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. 2024 Mar 15;28(1):135-150.
doi: 10.7812/TPP/23.127. Epub 2024 Mar 6.

Effectiveness of Trauma-Informed Care Implementation in Health Care Settings: Systematic Review of Reviews and Realist Synthesis

Ellen Goldstein  1 , Binny Chokshi  2 , G J Melendez-Torres  3 , Anna Rios  4 , Martina Jelley  5 , Annie Lewis-O'Connor  6
Affiliations

Effectiveness of Trauma-Informed Care Implementation in Health Care Settings: Systematic Review of Reviews and Realist Synthesis

Ellen Goldstein et al. Perm J. .

Abstract

Purpose: Given the ubiquity of traumatic exposures and the profound impact of trauma on health, a trauma-informed care (TIC) approach in health care is critical. TIC seeks to promote safety within health care and prevent retraumatization. The lack of systems-level data has been a major barrier to TIC implementation. This study aimed to understand the mechanisms and outcomes effective in implementing TIC across health systems using a systematic review of reviews and realist synthesis.

Methods: A systematic search of MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Applied Social Science Index & Abstracts identified reviews addressing TIC in health care published in the last 10 years in peer-reviewed journals. Realist synthesis methodology was used to develop context-mechanism-outcome configurations. Thematic analysis was performed to generate a framework for the mechanisms of implementation that produce successful TIC outcomes.

Results: Sixteen articles featuring varied review types were included. The results, highlighting the strategies that lead to improved outcomes for patients and systems, were mapped to SAMHSA's 10 TIC implementation domains, including engagement and involvement; training and workforce development; cross-sector collaboration; screening, assessment, and treatment services; governance and leadership; policy; evaluation; progress monitoring and quality assurance; financing; and physical environment.

Conclusion: The findings support the use of SAMHSA's 10 implementation domains in varied health care contexts to facilitate effective TIC processes. Future work should continue to evaluate the effectiveness of TIC approaches and may consider how health equity and strengths-based approaches fit within SAMHSA's framework.

Keywords: Health Care; Implementation; Organizations; Policy; Realist Synthesis; Trauma-Informed Care.

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Conflict of interest statement

Conflicts of interestNone declared

Figures

Figure 1:
Figure 1:
Intersectionality of trauma at multiple levels. © Lewis-O’Conner A, Rittenberg E, Grossman S, Levy-Carrick N 2024. Reproduced with permission. All rights reserved. Based on Ashworth et al 2023.
Figure 2:
Figure 2:
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram of systematic search. Flowchart created using PRISMA design from Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71. 36 Creative Commons Attribution (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/legalcode). ASSIA = Applied Social Sciences Index and Abstracts; CINAHL = Cumulative Index to Nursing and Allied Health Literature; TIC = trauma-informed care.
See this image and copyright information in PMC

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