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

Trauma 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. A 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. Among 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. This 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. Trauma is an emotional response to a distressing event and can affect health. Certain types of trauma, like sexual violence, can affect sexual and reproductive health especially. Because of this, clinicians who provide sexual and reproductive health care should know how to ask about past trauma and respond to patients in a way that promotes healing. In this study, we developed a training for clinicians on how to talk to patients about trauma in a sensitive way to improve their sexual and reproductive health. We also held discussion groups where clinicians could brainstorm ways to improve the way they provide sexual and reproductive health care to people who may have experienced trauma. Our training was effective in improving clinician comfort with talking to patients about trauma as it relates to their sexual and reproductive health. Clinicians also talked about ways to promote their own wellbeing so that they can best care for their patients. We found that training in trauma inquiry in sexual and reproductive health settings may benefit both patients and clinicians.