Changes in treatment content of services during trauma-informed integrated services for women with co-occurring disorders

An Umbrella Review of Systematic Reviews on Trauma Informed Approaches

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.

Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review

Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.

"..that warm feeling that [alcohol] gave me was what I interpreted love would feel like.." Lived experience of excessive alcohol use and care proceedings by mothers in the family justice system in the UK

BACKGROUND

When mothers who have been identified as using alcohol excessively appear in child care proceedings seeking to retain care of, or be reunited with, their children, family courts primarily focus on whether those mothers can make lasting changes to their use of alcohol, very often requiring them to achieve abstinence. The aim of this study was to advance the evidence base around how such mothers make sense of their alcohol use, and their position as mothers, in the systems and processes around care proceedings.

METHODS

Qualitative, face-to-face interviews were carried out at various children and families' services locations across the UK. These yielded in-depth accounts, to which Interpretative Phenomenological Analysis (IPA) was applied.

RESULTS

Six mothers were recruited from collaborations with 31 local authorities. Themes relating to alcohol use included relationships in childhood, repeated traumatic events, and the use of alcohol to self-manage these. In response to extreme fear arising from violence in their relationships with older men, alcohol provided the means to function. Escalation of alcohol use in participants' lives was accompanied by greater isolation, alongside shameful feelings about being a "drunk", which were barriers to help-seeking. Themes relating to motherhood in the context of care proceedings included wanting to change behaviour for themselves and their children, being excluded from their children's lives, and experiencing a continual requirement to prove their parenting and their abstinence from alcohol. Language used by social services, the courts and alcohol treatment services, placed mothers in conflicting positions of being in recovery, but having to present as recovered.

CONCLUSION

Despite excessive alcohol misuse in mothers being closely enmeshed with other issues, awareness and understanding of factors such as complex trauma, and how to support mothers with these factors, is limited, and should be considered in terms of improving research and best practice.

Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS

Introduction

The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care.

Methods

A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines.

Results and discussion

The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research.

Conclusions

This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV-positive women's health outcomes.

Managing traumatized children: a trauma systems perspective

PURPOSE OF REVIEW

To review the current research on trauma-informed child-serving systems. Research on this topic, although sparse, is critically important because most children who come into contact with systems, including the child welfare and juvenile justice systems, have experienced at least one traumatic event.

RECENT FINDINGS

Very little research has actually been done on this topic area. Although it makes intuitive sense to integrate a trauma-informed approach into child-serving systems, much more research needs to be conducted in order to determine the efficacy of trauma-informed thinking in child-serving systems.

SUMMARY

A number of research studies have been conducted that focus on adults with co-occurring disorders who have received trauma-informed treatment. These results suggest that a 'trauma-informed' approach is a helpful and effective way to implement services. These same principles may be applied to work with children in order to create a 'trauma-informed child-serving system'. Twelve literature-supported and research-supported components of such a system are introduced in this review, ranging from the importance of specialized knowledge about trauma to trauma assessment and the value of trauma-informed policy.