James Topitzes

Aims: This study aimed to describe how emergency nurses (ENs) experience secondary traumatic stress (STS) within their practice environments, focusing on the strategies they use to cope and the supportive resources they draw upon to manage its impact on their lives. Design: This paper presents the qualitative findings from a larger mixed‐methods survey study on STS among ENs. Methods: A geographically diverse U.S. sample of ENs was recruited through social media to participate in an online survey. All participants ( n = 275) were asked to respond to open‐ended survey questions, and 118 of these participants provided answers to at least one open‐ended question. A self‐selected sample of 20 ENs completed semi‐structured interviews. Inductive content analysis was used to analyse open‐ended survey responses and interview transcripts. Results: Three themes reflected ENs' experiences with STS: STS Is Real—It's Going to Affect Your Life; Something Must Be Wrong With Me: A Culture of Disconnection; and It's a Systems Issue, but We're in It Together. Participants described individual, unit, and organizational factors that influenced their experiences of STS and their access to and use of coping strategies and supportive resources. Conclusion: ENs and nurse leaders acknowledged the impact of STS on their personal and professional lives and emphasized how the practice environment shaped their experiences. They perceived the accessibility of organizational resources, leadership behaviours, and team culture as influencing the individual strategies ENs use to manage the effects of repeated exposure to others' traumatic experiences. STS is a predictable occupational hazard for ENs; thus, healthcare organizations must invest in nurse‐identified supports to preserve workforce well‐being and clinical expertise. Implications for the Profession: Assessing organizational readiness to address STS is recommended to ensure ENs receive effective, timely support. In response to these assessments, healthcare organizations should develop and implement policies that prioritize the mental health and well‐being of ENs, including proactive support systems and accessible mental health resources. Impact: This study identifies participant‐perceived individual, team, leadership, and organizational conditions that may hinder or support ENs' management of STS. These findings identify potential targets for organizational assessment and support strategies intended to foster healthier practice environments and promote safe, high‐quality care. Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting.

Purpose: Adverse childhood experiences (ACEs) are hypothesized to increase breast cancer risk via social and physiological pathways, yet associations between ACEs and young-onset breast cancer (BC) subtypes–and potential mediators (e.g., adiposity) of these associations–are largely unstudied. We sought to evaluate associations between ACEs and young-onset BC molecular subtypes, and the potential mediating effects of adiposity, in a population-based case–control study of invasive young-onset BC. Methods: Cases (n = 1,754) were identified from the Los Angeles County and Metropolitan Detroit SEER registries, 2010–2015, and area-based, frequency-matched controls (n = 1,350) sampled from the 2010 Census. Associations between ACEs aged < 18 years and young-onset BC (diagnosed ages 20 to < 50 years), overall and by subtype (luminal A, luminal B, HER2 + , triple negative [TN]), were examined using weighted logistic regression. Adult adiposity (i.e., body mass index 12 months before diagnosis, waist circumference at interview) was evaluated as a mediator of these associations using weighted path analyses. Results: ACEs (≥ 1 vs 0) were not significantly associated with young-onset BC (all p _trend > 0.10); however, reporting one ACE (vs 0) was associated with TN (odds ratio [OR] = 1.85 [95% confidence interval [95%CI] = 1.08–3.16]). For individual ACEs, death of a loved one (vs 0 ACEs) was associated with HER2 + (OR = 2.50 [95%CI = 1.06–5.88]) and potentially TN (OR = 1.72 [95%CI = 0.96–3.10]) young-onset BC; other associations were non-significant. In path analyses, ACEs had a significant total effect on luminal A (β = 0.08, p = 0.03) and TN (β = 0.13, p < 0.01) tumors, with adiposity mitigating this association for luminal A tumors (β = -0.01, p = 0.04; TN β = 0.00, p > 0.05). Conclusions: Bereavement during childhood was associated with higher odds of HER2 + young-onset BC, and there was some evidence of an association between ACEs and other young-onset BC subtypes, particularly TN.

Research on the effectiveness of Vocational Rehabilitation (VR) Programs has revealed that VR services are less effective for trauma-affected and Black consumers. For instance, consumers with trauma exposure disengage from services earlier than their non-traumatized counterparts, and Black consumers benefit less from each phase of VR services compared to others. One midwestern state’s VR program sought to address these disparities by offering trauma-informed and trauma-responsive services that emphasize cultural responsiveness, racial equity, and strengths-based practices. To begin this work, the state’s VR program collaborated with an applied research unit in a public university to establish two work groups: a communications group and a training group. The purpose of the communications group was to build a robust referral network within the VR Division and with other community-based agencies and providers, particularly for low-income, Black consumers. The purpose of the training group was to develop and deliver a training program to support VR professionals in providing trauma-informed and trauma-responsive services. Results from an evaluation of the training indicated that each training module generated for staff both reminders and new insights into ways to effectively work with consumers. Staff expressed that they wanted opportunities to further explore and apply the training content and needed additional, ongoing support to implement what they were learning. In response to staff needs, the state’s VR program is continuing to invest in this community–university partnership by establishing communities of practice for staff and evaluating the effectiveness of the training program.

The current study tested a trauma screening, brief intervention, and referral to treatment (T-SBIRT) interview protocol as implemented within Temporary Assistance to Needy Families programming. Using a non-experimental process evaluation and quasi-experimental outcome evaluation (N = 88), the study assessed four research questions. First, do T-SBIRT providers reach model adherence rates above 90%? Second, do over 90% of T-SBIRT completers experience the intervention as tolerable? Third, is T-SBIRT completion associated with decreases in mental health symptoms? Fourth, is T-SBIRT completion linked to reductions in positive mental health screenings? Process data emerged from provider-completed integrity checklists. Participant-completed baseline and follow-up surveys furnished outcome data, i.e., mental health indicators from validated scales of depression, anxiety, and post-traumatic stress disorder (PTSD). Descriptive statistics answered questions one and two; multivariate analyses addressed questions three and four. Results revealed that providers realized adherence rates at 98.5%; 91.3% of completers found the protocol tolerable; and completers reported significant reductions in depression symptoms, PTSD symptoms, and positive PTSD screenings relative to a comparison group. Findings recommend integrating T-SBIRT into social services to promote participant mental health and potentially enhance program outcomes. Future T-SBIRT research should include a randomized controlled trial assessing long-term mental health, employment, and income outcomes.

Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community‐based resources, and addressed structural and systemic barriers. The data generated a theory of “a mutual process of healing self and healing the community” through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer‐led, community‐engaged initiatives and holistic, trauma‐informed, healing‐centered practices.

Research suggests that low-income adults accessing employment services have experienced high levels of trauma exposure and associated consequences. Moreover, the health-related effects of trauma undermine employment and employability. A trauma-informed protocol—trauma screening, brief intervention, and referral to treatment or T-SBIRT—was therefore implemented within employment service programs serving low-income urban residents. To assess the feasibility of integrating T-SBIRT within employment services, five domains were explored as follows: suitability, acceptability, client adherence, provider adherence or fidelity, and intended outcomes. With a sample of low-income adults (N = 83), the study revealed that T-SBIRT is suitable for employment service participants given high rates of trauma exposure (90.4% experienced two or more lifetime traumas), along with high rates of positive screening results for post-traumatic stress disorder (48.8%), major depression (35.4%), and generalized anxiety (47.6%). Study participants appeared to find T-SBIRT acceptable as evidenced by an 83% acceptance rate. All participants accepting T-SBIRT services completed them, revealing strong client adherence. Provider adherence or model fidelity was high, that is, 98.5%. Finally, the majority of participants accepted a referral to a mental health care (i.e., 56.6%), and over three-quarters accepted a referral to any outside service including primary or mental health care. Implications of findings are discussed.

Trauma-informed or trauma-responsive programing has spread across many service sectors including child welfare. However, only a few evaluations of such child welfare programs have been published. The current mixed methods study assessed a trauma-responsive child welfare program implemented within a private agency located in the Midwest region of the United States. The intervention combined specialized training, assessment, case planning, and case consultation into a trauma-responsive case management model. Quantitative data, gathered through a quasi-experimental design (N = 598), revealed that program participation was associated with improved permanency but not with enhanced child safety. Qualitative data, gathered from staff interviews (N = 10), helped to contextualize quantitative results, highlighting staff experiences and impressions of the program. Implications of results are discussed.

Ellen Goldstein, PhD; Jann Murray-García, MD, MPH; Andrés F Sciolla,...