It takes more than rainbows: Supporting sexual and gender minority patients with trauma-informed cancer care.

BACKGROUND/PURPOSE: The American Society of Clinical Oncology has called for an increased priority to improve cancer care for sexual and gender minority (SGM) populations because of heightened risk of receiving disparate treatment and having suboptimal experiences, including perceived discrimination. We demonstrate how integrating trauma-informed care (TIC) principles across the cancer continuum is a key strategy to improving care delivery and outcomes among SGM populations. METHOD: This empirically informed perspective expands on the concepts generated through the American Society of Clinical Oncology position statement and uses the Substance Abuse and Mental Health Services Association's "Four Rs" Toward Trauma Informed Care: Realize, Recognize, Response, and Resist Traumatization. RESULTS: Recommendations for each component of TIC include: (1) Realize: Implement SGM cultural humility training, including modules on SGM-specific trauma, discrimination, harassment, and violence; (2) Recognize: Routinely screen for emotional distress using methods to ensure privacy, and/or normalize mental health screenings to cancer patients; (3) Respond: Create and widely disseminate policies and patients' rights that prohibit discrimination and ensure access to gender-neutral clinical environments; and (4) Resist Traumatization: Establish and respond to quality metrics (e.g., standardized patients, patient satisfaction surveys) that are informed by a community advisory board with the purpose of ensuring and maintaining quality care. CONCLUSIONS AND IMPLICATIONS: Integrating TIC principles into cancer care for SGM populations is crucial to address disparities in treatment and clinical outcomes. Our recommendations offer practical approaches for oncology teams to implement TIC care and ensure equitable and inclusive cancer care for patients and their families.

Situating nursing science and public health within a shared context.

The purpose of this editorial is to discuss the opportunities associated with situating nursing science and public health within a shared context as an avenue for nursing to capitalize on its strong foundation for promoting health equity and mitigating the many social and structural determinants of poor health. We highlight one example of how this might be done, by housing departments of nursing in larger colleges of public health. Conducting nursing science within a college of public health presents both opportunities and challenges which are discussed here. Considering the benefits and challenges of collectively situating nursing and public health with a shared context creates numerous natural starting points for productive conversation, collaboration, and discovery that can benefit both public health and nursing's ability to interrogate past harms and transform our approach to move towards a more healthy and equitable future for all.

Trauma History as a Significant Predictor of Posttraumatic Growth Beyond Mental Health Symptoms in Women-Identifying Survivors of Undergraduate Non-Consensual Sexual Experiences.

There is little data on what influences posttraumatic growth for women who experienced non-consensual sexual contact (NCSC) as an undergraduate college student. The purpose of this study is to garner a better understanding of posttraumatic growth among women-identifying survivors of undergraduate NCSC by addressing the following aims: 1) evaluate the mediating role of NCSC-related shame on the relationship between perceived peer rape myth acceptance and posttraumatic growth (n = 174); and 2) evaluate the shared and independent variance contributions of mental health symptoms and trauma history clusters on posttraumatic growth (n = 151).NCSC-related shame did not mediate the relationship between perceived peer rape myth acceptance and posttraumatic growth. Mental health symptoms and trauma history significantly contributed to 35.27% of posttraumatic growth variance, with the trauma history cluster significantly influencing posttraumatic growth scores beyond mental health symptoms. Based on these findings, it is important that clinicians assess for a history of trauma and the impact of that trauma in addition to mental health symptoms when trying to understand posttraumatic growth after campus sexual violence.

Capturing lifestyle changes and emotional experiences while having a compromised immune system during the COVID-19 pandemic: A photo-elicitation study.

This study aimed to describe lifestyle and emotional changes individuals with compromised immune systems experienced during the early months of the coronavirus disease 2019 pandemic. A survey was distributed to online support organizations for those with chronic illness and a national research volunteer registry from April to June 2020. Participants were asked to document their experiences via three photo-elicitation prompts, followed by reflection and Likert scale questions. Forty-seven individuals responded with 282 photos submitted. Lifestyle changes noted include shifts in wellness strategies, health management, routine, stressors, and time perception. Participants described significant distress stemming from deteriorating mental health, safety fears, isolation, health management, and longing. Wellness strategies documented included finding comfort, connection, and escape, managing uncertainty, maintaining physical health, and building resilience. These findings can increase a sense of community for immunocompromised individuals who are struggling in isolation and enhance knowledge of their day-to-day health needs during times of increased stress and health risk.

Developing the TIC Grade: A Youth Self-Report Measure of Perceptions of Trauma-Informed Care.

BACKGROUND: Service delivery organizations are advancing the provision of trauma-informed care (TIC) for youth to improve outcomes. However, currently there are no validated, reliable evaluation measures to capture the voices of adolescent clients and how well they perceive TIC implementation. AIMS: The purpose of this project was to create an evaluation measure with strong content validity for adolescent health and service users to give feedback to organizations about their implementation of TIC. This article outlines Step 1 of our instrument development, by discussing our process creating the measure and affirming content validity. Psychometric testing of this measure (Step 2) is described in a companion paper. METHODS: We combined deductive theory substruction with an inductive participatory process to create, revise, and finalize the measure. The National Center for Trauma-Informed Care's framework of four practices and six principles was substructed into an 18-item draft measure. A four-member community youth advisory board (CYAB) then worked to inductively modify our draft to provide age-appropriate clarity and ensure a nontriggering respondent experience. Finally, the CYAB members conducted cognitive interviews with 10 other adolescents in local evening data collection events, refining the measure for future psychometric testing. RESULTS: The process resulted in a 20-item form based on CYAB feedback. Refinements included providing an accessible definition of trauma, asking questions about trauma history, and asking whether trauma affected the client's visit on the day of service use. CONCLUSIONS: The CYAB involvement enhanced content validity and ensured a trauma-informed instrument development approach.

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.

Photo-experiencing and reflective listening: A trauma-informed photo-elicitation method to explore day-to-day health experiences.

Despite the promise of photography in research, few methods offer a guide to leverage this medium in conjunction with experience sampling to facilitate individual reflection while capturing the experiences of participants as they interact with their social world. The purpose of this paper is to introduce a new photo-elicitation method to add to the photography research repertoire, Photo-experiencing and Reflective Listening (PEARL). PEARL leverages the benefits of experience sampling, mindful self-awareness, and trauma-informed interviewing to document daily health experiences. After engaging in an at-home photography activity, participants meet for a one-on-one interview to share and cluster their photographs to discuss key themes and needs going forward. Using a study aimed to understand the recovery experiences of survivors of sexual violence, we illustrate how PEARL can be applied to study a population of interest. The products developed through PEARL provide rich opportunities for analysis, dissemination, story amplification, and action, making it a research method helpful for those interested in improving health equity and catalyzing social change. Because of the high satisfaction voiced by the participants of this approach, PEARL shows promise as a therapeutic data collection method, where the participants leave with some benefit through new awareness gained.

Healing is not linear: Using photography to describe the day-to-day healing journeys of undergraduate women survivors of sexual violence.

The purpose of this study was to describe the day-to-day healing processes of women who experienced undergraduate sexual violence. We engaged 19 women in a photo-elicitation experience with follow-up individual interviews to identify themes of both healing and darker moments in survivors' everyday lives. Healing was found to function on a continuum influenced by darker moments (i.e., moments that elicited fear, anxiety, loneliness, guilt, anger, and worthlessness) and healing moments (i.e., rebuilding moments of self-care, self-love, connection, hope, peace, and freedom). Responses to darker moments included feeling overwhelmed, disconnected, and intentional vulnerability. Healing moments were influenced by self-reflection, authentic interactions, and resource utilization. The photographs taken in this study shed light on the impact of sexual violence in women's daily lives long after these traumatic and unjust experiences. This knowledge can be used to foster a sense of universality in survivors who are currently struggling and growing after their experiences as well as give service providers greater insight into what survivors' day-to-day needs may be.

The Eco-Social Trauma Intervention Model.

OBJECTIVES: We describe a transdisciplinary theory of change for interventions to promote trauma recovery that utilizes an eco-social approach to enhance health status and well-being following trauma exposures. This four-level theory of change could be applied to other population health problems, as well. METHODS: This theory-development process included reviewing existing literature, identifying assumptions, defining core concepts, stating propositions, depicting concepts and propositions for clarity, and illustrating with case examples grounded in our focus on trauma. RESULTS: The resulting Eco-Social Trauma Intervention Model offers a framework for interventions that address the impact of trauma on the individual level through self-regulation, interpersonal level through relationships, community/organizational level through safety, and societal level through identities. Application of this model to intervention development for those affected by trauma is intended to promote resilience, recovery, posttraumatic growth, and positive adaptations to traumatic stress for populations, going beyond the current Western paradigm of treating individuals for psychopathology. CONCLUSIONS: The Eco-Social Trauma Intervention Model offers an adaptable transdisciplinary framework for developing and researching scalable trauma interventions for individuals, communities, and populations.

Measuring Healing and Recovery After Gender-Based Violence: A Scoping Review.

Healing after gender-based violence (GBV) is multidimensional, with varying instruments used in the scientific literature to capture this phenomenon quantitively in survivor populations. The purpose of this scoping review was to (a) describe quantitative measures used to evaluate recovery after GBV, (b) compare these findings with domains uncovered in a qualitative metasynthesis about survivors' perspectives about healing after GBV, and (c) summarize recovery relationships found. We searched Pubmed, PsycInfo, and Violence/Criminology/Family Studies Abstracts. Studies were included for review if they (a) used quantitative methods, (b) evaluated healing or recovery in survivors of GBV, (c) were available in English, and (d) were empirical articles in peer-reviewed journals. Two thousand nine hundred thirty-five articles were reviewed by title and abstract, and 92 articles were reviewed by full text. Twenty-six articles were included in this review. Eight studies used an alleviation of adverse symptomology as a proxy for recovery, eight used growth-related outcomes, and ten used a combination of both types of measures. While the quantitative instruments synthesized in this review seemed to map onto some of the recovery domains identified through qualitative metasynthesis, no study synthesized measured all domains simultaneously. Studies synthesized identified that recovery-related outcomes may be influenced by social support, symptom burden, disclosure, and various therapeutic intervention programs tested in the literature to date. Synthesizing research on recovery after GBV is an essential step to understand gaps in measurement and understanding. Streamlining and using holistic recovery outcome measurement can aid in the development of evidence-based interventions to promote healing in survivor populations.

A Feasibility and Acceptability Assessment of Photo-experiencing and Reflective Listening (PEARL): An Intervention to Promote Recovery Engagement After Gender-Based Harm.

Photo-experiencing and Reflective Listening (PEARL) is a trauma-informed intervention developed to promote recovery engagement in survivors of gender-based violence (GBV). This study aimed to understand the feasibility and acceptability of PEARL and identify potential healing elements. GBV survivors were recruited in Philadelphia through an online survey (n = 20). Participants completed the PEARL intervention, a postintervention survey, and a follow-up interview. Results revealed PEARL to be both feasible and acceptable, with thematic analysis revealing its ability to facilitate purposeful reflection, connection to the present, and progress toward healing goals. PEARL shows promise as an engaging strategy to promote healing for survivors of GBV.

Building a Trauma-Informed Community: Applying Community Building Circles to an Academic Health Research Setting.

PROBLEM: Within health science disciplines, power dynamics exist that can not only perpetuate harm but also foster feelings of powerlessness and disengagement. Although diversity, equity, and inclusion approaches have been prioritized by many institutions to improve student and staff recruitment, few effective structures exist to promote the retention, support, and inclusion of these individuals. APPROACH: Restorative justice circles facilitate a collaborative and personal exercise that welcomes the input of all members, thus acting as a catalyst toward broader and more deeply rooted culture changes and conflict resolution. Restorative justice circles can be applied to strengthen academic learning environments by building community and creating intentional dialog spaces to promote accountability and belonging. The Phoenix Gender-based Violence Lab is an interdisciplinary health research lab composed of diverse researchers who meet monthly for a restorative justice-inspired community-building circle and discussion. The lab members participated in community-building circles from August 2021 to August 2022 during which circle facilitators aimed to prioritize safety, trustworthiness, and transparency and provide collaboration opportunities. OUTCOMES: All 10 research team members consented to an anonymous evaluation survey to share their perspectives about incorporating this approach into lab time. Research team members expressed many benefits of circle discussions, including mitigated power dynamics (n = 5), increased lab cohesion (n = 9), improved research processes (n = 6), and enhanced honesty and accountability (n = 4). NEXT STEPS: Circle practice has shown promising results within the Phoenix Gender-based Violence Lab, indicating that other academic and medical settings should consider its potential to enhance group dynamics, foster accountability, and cultivate deeper collaboration and appreciation among group members. Further investigation of circle practice in diverse medical and academic settings is needed to fully comprehend the range of outcomes resulting from this intervention and whether they align with the fundamental principles of restorative justice.

Exploring Social Impairment in Those with Opioid Use Disorder: Linking Impulsivity, Childhood Trauma, and the Prefrontal Cortex.

Background: Challenges with social functioning, which is a hallmark of opioid use disorder (OUD), are a drawback in treatment adherence and maintenance. Yet, little research has explored the underlying mechanisms of this impairment. Impulsivity, a known risk factor for OUD, and corresponding neural alterations may be at the center of this issue. Childhood adversity, which has been linked to both impulsivity and poorer treatment outcomes, could also affect this relationship. This study aims to understand the relationship between impulsivity and social functioning in those recovering from OUD. Differences in the prefrontal cortex will be analyzed, as well as potential moderating effects of childhood trauma. Methods: Participants with (N = 16) and without (N = 19) social impairment completed a survey (e.g., social functioning, Barrat's Impulsivity Scale, Adverse Childhood Experiences (ACEs) and cognitive tasks while undergoing neuroimaging. Functional near infrared spectroscopy (fNIRS), a modern, portable, wearable and low-cost neuroimaging technology, was used to measure prefrontal cortex activity during a behavioral inhibition task (Go/No-Go task). Results: Those who social functioning survey scores indicated social impairment (n = 16) scored significantly higher on impulsivity scale (t(33)= -3.4, p < 0.01) and reported more depressive symptoms (t(33) = -2.8, p < 0.01) than those reporting no social impairment (n = 19). Social functioning was negatively correlated with impulsivity (r=-0.7, p < 0.001), such that increased impulsivity corresponded to decreased social functioning. Childhood trauma emerged as a moderator of this relationship, but only when controlling for the effects of depression, B=-0.11, p = 0.023. Although both groups had comparable Go/No-Go task performance, the socially impaired group displayed greater activation in the dorsolateral (F(1,100.8) = 7.89, p < 0.01), ventrolateral (F(1,88.8) = 7.33, p < 0.01), and ventromedial (F(1,95.6) = 7.56, p < 0.01) prefrontal cortex during impulse control. Conclusion: In addition to being more impulsive, individuals with social impairment exhibited differential activation in the prefrontal cortex when controlling responses. Furthermore, the impact of impulsivity on social functioning varies depending on ACEs demonstrating that it must be considered in treatment approaches. These findings have implications for addressing social needs and impulsivity of those in recovery, highlighting the importance of a more personalized, integrative, and trauma-informed approach to intervention.

Restorative Justice for Survivors of Sexual Violence Experienced in Adulthood: A Scoping Review.

Sexual violence (SV) is a widespread human rights issue. Survivors of SV often experience profound dehumanization and poor health outcomes when their trauma is not properly addressed, rendering it critical that they are honored and empowered within subsequent processes of healing and seeking justice. With adjudication through the criminal legal system largely underutilized due to retraumatization, scrutiny from law enforcement professionals, and high rates of case closure, restorative justice (RJ) has emerged as a promising option for survivors to repair harm and experience accountability. Little is known, however, regarding the best practices for its use in cases of SV. To meet this need, a scoping review was conducted to identify the best practices for the implementation of RJ after instances of SV experienced in adulthood. Following the search methodology outlined by the JBI Manual for Evidence Synthesis for scoping reviews, 15 articles met search criteria, including four empirical studies and 11 nonempirical research materials spanning five academic disciplines. Best practices and structures for RJ were subsequently identified, including key phases for appropriate implementation. This review can be used to create increasingly productive RJ processes for SV survivors, which is particularly important for those coming from marginalized communities facing structural inequities, as well as survivors on university campuses. As researchers, we have the power to use science to propel society toward the creation of more efficacious healing spaces for survivors of SV, and optimizing safe RJ processes plays a key role in bringing this to fruition.

Supporting student learning and development through trauma-informed campuses.

Many students come to higher education with a history of trauma. College life may also expose students to traumatizing events. While the past decade has witnessed greater discussion of trauma-informed frameworks, it has not regularly been applied to the college environment. We advance the concept of a trauma-informed campus, where administrators, faculty, staff, and students from diverse disciplines create an environment that recognizes the widespread nature of trauma, integrates knowledge about trauma into practices and procedures, and minimizes further re-traumatization for all community members. A trauma-informed campus is prepared for students' past or future traumatic experiences, while also recognizing and responding to structural and historical harms. In addition, it recognizes the role of the surrounding community challenges, particularly how violence, substance use, hunger, poverty, and housing insecurity may contribute to further trauma or negatively impact healing. We use an ecological model to frame and shape the construct of trauma-informed campuses.

Healing After Violence: The Effect of Perception of Social Support on Posttraumatic Growth in Female University Students.

This study investigated the Turkish validity and reliability of the Healing After Gender-based Violence Scale (GBV-Heal) and the relationship between social support perception, posttraumatic growth in university students who are victims of gender-based violence. The study sample consisted of 167 female students who experienced gender-based violence. The Turkish version of GBV-Heal of Kaiser-Meyer-Olkin value was 0.892; the Bartlett Sphericity Test result was determined as χ2 = 195,053, and the obtained variables were found suitable for factor analysis. Perception of social support related to post-violence healing in female university students is effective on posttraumatic growth.

Healing After Gender-Based Violence: A Qualitative Metasynthesis Using Meta-Ethnography.

Gender-based violence (GBV) is a significant violation of human rights, requiring specific understanding of how individuals heal and recover after these experiences. This article reports on findings of a qualitative metasynthesis that examined the nature of healing after GBV through the perspectives of female-identifying survivors. Empirical studies were identified by a search of peer-reviewed articles via electronic databases. Studies were included for review if they were available in the English language, reported on qualitative studies that directly engaged female-identifying survivors of GBV, and were aiming to understand the GBV healing journey, process, or goals. After our initial search, 1,107 articles were reviewed by title and abstract and 47 articles were reviewed for full text. Twenty-six peer-reviewed articles were included for the review and were analyzed using meta-ethnography. Key findings included the recovery journey as a nonlinear, iterative experience that requires active engagement and patience. Healing was composed of (1) trauma processing and reexamination, (2) managing negative states, (3) rebuilding the self, (4) connecting with others, and (5) regaining hope and power. "Shifts" or "turning points" are also mentioned which catalyzed healing prioritization. This article aggregates and examines the scientific literature to date on GBV healing and provides articulation of the limitations, gaps in evidence, and areas for intervention. The article considers implications for future research, policy, and practice and, in particular, focuses our attention on the need to expand our knowledge of alternative recovery pathways and mechanisms for healing.

Psychometric Evaluation of the Healing After Gender-Based Violence Scale: An Instrument for Cross-Sectional and Longitudinal Assessment of Recovery Progress for Women-Identifying Survivors.

Purpose: The Healing after Gender-based Violence Scale (GBV-Heal) was developed to measure the holistic recovery processes of woman-identifying survivors of gender-based violence (GBV). The GBV-Heal asks survivors to evaluate a series of statements based on perceptions of one's lowest point and how they currently feel. These scale response options create lowest point, current feelings, and difference scores to evaluate the healing outcome cross-sectionally. This manuscript aims to evaluate the psychometric properties of the GBV-Heal to understand its usefulness for research and practice. Method: Instrument evaluation consisted of two phases analyzing online survey data from two GBV survivor samples recruited from online health research portals in the United States. In Phase One (N = 236), we conducted factor analyses and evaluated convergent/discriminant validity using depression, anxiety, posttraumatic stress, posttraumatic growth, and wellbeing measures. In Phase Two (N = 47), we evaluated GBV-Heal response consistency via test-retest within two weeks. Results: Results showed that the scale's final model included 4 components with 18 items, explaining 61.2% and 65% of the overall scale variances for "at my lowest point" and "my current feelings," respectively. The GBV-Heal difference score showed a weak positive correlation with wellbeing and posttraumatic growth scores and a weak negative correlation with depression, anxiety, and PTSD scores. Test-retest revealed Pearson r correlations of 0.82, 0.82, and 0.69 for the lowest point, current feelings, and difference scores respectively. Conclusion: These findings substantiate the reliability and validity of our instrument as an outcome measure that can be used both cross-sectionally and longitudinally with survivors of GBV.