Delivering trauma-informed treatment in a women-only residential rehabilitation service: Qualitative study

Experiences of Women Receiving Trauma-Informed Care: A Qualitative Systematic Review

Exposure to trauma elevates the risk of illness in women, resulting in increased healthcare costs. The trauma-informed care approach seeks to enhance patient engagement and promote more effective recovery for those with a history of psychological trauma. This qualitative systematic review aims to synthesize evidence related to the experiences of women receiving trauma-informed care using Sandelowski and Barroso's two-step approach for qualitative research synthesis. A comprehensive search was conducted across 10 electronic databases from their inception until September 2023, coupled with an extensive bibliography search of relevant studies and reviews. In total, eleven studies meeting the inclusion criteria were selected: qualitative peer-reviewed and non-peer-reviewed studies in English with findings on the experiences of adult heterosexual women aged 19 to 64 years old who underwent various trauma-informed psychosocial interventions. From these studies, four main themes emerged, elucidating women's experiences as they engage with trauma-informed care: (a) Readiness to seek healing; (b) Healthcare providers: Extending the first hand; (c) An empowering paradigm shift; and (d) Better days ahead. Our major findings emphasize the importance of healthcare providers demonstrating sensitivity to trauma and culture, adopting a gender-sensitive approach, and taking a proactive stance in initiating discussions about trauma. Moreover, allocating more time for consultations, with an increased focus on building an initial rapport to ensure women's comfort, is also vital. The review further underscores the benefits of group sessions in aiding women's recovery from trauma. Ultimately, this review holds substantial implications for shaping future practices, emphasizing the critical necessity of personalized treatment plans.

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.

Client and staff perceptions of the integration of trauma informed care and specialist posttraumatic stress disorder treatment in residential treatment facilities for substance use: A qualitative study

INTRODUCTION

Comorbid posttraumatic stress disorder (PTSD) is prevalent among people seeking residential treatment for substance use disorders (SUD). We examined client and staff perceptions of the relationship between trauma and SUDs, and the integration of trauma-informed care (TIC) and specialist-delivered treatment for PTSD in residential alcohol and other drug (AOD) treatment facilities.

METHODS

Individual semi-structured interviews were conducted with frontline staff (n = 20) and clients (n = 18) in two residential AOD treatment facilities in Queensland, Australia. Interviews were audio recorded, transcribed and shared client and staff data was analysed using thematic analysis.

RESULTS

Major staff and client themes emerged: PTSD was perceived as an underlying cause of SUD, where AOD is used to cope with and avoid PTSD and related symptoms (Theme 1). Residential facilities were perceived to provide a safe and supportive environment for clients (Theme 2). Psychoeducation on SUD and PTSD was also highlighted to normalise experiences associated with comorbid SUD/PTSD and promote help-seeking pathways for specialist PTSD treatment. Concurrent treatment of SUD and PTSD in the residential setting was sought after and was perceived to enhance treatment outcomes (Theme 3). Staff saw the need for implementing TIC into the organisation and perceived TIC as a multi-faceted and consistent approach of service delivery.

DISCUSSION AND CONCLUSIONS

Both clients and staff perceive comorbid SUD/PTSD as a challenge in residential treatment, that may be overcome through integrating TIC and PTSD treatment in residential treatment facilitates for substance use. Organisational and practical implications are discussed.

Guiding Principles for Managing Co-occurring Alcohol/Other Drug and Mental Health Conditions: a Scoping Review

This scoping review aimed to synthesise the published literature on guiding principles for managing co-occurring alcohol/other drug (AOD) and mental health conditions in AOD treatment settings. Systematic search of key electronic databases (January 1, 2010, to February 17, 2021) produced 4583 articles, and independent title/abstract and full text screening left 43 articles for inclusion. Fifteen guiding principles were identified, most commonly: build a strong therapeutic relationship (n = 24 articles), provide holistic care (n = 12), involve peer support (n = 7), ensure continuity of care (n = 6), support the professional development and competence of workers (n = 6), and provide trauma-informed care (n = 5). Remaining principles were identified in < 5 articles. Limited empirical literature examined the impact of guiding principles on patient- and treatment-related outcomes. This review provides the first comprehensive synthesis of the international literature to derive guiding principles for managing co-occurring AOD and mental health conditions in AOD treatment. Further empirical research is needed to determine the effectiveness of principles at improving outcomes.

Iterative categorisation (IC) (part 2): interpreting qualitative data

Iterative categorisation (IC) is a systematic and transparent technique for analysing qualitative textual data, first presented in Addiction in 2016. IC breaks the analytical process down into stages, separating basic 'description' from more advanced 'interpretation'. This paper focuses on the interpretive analytical stage that is shown to comprise three core processes: (i) conceptualising (undertaken inductively, deductively or abductively); (ii) differentiating; and (iii) externalising. Each process is described, followed by published examples to support what has been explained. As qualitative analyses tend to be recursive rather than linear, the three processes often need to be repeated to account for all the data. Following the stages of IC will ensure that qualitative research generates improved understanding of the phenomena being studied, study findings contribute to and enhance the existing literature, the audience for any qualitative output is broad and international, and any practical implications or study recommendations are relevant to other contexts and settings.