Educational Interventions for Primary Care Providers to Promote a Trauma-Informed Care Approach in a Student Health Setting

Background: Adverse childhood experiences (ACEs) and trauma are associated with health-risk behaviors, leading to chronic illnesses and disease in adulthood. ACEs and trauma are widespread in the general population, with around 60% reporting at least one ACE. College students with increased exposure to ACEs exhibit higher levels of mental health symptoms and illnesses and engage in increased health-risk behaviors. As such, primary care clinicians treating college students to be educated in trauma-informed care (TIC) practices and approaches to combat this health crisis.
Purpose: The purpose of this project was to provide coordinated education to promote primary care clinicians’ understanding of trauma-informed care approaches in a student health setting.
Additional aims included measuring clinician satisfaction with educational, determining educational preferences, and measuring confidence in providing TIC post-intervention.
Methods: This project utilized a quasi-experimental one-group pre-test/post-test design to examine the effectiveness of educational interventions on TIC on a convenience sample of primary care clinicians in the student health setting affiliated with a large, mid-Atlantic public university. Participants were also asked to complete questionnaires on demographic data and prior exposure to TIC education before accessing the educational content. A post-intervention questionnaire was completed to assess participation, satisfaction with the education, and confidence level in the ability to provide TIC.
Results: In the pre-intervention baseline survey (N = 39), 76.9% had no prior TIC education, while 23.1% received prior TIC education through college, employer mandated education, and/or self-selected continuing education. When comparing the pre- and post-intervention knowledge assessment tests (n = 20), primary care clinicians’ knowledge of TIC approaches increased (p = .001) following participation in the coordinated education. No differences were noted in post-test scores between those without prior TIC education and those with prior TIC education (p = .672). Post-test scores revealed Licensed Independent Practitioners (LIPs) scored higher than nursing staff members (p = .046). There was no difference noted in post-intervention scores between those who completed only one or two interventions and those who completed all three interventions (p = .903). In the post-intervention evaluation survey (N = 31), 54.8% reported the in-person presentation as the most helpful in learning TIC approaches. 90.3% of participants reported feeling “very satisfied” with the mode and content of education provided. The majority felt “very confident” (48.4%) or “moderately confident” (41.9%) in their ability to provide TIC post-intervention. However, high confidence did not correlate with high knowledge assessment scores, with an analysis showing no relationship between test scores and confidence levels (p = .138).
Conclusions: Providing education may improve clinicians’ knowledge of trauma-informed approaches which are critical in patient interactions due to the high percentage of trauma within the greater community. Continuing education (CE) may also increase clinicians’ confidence in their ability to provide TIC. Trauma-informed education is needed not only in formal healthcare education (college, graduate school) but also as part of ongoing CE throughout a career. One exposure to trauma training is not sufficient. Because individuals’ learning preferences vary, utilizing different modes to educate may be helpful to accommodate different learning styles, however in-person training should be encouraged when available.