How is trauma-informed care currently conceptualised? A scoping review.

Introduction



In the UK, the Health Innovation team in Northeast and North Cumbria, have created a platform to help promote and advocate for trauma-informed approaches to mental health treatment, to support the development of a national trauma-informed community of practice. The current scoping review explored how trauma-informed care (TIC) is currently conceptualised, from the perspective of healthcare providers and professionals. This will foster its acceptance in the English healthcare workforce and internationally.



Methods



3 databases were used to identify relevant journal articles. Web-searches were used to identify policy handbooks and national guidelines relevant to healthcare settings. The included documents were published in the last 15 years. 



Results



An initial set of 14 documents were identified from 2008 to 2023, consisting of clinical trial reports, books, policy documents, and practice handbooks. Different interpretations of TIC were described. This included networking activities with a shared national vision of integrating the TIC principles at a systemic level. A few expressed that facilitating its implementation by tailoring it contextually to the organisation is significant. Many highlighted re-occurring implementation challenges such as safety, transparency, cultural sensitivity, trustworthiness, collaboration, empowerment, and choice. Barriers to the implementation of TIC at an organisational level were identified. These included having no dedicated strategy, agreed terminology, or framework, and only modest levels of evidence-based findings from the UK healthcare system. This worryingly creates a cohort of professionals lacking the skill to respond with confidence when a patient discloses assault, violence, or abuse within an organisation. 



Conclusion 



Future research should continuously document and evaluate robust trauma-informed practices across healthcare systems internationally. There are differing views on the future implementation of TIC; some believe it has gained critical momentum, but others are pessimistic, due to insufficient political support, creating a potential barrier to meaningful reforms to healthcare practice.