Evidence for trauma-informed organisational change programmes

Infographic illustrating the 10 components for trauma-informed organisational change programmes from the TAP CARE Study.

16 May 2023

Trauma-informed organisational change programmes may improve conditions for staff and patients in primary care and community mental healthcare, according to University of Bristol-led research published in Health & Social Care in the Community. Evidence was very limited and conflicting, but researchers found potential improvements to: staff readiness and sense of community, patient readiness for disease management and their access to services, staff and patient safety and some patient health outcomes.

Many patients and members of staff in primary care and community mental health care services have experienced individual, interpersonal, and collective trauma (e.g., rape, domestic abuse, political terror and war). Traumatic experiences accumulate throughout a person’s life. They shape how we behave and can harm our health.

Healthcare services which do not recognise how universal and impactful trauma is may fail to engage patients in treatment and re-traumatise patients and staff. Trauma-informed organisational change programmes can improve the way a service works and prevent re-traumatisation. Many UK policies and guidelines recommend implementing trauma-informed change in healthcare organisations.

Researchers from the Centre for Academic Primary Care, University of Bristol, funded by the National Institute for Health and Care Research Bristol Biomedical Research Centre (NIHR BRC), reviewed evidence for the effectiveness of trauma-informed organisational change programmes in primary care and community mental health care. This review was part of a programme of research on trauma-informed health systems, the Trauma-informed approaches in healthcare (TAP CARE) study.

The research team found that organisations developed bespoke models of trauma-informed change tailored to their needs, abilities, and preferences. Common organisational activities included an allocated budget, ongoing training and support for all staff, identification and response to trauma, evaluation of change, changes in physical environments, cross-sector collaboration, engagement of people with lived experience and leadership support.

Researchers found some evidence to suggest that implementing programmes at an organisational level may change organisational culture and create safe environments for patients and staff. Very limited evidence suggests that these programmes may improve patient quality of life, chronic pain, and mental health. No studies measured adverse events, harm, cost effectiveness, or staff health.

Dr Natalia Lewis, lead author, said: “We conducted a methodologically robust systematic review which found a very limited and uncertain evidence for the effects of trauma-informed organisational change interventions on staff and patient outcomes, with an overall direction towards some improvement.

“Funders, commissioners, policy makers, and healthcare providers can use this evidence to inform guidelines, policies, and their decisions about developing and implementing evidence-based trauma-informed organisational change programmes in primary care and community mental health care.”

Professor Stanley Zammit, mental health theme lead, said: “The TAP CARE systematic review has provided us with valuable insights regarding the evidence supporting the implementation of trauma-informed approaches in primary care and community mental health services.

“Going forward, Natalia's work forms an integral part of Bristol BRC’s Mental Health Theme programme of work aimed at developing interventions to improve treatment access and healthcare to people with mental health difficulties.”

Paper: Trauma-Informed Approaches in Primary Healthcare and Community Mental Healthcare: A Mixed Methods Systematic Review of Organisational Change Interventions. Natalia V Lewis, Angel Bierce, Gene S Feder, John Macleod, Katrina M Turner, Stan Zammit and Shoba Dawson. Published in Health & Social Care in the Community. May 2023.

Download the infographics: TAP CARE Study infographics (PDF, 368kB)

Infographic illustrating the 10 components for trauma-informed organisational change programmes from the TAP CARE Study.

Effectiveness of trauma-informed organisational change programmes for the individual patient, the care team and the organisation. Infographic highlighting key findings from the TAP CARE Study.

‌ Infographic from the TAP CARE Study.: 8 mechanisms of trauma-informed organisational change programmes: A package of varied components; women only space; dose of programme activities; staff education; tailoring education to organisational and wider context; staff self-care activities; safe environments; shared decision making.

Infographic from the TAP CARE Study: 7 factors impacting effectiveness of trauma-informed organisational change programmes. Contextual factors: Political and economic environments; Wider trauma-informed movement; Organisational culture; Organisational resources. Programme factors: Barriers to programme implementation; Programme components; Barriers to staff education.

Infographic from the TAP CARE Study: 5 barriers to trauma-informed organiational change programmes being implemented successfully in the UK.

Infographic from the TAP CARE Study: Recommendations for stakeholders - for funders, commissioners of healthcare services, policy makers and trauma leads, healthcare professionals and patients, and researchers and evaluators.

Watch the animation:

Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

Follow on Twitter: @capcbristol

About the NIHR

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

Funding high quality, timely research that benefits the NHS, public health and social care;
Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

The NIHR is the research partner of the NHS, public health and social care.