Lance's Corner

EHC Program Issues Trauma Informed Care Review

Jan 15, 2025

Per the notice below, the Effective Health Care (EHC) Program has issued a review of the trauma informed care health care delivery model.

Trauma Informed Care: A Systematic Review

Systematic Review

  • Evidence was insufficient to draw conclusions about the effects of Trauma Informed Care (TIC) in primary care or psychiatric hospitals for adult patients for any outcome.
  • Evidence was insufficient to draw conclusions about the effects of TIC in any setting for children or youth patients/clients for any outcome.
  • TIC models vary considerably in their socioecological components (cultural relevance, training, screening, system embedding) from youth to adult services across settings and disciplines.  Current organizational and clinical components encompass a broad range of considerations with only some overlap within both the organizational and clinical domains.
  • A few models of TIC had specific elements of cultural competence and/or humility (e.g., emphasizing a need to understand patient/client symptoms within the context of life experiences, culture, and historical issues).

Objectives.  To examine how Trauma Informed Care (TIC) and its components are defined and operationalized, and to examine the state of the evidence on effectiveness and potential harms of TIC approaches, frameworks, models, and components.

Data sources.  We searched Medline (Ovid)®, APA PsycInfo® (Ovid), CINAHL® (EBSCOHost), ERIC (EBSCOHost), and Scopus (Elsevier) for peer-reviewed articles published through July 19, 2024.  Grey literature was also searched for Contextual Questions regarding TIC definitions and organizational and clinical components.

Review methods.  We used methods consistent with the Agency for Healthcare Research and Quality’s Evidence-based Practice Center Program Methods Guide.  We prepared the review protocol with input from Key Informants, Technical Experts, and a public comment period in April 2023.  Using predefined criteria and dual review, we selected intervention studies that enrolled adult or pediatric patients/clients regardless of identified trauma exposure or type of trauma exposure in any healthcare or social service setting in any country.  Eligible studies included randomized controlled trials and comparative nonrandomized studies of interventions.  We assessed risk of bias and strength of evidence for a prespecified list of patient/client health related outcomes.

Results.  From 4,379 unique references, we identified 12 eligible studies discussed in 16 publications.  Study settings were varied: two studies in adult medical care settings, one in adult mental health service, one in primary prevention for children, one in adolescent medical care, four in residential child welfare, and three in non-residential child welfare.  We did not combine data quantitatively due to variability of interventions.  All studies were assessed as high risk of bias and evidence was insufficient to determine the effects of TIC on patient/client outcomes for all settings and comparisons.  Studies did not collect information on harms, adverse events, or unintended consequences of TIC.  TIC models vary considerably in their socioecological components from youth to adult services across settings and disciplines.  There was a broad range of organizational and clinical components, with only some overlap within both organizational and clinical domains.  A few TIC models described specific elements of cultural competency/humility.

Conclusions.  Evidence was insufficient to make any clear determinations on the effectiveness of TIC approaches across any patient/client health related outcome, but this does not mean the individual interventions described are not potentially useful.  Rather, it means the evidence does not yet provide clear answers.  Still, TIC is being widely implemented, and research on its effectiveness and potential harms seems to be neither informing nor keeping pace with related areas (e.g., evidence-based trauma treatments) or practice/implementation.

This evidence review was funded by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, under contract no. 75Q80120D00008.

Nguyen-Feng VN, Ramirez M, Behrens KL, Usset T, Claussen AM, Parikh RR, Lee EK, Mendenhall T, Wilt TJ, Butler M.  Trauma Informed Care: A Systematic Review.  Systematic Review.  (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 75Q80120D00008.)  AHRQ Publication No. 25-EHC007.  Rockville, MD: Agency for Healthcare Research and Quality; January 2025.  DOI: https://doi.org/10.23970/AHRQEPCSRTRAUMA.  Posted final reports are located on the Effective Health Care Program search page.

Project Timeline

Trauma Informed Care

Mar 6, 2023:  Topic Initiated

Oct 24, 2023:  Research Protocol

Jan 14, 2025:  Systematic Review

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc