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

Section 4: Key findings – Barriers

This review found limited evidence in relation to the barriers or obstacles to implementing trauma informed practice, with the exception of Galvin et al. (2021) who discussed the barriers they found when it came to implementing the Sanctuary Model within the child welfare system.

In the case of the Sanctuary Model, outdated, inaccessible, contextually inappropriate, or a general lack of resources had a negative impact on engaging young people in the programme (Galvin et al., 2021). Additionally, Bartlett et al. (2016) report that limited resources for trauma-related work appeared to be a significant barrier for TIC implementation. Lack of human resources, such as the limited availability of mental health providers that could deliver evidence-based trauma-informed treatment to children was also a significant barrier.

4.1 Lack of commitment to the programme

Lack of fidelity to the (Sanctuary) model is the main barrier discussed by Galvin et al. (2021). The lack of fidelity was the result of limited consistency in using the model's tools (community meetings, psychoeducation), staff having a limited understanding of their role, and confusion or scepticism. Similarly, Bartlett et al. (2016) observed that one of the main barriers associated with the functioning of the Trauma Informed Leadership Teams (TILTs) was reduced commitment after over time, also affected by high work demands (see Bartlett et al., 2016).

4.2 Lack of practice-based training and refreshers

In Galvin et al.'s (2021) study, the theoretical background provided was appreciated, but sometimes staff felt like the training was "content heavy and not interactive enough" (Galvin et al., 2021, p. 5), which did not allow them to see the model in practice with young people . Additionally, staff would benefit from regular refresher sessions to ensure they use the model's tools more consistently in their daily practice. These barriers highlight the need for systematic and practice-based training and refresher sessions for staff to ensure they know how to practically utilise the model, but also to ensure consistent knowledge and understanding of the programmes and their purposes (Galvin et al., 2021).

4.3 Poor resources

Not having enough of the resources required to implement and embed an approach were seen as a significant barrier.