Psychometric Evaluation of the TIC Grade, a Self-Report Measure to Assess Youth Perceptions of the Quality of Trauma-Informed Care They Received.

BACKGROUND: Agencies and clinical practices are beginning to provide trauma-informed care (TIC) to their clients. However, there are no measures to assess clients' perceptions of and satisfaction with the TIC care they have received. A 20-item questionnaire, the TIC Grade, was developed, based on the National Center for Trauma-Informed Care principles of TIC, to assess the patient or client perception of the TIC provided in settings that serve adolescents and emerging adults. OBJECTIVE: The goal of this project was to evaluate the psychometric properties of the TIC Grade instrument and to make recommendations for use of the full measure and its short form-an overall letter grade. STUDY DESIGN: The TIC Grade questionnaire was administered to youth over the age of 18 years from four community partners providing care to vulnerable young adults. Potential participants were offered questionnaires at the end of their visit. Those interested in participating left their completed anonymous questionnaire in a locked box to maintain confidentiality. Questionnaires were collected from 100 respondents; 95 were complete enough to include in analyses for psychometric evaluation. RESULTS: The findings of this project support the reliability and usability of the 20-item TIC Grade measure to assess youth's perceptions of the quality of TIC they received. CONCLUSIONS: This TIC-specific, behaviorally worded client report measure can assist service delivery organizations to assess their success at implementing TIC and to identify areas where further staff training and support are needed.

Improving lesbian, gay, bisexual, transgender, and queer/questioning health: Using a standardized patient experience to educate advanced practice nursing students.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) persons account for 3.5% of the population. Nursing programs in the United States provide a median of 2.13 hours of formal content regarding LGBTQ health, which contributes to iatrogenic barriers to care. Patient experiences related to inadequate provider preparation include misguided treatment strategies, impedance of communication, and abuse. A pilot educational project was developed to provide advanced practice nursing (APRN) students meaningful clinical interactions with LGBTQ-identifying standardized patients (SPs) to better prepare them to care for LGBTQ patients with cultural humility. This project was determined to be Exempt by the Institutional Review Board at the University of Michigan. Implemented in an advanced health assessment course with 99 APRN students, components of the project included course readings, lecture content, laboratory activities, an SP experience, and both large and small debriefing sessions. The SP experience itself was a 15-minute clinical encounter with a patient presenting with "abdominal pain," with an emphasis on history-taking, communication, and cultural humility. Qualitative data analysis was performed using the constant comparison method to interpret the results from student evaluations and other written feedback. This pilot project has promise to inform future educational offerings and set the standard for LGBTQ health content and application for APRN students. Further research is needed to evaluate the quality of LGBTQ content in APRN curricula to improve the ability of APRN students to provide care to LGBTQ patients.

Current State of Trauma-Informed Education in the Health Sciences: Lessons for Nursing.

BACKGROUND: Trauma has significant effects on individuals' health. Nurses are well-positioned to deliver trauma-informed care; however, there is a lack of trauma nursing education. The development of trauma education in nursing is just beginning; therefore, it is unclear what details should be integrated into nursing courses. METHOD: CINAHL, PsycINFO, MEDLINE, PubMed, and Google Scholar databases were searched to identify theoretical and empirical literature regarding trauma-information educational practices in health sciences. RESULTS: Given that different disciplines have their specific training goals and requirements, trauma-related course goals, content, format, and structure are distinct and unique across disciplines. Educators in health sciences developed guidelines for trauma curricula and strategies for maintaining classroom safety. CONCLUSION: Trauma curricula in other health science disciplines provide a framework for creating trauma curricula in nursing programs. More groundwork is needed to integrate trauma into nursing education. [J Nurs Educ. 2019;58(2):93-101.].

Application of the Modified Erikson Psychosocial Stage Inventory: 25 Years in Review.

The Modified Erikson Psychosocial Stage Inventory (MEPSI) is an 80-item, comprehensive measure of psychosocial development based on Erikson's theory with published reliability and validity data. Although designed as a comprehensive measure, some researchers have used individual subscales for specific developmental stages as a measure; however, these subscale reliability scores have not been generally shared. This article reviewed the literature to evaluate the use of the MEPSI: the major research questions, samples/populations studied, and individual subscale and total reliability and validity data. In total, 16 research articles (1990-2011) and 28 Dissertations/Theses (1991-2016) from nursing, social work, psychology, criminal justice, and religious studies met criteria. Results support the MEPSI's global reliability (aggregate scores ranged .89-.99) and validity in terms of consistent patterns of changes observed in the predicted direction. Reliability and validity data for individual subscales were more variable. Limitations of the tool and recommendations for possible revision and future research are addressed.

Lesbian, Gay, Bisexual, and Transgender health: Creating safe spaces and caring for patients with cultural humility.

BACKGROUND AND PURPOSE: This article provides foundational information about 1) the significant health disparities LGBT individuals face, which are associated with persistent discrimination, oppression, and stigmatization in both societal and healthcare settings; and 2) how cultural humility can help nurses to create safe spaces and provide optimal care for all patients. METHODS: CINAHL, Medline, PsychInfo, and GoogleScholar databases were searched to identify theoretical and empirical literature regarding LGBT health, health disparities, barriers to accessing care, unconscious bias, cultural humility, and creating safe spaces to better meet the healthcare needs of the LGBT population. CONCLUSIONS: LGBT patients' health needs are not being adequately met in many healthcare settings due to inadequate education and preparation of healthcare providers, including nurses. Lack of access to safe, appropriate, and affirming healthcare services increases the risk of poor health and persistent health disparities. IMPLICATIONS FOR PRACTICE: As the largest professional healthcare workforce, nurses can have a significant role in reducing the health disparities LGBT patients face. When armed with the tools to care for LGBT patients with cultural humility, nurses can lead clinical change within their institutions to create safe, accepting, affirming, inclusive, and welcoming environments for all patients.

Current state of screening high-ACE youth and emerging adults in primary care.

BACKGROUND AND PURPOSE: Trauma comes in many forms, including interpersonal, community, and institutional trauma. The adverse childhood event (ACE) studies demonstrated that adverse experiences in childhood can have a profound, cumulative impact on the course of health and development over a lifetime. It is critical for healthcare providers, such as nurse practitioners (NPs), working in primary care to screen adolescents and emerging adults for a history of ACEs and trauma. A review of current assessment tools used in assessing this population in health settings is needed to determine how screening for ACEs is being performed. CONCLUSIONS: Clinically efficient tools for screening and assessment of high-ACE youth in primary care settings are lacking.  Developing a process to assess ACEs, risk behaviors, and physical and mental health status that is efficient to use during a time limited clinical visit is an important step in providing holistic care to a challenging population. IMPLICATIONS FOR PRACTICE: Primary care NPs are in the perfect position to implement assessments of ACEs through trauma-informed nursing care. ACE assessment in clinical practice will provide vital information to guide the development of tailored interventions for reducing risk behaviors and mitigate the long-term impacts of ACEs.

The Effect of a Youth-Centered Sexual Risk Event History Calendar (SREHC) Assessment on Sexual Risk Attitudes, Intentions, and Behavior.

INTRODUCTION: The purpose of this study was to examine the effect of a youth-centered assessment, the Sexual Risk Event History Calendar (SREHC), compared with the Guidelines for Adolescent Preventive Services (GAPS) assessment, on sexual risk attitudes, intentions, and behaviors. METHODS: The Interaction Model of Client Health Behavior guided this participatory research-based randomized control trial. Youth participants recruited from university and community clinics in the Midwestern United States were randomized to a health care provider visit using either the SREHC or GAPS and completed surveys at baseline, postintervention, and 3, 6, and 12 months. RESULTS: Participants included 181 youth (15-25 years old) and nine providers. Findings showed that youth in the SREHC group reported stronger intentions to use condoms compared with those in the GAPS group. Age and race were also significant predictors of sexual experience. DISCUSSION: This study highlights the importance of using a youth-centered, systematic approach in the assessment of sexual risk behaviors.

Patient-Centered Participatory Research in Three Health Clinics: Benefits, Challenges, and Lessons Learned.

Research informed by individuals' lived experiences is a critical component of participatory research and nursing interventions for health promotion. Yet, few examples of participatory research in primary care settings with adolescents and young adults exist, especially with respect to their sexual health and health-risk behaviors. Therefore, we implemented a validated patient-centered clinical assessment tool to improve the quality of communication between youth patients and providers, sexual risk assessment, and youths' health-risk perception to promote sexual health and reduce health-risk behaviors among adolescents and young adults in three community health clinic settings, consistent with national recommendations as best practices in adolescent health care. We describe guiding principles, benefits, challenges, and lessons learned from our experience. Improving clinical translation of participatory research requires consideration of the needs and desires of key stakeholders (e.g., providers, patients, and researchers) while retaining flexibility to successfully navigate imperfect, real-world conditions.

What are we missing? Risk behaviors among Arab-American adolescents and emerging adults.

BACKGROUND AND PURPOSE: Research on Arab-Americans as a distinct ethnic group is limited, especially when considering the health of Arab-American youth. This study describes health risk (substance use, violence); health promotive behaviors (hope, spirituality); and sexual activity (oral, vaginal, anal sex) of Arab-American adolescents and emerging adults (aged 15-23) within their life context, as well as the association between these behaviors. METHODS: A secondary analysis of data on a subset of Arab-American participants obtained from a randomized-control trial was utilized to conduct mixed methods analyses. Qualitative analyses completed on the open-ended questions used the constant comparative method for a subsample (n = 24) of participants. Descriptive quantitative analyses of survey data utilized bivariate analyses and stepwise logistic regression to explore the relation between risk behaviors and sexual activity among the full sample (n = 57). CONCLUSIONS: Qualitative analyses revealed two groups of participants: (a) multiple risk behaviors and negative life-events, and (b) minimal risk behaviors and positive life-events. Quantitative analyses indicated older youth, smokers, and those with higher hope pathways were more likely to report vaginal sex. IMPLICATIONS FOR PRACTICE: The unique cultural and social contexts of Arab-American youth provide a framework for recommendations for the prevention of risk behaviors.

The Rapid Assessment for Adolescent Preventive Services (RAAPS): providers' assessment of its usefulness in their clinical practice settings.

INTRODUCTION: The purpose of this study was to evaluate health providers' use of the Rapid Assessment for Adolescent Preventive Services (RAAPS) screening tool to identify adolescent high-risk behaviors, its ease of use and efficiency, and its impact on provider/patient discussions of sensitive risk behaviors. METHOD: This mixed methods descriptive study used an online survey to assess providers' use of the RAAPS and their perspectives on its implementation and effect on adolescent-provider communication. The survey was completed by providers from a variety of settings across the United States (N = 201). RESULTS: Quantitative and qualitative analyses indicated that the RAAPS facilitated identification of risk behaviors and risk discussions and provided efficient and consistent assessments; 86% of providers believed that the RAAPS positively influenced their practice. DISCUSSION: Adoption of the RAAPS in practice settings could lead to more effective adolescent preventive services by giving providers a tool to systematically assess and identify adolescents at risk. Implementation of RAAPS offers health providers an efficient, consistent, and "adolescent friendly" way to identify risky behaviors and open the discussion needed to tailor interventions to meet their needs.

Patient-centered communication and health assessment with youth.

BACKGROUND: Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. OBJECTIVES: The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. METHODS: This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). RESULTS: Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. DISCUSSION: EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.

Sexual risk assessment using event history calendars with male and female adolescents.

INTRODUCTION: The purpose of this study was to explore male and female adolescents' perceptions of and differences in Event History Calendar (EHC) sexual risk assessment in a clinical setting. METHOD: This study is a secondary analysis exploring male and female qualitative data from a mixed methods study of adolescent and provider communication. Participants included 30 sexually active 15- to 19-year-old male (n = 11) and female (n = 19) patients at a school-linked clinic. The adolescents completed a pre-clinic visit EHC and then discussed it with a nurse practitioner during their visit. The adolescents shared their perceptions of the EHCs in a post-clinic visit interview. RESULTS: Constant comparative analyses revealed gender differences in: (a) adolescents' perceptions of how EHCs helped report, reflect on, and discuss sexual risk histories; (b) how adolescents self-administered EHCs; and (c) the histories they reported. DISCUSSION: The EHC was well received by both male and female adolescents, resulting in a more complete sexual risk history disclosure. Self-administration of the EHC is recommended for all adolescents, but further sexual risk assessment by nurse practitioners who use EHCs is needed.

Development and clinical use of Rapid Assessment for Adolescent Preventive Services (RAAPS) questionnaire in school-based health centers.

INTRODUCTION: The purpose of this study is to describe the development and clinical use of Rapid Assessment for Adolescent Preventive Services (RAAPS), a time-efficient screening tool to assess for multiple adolescent risk behaviors. METHOD: A retrospective chart audit was conducted to obtain descriptive data of middle school (N = 106) and alternative high school (N = 39) adolescents who completed the 17- to 18-item RAAPS questionnaire. Surveys assessed providers' evaluations of the RAAPS. RESULTS: Descriptive statistics and qualitative analysis indicated that providers using the RAAPS were able to identify risk behaviors/factors, provide counseling for these behaviors, and refer 26% of 9- to 15-year-olds and 43% of 16- to 20-year-olds for further assessment or ongoing risk counseling. In one brief clinic visit, the providers were able to address and document most risk behaviors/factors reported by the adolescents. DISCUSSION: Although psychometric analysis is needed, the RAAPS is a time efficient and comprehensive risk assessment tool. Early risk identification can assist providers in tailoring specific preventative education counseling and intervention programs that are geared to meet the specific needs of the adolescent population.

Physical activity intervention in an academic setting: focus group results.

The purpose of this study was to elicit beliefs and attitudes about increasing physical activity in the workplace among staff and faculty in an academic setting as the first phase of a three-phase pilot study. Focus groups were conducted using the Theory of Planned Behavior as the basis for exploratory questions regarding workplace physical activity. The responses were tallied and themes emerged from the qualitative analysis. The primary themes indicated that physical activity at work would be beneficial because it could allow for more free time at home. However, it would not be advantageous if it took time away from work or conflicted with supervisors' needs. Differences in the likelihood of participation in a physical activity program were noted between staff and faculty. It was clear that successful design and implementation of the program needed the support of all employees in the school.