Outcomes Matter, Wicklow, Ireland.
Community Ment Health J. 2024 Nov;60(8):1627-1651. doi: 10.1007/s10597-024-01317-z. Epub 2024 Jul 24.
Trauma and adversity significantly impact on morbidity and mortality. Hence, trauma-informed care is proliferating practice and research contexts. However, the evidence base for organisational wide trauma-informed care is far from conclusive, with the extant literature providing low quality and conflicting evidence. The purpose of this umbrella review of systematic reviews, is to summarise the existing evidence on trauma-informed care implemented at the organisational level. The preferred reporting items for systematic review and meta-analyses (PRISMA) was used to conduct an umbrella review. Six databases were searched; Academic Search Complete, APA Psych Articles, Cochrane Library, Embase, Scopus, and the Web of Science, supplemented with bibliography searches. Articles were included if they were peer reviewed in the English language from inception to 2024 and reported on trauma-informed care with an implementation context. The Joanne Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses was used to assess the quality of the included reviews. Findings are mapped to the 10 trauma-informed care implementation domains described by the Substance Use and Mental Health Service Administration (SAMHSA) and reported using a narrative synthesis. The search strategy yielded 5,297 articles, of which (N = 14) systematic reviews are included. The reviews had a combined study count of (N = 311), with a total sample size of (N = 157,724). Most reviews used a narrative synthesis to report results, with no meta-analyses. Critical appraisal categorised the reviews as 28% high quality, 22% moderate quality, and 50% as low quality. Most reviews (50%), were conducted on youth populations, with school settings being the most studied context. There was a great deal of heterogeneity across the reviews, with 62 different models of trauma informed approaches discussed. The composition of the individual studies included in each systematic review were generally of low quality with mixed findings of effectiveness and implementation. Findings are discussed for moving forward with trauma-informed care implementation. Trauma-informed care is proposed as a system wide intervention to improve outcomes for service users, however the research base is still under scrutiny. Emerging research identifies the benefit of using the 10 trauma-informed implementation domains to shift cultural practices. Further research needs to be undertaken in various contexts with different populations.
创伤和逆境对发病率和死亡率有重大影响。因此，以创伤为中心的护理正在普及实践和研究领域。然而，组织范围内以创伤为中心的护理的证据基础远非定论，现有文献提供的证据质量低且相互矛盾。本系统综述的目的是总结组织层面实施以创伤为中心的护理的现有证据。采用系统评价和荟萃分析的首选报告项目 (PRISMA) 进行系统综述。共检索了 6 个数据库：学术搜索完整、APA 心理文章、考科蓝图书馆、Embase、Scopus 和 Web of Science，并补充了文献检索。如果文章是在英语中发表的，并且从成立到 2024 年报告了以创伤为中心的护理，并具有实施背景，则将其纳入。使用乔安妮·布里格斯研究所的系统评价和研究综合批判性评估清单来评估纳入的综述的质量。研究结果与物质使用和心理健康服务管理局 (SAMHSA) 描述的 10 个以创伤为中心的护理实施领域相映射，并使用叙述性综合报告。搜索策略产生了 5297 篇文章，其中 14 篇是系统综述。这些综述的综合研究数量为 (N=311)，总样本量为 (N=157724)。大多数综述使用叙述性综合报告结果，没有进行荟萃分析。批判性评估将综述分为 28%的高质量、22%的中等质量和 50%的低质量。大多数综述 (50%)是针对青年人群进行的，学校环境是研究最多的环境。这些综述之间存在很大的异质性，讨论了 62 种不同的创伤知情方法模型。纳入每个系统综述的个体研究的组成通常质量较低，有效性和实施情况的结果混合。讨论了推进以创伤为中心的护理实施的问题。以创伤为中心的护理被提议作为一种系统干预措施，以改善服务使用者的结果，然而，研究基础仍在审查中。新兴研究表明，使用 10 个以创伤为中心的实施领域来改变文化实践是有益的。需要在不同的背景和不同的人群中进行进一步的研究。
