Trauma inquiry and response in sexual and reproductive health settings: collaborative learning among clinicians.

backgroundTrauma impacts sexual and reproductive health. Trauma inquiry is an opportunity for clinicians to identify and respond to trauma histories. The Trauma and Resilience-informed Inquiry for Adversity, Distress, and Strengths (TRIADS) framework could be relevant to sexual and reproductive health clinicians. The objectives of this study were to: (1) explore application of the TRIADS framework to sexual and reproductive health, (2) develop and evaluate a TRIADS-based training for sexual and reproductive health clinicians, and (3) identify practices in trauma inquiry and response in sexual and reproductive health settings.

methodsA narrative literature review informed the development of trainings (a webinar and collaborative learning groups) on applying TRIADS to sexual and reproductive health. Training participants completed an online survey of implementation outcomes. We used Wilcoxon matched-pairs signed-rank tests to compare self-reported comfort with trauma screening and response before, immediately after, and four months after the training. Collaborative learning groups were recorded, transcribed, and analyzed based on a deductive approach.

resultsAmong 117 webinar participants who completed the post-webinar survey, 90% were “likely” or “very likely” to use TRIADS in their clinical practice. Among the 15 collaborative learning group participants, few (13%) reported previous formal training on trauma inquiry or response. Most (80–93%) cared for patients with risk factors for trauma, including substance use, unstable housing, and intimate partner violence. After the collaborative learning group, participants’ comfort with responding to patients’ trauma disclosure, applying the TRIADS framework, and performing a trauma-informed pelvic exam increased. Collaborative learning group participants reported increased resilience and decreased burnout since participation. The following themes emerged from qualitative analysis: Inquiring about Adversity (e.g., building trust before trauma inquiry), Assessing Distress (e.g., practicing trauma-informed pelvic exam), and Identifying Strengths (e.g., promoting reproductive empowerment). Participants reported time and burnout as major barriers to trauma inquiry in sexual and reproductive healthcare.

conclusionsThis study found a meaningful impact of applying the TRIADS framework to sexual and reproductive healthcare. Participation in the webinar and collaborative learning groups demonstrated increased comfort in trauma inquiry and decreased burnout over time. Clinician training in trauma inquiry in sexual and reproductive health settings may benefit both patients and clinicians.