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Table 1 Characteristics of included studies

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

Study (country)

Study design

Study setting

Population

# of sites

Implementation strategies

Outcome data type

Amaro, 2005 [25] (USA)

Case study

Drug and alcohol, residential, outpatient and inpatient

Adult women

5

Staff education (e.g. staff education, manualised intervention protocols)

Organisational strategies (e.g. project steering committee, establishing a shared philosophy, shared resources, routine trauma screening)

Consumer-orientated strategies (e.g. group therapy, peer support group)

Qual

Azeem, 2015 [34] (USA)

Case study

Psychiatric hospital, inpatient

Children

1

Staff education

Organisational interventions (e.g. executive support and consultation, audit and feedback, routine screening, restraint reduction and prevention tools, debriefing)

Consumer-orientated strategies (e.g. consumer involvement, calming and recreational activities)

Mixed

Bartlett, 2016 [35] (USA)

Case study, Single group pre-post

Child welfare area offices and mental health network, community

Children

20

Staff education and communication (e.g. staff training, staff wellness classes)

Organisational interventions (e.g. development of trauma-informed leadership teams, monthly planning meetings)

Consumer-orientated strategies: (e.g. statewide implementation of three evidence-based trauma treatments using learning collaboratives, creating a welcoming space for children and families, trauma workshops for resource (foster) parents, local schools, and community providers)

Mixed

Beidas, 2016 [23] (USA)

Case study

Behavioural health organisations, inpatient, residential, outpatient, and community

Children and adolescents

 > 14

Staff education and communication (e.g. staff training, consultation and technical assistance)

Organisational strategies: (e.g. routine screening, cross-organisational collaboration, building a referral network)

Consumer-orientated strategies (e.g. implementation of trauma-focussed therapies)

Quant

Caldwell, 2014 [36] (USA)

Case study

Psychiatric hospital, inpatient

Children

1b

Staff education and communication (e.g. staff supervision, new employee orientation)

Organisational strategies (e.g. strategic plan, leadership support and weekly meetings, policy and procedure change, individualised treatment and safety plans, routine debriefing)

Consumer-orientated strategies (e.g. family education, child and family inclusion in implementation)

Mixed

Chandler, 2008 [37] (USA)

Cross-sectional

Psychiatric hospital, inpatient

Adult

1

Staff education (e.g. staff training)

Organisational strategies (e.g. patient management plan, patient safety checklist, shared resources)

Qual

Conover, 2015 [38] (USA)

Case series, Single group pre-post

Behavioural health organisations, setting NR

NR

32

Staff education (e.g. staff education and supervision, learning community)

Organisational strategies (e.g. establishing an implementation team, organisational assessment, offering trauma-specific evidence-based practice)

Mixed

Damian, 2017 [39] (USA)

Single-group pre-post

Police, social services, health, and education agencies, setting NR

All

90a

Staff education (e.g. monthly staff training, ongoing coaching and feedback)

Organisational strategies (e.g. implementation of trauma-informed care policies and practices)

Mixed

Dike, 2020 [40] (USA)

Interrupted time series

Psychiatric hospital, inpatient

Adult

27

Staff education (e.g. staff training, recognition of good performance)

Organisational strategies: (e.g. project steering committees, routine screening, comfort rooms, policy and procedure change, behavioural consultation service, audit and feedback, patient participation, debriefing protocols,)

Consumer-orientated strategies (e.g. sensory modulation interventions)

Quant

Dorr, 2019 [27] (USA)

Case study

Psychiatric hospital, inpatient

Adolescent

1

Staff education (e.g. staff training and supervision, role play)

Organisational strategies (e.g. case review protocols, new staff hiring protocols, collaborative patient-staff problem-solving assessment process, environmental change, nominated program implementers)

Consumer-orientated strategies (e.g. daily programming schedule which allowed patient-staff interaction)

Mixed

Dueweke, 2019 [41] (USA)

Single group pre-post

Primary care, community

Children

1

Staff education

Organisational strategies (e.g. availability of routine screening tools)

Mixed

Hale, 2020 [42] (USA)

Case study

Psychiatric hospital, inpatient

Children and adolescents

3

Staff education (e.g. culture change, staff training and debriefing)

Organisational strategies (e.g. updated policies and procedures, de-escalation techniques, case review)

Consumer-orientated strategies (patient education)

Mixed

Hall, 2016 [43] (Australia)

Single-group pre-post

Emergency departments, inpatient

All

2

Staff education (staff training)

Mixed

Huntington, 2005 and Moses 2003 [44, 45] (USA)

Case series

Drug and alcohol, mental health, public health, and education services, residential, outpatient and community

Adult women

9

Staff education and communication (e.g. monthly-quarterly group meetings, staff training)

Organisational strategies (e.g. interagency steering committee, formal voting mechanism to resolve issues)

Consumer-orientated strategies (e.g. trauma-specific services, peer-run services, consumer involvement, trauma consultation-liaison services)

Qual

Jee, 2020 [46] (USA)

Single group pre-post

Primary care, community

Children

1

Staff education (e.g. staff training)

Mixed

Korchmaros, 2021 [33] (USA)

Single group longitudinal

Drug and alcohol, residential

Adolescent

1

Staff education (e.g. staff training)

Organisational strategies (e.g. steering group, agency-specific protocols, routine safety plans and red flag reviews)

Consumer-orientated strategies (e.g. client-specific Seeking Safety groups)

Quant

Koury, 2017 [47] (USA)

Case study

Drug and alcohol, setting NR

Adolescent

30

Staff education (e.g. learning collaborative, training ‘champions’, monthly consultations, resource sharing)

Qual

Levine, 2021 [48] (Canada)

Cross-sectional

Primary care clinics, community

All

4

Staff education (e.g. interprofessional education sessions, group discussions)

Qual

Loomis, 2019 [32] (USA)

Case study

Whole of city health system, all settings

All

City-wide

Staff education (e.g. learning collaborative, workforce training, monthly meetings, train-the-trainer program)

Organisational strategies (e.g. leadership engagement, expert workgroup available to guide implementation, resources to promote policy and procedure change)

Qual

Mantler, 2018 [49] (Canada)

Case series

Health services delivered within domestic violence services, community

Adult women

3

Organisational strategies (e.g. integration of nurse practitioner clinic within domestic violence services)

Qual

McEvedy, 2017 [50] (Australia)

Cross-sectional

Mental health, all settings

All

19

Staff education (e.g. train-the-trainer program)

Qual

McNamara, 2021 [51] (USA)

Single group pre-post

Paediatric hospital, inpatient

Children

2

Staff education (e.g. staff training)

Quant

Palfrey, 2019 [52] (Australia)

Single group pre-post

Mental health, all settings

All

102a

Staff education (e.g. staff training, regular supervision)

Organisational strategies (e.g.routine screening)

Mixed

Purbeck, 2020 [29] (USA)

Case series

Mental health and drug and alcohol, community, outpatient and residential

Children

7

Staff education (e.g. staff training and consultation, monthly team meetings)

Organisational strategies (e.g. fostering practice-based capacities, assessing readiness, capacity building)

Consumer-orientated strategies (e.g. engaging children and caregivers)

Mixed

Sala-Hamrick, 2021 [30] (USA)

Cross-sectional

Primary care, community

Children

1

Staff education (e.g. staff training, collaborative creation of implementation strategy)

Organisational strategies (e.g. routine screening, shared resources, data availability)

Mixed

Simonich, 2015 [53] (USA)

Single group pre-post

All childhood services across state, system

Children

State-wide

Staff education (e.g. staff training, train-the-trainer program, annual clinician meetings)

Organisational strategies (e.g. established network of trained clinicians))

Mixed

Tuck, 2017 [54] (USA)

Case study

Maternal health services, community

Adult women

City-wide

Staff education (e.g. staff training, coaching)

Organisational strategies (e.g. working group, policy and procedure change)

Mixed

  1. Abbreviations: NR not reported, USA United States of America
  2. aNumber of participants, paper did not report number of sites; b Only the health setting was included here