Table 2 Barriers and facilitating factors for implementation identified in included studies
Study (country) | Evaluation method a | Outcomes reported b | Barriers identified | Facilitators identified |
|---|---|---|---|---|
Amaro, 2005 [25] (USA) | Field notes Focus group | Acceptability Effectiveness (patient satisfaction) | Staff resistance to change Lack of communication and collaboration Lack of consumer engagement Reliance on volunteers Insufficient training Insufficient staff skill mix Lack of data collection and evaluation Staff time constraints | Leadership buy-in Ongoing staff training Ongoing availability of experts Intervention tailored for culturally and linguistically diverse groups |
Azeem, 2015 [34] (USA) | File audit Field notes | Adoption Feasibility Effectiveness (restraint use) | NR | Staff buy-in Leadership buy-in TIC embedded into strategic planning Policy and procedure change Data collection and evaluation Ongoing availability of experts Collaboration and teamwork Consumer involvement Regular debriefing |
Bartlett, 2016 [35] (USA) | Survey Interviews Focus group File audit Field notes | Adoption Feasibility Sustainability Effectiveness (psychiatric symptoms and behaviour problems) | Staff time constraints Staff turnover Competing priorities Lack of appropriate services Lack of leadership commitment Financial constraints Lack of knowledge about steps for implementing TIC | Ongoing availability of experts Events that promote collaboration |
Beidas, 2016 [23] (USA) | Survey File audit Field notes | Acceptability Feasibility Adoption Penetration | Staff turnover Lack of perceived relevance of TIC Staff time constraints Staff resistance to change Inflexible policies and procedures | Leadership buy-in Financial incentives Resources allocated to staff who can coordinate collaboration between staff and organisations Availability of structured screening tools Community and academic partnership |
Caldwell, 2014 [36] (USA) c | File audit Field notes | Adoption Effectiveness (restraint/seclusion usage) | NR | Leadership buy-in Data collection and monitoring Consumer engagement Ongoing training for all staff and availability of experts Regular debriefing |
Chandler, 2008 [37] (USA) | Interviews | Acceptability Adoption Penetration Feasibility Sustainability | Restricted budget Confined physical space | Culture of support, respect for staff Flexibility in policies and procedures Ongoing availability of experts Flexible protocols Modelling Adequate staffing ratios |
Conover, 2015 [38] USA | File audit Field notes | Adoption | Lack of data collection and monitoring | NR |
Damian, 2017 [39] USA | Survey Interview | Acceptability Adoption | NR | Policy and procedure change Provision of appropriate physical space and design Staff appreciation from leadership Prioritisation of staff self-care |
Dike, 2020 [40] USA | File audit Field notes | Adoption Acceptability Costs Effectiveness (restraint use and staff injury) | Staff resistance to change Staff time constraints Competing priorities | Leadership buy-in Modelling Consumer involvement Having a precedent established by earlier implementation efforts in other states Data collection and monitoring On-site psychologists Financial resources |
Dorr, 2019 [27] USA | File audit Field notes | Adoption Acceptability Sustainability Effectiveness (restraint/seclusion usage) | Insufficient training Staff resistance to change Lack of ongoing training or training for new staff Lack of collaboration and communication within organisation Lack of multidisciplinary teamwork Limited ongoing feedback and evaluation Low perceived relevance of TIC Lack of trust in leadership Lack of staff confidence to implement TIC Insufficient preparation Uneven allocation of financial resources | Provision of appropriate physical space and design Recruitment of staff open to TIC implementation Culture that valued evidence-based practice and high-quality care Financial resources |
Dueweke, 2019 [41] USA | File audit Interviews Surveys | Acceptability Adoption Feasibility Penetration | Staff time constraints Lack of collaboration and communication within organisation Fear of retraumatising clients Screening tools too long for use in clinical practice | Perceived relevance of TIC Ongoing availability of resources Modelling Interactive, clear, and straightforward training approach Availability of structured screening tools |
Hale, 2020 [42]USA | File audit Field notes | Acceptability Adoption Sustainability Effectiveness (restraint/seclusion use) | NR | Mapping TIC to existing organisational priorities Leadership buy-in Implementation group with representation from staff at all levels Data collection and monitoring Regular debriefing Policy and procedure change Targets and incentives Training included in new employee orientation and yearly competencies |
Hall, 2016 [43] Australia | Survey Focus groups Field notes | Acceptability Adoption Penetration Feasibility | Staff time constraints Staff resistance to change | Involvement of person with lived experience of trauma as training co-facilitator |
File audit Field notes | Acceptability Adoption Fidelity Feasibility Sustainability | Staff resistance to change Staff time constraints Staff turnover Competing priorities Financial constraints Lack of interagency collaboration and communication | Activities to promote integration including team building and developing shared philosophy Consumer involvement Flexibility and training to promote consumer involvement Ongoing availability of experts Partnerships with referring and support organisations Reduce use of jargon Mentoring and supervision Leadership and stakeholder buy-in Outreach to promote TIC in other organisations Availability of structured screening tools Resources allocated to staff who can coordinate collaboration between staff and organisations Interagency committees Strategies to increase training accessibility Perceived relevance of TIC Policy and procedure change Regular debriefing | |
Jee, 2020 [46] USA | Survey Focus group Interviews | Acceptability Adoption Feasibility | Staff time constraints Additional training required Lack of debriefing Competing priorities | Use of videos within training |
Korchmaros, 2021 [33] USA | Survey | Fidelity Feasibility Acceptability Sustainability | Commitment to TIC by leadership not sustained over time Low staff confidence in ability to implement TIC | Policy and procedure change |
Koury, 2017 [47] USA | File audit Field notes Survey | Acceptability Feasibility | Lack of access to technology and technological difficulties Staff time constraints | Regular debriefing Staff accountability Homework and monthly consultations following training Participants supporting each other and having a sense of being a team |
Levine, 2021 [48] Canada | Field notes Interviews | Acceptability Adoption Feasibility | Staff resistance to change Competing priorities Lack of staff teamwork Financial constraints Staff time constraints Policy and regulation not consistent with TIC Lack of knowledge about steps for implementing TIC Systemic racism | Perceived relevance of TIC Embedding TIC into new staff orientation A supportive, flexible work environment Other TIC initiatives in the community Ongoing interprofessional discussions about trauma after training |
Loomis, 2019 [32] USA | File audit Field notes | Feasibility Fidelity | Financial constraints Staff time constraints Competing priorities Staff turnover | Intervention development included workforce feedback Leadership engagement Training delivered to all levels of organisational hierarchy Regular TIC training across multiple sites TIC training incorporated into employee orientation Embedding TIC principles into existing initiatives; no additional initiatives |
Mantler, 2018 [49] Canada | Interviews Field notes Survey Field notes | Acceptability Feasibility Fidelity Sustainability Effectiveness (patient satisfaction) | Financial constraints Lack of external services providing TIC Lack of trust in healthcare providers Staff time constraints Lack of interagency collaboration and communication: | Integration and co-location of health and domestic violence services Policy and procedure change Collaboration between service providers |
McEvedy, 2017 [50] Australia | Interviews Focus group | Acceptability Adoption Appropriateness Penetration | Lack of organisational support Staff resistance to change Competing priorities Staff not strategically selected for training Training content not practical enough Training too long | Tailored training Making the training compulsory and rostered staff to attend Targeting experienced educators for train-the-trainer training Establishing a multidisciplinary team including consumers Staff openness to change |
McNamara, 2021 [51] USA | Survey File audit | Acceptability Adoption Penetration | Staff turnover Competing priorities TIC training voluntary, poor uptake | Consumer engagement Conducting workshops in a variety of educational environments |
Palfrey, 2019 [52] Australia | Survey Focus group | Acceptability Adoption Feasibility Penetration Sustainability | NR | Perceived relevance of TIC Practical components of training (e.g. role plays) Training content about trauma presentation, neurobiology, and prevalence |
Purbeck, 2020 [29] USA | Survey Focus group Interviews | Acceptability Appropriateness Adoption Feasibility | Low perceived relevance of TIC Program complexity Staff time constraints | Internal implementation leaders with dedicated time for implementation Ongoing availability of experts Regular meetings between clinical team and evaluation team Having a full-time evaluator Staff time dedicated to implementation Clinical supervision that integrated the initiative Sessions with clients are long enough to implement the intervention Staff openness to change |
Sala-Hamrick, 2021 [30] USA | File audit Focus group | Acceptability Adoption Feasibility Fidelity Penetration | Staff time constraints Staff lack of confidence | Data collection and evaluation Consistent use of trauma screening Visual screening reminders Availability of structured screening tools Strengths-based focus Adequate preparation before implementation Ongoing training Staff given time to develop their confidence |
Simonich, 2015 [53] USA | Field notes Survey | Feasibility Fidelity | Lack of routine trauma screening Lack of skill in trauma identification among referring services Lack of awareness of TIC among referring services | Engaging and training other relevant child-serving systems and referring services Flexible training curriculum |
Tuck, 2017 [54] USA | Focus groups Survey | Feasibility Fidelity Effectiveness (participant experience) | Lack of data collection and monitoring | Leadership buy-in Interagency collaboration Financial resources Prior familiarity with TIC |