AguilarT PSY 7103-12

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Develop a Research Proposal Tanya Aguilar Assignment 12 Research Methods – PSY 7103 Northcentral University July 2023

Research Proposal: Study of how service providers in the aggressive community respond to patients with severe mental illness who have experienced trauma and posttraumatic stress disorder. Introduction In the realm of mental health care, the recognition and appropriate response to trauma hold paramount importance. Traumatic experiences can have profound and lasting effects on individuals, often impacting their psychological well-being and overall quality of life (Sharif et al., 2021). The integration of trauma-informed approaches into treatment practices has been widely advocated as a means to provide effective and sensitive care to those affected by trauma. However, despite the significance of trauma-informed care, there are persistent challenges in its implementation within mental health systems. One particular concern is the existence of trauma avoidant cultures, where the acknowledgment and discussion of trauma- related issues are discouraged or overlooked. Such cultures can hinder the identification, understanding, and treatment of trauma, thereby impeding the recovery and healing process for individuals in need (Sharif et al., 2021). The Acceptance and Commitment Therapy (ACT) is an innovative new treatment that can be used in place of conventional therapies, many of which, despite being helpful, do not cater to all of the requirements that patients with PTSD have. ACT offers an alternative to the singular emphasis placed on the suppression of symptoms. As an alternative to the practice of avoiding unpleasant experiences, acceptance and openness to one's own experiences can be explored through the six main processes of ACT (Scarlet et al., 2016). The patient is then able to act on personally determined values when they demonstrate a willingness to experience. The end goal is to maintain an active engagement in the process of building a vital existence while

simultaneously living consciously. The preliminary research shows some cause for optimism, but there is a clear need for additional study of this intervention with regard to this particular demographic. In light of the foregoing, acceptance and commitment therapy (ACT) can be utilized as a pre-intervention, post-intervention, or addition to trauma-based therapies (Scarlet et al., 2016). Furthermore, ACT is extremely complementary to prolonged exposure and other exposure-based interventions. In addition to treating PTSD and its associated comorbidities, acceptance and commitment therapy (ACT) can be utilized to treat a variety of other life issues that are significant to trauma survivors but are not included in the diagnostic system. For instance, in order to effectively treat depression in veterans, the Acceptance and Commitment Therapy (ACT) program is currently being rolled out on a nationwide scale within the Department of Veterans Affairs (Scarlet et al., 2016). The initial review of the training that doctors received in ACT revealed considerable changes in patients' levels of depression and quality of life, in addition to the patient-therapist alliance and therapists' perceptions of their own level of self-efficacy. It has been expected that applying ACT to treat PTSD will lead to results that are comparable to those seen with other conditions. At this point, the only evidence to support this idea comes from open and closed small trials as well as case studies. This article aims to shed light on the pressing issue of working within a trauma avoidant culture specifically in the context of ACT (Acceptance and Commitment Therapy) teams. ACT teams are known for their holistic and person-centered approach, providing comprehensive mental health services to individuals with complex needs (Sharif et al., 2021). However, the extent to which trauma care is addressed within these teams and the barriers faced in discussing and treating trauma remain underexplored.

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By employing a qualitative research methodology, this study examines the perspectives of ACT providers regarding working with trauma in clients and the cultural factors that contribute to trauma avoidance. Through in-depth interviews with ACT providers, this research seeks to uncover the challenges and recommendations for fostering discussions and enabling effective treatment of trauma within ACT teams. The findings of this study hold potential implications for improving trauma-informed practices within ACT teams and enhancing the overall quality of care provided to individuals affected by trauma (Sharif et al., 2021). By identifying the existing barriers and proposing recommendations for change, this research aims to contribute to a transformative shift in the culture of trauma care, promoting a more inclusive and responsive approach that prioritizes the needs and experiences of diverse populations. Ultimately, the goal of this article is to stimulate critical dialogue, raise awareness, and inspire action towards creating a trauma-informed and culturally sensitive environment within ACT teams. By addressing the underlying issue of a trauma avoidant culture, we can strive towards a system that supports the healing, resilience, and recovery of individuals impacted by trauma. Problem Statement The study aims to explore the perspectives of Acceptance and Commitment Therapy (ACT) providers on working with trauma in clients and to identify the challenges and recommendations for facilitating trauma discussions and treatment within a trauma avoidant culture (Sharif et al., 2021).

The article addresses the problem of a culture that avoids acknowledging and addressing trauma, particularly within the context of ACT teams and models. The study seeks to understand the role and scope of ACT teams in relation to trauma, the discussions of trauma with clients, the current treatment practices for trauma, the barriers faced when working with trauma, and the recommendations for creating an environment that encourages trauma discussions and treatment (Sharif et al., 2021). The identified themes and sub-themes provide insights into the perspectives and experiences of ACT providers in relation to trauma and highlight potential areas for improvement. Purpose Statement The purpose of this qualitative study is to understand the perspectives of assertive community treatment (ACT) providers regarding their experiences and challenges in working with trauma and post-traumatic stress disorder (PTSD) in individuals with severe mental illness (Hayllar, 2018). The article aims to explore the specific issue of a "trauma avoidant culture" within the context of ACT providers' work. It seeks to examine the barriers and difficulties these providers encounter when addressing trauma and PTSD in individuals with severe mental illness, as well as their perspectives on the existing cultural dynamics surrounding trauma within their work environment. By conducting a qualitative study, the authors aim to shed light on the experiences, insights, and perceptions of ACT providers, with the ultimate goal of informing and improving clinical practice in addressing trauma and PTSD in this population.

Research Questions and Hypotheses These research questions would help to explore the experiences, perspectives, and challenges faced by ACT providers when working with trauma and PTSD in individuals with severe mental illness. They can provide valuable insights into the need for trauma-informed care and inform interventions and support systems to better address the trauma-related needs of this population. RQ1 How do ACT providers perceive the impact of addressing trauma and PTSD on the overall treatment outcomes and well-being of individuals with severe mental illness? RQ2 How do ACT providers navigate the cultural dynamics and organizational structures that contribute to a "trauma avoidant culture" in their work settings? Research Method and Design In this study, the researchers conducted interviews with ACT (Acceptance and Commitment Therapy) providers. The interviews were likely semi-structured, meaning there were predetermined questions or topics to guide the discussion, but also allowing for flexibility and exploration of new themes that may arise during the interviews (Sharif et al., 2021). Following the interviews, the researchers analyzed the data using thematic analysis. This involved systematically reviewing and coding the interview transcripts to identify recurring patterns or themes related to the perspectives of ACT providers on working with trauma (Sharif et al., 2021). The researchers likely used an iterative process, involving multiple rounds of coding and analysis, to refine and develop the themes.

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Overall, the research design in the article is qualitative, using thematic analysis as the method of data analysis to gain insights into the perspectives and experiences of ACT providers regarding trauma within a trauma avoidant culture. Population, Sample, and Recruitment Population: Service providers from ACT teams in Eastern Ontario, Canada. Sample: Purposive sample of ACT team members whose roles enable discussion on trauma, including psychiatrists, nurses, social workers, peer support workers, mental health workers, and occupational therapists. In total, sixteen interviews were conducted, distributed across different professional roles. Recruitment: ACT team members fulfilling the criteria for participation were invited to take part in the study (Sharif et al., 2021). Data Collection Data Collection: One-on-one semi-structured interviews were conducted by the first author of the study. Participants were given a copy of the interview protocol in advance to reflect on the questions. The interviews were held in private rooms at each team's ACT main office. Participant Consent: Participants were informed about their rights to withdraw from the interview at any time, with the assurance that their data would not be used in such cases. Confidentiality was assured, and efforts were made to prevent personal identification or linking of responses. Participants were required to sign a consent form before their involvement.

Ethics Approval: The study received approval from the University of Ottawa Research and Ethics Board (Sharif et al., 2021). Overall, the study utilized qualitative interviews as the primary data collection method to gather perspectives from ACT team members regarding working with trauma in a trauma avoidant culture. Proposed Data Analysis The data analysis method used is thematic analysis, specifically following the six steps outlined by Braun and Clarke (2006). The analysis focused on identifying patterns, issues, and topics of potential interest to the research problem. Here are the steps involved in the data analysis: Transcription: The audio recordings of the interviews were transcribed to convert the spoken language into written text, ensuring accuracy in the subsequent analysis. Familiarization: The research team, including four research assistants, read the transcribed data in its entirety to become familiar with the content and gain an overall understanding. Coding: The first author of the study grouped responses under 21 sub-themes, representing specific issues or topics derived from the interview data. Codes were created, refined, or eliminated based on similarities and differences in the transcribed interview texts.

Theme Development: The sub-themes were then grouped into five overarching themes, which captured the main patterns and issues present in the data. These overarching themes represented the larger categories of analysis. Review and Refinement: The researchers reviewed and refined the emerging themes, ensuring they accurately represented the patterns and issues identified in the data. This iterative process may have involved revisiting the original transcripts for validation and refinement. Meaningful Results: The analysis aimed to reach meaningful results by organizing the sub-themes and overarching themes into a coherent framework. This framework provided a rich and detailed analysis of the data, aligning with the research objectives (Sharif et al., 2021). Reliability/Validity/Trustworthiness Reliability: Reliability refers to the consistency and stability of the research findings. In qualitative research, reliability can be enhanced through steps such as using standardized interview protocols, ensuring consistency in data collection and transcription, and employing a systematic and transparent data analysis process (Elsayed et al., 2022). Validity: Validity refers to the accuracy and truthfulness of the research findings. In qualitative research, validity can be enhanced through measures such as ensuring data credibility, transferability, dependability, and confirmability. Credibility involves demonstrating that the findings accurately represent the participants' perspectives and experiences. Transferability refers to the potential applicability of the findings to other contexts or settings. Dependability refers to the consistency and replicability of the research process (Watkins et al., 2018). Confirmability relates to the objectivity and neutrality of the findings, demonstrating that they are not influenced by the researchers' biases.

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Trustworthiness: Trustworthiness is a broader concept that encompasses both reliability and validity. It refers to the overall quality and credibility of the research findings (Elsayed et al., 2022). Trustworthiness can be demonstrated through rigorous data collection and analysis methods, transparent reporting of the research process, and providing evidence of the researchers' reflexivity and transparency. Limitations and Ethical Considerations This research study discusses the importance of considering the differential impact of trauma on various groups of people and the potential marginalization and biases faced by certain communities, such as Black and Indigenous persons, migrants and refugees, and women. It highlights the need for trauma-informed practices that address the unique needs and experiences of individuals with diverse identities. Furthermore, the excerpt acknowledges the limitations of the present study, including the limited scope and purposive sample. It suggests that future research should involve a broader range of ACT teams and providers, as well as incorporate the perspectives of ACT clients to gain a better understanding of their experiences, barriers, and recommendations regarding trauma care. It also suggests the inclusion of ACT clients as equal partners in the research process, employing participatory design methods, which has shown positive outcomes in terms of engagement, well-being, and empowerment for individuals with serious mental illness. The mentioned research gaps and recommendations highlight the need for more comprehensive and inclusive studies that address the voices and experiences of diverse populations within the context of trauma and ACT. By involving a broader range of participants and adopting participatory approaches, future research can provide more nuanced insights into the needs and preferences of individuals receiving trauma-related care in ACT teams.

The limited scope of the study, which involved only four ACT groups and a purposive sample of providers, may restrict the generalizability of the findings. It suggests that future research should expand the perspectives by including a broader range of ACT teams from different regions and various types of ACT providers. Additionally, the excerpt suggests that future research should include the perspectives of ACT clients to gain a better understanding of their experiences in receiving care for trauma, identify barriers they face in discussing trauma, and document their recommendations for improvement. This would provide valuable insights into the lived experiences and preferences of those receiving trauma-related care in ACT teams. Moreover, the excerpt highlights the importance of actively involving ACT clients as equal voices in the research process, employing participatory design methods. This approach has shown positive outcomes in terms of engagement, well-being, inclusion, and empowerment for individuals with serious mental illness. It suggests that future work should consider including ACT clients as active participants, allowing them to contribute their perspectives, preferences, and needs regarding trauma-related symptoms and their desired approaches to addressing them within ACT teams. In summary, the limitations of the present study underscore the need for future research to include a broader range of participants, such as ACT clients, and to actively involve them in the research process (Humblet et al., 2018). By doing so, future studies can provide a more comprehensive understanding of the experiences and needs of individuals in ACT teams regarding trauma care and facilitate improvements in practice and services.

People who suffer from PTSD are likely to benefit from Assertive Community Treatment (ACT), which is the evidence-based community mental health intervention that is utilized the most frequently. The ACT service model does not have uniform recommendations on how to handle trauma in its client population, despite research revealing that the vast majority of persons with SMI have histories of traumatic events (Humblet et al., 2018). This research utilized the method of theme analysis by conducting interviews with ACT service providers to better understand the providers' points of view on working with clients who had experienced trauma. There were five broad themes that developed, each with 21 subthemes: the role and scope of ACT teams and the model with reference to trauma; talks of trauma with clients; current treatment of trauma; hurdles to working with trauma; and recommendations for facilitating trauma discussions and treatment (Sharif et al., 2021). There was a need for additional training addressing trauma, an increase in resources such as having a psychologist and trauma-specialized specialists on the team, increased support from leadership, and a cultural shift away from the medicalization of trauma.

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References Elsayed Rashed, S., Mohammed Eid, N., & Hassan El-sayed, H. (2022). Designing and implementing electronic health records software for intern-nurses by using advanced mobile devices. Journal of Nursing Science Benha University, 3 (2), 1001-1023. doi: 10.21608/jnsbu.2022.248703 Hayllar, A. (2018). ‘Once we’ve just connected, we are broken apart’: A qualitative exploration of the views of primary-school children from military families Student thesis: Doctoral Thesis › Doctor of Educational Psychology (DEdPsy) Humblet, O., Diaz-Ramirez, L. G., Balmes, J. R., Pinney, S. M., & Hiatt, R. A. (2014). Perfluoroalkyl chemicals and asthma among children 12-19 years of age: NHANES (1999-2008). Environmental health perspectives, 122 (10), 1129–1133. https://doi.org/10.1289/ehp.1306606 Scarlet, J., Lang, A. J., & Walser, R. D. (2016). Acceptance and commitment therapy for posttraumatic stress disorder. In D. M. Benedek & G. H. Wynn (Eds.), Complementary and alternative medicine for PTSD (pp. 35–57). Oxford University Press. Sharif, N., Karasavva, V., Thai, H., & Farrell, S. (2021). “We’re working in a trauma avoidant culture”: A qualitative study exploring assertive community treatment providers’ perspectives on working with trauma and PTSD in people with severe mental illness. Community Mental Health Journal, 57 (8), 1478–1488. https://doi.org/10.1007/s10597-020-00764-8 Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.0025