***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Context : Exposure to traumatic events should be systematic ally assessed in health care services so that trauma-related treatment can be offered when appropriate . However , professionals often lack expertise in trauma inquiry and response , and therefore require training in this field . Objective : We aim ed to determine whether the “ Learning how to ask ” training for trauma inquiry and response ( Read , Hammersley , & Rudegeair , 2007 ) is effective in increasing health care professionals ’ trauma inquiry behavior . Method : 148 professionals working in outpatient substance use disorder ( SUD ) services were cluster-r and omized into an intervention or a waiting control group . The intervention group received a 1-day training and a refresher session 3 months later , while the control group received no training . The primary outcome was the change from baseline in the frequency of asking clients about traumatic events . Secondary outcomes were professionals ’ evaluation of the training , knowledge , attitudes toward and confidence in trauma inquiry and response . Results : Change from baseline in the frequency of asking clients about traumatic events was significantly greater at 3-month and 6-month follow-up in the intervention group compared with the control group ( b = 0.43 , 95 % CI [ 0.27 , 0.59 ] , p < .001 ) . The training was positively evaluated by the participants . Knowledge , positive attitudes toward and confidence in trauma inquiry and response all showed significantly greater increases in the intervention group than in the control group . Conclusions : These findings suggest that health care professionals can acquire skills in trauma inquiry and response from short trainings , which may enhance systematic assessment of traumatic events CONTEXT Despite multiple calls for clinic-based services to identify and support women victimized by partner violence , screening remains uncommon in family planning clinics . Furthermore , traditional screening , based on disclosure of violence , may miss women who fear reporting their experiences . Strategies that are sensitive to the signs , symptoms and impact of trauma require exploration . METHODS In 2011 , as part of a cluster r and omized controlled trial , staff at 11 Pennsylvania family planning clinics were trained to offer a trauma-informed intervention addressing intimate partner violence and reproductive coercion to all women seeking care , regardless of exposure to violence . The intervention sought to educate women about available re sources and harm reduction strategies . In 2013 , at the conclusion of the trial , 18 providers , five administrators and 49 patients completed semistructured interviews  exploring acceptability of the intervention and barriers to implementation . Consensus and open coding strategies were used to analyze the data . RESULTS Providers reported that the intervention increased their confidence in discussing intimate partner violence and reproductive coercion . They noted that asking patients to share the educational information with other women facilitated the conversation . Barriers to implementation included lack of time and not having routine reminders to offer the intervention . Patients described how receiving the intervention gave them important information , made them feel supported and less isolated , and empowered them to help others . CONCLUSIONS A universal intervention may be acceptable to providers and patients . However , successful implementation in family planning setting s may require attention to system-level factors that providers view as barriers OBJECTIVES This study used an experimental design to examine the effect of systematic implementation of behavioral interventions on the rate of seclusion and restraint  in an inpatient psychiatric hospital . METHODS With a variant of the multiple-baseline design , a model design ed to reduce seclusion and restraint was implemented at a large state-funded hospital in the southeastern United States . The implementation schedule was established such that each of five inpatient units was r and omly assigned to implement the intervention components in a different order , and each unit served as its own control . Participants were patients and staff , for a total of 89,783 patient-days over a 3.5-year period from January 2005 through June 2008 . The components included trauma-informed care training , changes to unit rules and language , changes to the physical characteristics of the therapeutic environment , and involvement of patients in treatment planning . The rate of inpatient psychiatric seclusion and restraint  ( per patient day ) was tracked continuously during the 3.5-year period . RESULTS A significant reduction of 82.3 % ( p=.008 ) in the rate of seclusion and restraint was observed between the baseline phase ( January 2005 through February 2006 ) and the follow-up , postintervention phase ( April 2008 through June 2008 ) . After control for illness severity and nonspecific effects associated with an observation-only phase , changes to the physical environment were uniquely associated with a significant reduction in rate of seclusion and restraint during the intervention rollout period . CONCLUSIONS These data suggest that substantial reductions in use of  seclusion and restraint  are possible in inpatient psychiatric setting s and that changes to the physical characteristics of the therapeutic environment may have a significant effect on use of seclusion and restraint Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system ( CWS ) . State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems . This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS , including workforce development , trauma screening , policy change , and improved access to evidence -based trauma-focused treatments during the initial 2-year implementation period . Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified r and om sample s of child welfare staff who completed a comprehensive assessment prior to ( N = 223 ) and 2 years following implementation ( N = 231 ) . Results indicated significant improvements in trauma-informed knowledge , practice , and collaboration across nearly all child welfare domains assessed , suggesting system-wide improvements in readiness and capacity to provide trauma-informed care . Variability across domains was observed , and frontline staff reported greater improvements than supervisors/managers in some domains . Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed 
    Output:
    
Whilst weaknesses in study design often limited generalisability , there was preliminary evidence for the efficacy of trauma-informed approaches in improving the mental and emotional well-being of children served by community-based child welfare services , as well as their potential for reducing caregiver stress and improving placement stability