Publications by authors named "Megan Gerber"

Introduction: Refugee and migrant communities carry histories wrought with trauma. These traumas and trauma-related responses often contribute to feelings of mistrust towards Western health care systems and can additionally foster negative clinician biases (conscious or unconscious) and attitudes towards these communities. Consequently, clinicians often fail to uncover underlying causes of poor health and distress for their refugee and migrant patients.

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Trauma-informed care (TIC) is a patient-centered, strength-based approach to caring for and empowering patients. The adolescent well visit is an opportune moment to assess and address the impact of trauma. Given the well-documented impact of trauma exposure on adolescent health, and the relationship present between social determinants of health and trauma, physicians and advanced practice practitioners are well positioned to utilize TIC in the medical visit.

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Article Synopsis
  • The Veterans Health Administration (VHA) used implementation facilitation (IF) to increase intimate partner violence (IPV) screening in primary care, examining its effectiveness a year later.
  • A mixed-methods evaluation revealed that seven out of nine sites maintained or improved their screening rates, with successful sites showing strong medical leadership, ongoing clinician training, and clear referral processes.
  • Barriers such as staff shortages and lack of support from leadership hindered sustainment in some sites, highlighting the need for tailored strategies to overcome these challenges in health care settings.
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Background: Trauma is common in the United States, increases risk of long-term adverse health effects, and individuals who experience it often find seeking medical care difficult. Trauma-informed care (TIC) builds trust and fosters healing relationships between clinicians and patients; however medical education has lacked consistent training in TIC. Using recently published competencies for undergraduate medical education (UME), this manuscript provides curricular examples across 8 domains to assist faculty in developing educational content.

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The concept of trauma and traumatic stress and its impact on health and mental health has been studied for nearly half a century. Trauma-informed care (TIC) is person-centered care designed and delivered based on knowledge of the ubiquity of trauma. It requires building an understanding of the role that trauma plays in the lives and health outcomes of survivors.

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Article Synopsis
  • * Using a Matrixed Multiple Case Study approach, researchers analyzed qualitative and quantitative data to identify multilevel factors affecting the program’s implementation, guided by the i-PARIHS framework.
  • * A total of fifteen factors were identified, categorized into three groups: enabling factors present at all sites, critical elements for implementation success, and additional influences impacting screening rates.
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Introduction: The Veterans Health Administration initiated implementation facilitation to integrate intimate partner screening programs in primary care. This study investigates implementation facilitation's impact on implementation and clinical effectiveness outcomes.

Study Design: A cluster randomized, stepped-wedge, hybrid-II implementation-effectiveness trial (January 2021-April 2022) was conducted amidst the COVID-19 pandemic.

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Research has established that trauma is nearly universal and a root cause of numerous health and social problems, including 6 of the 10 leading causes of death, with devastating consequences across the life course. Scientific evidence now recognizes the complex injurious nature of structural and historical trauma (i.e.

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Thousands of women Veterans experience intimate partner violence (IPV) each year. The Veterans Health Administration (VHA) has encouraged IPV screening in Veterans Affairs medical centers (VAMCs) since 2014. Through retrospective analysis of VHA administrative data from fiscal year (FY) 2014 into FY2020, we examined IPV screening implementation outcomes of reach and adoption, as well as screen-positive rates using descriptive and multivariate linear regression analyses.

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Background: Little is known about women veterans' intimate partner violence (IPV) experiences during the COVID-19 pandemic or the impacts of pandemic-related stress on their mental and physical health.

Objectives: To identify IPV experiences among women veterans prior to and during the pandemic, pandemic-related stressors, and examine their respective contributions to mental and physical health.

Design: National sample of women veterans drawn from a larger web-based longitudinal study.

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Background: The Veterans Health Administration (VA) is the largest integrated health system in the US and provides access to comprehensive primary care. Women Veterans are the fastest growing segment of new VA users, yet little is known about the characteristics of those who routinely access VA primary care in general or by age group.

Objective: Describe healthcare needs, utilization, and preferences of women Veterans who routinely use VA primary care.

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Reports an error in "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women" by Katherine M. Iverson, Sara B. Danitz, Mary Driscoll, Dawne Vogt, Alison B.

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Article Synopsis
  • The study explores trust levels among women veterans in Veterans Affairs (VA) health care, focusing on factors that influence this trust in their providers.
  • It analyzed data from a survey of 1,395 women veterans to determine how patient-provider communication and gender-appropriate care relate to trust levels.
  • Results showed that 39.7% of women veterans had complete trust in their VA providers, with better communication and trauma-sensitive care linked to higher trust scores, suggesting that improving these areas could further enhance trust among this population.
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Many primary care providers (PCPs) in the Veterans Health Administration need updated clinical training in women's health. The objective was to design, implement, and evaluate a training program to increase participants' comfort with and provision of care to women Veterans, and foster practice changes in women's health care at their local institutions. The Women's Health Mini-Residency was developed as a multi-day training program, based on principles of adult learning, wherein knowledge gleaned through didactic presentations was solidified during small-group case study discussions and further enhanced by hands-on training and creation of a facility-specific action plan to improve women Veterans' care.

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Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE) is a brief, variable-length (1-6 sessions), modular, individualized psychosocial counseling intervention for women experiencing intimate partner violence (IPV). Pilot findings demonstrated the potential helpfulness, acceptability, and feasibility of RISE; however, a randomized clinical trial (RCT) is needed to support program effectiveness. This RCT enrolled 60 women who experienced IPV within the prior year.

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[Correction Notice: An Erratum for this article was reported online in on May 12 2022 (see record 2022-63047-001). In the original article, the columns in Table 3 were misaligned such that the data presented in the columns did not correspond with the correct variable. Additionally, for clarity, the table should have presented a separate column "n" for sample size and displayed total scores for the Personal Progress Scale (PPS) as opposed to mean scores.

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Background: Evidence supports the clinical effectiveness of intimate partner violence (IPV) screening programs, but less is known about implementing and sustaining them. This qualitative study identified implementation strategies used to integrate IPV screening programs within Veterans Health Administration (VHA) women's health primary care.

Methods: Thirty-two administrators and clinician key informants from 11 VHA facilities participated in semistructured interviews.

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Objective: The Veterans Health Administration established comprehensive women's health clinics (CWHCs) to provide coordinated, high-quality primary care to women veterans. Intimate partner violence (IPV) is prevalent among women using these clinics. The Veterans Health Administration recommends screening women for IPV, yet screening uptake is low in CWHCs nationwide.

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Background: The Veterans Health Administration (VHA) entered the COVID-19 pandemic crisis with an existing and robust telehealth program, but it still faces a fundamental paradigm shift as most routine outpatient in-person care was converted to telehealth visits. Veterans are a highly trauma-exposed population, and VHA has long offered effective telemental health services. Natural disasters and pandemics like COVID-19 are known to be traumatic.

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Background: When hysterectomy is used to treat uterine fibroids, a minimally invasive versus open abdominal approach is preferred. Depression and post-traumatic stress disorder (PTSD) may be associated with surgical mode. We sought to examine whether depression and PTSD are associated with minimally invasive hysterectomy (MIH).

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Background: Intimate partner violence (IPV) against women in the United States (US) remains a complex public health crisis. Women who experience IPV are among the most vulnerable patients seen in primary care. Screening increases the detection of IPV and, when paired with appropriate response interventions, can mitigate the health effects of IPV.

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Background: Intimate partner violence (IPV) against women is a global health problem that is a substantial source of human suffering. Within the United States (US), women veterans are at high risk for experiencing IPV. There is an urgent need for feasible, acceptable, and patient-centered IPV counseling interventions for the growing number of women treated in the US's largest integrated healthcare system, the Veterans Health Administration (VHA).

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