WITHDRAWN: The Landscape of Trauma Informed Care in Community-Based HIV Service Organizations in the US South

Background and Significance

Among people living with HIV, trauma is associated with negative impact on one's immune system, increased viral loads (Lesserman, 2005) and obstructed access to HIV care (Kouyoumdjian et al., 2013). Trauma-Informed Care (TIC), a SAMHSA EBP, responds to the impact of trauma for service users by focusing on all aspects of service delivery systems and structures. Though TIC has been found to improve service users’ health outcomes in other fields, little is known about HIV organizations’ capacity around TIC. TIC could be potentially life saving in regions where HIV rates continue to rise, like the US South. An understanding of Southern organizations’ TIC capacity will help to build organizational-level interventions to move the needle on achieving HIV related health equity. Embedded in a larger series of public impact studies that examine the impact of TIC organizational change intervention, this study explores the extent to which HIV service organizations in the U.S. South employ TIC approaches.

Methods

Survey data were collected online with HIV service organizations in the U.S. South (n=207; AL, FL, GA, LA, MS, NC, SC, TN, TX) to identify service needs related to HIV healthcare, including TIC. Survey participants were identified using the National Prevention Information Network (NPIN) and Substance Abuse and Mental Health Services Association (SAMHSA) databases. Analysis consisted of frequency distributions of questions related to TIC and logistic regression investigating the relationship between TIC training and the implementation of TIC organizational strategies, controlling for potential covariates.

Results

43% of organizations reported that they did not utilize a trauma-informed approach to care. Less than a third of organizations provided a trauma intervention such as Seeking Safety. Regarding specific trauma-informed organizational strategies, 43% of organizations reported screening clients for trauma, 36% addressed trauma in their organizational policies, 37% addressed vicarious/secondary trauma with staff, and 55% included clients in decision making. 21% of organizations reported not addressing trauma in these or any other ways at their organization. Of these, 74% said they were interested in utilizing TIC. Only 44% of organizations had participated in TIC training but 84% expressed interest in TIC training. Organizations who completed TIC training were 10 times more likely than those who did not to report that they implemented at least one trauma informed care strategies (p<0.001), controlling for covariates. 60% of organizations cited lack of staff expertise or training as a barrier to employing TIC. Other barriers were issues with capacity (65%) and lack of funding to implement TIC (70%).

Discussion

To the authors’ knowledge, this is the largest organizational survey of HIV service organizations in the U.S. South. We found that despite interest in TIC, there were low rates of TIC implementation. This points to the need to address barriers related to training, capacity and funding. The research team has begun to use these findings to inform a racial justice-focused TIC organizational capacity intervention for HIV service organizations in the South and will share the impact of this research during the presentation.