Outcomes of trauma-informed care on the psychological health of women experiencing intimate partner violence: A systematic review and meta-analysis

Evaluating the Effectiveness of Trauma-Informed Care Frameworks in Provider Education and the Care of Traumatized Patients

INTRODUCTION

Trauma-informed care (TIC) spans many different health care fields and is essential in promoting the well-being and recovery of traumatized individuals. This review aims to assess the efficacy of TIC frameworks in both educating providers and enhancing care for adult and pediatric patients.

METHODS

A literature search was conducted using PubMed, EMBASE, Proquest, Cochrane, and Google Scholar to identify relevant articles up to September 28, 2023. Studies implementing TIC frameworks in health care settings as a provider education tool or in patient care were included. Studies were further categorized based on adult or pediatric patient populations and relevant outcomes were extracted.

RESULTS

A total of 36 articles were included in this review, evaluating over 7843 providers and patients. When implemented as a provider education tool, TIC frameworks significantly improved provider knowledge, confidence, awareness, and attitudes toward TIC (P < 0.05 to P < 0.001). Trauma screenings and assessments also increased (P < 0.001). When these frameworks were applied in adult patient care, there were positive effects across a multitude of settings, including women's health, intimate partner violence, post-traumatic stress disorder, and inpatient mental health. Findings included reduced depression and anxiety (P < 0.05), increased trauma disclosures (5%-30%), and enhanced mental and physical health (P < 0.001).

CONCLUSIONS

This review underscores the multifaceted effectiveness of TIC frameworks, serving both as a valuable educational resource for providers and as a fundamental approach to patient care. Providers reported increased knowledge and comfort with core trauma principles. Patients were also found to derive benefits from these approaches in a variety of settings. These findings demonstrate the extensive applicability of TIC frameworks and highlight the need for a more comprehensive understanding of their applications and long-term effects.

Potential Benefits of a 'Trauma-Informed Care' Approach to Improve the Assessment and Management of Dogs Presented with Anxiety Disorders

Dog caregiver reporting on the spectrum of fearful-aggressive behaviours often describes 'unpredictable' or 'exaggerated' responses to a situation/animal/person. A possible explanation for these behavioural responses considers that the dog is reacting to triggered memories for which the dog has a negative association. For many dogs undergoing veterinary behavioural treatment or rehabilitation through a canine rescue organisation, the assessing clinician relies on "proxy" reporting of the history/background by a caregiver (dog owner, foster carer, or shelter personnel). Detailed information on the event or circumstances resulting in this negative association may be limited or absent altogether. Consideration of a trauma-informed care (TIC) approach, currently applied in a wide range of human psychology and social care fields, may be helpful in guiding the clinical approach taken. The literature relating to adverse early experience (AEE) and trauma-informed care (TIC) in puppies/dogs compared to children/adults was evaluated to identify common themes and conclusions identified across both species. In the absence of known/identifiable trauma, behavioural assessment and management should consider that a 'problem' dog may behave as it does, as the result of previous trauma. The dog can then be viewed through a lens of empathy and understanding, often lacking for dogs presenting with impulsive, reactive, or aggressive behaviours. Assessment must avoid re-traumatising the animal through exposure to triggering stimuli and, treatment options should include counselling of caregivers on the impact of adverse early experiences, consideration of the window of tolerance, and TIC behavioural modification techniques.