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Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review

BACKGROUND: Healthcare services can be re-traumatising for trauma survivors where they trigger memories of past distressing events and exert limits to a survivor’s sense of autonomy, choice, and control. The benefits of receiving trauma-informed healthcare are well established; however, factors that...

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Autores principales: Huo, Yan, Couzner, Leah, Windsor, Tim, Laver, Kate, Dissanayaka, Nadeeka N., Cations, Monica
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161455/
https://www.ncbi.nlm.nih.gov/pubmed/37147695
http://dx.doi.org/10.1186/s43058-023-00428-0
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author Huo, Yan
Couzner, Leah
Windsor, Tim
Laver, Kate
Dissanayaka, Nadeeka N.
Cations, Monica
author_facet Huo, Yan
Couzner, Leah
Windsor, Tim
Laver, Kate
Dissanayaka, Nadeeka N.
Cations, Monica
author_sort Huo, Yan
collection PubMed
description BACKGROUND: Healthcare services can be re-traumatising for trauma survivors where they trigger memories of past distressing events and exert limits to a survivor’s sense of autonomy, choice, and control. The benefits of receiving trauma-informed healthcare are well established; however, factors that promote or impede the implementation of trauma-informed care are not yet well characterised and understood. The aim of this review was to systematically identify and synthesise evidence regarding factors that promote or reduce the implementation of TIC in healthcare settings. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2.0 guidelines. Scopus, MEDLINE, Proquest, PsycINFO and grey literature were searched for original research or evaluations published between January 2000 and April 2021 reporting barriers and/or facilitating factors for the implementation of trauma-informed care in a healthcare setting. Two reviewers independently assessed the quality of each included study using the Mixed Methods Appraisal Tool (MMAT) Checklist. RESULTS: Twenty-seven studies were included, 22 of which were published in the USA. Implementation occurred in a range of health settings, predominantly mental health services. The barriers and facilitators of implementing trauma-informed care were categorised as follows: intervention characteristics (perceived relevance of trauma-informed care to the health setting and target population), influences external to the organisation (e.g. interagency collaboration or the actions of other agencies) and influences within the organisation in which implementation occurred (e.g. leadership engagement, financial and staffing resources and policy and procedure changes that promote flexibility in protocols). Other factors related to the implementation processes (e.g. flexible and accessible training, service user feedback and the collection and review of initiative outcomes) and finally the characteristics of individuals within the service or system such as a resistance to change. CONCLUSIONS: This review identifies key factors that should be targeted to promote trauma-informed care implementation. Continued research will be helpful for characterising what trauma-informed care looks like when it is delivered well, and providing validated frameworks to promote organisational uptake for the benefit of trauma survivors. REGISTRATION: The protocol for this review was registered on the PROSPERO database (CRD42021242891). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-023-00428-0.
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spelling pubmed-101614552023-05-06 Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review Huo, Yan Couzner, Leah Windsor, Tim Laver, Kate Dissanayaka, Nadeeka N. Cations, Monica Implement Sci Commun Systematic Review BACKGROUND: Healthcare services can be re-traumatising for trauma survivors where they trigger memories of past distressing events and exert limits to a survivor’s sense of autonomy, choice, and control. The benefits of receiving trauma-informed healthcare are well established; however, factors that promote or impede the implementation of trauma-informed care are not yet well characterised and understood. The aim of this review was to systematically identify and synthesise evidence regarding factors that promote or reduce the implementation of TIC in healthcare settings. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2.0 guidelines. Scopus, MEDLINE, Proquest, PsycINFO and grey literature were searched for original research or evaluations published between January 2000 and April 2021 reporting barriers and/or facilitating factors for the implementation of trauma-informed care in a healthcare setting. Two reviewers independently assessed the quality of each included study using the Mixed Methods Appraisal Tool (MMAT) Checklist. RESULTS: Twenty-seven studies were included, 22 of which were published in the USA. Implementation occurred in a range of health settings, predominantly mental health services. The barriers and facilitators of implementing trauma-informed care were categorised as follows: intervention characteristics (perceived relevance of trauma-informed care to the health setting and target population), influences external to the organisation (e.g. interagency collaboration or the actions of other agencies) and influences within the organisation in which implementation occurred (e.g. leadership engagement, financial and staffing resources and policy and procedure changes that promote flexibility in protocols). Other factors related to the implementation processes (e.g. flexible and accessible training, service user feedback and the collection and review of initiative outcomes) and finally the characteristics of individuals within the service or system such as a resistance to change. CONCLUSIONS: This review identifies key factors that should be targeted to promote trauma-informed care implementation. Continued research will be helpful for characterising what trauma-informed care looks like when it is delivered well, and providing validated frameworks to promote organisational uptake for the benefit of trauma survivors. REGISTRATION: The protocol for this review was registered on the PROSPERO database (CRD42021242891). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-023-00428-0. BioMed Central 2023-05-05 /pmc/articles/PMC10161455/ /pubmed/37147695 http://dx.doi.org/10.1186/s43058-023-00428-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Systematic Review
Huo, Yan
Couzner, Leah
Windsor, Tim
Laver, Kate
Dissanayaka, Nadeeka N.
Cations, Monica
Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review
title Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review
title_full Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review
title_fullStr Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review
title_full_unstemmed Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review
title_short Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review
title_sort barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161455/
https://www.ncbi.nlm.nih.gov/pubmed/37147695
http://dx.doi.org/10.1186/s43058-023-00428-0
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