An Umbrella Review of Systematic Reviews on Trauma Informed Approaches

Area of Science:

• Public Health
• Psychology
• Social Sciences

Background:

• Trauma and adversity significantly impact health outcomes, increasing morbidity and mortality.
• Trauma-informed care (TIC) is increasingly adopted in practice and research.
• The evidence for organization-wide TIC is inconclusive, with existing literature showing low quality and conflicting results.

Purpose of the Study:

• To summarize the existing evidence on trauma-informed care implemented at the organizational level.
• To assess the quality of systematic reviews on organizational trauma-informed care.
• To map findings to established TIC implementation domains.

Main Methods:

• An umbrella review of systematic reviews was conducted using PRISMA guidelines.
• Searches were performed across six databases, supplemented by bibliography searches.
• Included reviews were peer-reviewed, in English, from inception to 2024, and focused on organizational TIC implementation.

Main Results:

• Fourteen systematic reviews, synthesizing 311 studies with 157,724 participants, were included.
• Critical appraisal revealed 50% of reviews were low quality, 28% high, and 22% moderate.
• Significant heterogeneity was found, with 62 different TIC models and mixed findings on effectiveness and implementation.

Conclusions:

• The evidence base for organizational trauma-informed care requires further scrutiny.
• Emerging research highlights the utility of the 10 trauma-informed implementation domains for cultural shifts.
• Additional research is necessary in diverse contexts and populations to strengthen the evidence base for TIC.