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Table 1 Framework Guiding the EQUIP Intervention

From: Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics

Trauma- and Violence-Informed Care

• Based on understanding the effects of interpersonal (e.g., child maltreatment, intimate partner violence) and structural (e.g., poverty, racism) forms of violence as intersecting, with compounding impacts on health; recognizes that people disadvantaged by systemic inequities often experience multiple forms of violence that have ongoing traumatic impacts

• Shifts emphasis from client disclosure of violence experiences to care providers creating a safe environment, including for those most traumatized

• Creates a safer environment for all, including staff; counters the tendency to locate ‘the problem’ of trauma primarily in the psyche of those experiencing violence by emphasizing social and structural conditions as causes of trauma

Contextually-Tailored Care

• Based on understanding how the evolving local community and context shape health and health care inequities

• Expands on the notion of patient or client-centered care to tailor services and programs explicitly to the populations served and local contexts

• Is responsive to the complexity inherent in designing EOHC with both standardized and tailored components to meet the needs of different contexts and populations; counters a ‘one size fits all’ approach in health care

Cultural Safety

• Based on understanding the impacts of inequitable power relations, racism, discrimination, colonization, and historical and current inequities on health and health care

• Shifts attention from ‘cultural differences’ as the source of the problem to the culture of health care as the site for transformation; moves beyond cultural sensitivity to place responsibility on care providers to create culturally safe environments

• Foregrounds social justice goals as integral to health care with the aim of shaping health care practices, organizations and policies accordingly