Enablers and barriers to trauma-informed systems, organisations and workforces: evidence review

Research summary

Overview

This research report presents the findings of a rapid evidence review of the international literature published between 2016-2022 describing the enablers that support the effective implementation of trauma-informed approaches across different systems, organisations and workforces, alongside barriers to implementation.

This review was conducted by the Scottish Government Health and Social Care Analysis Unit in 2022 with the initial search and screening phase conducted by NHS Education for Scotland (NES) Knowledge Services.

Approach

A rapid review of the literature was conducted to help identify predictors (enablers) that enhance the implementation of trauma-informed approaches in a variety of different services and systems, and the positive outcomes (successes) for staff and people with experience of trauma. Additionally, barriers and challenges identified in the implementation of these strategies to promote a trauma-informed approach are described. The main systems, services and organisations where these trauma-informed initiatives were adopted and have also been evaluated, include schools, child welfare systems, community-based organisations, health services and youth justice facilities.

A decision making tool (see Appendix A) was used to determine the effectiveness of the enablers or predictors described in the literature search. Effectiveness was assessed by determining how efficient the strategies were in supporting the successful implementation of trauma-informed approaches, and bringing positive change to staff and people with lived experience of trauma involved with the different systems, organisations and workforces covered here.

Key findings

In relation to the workforce in the services covered by the studies in our literature search, evidence shows that trauma-informed approaches can have a positive impact on staff wellbeing and satisfaction, improved communication and collaboration between systems and services, as well as increased confidence, knowledge and skills in relation to responding to psychological trauma.

For people with lived experience of psychological trauma, evidence shows that trauma-informed approaches can improve wellbeing, reduce emotional difficulties for children and young people and have a positive impact on families and caregivers. It can also increase knowledge and skills of people with experience of trauma, improve access to specialist treatment or services where required, increase completion rates of treatment and result in a reduction in the experience of seclusion and physical restraint.

Nine key enablers of successful trauma-informed approaches were identified with varying strengths of supporting evidence (discussed in Section 3). These include:

• Workforce development
• Organisational readiness/pre-intervention strategies
• Trauma-informed leadership
• Training and education for parents, carers and people with experience of trauma
• Use of trauma screening or routine enquiry (where appropriate)
• Adoption of strengths-based approaches
• A flexible approach
• Promoting involvement, positive relationships and effective communication with stakeholders
• Extended implementation periods

Evidence shows that the challenges or obstacles to embedding trauma-informed approaches can arise as a result of the following:

• Lack of clarity for staff on what a trauma-informed approach involves
• Lack of clarity for staff around what constitutes 'effective training'
• Difficulties related to implementing trauma screening or routine enquiry (where appropriate)
• The length of time required for implementation including unforeseen delays.