Research Article

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

Table 3

Evidence for effects and perceived effects of trauma-informed organisational change interventions on provider and patient outcomes.

Outcomes/phenomena of interest domainNil effect, study IDImprovement, study IDMixed effect, study ID
QuantitativeQualitativeQuantitativeQualitativeQuantitativeQualitative

Intermediate cognitive, affective, and behavioural outcomes

Provider readiness for trauma-informed careNoneNoneOrganisation level
Confidence scores 5.8 (SD 2.02) →6.9 (SD 2.00) →7.7 (SD 1.34), Browne [45]
Organisation levelNoneNone
Confidence, Browne et al. [45, 51]
NoneNoneNoneAwareness, Bradley [41, 45, 51]NoneNone
NoneNoneNoneSkills, Bradley [41, 48]NoneNone
NoneNoneNoneAttitudes, Bradley [41, 42, 45]NoneNone

Provider sense of communityNoneNoneNoneOrganisation levelNoneNone
Perceived support, Bradley [41, 48]
NoneNoneNonePerception of being valued, Bradley [41]NoneNone

Provider behaviour regarding trauma-informed careNoneNoneOrganisation levelOrganisation levelNoneOrganisation level
Screening rates for traumatic experiences 25% → 47%, Kimberg et al. [50]Screening for traumatic experiences, Dubay [48]
NoneNoneNoneUptake of self-care activities, Bradley [41]NoneUptake of self-care activities, Dubay [48]

Patient readiness for disease managementNoneNoneNoneCare-team levelNoneNone
Feeling in control of treatment, Brooks [42, 43, 48]
NoneNoneIndividual-patient levelIndividual patient levelNoneNone
Confidence in preventing and managing health conditions score β = 0.213, p < 0.001, Browne [49]Self-confidence, Bradley [4143]

Patient satisfactionNoneNoneOrganisation levelOrganisation levelNoneOrganisation level
Comfort and confidence in care score β = 0.5284, p < 0.001, Browne [49]Comfort and confidence in care, Bradley [4144, 48]
NoneNoneNonePerceived support, Bradley [4144]NoneNone
NoneNoneNoneSatisfaction with services, Bradley [4144]NoneSatisfaction with services, Dubay et al. [48]

Patient access to servicesNoneNoneNoneOrganisation levelNoneNone
Access to services, Bradley [4144, 48]

Provider and patient safetyNoneNoneNoneOrganisation levelNoneNone
Provider perceived safety, Bradley [41]
NoneNoneNonePatient perceived safety, Bradley [4143]NoneNone

Long-term health outcomes, individual-patient LEVEL

Quality of lifeNoneNoneQuality of life: 18 months β = 0.322, p < 0.001; 24 months β = 0.130, p < 0.001, Browne 2018 [49]NoneNoneNone

Chronic painNoneNoneChronic pain: 18 months β = −0.194, p < 0.001; 24 months β = −0.078, p < 0.001, Browne 2018 [49]NoneNoneNone

Mental healthMental health symptoms score:
6-month effect size 95% CI crosses 0, McHugo 2005 [47]; 12-month 0.274 (95% CI -0.053 to 0.600), McHugo 2005 [53]
NoneNoneNoneNone
NoneNoneDepressive symptoms score: 18 months β = −0.302, p < 0.001; 24 months β = − 0.1223, p < 0.001, Browne 2018 [49]Depressive symptoms, Brooks et al. [42, 43]NoneNone
NoneNonePTSD score: 18 months β = −0.305, p < 0.001; 24 months β = − 0.123, p < 0.001, Browne 2018 [49]NonePTSD score:
6-month 95% CI crosses 0, McHugo 2005 [47]; 12-month 0.414 (95% CI 0.081 to 0.747), McHugo 2005 [53]
None

Substance useNoneNoneNoneNoneAlcohol use problem severity score:
6-month 95% CI crosses 0, McHugo 2005 [47]; 12-month 0.017 (95% CI 0.073 to 0.107), McHugo 2005 [53]
None
Drug use problem severity score:
6-month 95% CI crosses 0, McHugo 2005 [47]; 12-month 0.004 (95% CI-0.086 to 0.094), McHugo 2005 [53]
NoneNoneNoneNoneNone

Note. Mixed effect, when one or more, but not all measures of the same outcome changed under the same intervention. PTSD, post-traumatic stress disorder. CI, confidence interval.