point Likert scale: 1=Not at all skilled 2=Not very skilled 3=Somewhat skilled 4=Skilled 5=Highly skilled	My use of evidence-based screening strategies for the side effects of trauma on my patient/clients/students. My ability to use self-care strategies in my practice/workplace.
Attitudes	5-point Likert scale: 1=Strongly disagree 2=Disagree 3=Unsure 4=Agree 5=Strongly agree	I believe potential side effects may manifest in children and youth exposed to trauma whether or not they have a specific trauma diagnosis. I believe children and youth from vulnerable populations are at higher risk of exposure to traumatic events.

Table 4. Childhood trauma ECHO participant characteristics.

	Behavioural Health Providers (n=19)	Medical Providers (n=5)	Care Team (n = 7)
Organisation Type Academic Medical Center Federally Qualified Health Center Community Mental Health Center Consulting Agency Government Agency Healthcare System Private Health Center School Based Health Center Social Determinants of Health Services University of College	1 (5%) 5 (26%) 1 (5%) 0 (0) 3 (16%) 2 (11%) 0 (0) 4 (21%) 2 (11%) 1 (5%)	0 (0) 2 (40%) 0 (0) 0 (0) 0 (0) 0 (0) 1 (20%) 1 (20%) 0 (0) 1 (20%)	0 (0) 3 (43%) 2 (29%) 1 (14%) 0 (0) 1 (14%) 0 (0) 0 (0) 0 (0) 0 (0)
Years of Experience 1–5 Years 6–10 Years	17 (89%) 2 (11%)	3 (60%) 2 (40%)	4 (57%) 3 (47%)
Team-Based Care Practices M±SD (5-point Likert scale) Discuss patients/clients with one or more care teammembers Receive referrals from other care team members Work with other care team members to refer patients/clients/students Work with other members to provide resources on where patients/clients/students can receive additional care	3.52 ± 0.84 3.68 ± 1.00 4.00 ± 0.74 3.78 ± 0.80	3.60 ± 2.00 2.8 ± 2.04 3.40 ± 1.70 3.00 ± 1.60	3.43 ± 0.80 3.0 ± 1.30 3.28 ± 1.10 3.57 ± 1.30

Table 5. Results of the paired samples t-test analysis of participant self-reported learner outcomes.

Domain	Provider Type	n	Baseline(M±SD)	Post-Series(M±SD)	Cohen’s d	P-value
Knowledge	Behavioural Health Provider Medical Provider Care Team	19 5 7	17.95 ± 2.93 14.60 ± 4.10 15.86 ± 3.08	21.00 ± 2.65 18.80 ± 4.15 21.43 ± 3.41	1.02 3.22 2.02	P < .001 P = .002 P = .002
Self-Efficacy	Behavioural Health Provider Medical Provider Care Team	18 5 6	7.00 ± 1.61 5.60 ± 1.34 6.50 ± 1.23	8.00 ± 1.33 6.00 ± 1.58 8.00 ± 1.10	0.65 0.73 1.79	P = .01 P = .18 P = .007
Skills	Behavioural Health Provider Medical Provider Care Team	17 5 5	7.18 ± 1.29 5.20 ± 1.92 6.00 ± 0.71	8.53 ± 1.28 6.40 ± 1.67 8.20 ± 1.10	0.88 0.92 2.01	P = .002 P = .11 P = .01
Attitudes	Behavioural Health Provider Medical Provider Care Team	18 5 7	9.28 ± 0.90 9.20 ± 0.84 9.00 ± 1.16	9.39 ± 0.85 9.80 ± 0.45 9.57 ± 0.79	0.12 0.67 0.59	P = .61 P = .21 P = .17

Table 6. Results of the one-way between-subjects ANOVA analysis of learner outcomes by provider type.

Domain	Provider Type	n	M±SD	F	P-value
Knowledge	Behavioural Health Provider Medical Provider Care Team	19 5 7	21.00 ± 2.65 18.80 ± 4.15 21.43 ± 3.41	1.240	P = .31
Self-Efficacy	Behavioural Health Provider Medical Provider Care Team	18 5 6	8.00 ± 1.33 6.00 ± 1.58 8.00 ± 1.10	4.678	P = .02
Skills	Behavioural Health Provider Medical Provider Care Team	17 5 5	8.53 ± 1.28 6.40 ± 1.67 8.20 ± 1.10	5.005	P = .02
Attitudes	Behavioural Health Provider Medical Provider Care Team	18 5 7	9.39 ± 0.85 9.80 ± 0.45 9.57 ± 0.79	.569	P = .57

Table 7. Summary table of Tukey’s HSD post-hoc test results among provider types’ self-reported learner outcome scores.

Dependent Variable	Provider Types (I)	Provider Types (J)	Mean Difference (I-J)	Std. Error	P
Knowledge	Behavioural Health Providers Medical Providers Care Team Members	Medical Providers Care Team Members Behavioural Health Providers	2.200 −2.629 .429	1.545 1.800 1.359	.34 .33 .95
Skills	Behavioural Health Providers Medical Providers Care Team Members	Medical Providers Care Team Members Behavioural Health Providers	2.129 −1.800 −.329	.675 .839 .675	.01* .10 .88
Self-Efficacy	Behavioural Health Providers Medical Providers Care Team Members	Medical Providers Care Team Members Behavioural Health Providers	2.000 −2.000 .000	.672 .805 .627	.02* .05 1.00
Attitudes	Behavioural Health Providers Medical Providers Care Team Members	Medical Providers Care Team Members Behavioural Health Providers	−.411 .299 .183	.399 .462 .351	.56 .87 .86

Table

	No knowledge	Minimal knowledge	Basic knowledge	Adequate knowledge	Superior knowledge	N/A
Tools to screen and assess patients/clients/students for the side effects of trauma	o	o	o	o	o	o
Best practices to treat patients/clients/students experiencing side effects from trauma	o	o	o	o	o	o
Patient/Client/Student and Family engagement communication techniques	o	o	o	o	o	o
Best practices to develop a trauma-informed work climate	o	o	o	o	o	o
A justice, equity, diversity, and inclusion approach to care	o	o	o	o	o	o

Table

	Not at all skilled	Not very skilled	Somewhat skilled	Skilled	Highly skilled	N/A
My use of evidence-based screening strategies for the side effects of trauma on my patient/clients/students	o	o	o	o	o	o
My ability to use self-care strategies in my practice/workplace	o	o	o	o	o	o

Table

	Not confident at all	Slightly confident	Somewhat confident	Very confident	Completely confident	N/A
My ability to use trauma-informed treatment best practices	o	o	o	o	o	o
Communicating effectively with patients/clients/students and their families	o	o	o	o	o	o

Table

	Strongly disagree	Disagree	Not sure/Neutral	Agree	Strongly Agree	N/A
I believe potential side effects may manifest in children and youth exposed to trauma whether or not they have a specific trauma diagnosis	o	o	o	o	o	o
I believe children and youth from vulnerable populations are at higher risk of exposure to traumatic events	o	o	o	o	o	o

Table

	Never	Seldom	About half the time	Usually	Always	N/A
Screen patients/clients/students for trauma	o	o	o	o	o	o
Create trauma-informed care plans for patients/clients/students	o	o	o	o	o	o
Engage in effective communication with your patients/clients/students and their families	o	o	o	o	o	o

Table

	They haven’t discussed it yet	There has been some discussion, but no action	They are actively making plans for implementation	They are currently implementing at least one strategy	They have implemented at least one strategy and are monitoring it	I do not know
Created self-care guidelines in your practice	o	o	o	o	o	o
Established best practice approaches to develop a trauma-informed work climate	o	o	o	o	o	o
Created policy guidelines on justice, equity, diversity and inclusion for paediatric patients/clients/students experiencing side effects from traumatic events	o	o	o	o	o	o

Table

	Never	Rarely	Sometimes	Often	Always	N/A
I communicate with other providers/care team members through Electronic Health Records.	o	o	o	o	o	o
I discuss patients/clients/students in rounds/meetings with one or more providers/care team members present.	o	o	o	o	o	o
I receive patient/client/student referrals from other providers/care team members.	o	o	o	o	o	o
I work with other members to refer the patient/client/student to a provider/care team member.	o	o	o	o	o	o
I work with other members to provide resources to patients/clients/students on where they can receive additional care.	o	o	o	o	o	o

Table

	Strongly disagree	Disagree	Not Sure/Neutral	Agree	Strongly agree
I actively participated in every ECHO session I attended.	o	o	o	o	o
I was free from distraction during every ECHO session I attended.	o	o	o	o	o
I have often referenced the materials and resources shared on this ECHO (e.g. PPT slides, recordings, etc.).	o	o	o	o	o
I often shared what I learned from this ECHO with my colleagues.	o	o	o	o	o

Table

	Very dissatisfied	Dissatisfied	Unsure	Satisfied	Very satisfied
Support provided by Programme Specialist	o	o	o	o	o
Knowledge gained from Faculty	o	o	o	o	o
Content covered during didactic presentations	o	o	o	o	o
Strategies discussed during case presentations	o	o	o	o	o
ECHO Learning Environment	o	o	o	o	o

Table

	No knowledge	Minimal knowledge	Basic knowledge	Adequate knowledge	Superior knowledge	N/A
Tools to screen and assess patients/clients/students for the side effects of trauma	o	o	o	o	o	o
Best practices to treat patients/clients/students experiencing side effects from trauma	o	o	o	o	o	o
Patient/Client/Student and Family engagement communication techniques	o	o	o	o	o	o
Best practices to develop a trauma-informed work climate	o	o	o	o	o	o
A justice, equity, diversity, and inclusion approach to care	o	o	o	o	o	o

Table

	Not at all skilled	Not very skilled	Somewhat skilled	Skilled	Highly skilled	N/A
My use of evidence-based screening strategies for the side effects of trauma on my patient/clients/students	o	o	o	o	o	o
My ability to use self-care strategies in my practice/workplace	o	o	o	o	o	o

Table

	Not at all confident	Slightly confident	Moderately confident	Very confident	Completely confident	N/A
My ability to use trauma-informed treatment best practices	o	o	o	o	o	o
Communicating effectively with patients/clients/students and their families	o	o	o	o	o	o

Table

	Strongly disagree	Disagree	Unsure	Agree	Strongly agree
I believe potential side effects may manifest in children and youth exposed to trauma whether or not they have a specific trauma diagnosis	o	o	o	o	o
I believe children and youth from vulnerable populations are at higher risk of exposure to traumatic events	o	o	o	o	o

Table

	Never	Rarely	Sometimes	Often	Always	N/A
I receive patient/client/student referrals from other care team members.	o	o	o	o	o	o
I communicate with other care team members through Electronic Health Records.	o	o	o	o	o	o
I discuss patients/clients/students in rounds with one or more members present.	o	o	o	o	o	o
I work with other care team members to refer patients/clients/students to a provider/care team member.	o	o	o	o	o	o
I work with other care team members to provide resources to patients/clients/students on where they can receive additional care.	o	o	o	o	o	o

Table

	Strongly disagree	Disagree	Unsure	Agree	Strongly agree
Participation in this ECHO has enhanced my professional satisfaction.	o	o	o	o	o
Participation in this ECHO has reduced my professional isolation.	o	o	o	o	o

Table

	Strongly disagree	Disagree	Not Sure/Neutral	Agree	Strongly agree
I apply best practices I have learned through this ECHO to all of my patients/clients/students who have been exposed to a potentially traumatic event.	o	o	o	o	o
I have applied new team-based care strategies to my practice as a result of what I learned in this ECHO.	o	o	o	o	o
I am working to change clinical operations (e.g. policies, procedures, etc.) based on best practices learned in this ECHO.	o	o	o	o	o
I am working to provide a new clinical offering (e.g. a new clinical programme, patient-focused activity, etc.) based on what I learned in this ECHO.	o	o	o	o	o

Table

	Strongly disagree	Disagree	Unsure	Agree	Strongly agree
My patients’/students’/clients’ health outcomes have changed because I practiced what I learned in Weitzman ECHO: Childhood Trauma	o	o	o	o	o
My patients’/students’/clients’ health behaviours have changed because I practiced what I learned in Weitzman ECHO: Childhood Trauma.	o	o	o	o	o

Data Availability Statement

The participants of this study did not give written consent for their data to be shared publicly. The IRB approved our application on an exemption basis. So, due to the sensitive nature of the research supporting data is not available.