Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives
Abstract Background Trauma-informed (TI) approach is a framework for a system change intervention that transforms the organizational culture and practices to address the high prevalence and impact of trauma on patients and healthcare professionals, and prevents re-traumatization in healthcare servic...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-022-08461-w |
| _version_ | 1818020404031127552 |
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| author | Elizabeth Emsley Joshua Smith David Martin Natalia V. Lewis |
| author_facet | Elizabeth Emsley Joshua Smith David Martin Natalia V. Lewis |
| author_sort | Elizabeth Emsley |
| collection | DOAJ |
| description | Abstract Background Trauma-informed (TI) approach is a framework for a system change intervention that transforms the organizational culture and practices to address the high prevalence and impact of trauma on patients and healthcare professionals, and prevents re-traumatization in healthcare services. Review of TI approaches in primary and community mental healthcare identified limited evidence for its effectiveness in the UK, however it is endorsed in various policies. This study aimed to investigate the UK-specific context through exploring how TI approaches are represented in health policies, and how they are understood and implemented by policy makers and healthcare professionals. Methods A qualitative study comprising of a document analysis of UK health policies followed by semi-structured interviews with key informants with direct experience of developing and implementing TI approaches. We used the Ready Extract Analyse Distil (READ) approach to guide policy document review, and the framework method to analyse data. Results We analysed 24 documents and interviewed 11 professionals from healthcare organizations and local authorities. TI approach was included in national, regional and local policies, however, there was no UK- or NHS-wide strategy or legislation, nor funding commitment. Although documents and interviews provided differing interpretations of TI care, they were aligned in describing the integration of TI principles at the system level, contextual tailoring to each organization, and addressing varied challenges within health systems. TI care in the UK has had piecemeal implementation, with a nation-wide strategy and leadership visible in Scotland and Wales and more disjointed implementation in England. Professionals wanted enhanced coordination between organizations and regions. We identified factors affecting implementation of TI approaches at the level of organization (leadership, service user involvement, organizational culture, resource allocation, competing priorities) and wider context (government support, funding). Professionals had conflicting views on the future of TI approaches, however all agreed that government backing is essential for implementing policies into practice. Conclusions A coordinated, more centralized strategy and provision for TI healthcare, increased funding for evaluation, and education through professional networks about evidence-based TI health systems can contribute towards evidence-informed policies and implementation of TI approaches in the UK. |
| first_indexed | 2024-04-14T08:04:26Z |
| format | Article |
| id | doaj.art-bb544ab29e5a46d19401f41335a8f33d |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-14T08:04:26Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-bb544ab29e5a46d19401f41335a8f33d2022-12-22T02:04:47ZengBMCBMC Health Services Research1472-69632022-09-0122111210.1186/s12913-022-08461-wTrauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectivesElizabeth Emsley0Joshua Smith1David Martin2Natalia V. Lewis3Centre for Academic Primary Care, Bristol Medical School, University of BristolCentre for Academic Primary Care, Bristol Medical School, University of BristolCentre for Academic Mental Health, Bristol Medical School, University of BristolNIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolAbstract Background Trauma-informed (TI) approach is a framework for a system change intervention that transforms the organizational culture and practices to address the high prevalence and impact of trauma on patients and healthcare professionals, and prevents re-traumatization in healthcare services. Review of TI approaches in primary and community mental healthcare identified limited evidence for its effectiveness in the UK, however it is endorsed in various policies. This study aimed to investigate the UK-specific context through exploring how TI approaches are represented in health policies, and how they are understood and implemented by policy makers and healthcare professionals. Methods A qualitative study comprising of a document analysis of UK health policies followed by semi-structured interviews with key informants with direct experience of developing and implementing TI approaches. We used the Ready Extract Analyse Distil (READ) approach to guide policy document review, and the framework method to analyse data. Results We analysed 24 documents and interviewed 11 professionals from healthcare organizations and local authorities. TI approach was included in national, regional and local policies, however, there was no UK- or NHS-wide strategy or legislation, nor funding commitment. Although documents and interviews provided differing interpretations of TI care, they were aligned in describing the integration of TI principles at the system level, contextual tailoring to each organization, and addressing varied challenges within health systems. TI care in the UK has had piecemeal implementation, with a nation-wide strategy and leadership visible in Scotland and Wales and more disjointed implementation in England. Professionals wanted enhanced coordination between organizations and regions. We identified factors affecting implementation of TI approaches at the level of organization (leadership, service user involvement, organizational culture, resource allocation, competing priorities) and wider context (government support, funding). Professionals had conflicting views on the future of TI approaches, however all agreed that government backing is essential for implementing policies into practice. Conclusions A coordinated, more centralized strategy and provision for TI healthcare, increased funding for evaluation, and education through professional networks about evidence-based TI health systems can contribute towards evidence-informed policies and implementation of TI approaches in the UK.https://doi.org/10.1186/s12913-022-08461-wPsychological traumaMental healthPrimary health carePublic healthQualitative researchPolicy making |
| spellingShingle | Elizabeth Emsley Joshua Smith David Martin Natalia V. Lewis Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives BMC Health Services Research Psychological trauma Mental health Primary health care Public health Qualitative research Policy making |
| title | Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives |
| title_full | Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives |
| title_fullStr | Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives |
| title_full_unstemmed | Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives |
| title_short | Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives |
| title_sort | trauma informed care in the uk where are we a qualitative study of health policies and professional perspectives |
| topic | Psychological trauma Mental health Primary health care Public health Qualitative research Policy making |
| url | https://doi.org/10.1186/s12913-022-08461-w |
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