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\"A powerful book that uses plain language to talk about colonial trauma and transformational change. History. Identity. Lateral Violence. Complex Trauma. Who are we and how are we seen? How do we learn what safety is when we've never experienced it? Killing the Wittigo talks about the effects of colonization and the healing work being done by young Indigenous people toward individual and systemic change, through song lyrics and first-person accounts of their own journeys of decolonization and healing. Sexual Abuse. Relationships. Kindness and Kinship. Are your relationships harmful or healthy? What do healthy families look like? Killing the Wittigo shatters the isolation and shame to talk about everything from managing triggers to what young people are asking of their parents and their leadership. Abandonment. Dis-Ease. Reconnection. Change. How do you turn distressing feelings into emotions that you can understand? How does making sense of your stories help you gain choice and control? From market capitalism and food security to community hubs and sustainable development goals, Killing the Wittigo has everything a young person needs to move from surviving to thriving. Killing the Wittigo offers: Reflection questions to anchor/reframe life experiences. Mindfulness activities to help readers center themselves in the present, develop self-awareness, and create new patterns of behaviour. Activities and exercises to support meaning making and change. Full of bold graphics, Killing the Wittigo is a much-needed resource for young Indigenous people and those who work in the helping professions.\" -- Back cover.

Invisible Scars explores the treatment of psychological casualties during the Korean War and the long-term repercussions for former soldiers living with trauma.

At cheerleading camp, Hermione is drugged and raped, but she is not sure whether it was one of her teammates or a boy on another team--and in the aftermath she has to deal with the rumors in her small Ontario town, the often awkward reaction of her classmates, the rejection of her boyfriend, the discovery that her best friend, Polly, is gay, and above all the need to remember what happened so that the guilty boy can be brought to justice.

Gorfinkel et al present several facts about genital and gynecologic examination. A history of sexual violence reduces the likelihood of people having timely genital or gynecologic examinations. In Canada, more than half of transgender people, 1 in 3 women, and 1 in 8 men report experiencing sexual violence. Genital examinations trigger flashbacks and increase symptoms of anxiety in about 50% of people who have experienced sexual assault. Given this high prevalence, trauma-informed care starts with the assumption that all people have experienced sexual trauma.

Background Trauma-informed care (TIC) is a framework that recognizes the pervasive impact of trauma, aiming to enhance both patient outcomes and provider well-being. Given the high prevalence of trauma among individuals seeking healthcare, it is essential for healthcare providers (HCPs) to be trauma informed. However, standardized TIC curricula for training healthcare staff are lacking. This study assessed perceptions towards TIC among multidisciplinary HCPs, patients, and leadership staff at two urban hospitals in Canada. Methods This mixed-methods prospective cross-sectional study employed Kern’s six-step approach for curriculum development. A needs assessment was conducted via an online questionnaire for HCPs and semi-structed interviews with individuals from the three participant groups: HCPs, patients, and leadership staff. The questionnaire assessed knowledge, skills, and attitudes regarding TIC. Semi-structured interviews explored perspectives on TIC, including curriculum priorities and potential implementation barriers. Findings informed the development of a virtual TIC curriculum, with iterative feedback collected to refine and assess its acceptability. Results Among 106 HCP questionnaire respondents including Medical Doctors, Social Workers and Registered Nurses, 96 (90.6%) identified as women, and 97 (91.5%) as providers of direct patient care. Despite 93 (87.7%) having prior TIC education, 77 (72.6%) reported low confidence in applying TIC knowledge in clinical practice. Key perceived challenges to TIC training implementation included time constraints and lack of standardization across disciplines. A multimedia, self-paced course was the preferred solution. Thematic analysis of interviews with 28 participants (10 HCPs, 10 patients, 8 leadership staff) revealed six major themes: healthcare interactions, TIC implementation, training needs, system level barriers, curriculum preferences, and systems level improvements. Participants underscored the risk of re-traumatization to patients in healthcare settings without TIC and emphasized the need for universal TIC training for all staff. Conclusion This study revealed a strong interest in a TIC course for multidisciplinary HCPs, supports the translation of knowledge into practice and incorporates a focus on cultural humility. Integrating insights from key stakeholders in this needs assessment phase resulted in the development of a TIC curriculum inclusive of diverse voices and viewpoints and strengthened the understanding of contextual factors that will support effective TIC implementation.

Anti-Black racism in Canada remains a significant barrier to the career advancement and overall well-being of Black professionals. Despite the existence of policies and legislation aimed at reducing workplace discrimination, Black Canadians continue to face systemic racism, microaggressions, and various forms of discrimination that hinder their professional growth and contribute to a hostile work environment. This study explores the specific manifestations of anti-Black racism in Canadian workplaces, examines the physical and mental health impacts on Black professionals, and investigates the responses and coping mechanisms employed by these individuals in the face of racism. A qualitative study was conducted involving semi-structured interviews with 24 Black professionals from diverse sectors, including healthcare, information technology, academia, and public service. Participants were selected based on their professional experience and self-identification as Black. Data were collected through in-depth interviews, which were transcribed and analyzed using LeximancerTM software to identify recurring themes and patterns. The study identified three primary themes: (1) Mechanisms of anti-Black racism, including microaggressions, overt bias, and tokenism; (2) Impacts of anti-Black racism, such as mental health trauma, career stagnation, and exacerbation of chronic health conditions; and (3) Responses of Black professionals, including code-switching, self-preservation behaviors, and early exit from the workplace. The findings reveal that despite high academic achievement and leadership positions, Black professionals face persistent discrimination that affects their career trajectories and personal lives. Anti-Black racism in Canadian workplaces is deeply entrenched and continues to negatively impact the lives and careers of Black professionals. The study highlights the need for more effective diversity and inclusion initiatives that address the root causes of racism. Further research is recommended to explore the economic and psychological impacts of anti-Black racism and to develop strategies to mitigate its effects in the workplace.

Background While simple Audit & Feedback (A&F) has shown modest effectiveness in reducing low-value care, there is a knowledge gap on the effectiveness of multifaceted interventions to support de-implementation efforts. Given the need to make rapid decisions in a context of multiple diagnostic and therapeutic options, trauma is a high-risk setting for low-value care. Furthermore, trauma systems are a favorable setting for de-implementation interventions as they have quality improvement teams with medical leadership, routinely collected clinical data, and performance-linked to accreditation. We aim to evaluate the effectiveness of a multifaceted intervention for reducing low-value clinical practices in acute adult trauma care. Methods We will conduct a pragmatic cluster randomized controlled trial (cRCT) embedded in a Canadian provincial quality assurance program. Level I–III trauma centers ( n  = 30) will be randomized (1:1) to receive simple A&F (control) or a multifaceted intervention (intervention). The intervention, developed using extensive background work and UK Medical Research Council guidelines , includes an A&F report, educational meetings, and facilitation visits. The primary outcome will be the use of low-value initial diagnostic imaging, assessed at the patient level using routinely collected trauma registry data. Secondary outcomes will be low-value specialist consultation, low-value repeat imaging after a patient transfer, unintended consequences, determinants for successful implementation, and incremental cost-effectiveness ratios. Discussion On completion of the cRCT, if the intervention is effective and cost-effective, the multifaceted intervention will be integrated into trauma systems across Canada. Medium and long-term benefits may include a reduction in adverse events for patients and an increase in resource availability. The proposed intervention targets a problem identified by stakeholders, is based on extensive background work, was developed using a partnership approach, is low-cost, and is linked to accreditation. There will be no attrition, identification, or recruitment bias as the intervention is mandatory in line with trauma center designation requirements, and all outcomes will be assessed with routinely collected data. However, investigators cannot be blinded to group allocation and there is a possibility of contamination bias that will be minimized by conducting intervention refinement only with participants in the intervention arm. Trial registration This protocol has been registered on ClinicalTrials.gov (February 24, 2023, # NCT05744154 ).

Injury severity scales have traditionally been used to assess the performance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a list of in-hospital urgent and specialized trauma care interventions that require direct transport to the highest-level trauma centre within the catchment area. Based on a list of potential participants we obtained using data on training, experience, geographic location, affiliations and role within key trauma organizations, we recruited multidisciplinary trauma experts (including prehospital, emergency, surgery and intensive care clinicians, epidemiologists and clinician/decision-makers) from across Canada to complete a 3-round modified Delphi survey. We conducted a literature review of the criteria used to define urgent and specialized trauma care, and included all diagnostic and therapeutic interventions presented in previously published studies in the list of interventions to present to the panellists. The final list was determined by our advisory committee, 5 clinicians with experience in trauma care. Participants were asked to rate their level of agreement for potentially including the 38 items as urgent and specialized trauma care interventions on a 9-point Likert scale. Interventions were retained if more than 67% of participants moderately or strongly agreed (7–9 on the Likert scale). Interventions that did not reach consensus were presented again in the subsequent round. Twenty-three panellists were recruited. The response rate was 91%, 96% and 83% for the 3 rounds. After the Delphi process, 30 of the 38 interventions, including endotracheal intubation, blood product administration and angioembolization, and abdominal, thoracic, neurosurgical, spinal and/or orthopedic operations (excluding hip or limb surgery, and toe or finger amputation), were selected. Hospital admission to the intensive care unit and/or for observation of brain, spinal, thoracic or abdominal injuries were also retained. We developed a Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions requiring direct transportation to a major trauma centre. This list should help standardize assessments of current protocols and derive new triage tools. Les échelles de gravité des blessures sont habituellement utilisées pour évaluer les performances des protocoles de triage préhospitalier des traumatismes, mais elles sont inadaptées aux besoins urgents des interventions spécialisées en traumatologie. La présente étude visait à concevoir une liste des interventions hospitalières urgentes et spécialisées en traumatologie nécessitant un transport direct vers le centre de traumatologie du niveau le plus élevé de la circonscription hospitalière. Nous avons constitué une liste de participants potentiels d’après des données sur la formation, l’expérience, l’emplacement géographique, les affiliations et le poste au sein d’établissements majeurs en traumatologie pour recruter différents experts en traumatologie (dont des professionnels des soins préhospitaliers, des soins d’urgence, des soins intensifs et de la chirurgie, des épidémiologistes ainsi que des cliniciens décideurs) de tout le Canada à qui nous avons demandé de remplir un questionnaire Delphi modifié en 3 étapes. Nous avons effectué une revue de la littérature des critères utilisés pour définir les soins urgents et spécialisés en traumatologie et avons inclus l’ensemble des interventions diagnostiques et thérapeutiques décrites dans les études précédentes à la liste des interventions présentées aux panélistes. Notre comité consultatif, 5 professionnels de la santé connaissant bien la traumatologie, s’est entendu sur la liste définitive. Les participants ont noté la classification potentielle de 38 éléments comme des interventions urgentes et spécialisées en traumatologie sur une échelle de Likert en 9 points. Les interventions modérément ou fortement approuvées par plus de 67 % des participants (7–9 sur l’échelle de Likert) ont été retenues, tandis que celles qui n’ont pas abouti à un consensus ont été présentées à nouveau à l’étape suivante. Vingt-trois panélistes ont été recrutés et ont été 91 %, 96 % et 83 % à répondre à chaque étape du sondage. À l’issue du processus Delphi, 30 des 38 interventions, dont l’intubation trachéale, l’administration de produits sanguins et l’angioembolisation, ainsi que les chirurgies abdominales, thoraciques, neurochirurgicales, orthopédiques et du rachis (à l’exclusion de la chirurgie de la hanche ou des membres et l’amputation des orteils ou des doigts) ont été sélectionnées. L’hospitalisation en soins intensifs ou pour observation d’un traumatisme crânien, médullaire, thoracique ou abdominal a aussi été retenue. Nous avons élaboré une liste canadienne par consensus des interventions hospitalières urgentes et spécialisées en traumatologie nécessitant un transport direct vers un grand centre de traumatologie afin de normaliser les évaluations des protocoles actuels pour en tirer de nouveaux outils de triage.

Background Traumatic hemorrhage is a significant cause of morbidity and mortality. There is considerable interest in risk stratification tools to aid with early activation of intervention pathways for bleeding patients. In this study, we refine the Canadian Bleeding (CAN-BLEED) score for the prediction of major interventions in bleeding trauma patients. Methods We conducted a mixed retrospective-prospective cohort study. We included a retrospective cohort from the CAN-BLEED derivation study, from September 2014 to September 2017. We also conducted a prospective cohort from May 2019 to August 2021 and included both datasets for refinement of the CAN-BLEED score. The primary outcome was major intervention, defined by a composite of massive transfusion, embolization, or surgery for hemostasis. Predictors were pre-specified based on previous validation work. We used a stepdown procedure and regression coefficients to create a clinical risk stratification score. We used bootstrap internal validation to assess optimism-corrected performance. Results We included 1368 patients in the overall cohort. Incidence of penetrating injury was 23% and median injury severity score was 17. The overall incidence of the need for major intervention was 17%. The revised score included 8 variables: systolic blood pressure, heart rate, lactate, penetrating mechanism, pelvic instability, Focused Abdominal Sonography for Trauma positive for free fluid, computed tomography positive for free fluid, or contrast extravasation. The C-statistic for the simplified score is 0.89. A score cut-off of less than 2 points yielded a 97% (94–98%) sensitivity in ruling out the need for major intervention. Conclusion The revised CAN-BLEED score offers a clinically intuitive and internally validated tool with excellent performance in identifying patients requiring major intervention for traumatic bleeding. Further efforts are required to evaluate its performance with an external validation.

BackgroundDespite the existing knowledge about stress, trauma and pregnancy and maternal stress during natural disasters, little is known about what types of trauma pregnant or preconception women experience during these disasters. In May 2016, the worst natural disaster in modern Canadian history required the evacuation of nearly 90,000 residents of the Fort McMurray Wood Buffalo (FMWB) area of northern Alberta. Among the thousands of evacuees were an estimated 1850 women who were pregnant or soon to conceive. In August 2017, Hurricane Harvey devastated areas of the United States including Texas, with 30,000 people forced to flee their homes due to the intense flooding.ObjectiveTo explore immediate and past traumatic experiences of pregnant or preconception women who experienced one of two natural disasters (a wildfire and a hurricane) as captured in their expressive writing. Research questions were: (1) What trauma did pregnant or preconception women experience during the fire and the hurricane? (2) What past traumatic experiences, apart from the disasters, did the women discuss in their expressive writing?MethodsA qualitative secondary analysis of expressive writing using thematic content analysis was conducted on the expressive writing of 50 pregnant or preconception women who experienced the 2016 Fort McMurray Wood Buffalo Wildfire (n = 25) and the 2017 Houston Hurricane Harvey (n = 25) Narrative data in the form of expressive writing entries from participants of two primary studies were thematically analyzed. One of the expressive writing questions was used in this analysis: “What is the most traumatic, upsetting experience of your entire life, especially that you have never discussed in great detail with others?” NVivo 12 supported thematic content analysis.ResultsFor some women, the disasters elicited immense fear and anxiety that surpassed previous traumatic life events. Others, however, disclosed significant past traumas that continue to impact them, including betrayal by a loved one, abuse, maternal health complications, and illness.ConclusionWe recommend a strengths-based and trauma-informed care approach in both maternal health and post-disaster relief care.