Innovations in Trauma-Informed Care: Building the Nation's First System of Trauma-Informed Recreation Centers.

Exposure to adversity and traumatic events affects well-being across important domains of functioning, including mental, physical, social, emotional, spiritual, and neurobiological. Situated as a focal point throughout neighborhoods, recreation centers are a prime opportunity to cultivate spaces of safety and healing. However, current models of trauma-informed care largely do not map neatly onto the recreation organizational structure and functioning. This paper describes the efforts over the past five years to transform the City of Cleveland, Ohio's 22 recreation centers into trauma-informed Neighborhood Resource and Recreation Centers (NRRCs)--places where children, youth, and adults can readily acquire the support and services they need in an environment in which trauma-informed care principles are fully embedded in the fabric of the organization's culture. Phase 1 included transitioning the recreation centers to NRRCs, hiring of trained social workers and counselors to work within the recreation centers, and training all recreation staff about trauma. Phase 2 included development of NRRC trauma-informed standards, development of the Trauma-Informed Progress Tool to track change over time, development of Trauma-Informed Leadership Competencies for Center Managers, and ongoing training for the social workers and counselors. We discuss ideas for future work and lessons learned from each phase.

Impact of COVID-19 Pandemic on Posttraumatic Stress, Grief, Burnout, and Secondary Trauma of Social Workers in the United States.

The purpose of this study is to measure posttraumatic stress, grief, burnout, and secondary trauma experienced by employed social workers in the United States and to describe organizational support provided to social workers during the novel coronavirus disease 2019 (COVID-19) pandemic. This study used data from the first wave of the COVID-19 Pandemic and Emotional Well-Being Study, a prospective panel study examining the psychological impact of the COVID-19 pandemic, and includes a sample of 181 social workers. We conducted univariate analyses. Over a quarter (26.21%) of social workers met the diagnostic criteria for PTSD and 16.22% reported severe grief symptoms. While 99.19% of the sample reported average to high compassion satisfaction, 63.71% reported average burnout and 49.59% reported average secondary trauma. Findings indicate that social workers are reporting higher than national estimates of PTSD, indicating a greater need for more emotional support during the COVID-19 pandemic. Given the significance and severity of the pandemic, it is essential that organizations provide resources for both immediate and ongoing support for the emotional well-being of their employees.

Pregnant or recently pregnant opioid users: contraception decisions, perceptions and preferences.

BACKGROUND: Multiple factors are linked to extremely high unintended pregnancy rates among women who use opioids, including various barriers to contraception adherence. These include patient level barriers such as lack of knowledge and education about highly effective contraception, and potential provider barriers. Using a mixed-methods framework to examine the contraception-related perceptions and preferences of opioid using women is a necessary next step to understanding this phenomenon. METHODS: A mixed-method study was conducted which included both self-report questionnaires along with a semi-structured qualitative interview of opioid-using pregnant or recently pregnant women in two drug treatment facilities in Ohio. RESULTS: Forty-two women completed the study. The majority of recent (75%) and total pregnancies were unintended. Male condoms were reported as the highest form of lifetime contraception used within the present sample (69%). Participants reported low lifetime use of long acting reversible contraception (LARC) (ranging from 5 to 12%). Participants preferred hormonal injections first (40%), followed by IUDs (17%). Reasons for preferences of injections and LARC were similar: not needing to remember, side effects, and long-term effectiveness. CONCLUSIONS: Most of the study population participants stated they would utilize contraception, particularly Tier 1 LARC methods, if freely available; however, high rates of unintended pregnancy were observed in this sample. This indicates the need for contraception education, and addressing the procedural, logistical and economic barriers that may be preventing the use of LARC among this population.

Leads in Arctic pack ice enable early phytoplankton blooms below snow-covered sea ice.

The Arctic icescape is rapidly transforming from a thicker multiyear ice cover to a thinner and largely seasonal first-year ice cover with significant consequences for Arctic primary production. One critical challenge is to understand how productivity will change within the next decades. Recent studies have reported extensive phytoplankton blooms beneath ponded sea ice during summer, indicating that satellite-based Arctic annual primary production estimates may be significantly underestimated. Here we present a unique time-series of a phytoplankton spring bloom observed beneath snow-covered Arctic pack ice. The bloom, dominated by the haptophyte algae Phaeocystis pouchetii, caused near depletion of the surface nitrate inventory and a decline in dissolved inorganic carbon by 16 ± 6 g C m-2. Ocean circulation characteristics in the area indicated that the bloom developed in situ despite the snow-covered sea ice. Leads in the dynamic ice cover provided added sunlight necessary to initiate and sustain the bloom. Phytoplankton blooms beneath snow-covered ice might become more common and widespread in the future Arctic Ocean with frequent lead formation due to thinner and more dynamic sea ice despite projected increases in high-Arctic snowfall. This could alter productivity, marine food webs and carbon sequestration in the Arctic Ocean.

Physician and Practice-Level Drivers and Disparities around Meaningful Use Progress.

OBJECTIVE: To identify physician and practice characteristics that are markers of success for meaningful use of electronic health records (EHRs). DATA SOURCES: American Medical Association survey, Centers for Medicare & Medicaid Services' (CMS) EHR Incentive, Pioneer Accountable Care Organization, and PECOS Programs, the Office of the National Coordinator for Health IT's Regional Extension Center Program, and National Committee for Quality Assurance Patient-centered Medical Home certification program. STUDY DESIGN: Retrospective analysis of 865,370 physicians' participation in CMS's EHR Incentive Program and progress to stage 1 Meaningful Use between 2011 and 2013. Physician specialty, age, practice size, geographic markers, delivery reform participation, and technical assistance receipt were predictive elements. PRINCIPAL FINDINGS: Medicaid physicians were progressing more slowly to Meaningful Use than Medicare physicians: by 2013, 8 in 10 physicians registered with Medicare had achieved meaningful use, compared to one-third of Medicaid-registered physicians. The strongest predictors of meaningful use were technical assistance (79 percent more likely) and delivery reform participation (34 percent more likely). CONCLUSIONS: Continued outreach and technical assistance that demonstrates strong interactions between meaningful use of health IT and delivery reform may facilitate further adoption of both initiatives.

The Cameron Complex Trauma Interview (CCTI): Development, psychometric properties, and clinical utility.

OBJECTIVE: To develop and test a pictorial-based assessment tool, the Cameron Complex Trauma Interview (CCTI), evaluating complex trauma history and symptomatology in children ages 5 to 11. METHOD: 21 participating clinicians (master's level or higher) were asked to utilize a prototype version of the CCTI and the UCLA Posttraumatic Stress Disorder Reaction Index (PTSD-RI) with 1 client, ages 5-11, with known exposure to trauma, provide demographic information, scores, and complete a Clinical Utility and Feasibility Survey (CUFS). RESULTS: The CCTI Symptomatology scale was internally consistent (a = .931). CCTI convergent validity was supported by robust correlations between the CCTI and UCLA PTSD-RI trauma history and symptomatology scales, r = .677 and .810, respectively, p < .001. CONCLUSION: Clinicians responding to the CUFS described the CCTI as comprehensive, developmentally and culturally appropriate, easy to use, and engaging. Survey data illustrated that while clinicians reported positive experiences using the CCTI, some struggled with the symptomatology scale and did not elicit information from the child on several domains of impairment. (PsycINFO Database Record