Trauma-informed approaches in primary healthcare and community mental healthcare: a mixed methods systematic review of organisational change interventions

Abstract

A trauma-informed approach is a framework for health system interventions that address the universal prevalence and impact of trauma. This mixed methods systematic review integrated evidence on the models, effects, and programme theories of trauma-informed primary healthcare and community mental healthcare. We searched five databases (January 1990-June 2021) and grey literature and consulted experts. The quantitative descriptive and qualitative framework syntheses were integrated through a line of argument and mapped onto a logic model. We included six studies that evaluated eight interventions with varied theoretical development, components, and outcomes. We found limited conflicting evidence for intervention effects on patient and provider psychological, behavioural, and health outcomes. Four studies reported improvement in provider psychological readiness and sense of community while three reported conflicting effects on provider behaviour. Four studies reported some improvement in patient readiness for disease management and access to services; however, the evidence for patient satisfaction was conflicting. Two studies found that patients and providers felt safe. While one study reported improvement in patient quality of life and chronic pain, another found nil effect on substance abuse, and three studies reported conflicting effects on mental health. Interventions worked as a whole package and through tailoring to the local context, staff education and self-care, safe environments, shared decision making. Intervention effects were moderated by contextual (health system values, policies, governance, business models, trauma-informed movement, organisational culture, social determinants of health) and intervention factors (buy-in from all staff, collective learning through conversations, equal attention to well-being of staff and patients, sustainable funding).

Why aren’t we doing better? Are dentists and dental students prepared to support patients with lived experience of intimate partner violence and abuse?

“…This is supported by studies that show that women are more likely to disclose IPVA to health professionals who enquire in a validating, supportive, non-judgemental way 21,24 . A systematic analysis showed that trauma informed organisational interventions may improve the readiness of practitioners and improve patient outcomes 25 . Additionally studies show that ineffective communication with dental patients can lead to adverse outcomes such as anxiety in the clinician and patient, and breakdown in the patientclinical relationship 26 .…”

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

“…A preprint of this article has previously been deposited in the preprint server for health sciences [58]. Te views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.…”