Differences in trauma-informed care implementation by clinic-level factors across Ryan White HIV clinics in the Southeastern United States

ABSTRACT

Trauma is common among people with HIV (PWH) and associated with low HIV care engagement, thus trauma-informed care (TIC) integration within HIV services is critical. From December 2019 to April 2020, we conducted surveys with 321 administrators, providers, and staff of 46 Ryan White HIV clinics (RWCs) in 8 Southeastern U.S. states to assess level of TIC implementation and clinic-level factors associated with TIC adoption. The mean score for TIC implementation was highest for the Physical Environment domain (μ = 4.08, SE = 0.07), followed by Screening, Assessment, and Treatment Services (μ = 3.96, SE = 0.07), Cross-sector Collaboration (μ = 3.75, SE = 0.08), Engagement and Involvement (μ = 3.92, SE = 0.09); and Training and Workforce Development (μ = 3.54, SE = 0.12). Greatest gaps were in staff TIC training, staff support, presence of onsite legal, spiritual, and housing services, and seeking patients’ definitions of safety and developing their individualized crisis/safety plans. Across most TIC implementation domains, clinic type, urbanicity, academic affiliation, and presence of onsite psychosocial support services were associated with level of TIC adoption. Thus, RWCs have the necessary foundation to integrate TIC practices, but further progress will require addressing identified gaps. The overall lack of significant difference in TIC implementation across domains by clinic-level factors suggests that a RW network-wide approach to enhancing TIC integration is feasible.

KEYWORDS:

• Trauma-informed care
• HIV
• trauma
• HIV care

Acknowledgements

We would like to sincerely thank the study participants for openly their sharing their perspectives and the Southeast AIDS Education and Training Center and the Ryan White Clinical Conference organizers for allowing us to publicize the study.

Data availability statement

The data underlying this study contain sensitive and potentially identifying information and cannot be shared publicly. Interested researchers can request access to the data by contacting the Corresponding Author.

Disclosure statement

No potential competing interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institutes of Health/National Institute of Mental Health under [Grant #R56MH119903-01A1].