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

Section 9: Conclusions

The evidence review demonstrates that the implementation of trauma-informed approaches is a growing field, and that they are being introduced within different services and organisations, particularly schools and child welfare systems. However, others like community-based organisations, health services or youth custody facilities are beginning to adopt these approaches to bring positive changes for staff and service users.

Despite the complexity of the topic, and the methodological weaknesses that still need to be addressed, the findings of this rapid evidence review highlight the positive and promising short- and medium-term impact of trauma-informed approaches.

The evidence reviwed shows that staff training and other forms of workforce development could be the most effective strategy to promote organisational change by creating shared trauma-related language, knowledge and skills. Additionally, other strategies such as carrying out pre-intervention or organisational readiness assessments, promoting trauma-informed leadership teams, cross-system collaboration, and educating all stakeholders on the impact of trauma, together with conducting routine enquiry where appropriate seem to be promising. This means that they seem to be having a positive impact on the short- and medium-term outcomes of individuals and organisations.

However, there is a need for more robust evidence to determine their efficacy. Additionally, although not linked to negative results, there is also need for more evidence to determine the effectiveness of components such as taking proactive, flexible approaches to TIC implementation, or promoting positive relationships with stakeholders, currently deemed as inconclusive. Therefore broad, multi-layered, tailored interventions that aim at embedding trauma-informed approaches across all levels for all stakeholders, and that provide specific support when needed, could be the most appropriate way forward to promote short- and medium-term improvements for individuals and organisations.

Nonetheless, there is a need to develop more rigorous and robust research that is adapted to the characteristics of the field, but that can also provide solid support to the evidence underpinning the implementation of trauma-informed interventions. Additionally, it would be beneficial to extend the implementation and evaluation times . This could help to better understand the needs of long-term implementation of these interventions and the sustainability of the short- and medium-term changes they aim to deliver. It would also help understand the impact on long-term outcomes for people with lived experience of trauma, including the inequalities they face and potential improvements across different domains of life.