Background: Approximately one in five women in the United States experience childhood sexual abuse or rape as an adult. Healthcare providers are often not equipped to address the long-term effects of sexual trauma and its impact on one's health. Research Question: How can healthcare providers lessen service barriers for SA survivors? Method: This qualitative study employed convenience sampling from clinics that offered family medicine, urgent care, gynecology, or obstetrics. Participants included 11 physicians, physician assistants, and nurses. A semi-structured interview guide was used to explore health providers' perspectives and current practice procedures regarding treatment for sexual assault survivors and the barriers they face in treating this population. Data analysis involved a constant comparative method for identifying, organizing, describing, analyzing, and reporting themes within the data set. Results: The findings indicated three key barriers to providing care for female SA survivors: 1) personal/professional discomfort in discussing the topic of SA, 2) lack of knowledge and training on trauma-informed care, and 3) lack of time spent with each patient. Discussion: Recommendations for healthcare providers include 1) universal trauma-informed care training to better serve and support sexual assault and other trauma survivors, 2) revision of intake forms to include questions on sexual trauma history, and 3) inclusive services such as spending extra time on procedures, talking gently with the patient, and providing resources for mental healthcare services. Implications: Sexual assault survivors are less likely to be triggered or retraumatized by trauma-informed healthcare providers. Thus, they do not avoid annual physicals, medical tests, or setting up appointments when not feeling well, thereby enhancing their health outcomes.

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Addressing childhood trauma is increasingly being recognized as a priority in public health, healthcare and health policy sectors. As evidence mounts that the effects of trauma are both graded and dose responsive, stakeholders in healthcare are turning more attention to preventing and addressing experiences of trauma in childhood, commonly referred to as adverse childhood experiences (ACEs). Trauma Informed Care (TIC), is a promising clinical approach attuned to the specific needs of traumatized patients that is still in its infancy with regards to training and evaluation of practitioner skills. Although physicians of all specialties will encounter patients who have experienced trauma, few undergraduate medical education curriculums provide formal training in TIC. Additionally, the approach to TIC in clinical settings has largely been biomedical and individual, with a focus on screening and treatment. This model ignores the role that communities play in both propagating trauma and generating resiliency. Urban academic medical centers, often geographically located in highly traumatized communities, must take a specific interest in developing TIC research, theory and praxis that includes and empowers communities. Service learning, a form of experiential education that cultivates self-awareness in students while simultaneously meeting community objectives, is a pedagogy that aligns with a community driven TIC framework. This thesis outlines the implementation of a community driven, bi-directional TIC learning model designed to serve the needs of medical students and low income K-8th grade students living in the geographic catchment of an urban, academic medical center. / Urban Bioethics

Immigration is a highly politicized topic increasingly on the forefront of the nation’s consciousness. Though news media and academia have drawn attention to evidence of physical health needs of undocumented immigrants being compromised due to their documentation status, relatively less attention is brought to their mental health needs. The purpose of this paper is to review literature about the mental health care needs of immigrants and refugees to the United States, with a particular focus on recent adult immigrants from Latin America and their youth, who may directly or indirectly suffer trauma related to deportation, violence, family separation and/or loss. This paper serves to provide ethical arguments for increased awareness, education and resources towards trauma-informed, culturally sensitive mental health care for immigrants and refugees to the United States. The ultimate aim of this paper is to provide its readers with essential information regarding the impact of trauma and cultural identity in the mental health care (or lack thereof) of Latinx immigrants. / Urban Bioethics

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Early stressors like trauma can lead to developmental changes that have life-long negative health consequences (Merikangas et al., 2010; Anda et al., 2006). Approximately 1 in 4 youth experience substantial trauma during their developmental years (Merikangas et al., 2010; Duke, Pettingell, McMorris, and Borowsky, 2010). Such findings suggest the need for early intervention and treatment for adolescents exposed to traumatic events and adversity. Ideally, adolescents could be treated within primary care settings where parents overwhelmingly seek services for their children. Primary care settings are sought out at a 94% to 97% rate of services as compared to only a 4% to 33% rate of parents seeking out mental health services (Guevara et al., 2001). Unfortunately, no adolescent trauma-informed interventions have yet been adapted for use in primary care (Glowa, Olson, and Johnson, 2016). This study aimed to fill this critical gap between adolescent mental health issues associated with trauma and adverse childhood experiences and the lack of treatment in integrated primary care settings. The need for trauma-informed treatment for adolescents who have experienced trauma and adverse experiences is especially salient as evidence-based treatment for adolescents in this setting is limited. A modified Delphi approach was employed to address this gap in the research. Two rounds of questionnaires and focus groups were utilized with a panel of experts and youth stakeholders to gain consensus on treatment recommendations. Ultimately, expert panelists and youth stakeholders identified 59 recommendations for adolescent trauma treatment to be delivered in integrated primary care settings. / Doctor of Philosophy / Childhood trauma can have negative health, social, and educational outcomes that extend into adulthood and over one’s lifespan (Black, Woodworth, Tremblay, & Carpenter, 2012; Merikangas et al., 2010). Approximately 1 in 4 youth today experience trauma (Duke et al., 2010). Trauma can include a variety of things such as physical, sexual, or emotional abuse; being the victim of a crime; witnessing violence in the home; living through a natural disaster or experiencing an accident (Anda et al., 2006; APA, 2017). The frequency of trauma in adolescence suggests the need for early intervention and treatment. Ideally, adolescents could be treated within primary care settings where parents and adolescents frequently seek care services. Unfortunately, no adolescent trauma interventions have been created for this setting (Glowa, Olson, & Johnson, 2016). This study was designed to improve the treatment of adolescent trauma in primary care settings. For this research study a modified Delphi technique was used. Two rounds of questionnaires and focus groups were utilized with participants that consisted of a panel of experts from the field and youth aged 14-18 years old. Ultimately, the study participants made 59 recommendations for adolescent trauma treatment to be delivered in primary care settings.

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