Research Article

Trauma-Informed Approaches in Primary Healthcare and Community Mental Healthcare: A Mixed Methods Systematic Review of Organisational Change Interventions

Table 1

Study inclusion and exclusion criteria.

Inclusion criteriaExclusion criteria

PopulationPeople aged 18 and over receiving healthcare (synonyms patient and service user)People aged under 18 years
AND/OR
Health-care providers-individuals or organisations that provide healthcare services in a systematic way [36]

InterventionTrauma-informed organisational change interventionInterventions that do not incorporate key assumptions and principles at the organisational level
To address the heterogeneity in terminology and definitions, we used the SAMHSA’s framework for trauma-informed approach that is grounded in a set of four assumptions, six key principles, and ten implementation domains (supplementary materials S1) [8]

ComparatorNo trauma-informed organisational change intervention
We included studies without a control group

Quantitative outcomesMain outcomes: any psychological, behaviour, health outcomes at the organisational levelNo outcomes reported
Additional outcomes: any psychological, behavioural, and health outcomes at the individual level
Psychological outcomes can be measured through cognitive (e.g., knowledge and skills), affective (e.g., attitudes), behavioural (e.g., clinical practices) outcomes

Qualitative phenomenon of interestPerceived effects of interventions, views on factors that can impact intervention effectsNo phenomenon of interest reported

ContextAny organisations providing primary care and/or community mental healthcare services in public, private, and third sector [25]Organisations that do not provide primary care and/or community mental healthcare services
Studies with mixed samples if they reported outcomes for the primary care and/or community mental healthcare subsample irrespective of the proportion of the subsampleStudies with mixed samples that did not reported separately outcomes for the primary care and/or community mental healthcare subsample

Types of studiesEmpirical primary studies of any design that evaluated a trauma-informed organisational change interventionTheoretical papers, systematic reviews, editorials, policy documents, and books
Qualitative studies if they reported participant quotes

Time frameFrom 1990
Although the seminal paper introducing the philosophy and principles of trauma-informed mental healthcare was published in 2001 [7], professional stakeholders advised to extend searches to the preceding 10 years to capture early discussions of trauma-informed approach principles

LanguageNo language restrictions provided an English language abstract is availablePaper without abstract in English

Note. SAMHSA, the Substance Abuse and Mental Health Services Administration and United States Department of Health and Human Services.