|
| Study title, country, study ID, reports | Study design and duration | Setting | Participants | Trauma-informed organisational change intervention | Outcome domains | Mechanisms proposed | Moderators identified | MMAT % yes |
|
| Women, Co-occurring Disorders, and Violence Study (WCDVS), US, McHugo 2005, [47, 52, 53] | Controlled before-after: repeated cross-sectional, structured interviews with patients. 12 months | Site 4/D: 4 outpatient community mental health centres (2 intervention vs 2 service as usual) providing mental health, trauma, and substance use services for women with co-occurring disorders and histories of abuse | 153 intervention 98 control all female; aged 42 (+8.6); 82.1% african american; 76.8% high school; 17.5% employed; 70.1% mood disorder; 23.9% schizophrenia spectrum disorder; 34.3% alcohol disorder; 22.7% crack/cocaine; 10.4% opioids | Comprehensive, integrated, trauma-informed, and survivor involved services:
(1) Eight core services (outreach and engagement, screening and assessment, treatment activities, parenting skills training, resource coordination and advocacy, trauma-specific services, crisis intervention, peer-run services);
(2) Integration of trauma-specific, addiction, and mental health services at organisational and clinical level;
(3) Trauma-informed services;
(4) Patients with lived experience in advisory and service provision roles | (1) Patient mental health
(2) Patient substance use | (1) Whole intervention ⟶ change patient health | (1) Intervention components | 71 |
|
| EQUIP Primary Care Study (Equipping Primary Health Care for Equity), Canada, Browne 2018, [45, 46, 49, 51] | Mixed methods: uncontrolled before-after cross-sectional survey with healthcare providers; qualitative interviews with providers; observations of setting and provider meetings; repeated structured interviews with patients. 24 months | 4 public primary health care clinics from diverse geographical areas that serve marginalised populations | 86 provider survey 31 provider interviews: 10 nurses, 3 physicians, 4 managers, 5 social service providers, 3 receptionists, 3 administrative, 3 others. 380 hours of observational data. 395 patient repeated structured interviews: 60% female; aged 45.8 (SD 14.6; 18–94); 42% indigenous; 42% did not complete school; 60% unemployed; 29.4% on social assistance; 38.7% disability benefits | An organisational level, multicomponent health equity EQUIP intervention:
(1) All staff education;
(2) Trauma champions;
(3) Organisational integration of three dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care;
(4) Intervention tailoring to context
(5) Patients with lived experience in advisory role | (1) Provider readiness for trauma-informed care
(2) Patient readiness for disease management
(3) Patient satisfaction
(4) Patient quality of life
(5) Patient chronic pain
(6) Patient mental health | (1) Whole intervention ⟶ change staff awareness and confidence ⟶ tensions ⟶ disrupted usual practice ⟶change organisational culture
(2) Tailoring staff education to local context
(3) EQUIP dose ⟶ change patient comfort and confidence in care ⟶change management health problems ⟶ change patient health | (1) Political and economic environments
(2) Organisational culture.
(3) Implementation process
(4) Staff education
(5) Patient characteristics | 88 |
|
| Aspire to Realize Improved Safety and Equity (ARISE) quality improvement programme, US, Kimberg 2019 [50] | Cross-sectional routine data | San Francisco health network primary care clinics | 116,871 screening records patients aged 18+ | Quality improvement programme:
(1) Quality improvement team;
(2) Staff education;
(3) Trauma-informed team-based clinical practice;
(3) Internal single performance metric for depression, alcohol/substance use; interpersonal violence;
(4) Single screening tool and pathway for depression, alcohol/substance use, interpersonal violence;
(5) Cross-sector partnerships;
(6) On-site and external therapy | (1) Provider behaviour regarding trauma-informed care | Not reported | Not reported | 29 |
|
| Advancing Trauma Informed Care Initiative, US, Dubay 2018 [48] | Qualitative service evaluation: interviews with healthcare providers and patients | 3 organisations providing primary care and behavioural health services to populations with high rates of traumatic experiences:
(1) Women’s HIV clinic at university of California, San Francisco
(2) Montefiore medical group of 22 primary care practices New York
(3) Family health clinic Philadelphia | 35 providers: 16 managers, 19 frontline staff (physicians, nurses, social workers, administrative) 6 patients | 3 different models, common components:
(1) Activities on changing organisational culture;
(2) All staff education and self-care;
(4) Trauma champions;
(5) Screening for trauma;
(6) Trauma-specific services;
(7) Patients with lived experience in advisory role | (1) Provider readiness for trauma-informed care
(2) Provider sense of community
(3) Provider behaviour regarding trauma-informed care
(4) Patient readiness for disease management
(5) Patient access to services | (1) Whole intervention ⟶ change organisational culture.
(2) Staff education ⟶ change awareness, knowledge, skills, staff relationships | (1) Political and economic environments
(2) Organisational culture
(3) Implementation process
(4) Staff education | 100 |
|
| Trauma-informed Young Women’s Clinic, Australia, Brooks 2017, [42–44] | Qualitative service evaluation: focus groups and interviews with healthcare providers and patients | The Blue Mountains Women’s Health and Resource Centre, Young Women’s Clinic that serves marginalised populations | 12 providers: 2 general practitioners, 2 nurses, 2 counsellors, 2 receptionists, art therapist, manager, youth worker, social work intern.
14 patients: aged 12–25; 10 anglo-australian, 1 aboriginal, 2 from culturally and linguistically diverse background, 1 in wheelchair | Trauma-informed youth-oriented clinic:
(1) Women-only policy;
(2) Drop-in appointment with a nurse, counsellor and general practitioner;
(3) Trauma-informed clinical practice;
(4) Drop-in facilitated art group;
(5) Patients with lived experience in service provision role | (1) Provider readiness for trauma-informed care
(2) Patient readiness for disease management
(3) Patient satisfaction
(4) Patient access to services
(5) Patient safety | (1) Whole intervention ⟶ change access to services
(2) Staff self-care⟶change provider feeling valued
(3) Women only space ⟶change access to services, safety, support, better health
(4) Staff education ⟶change awareness
(5) Staff self-care ⟶change provider feeling valued
(6) Safe environment ⟶change patient trust, safety
(7) Shared decision making ⟶change patient education, feeling in control | (1) Implementation process | 100 |
|
| One-stop-shop Women’s Centre, UK, Bradley 2020 [41] | Qualitative service evaluation: focus groups and interviews with patients, interviews with healthcare providers | The Nelson Trust Charity, One-stop-shop Women’s Centre for women with addiction, history of abuse, and criminal justice involvement | 4 providers
8 women | Trauma-informed service system:
(1) Hiring practices;
(2) All staff education and self-care;
(3) Trauma champions;
(4) Monthly trauma-informed guide team;
(5) Trauma-informed environment;
(6) Trauma-informed practices;
(7) Patients with lived experience in advisory role | (1) Provider readiness for trauma-informed care
(2) Provider sense of community
(2) Provider behaviour regarding trauma-informed care
(3) Patient readiness for disease management
(4) Patient satisfaction
(5) Patient access to services.
(6) Provider and patient safety | (1) Whole intervention ⟶change patient and provider safety and support, patient self-confidence, confidence in care, health
(2) Women only space ⟶change access to services, safety, support, health
(3) Staff education⟶change provider knowledge, skills
(4) Staff self-care⟶change provider feeling valued
(5) Safe environment ⟶change patient trust | (1) Political and economic environments.
(2) Organisational resources.
(3) Implementation process.
(4) Intervention components | 100 |
|
