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Background Experiencing trauma can affect health and wellbeing throughout the lifespan. Trauma-informed care is a framework that addresses the impact of trauma and promotes treatment approaches sensitive to this lived experience. In response to emerging awareness about trauma-informed care, educators are beginning to adapt undergraduate medical education (UME) to include content about using a trauma-informed approach when caring for patients. In 2023, leaders in the field of trauma-informed care developed a core set of competencies that institutions can use to guide their curricula in this area. This scoping review aggregated and synthesized studies evaluating trauma-informed care curricula in medical schools to examine the efficacy of different pedagogical approaches. It also mapped how these approaches align with the recently developed trauma-informed competencies for UME. Methods A comprehensive search strategy was used to search seven databases for articles related to teaching trauma-informed care principles to undergraduate medical students. Articles were included only if the curricula had been implemented and evaluated. A total of 233 articles were retrieved. Independent coders used a two-tier process to determine which papers met inclusion criteria. The coders extracted key information from the studies focused on training facilitators, participants, curriculum content, teaching methods, learner outcomes, and competencies. Results Fifteen papers were included in this scoping review, and several common themes emerged among the studies. Most trainings were brief (median 3.5 h) and taught by a multidisciplinary team. All trainings incorporated didactic components. Most also gave the trainees opportunities to apply and practice their knowledge through role playing, simulations, or patient interviews. All studies included a qualitative evaluation component, with most also having a quantitative component. Most studies reported that students acquired more knowledge and confidence in implementing trauma-informed care following the trainings. However, only two included a longitudinal follow-up component in their evaluation. Conclusions Trauma-informed care is beginning to be implemented in undergraduate medical education. Brief trainings in this area can increase future providers’ abilities to understand how trauma affects patients and to work in appropriate ways with patients who have experienced trauma. The literature in this review can be used to guide educators seeking to incorporate trauma-informed care into undergraduate medical curricula.

Background Exposure to trauma is widespread and has significant implications for health outcomes and healthcare delivery. Comprehensive Trauma-Informed Care (TIC) recognizes the prevalence and impact of trauma and seeks to create policies, practices, and environments grounded in safety, trust, collaboration, choice, and empowerment. University Health, a large academic medical center in San Antonio, Texas, launched a comprehensive initiative to embed TIC principles system-wide, positioning itself as both an educator and a provider of trauma-informed practices. Methods Guided by the 10 key development areas defined by the Institute on Trauma and Trauma-Informed Care (ITTIC), University Health initiated its comprehensive TIC transformation in 2020. The organization established an internal Trauma-Informed Care Workgroup, provided staff and community training, integrated TIC into organizational policies and procedures, created peer support and wellness initiatives, and implemented trauma screening and treatment protocols. Evaluation methods included biennial administration of the TICS-10 (Trauma-Informed Climate Scale) and qualitative feedback from Schwartz Rounds participants. Results Over five years, University Health trained more than 130 TIC Advocates, updated over 90 policies with trauma-informed language, and launched programs supporting staff well-being and patient-centered care. In 2024, University Health became the first major health system in Bexar County to earn local Level 1 TIC certification. TICS-10 scores improved from 34.1 (low) in 2020 to 35.0 (moderate) in 2024, indicating progress in creating a trauma-informed work environment. Schwartz Rounds sentiment analysis showed 71% of comments were positive, highlighting increased empathy, connection, and validation among staff members. Conclusions University Health’s experience demonstrates that comprehensive, system-wide trauma-informed transformation is achievable in large healthcare settings. Through leadership support, cross-departmental collaboration, and intentional policy and practice change, TIC principles were embedded into organizational culture. An impartial certification process and program evaluation data validated the impact of the initiative, although continued efforts are needed to assess long-term outcomes on patient care and staff well-being. This case study offers a replicable model for other health systems pursuing trauma-informed organizational change.

Background People who are homeless experience an increased prevalence of traumatic events, including childhood trauma, trauma related to being homeless, and structural trauma. It is important to consider trauma in the delivery of health services for this population. Using a trauma-informed care approach is one way to ensure that a service or program takes into consideration the effects of trauma. The aims of this study are to describe how best to design a service to engage people experiencing homelessness in a trauma-focused therapy as well as detail what trauma-informed care would look like in this setting. Methods We conducted a series of qualitative interviews about how to design a trauma-informed trauma therapy for people experiencing homelessness and their perspectives on different principles of trauma-informed care. Thematic analysis was used to identify, analyze and report themes identified in the data. Results We conducted 12 in-depth interviews (8 women, 4 men) with people who were currently peer support workers with lived experience of trauma and homelessness. We identified themes to design a trauma-informed service including low-barrier access, communication strategies, meeting people’s needs, and how to engage and retain people in the service. We also identified themes related to how people with lived experience understand the principles of trauma informed care. Discussion The findings from this study provide insight and practical recommendations for designing and implementing a trauma-informed therapy tailored for people experiencing homelessness. The findings here shed light on the lived experience perspective of trauma-informed care principles, adding nuance to our understanding of what it means to be trauma-informed.

Background Trauma-informed services can benefit people involved in a healthcare or legal process by supporting them to engage with systems and minimise risk of retraumatisation. Research also suggests that the integration of trauma-informed services can benefit staff members who work with these services. This study sought to explore outcomes for staff members following the introduction of a trauma-informed navigation and support service for victim-survivors involved in sexual boundary violation complaints lodged with the Australian health practitioner regulator. Methods Researchers conducted a series of semi-structured interviews ( n  = 13) with regulatory staff members who had engaged with the support service. Interview transcripts were analysed using reflexive thematic analysis to qualify participant experiences and detail outcomes of working with the service. Results Four main themes related to outcomes of collaborating with the support service were identified: (1) additional support for engagement work, (2) changes to interactions with victim-survivors (notifiers), (3) personal benefits of collaboration, and (4) improved perception of workload. These themes showed that staff identified positive collaboration with the service and benefits resulting from that collaboration. However, a negative case analysis identified perspectives that did not fit with the main interpretation of the data, where participants did not see a clear need for the service. This demonstrates some of the challenges implicit to integrating a new service within an organisation, including how perception of benefits can be limited due to conflicting personal or professional ideologies. Conclusions Staff within a national regulator identified personal and professional benefits resulting from workplace collaboration with a trauma-informed service introduced to support victim-survivors. With the introduction of any new service, challenges can arise, and thoughtful planning is required prior and during implementation to understand individual and environmental factors that may impact integration.

Background People experiencing homelessness have often faced both historical and ongoing trauma, which can be compounded by their interactions with different support services. Trauma-informed care aims to meet the complex needs of people who have experienced trauma and prevent re-traumatisation during service interactions. In rural and coastal areas, where services are often geographically dispersed, multi-agency approaches are particularly crucial for ensuring continuous, coordinated support. This study examines the learning from implementing a multi-agency trauma-informed training pilot for providers supporting people experiencing homelessness. Methods A qualitative study was undertaken following a trauma-informed care training pilot delivered to health and social care providers in Northumberland and North Tyneside, two geographically diverse rural and coastal areas in North East England. Those who attended the training were invited to take part in follow-up semi-structured interviews, thirteen out of 16 attendees participated, representing healthcare, emergency care, housing, voluntary sector, and social care services. Interviews explored how training influenced trauma-informed practice and cross-service collaboration. Results Interviews highlighted the value that participants of the training found in bringing different services together for undertaking trauma-informed training, and the opportunity for shared learning amongst those who provide care for people with multiple needs and interacting with different services. Three key themes were identified from the thematic analysis: (1) training cultivated awareness, sensitivity and compassion in communication across services (2) the need to foster support and trauma sensitivity through multi-agency collaboration and wider-system engagement and (3) building organisational and individual resilience through shared learning and coordinated supportive practices. Conclusions Multi-agency trauma-informed training helps ensure consistent approaches across geographically dispersed services supporting people experiencing homelessness. When staff from different organisations train together, it builds a shared understanding of trauma, encourages collaborative working, and supports staff wellbeing. This integrated approach is particularly valuable in rural and coastal areas where service coordination can be challenging due to geographical dispersion and resource constraints.

Background Trauma-informed care (TIC) is a critical approach for addressing the mental health needs of individuals exposed to various forms of trauma, including racial discrimination. Community mental health services are uniquely positioned to support both service users and staff in navigating the psychological impact of societal and interpersonal events. However, there is limited research on how these services can effectively address racial trauma, foster culturally responsive care, and support staff wellbeing within trauma-informed frameworks. This study examines the experiences of staff at a community psychological intervention service in the UK in supporting service users during the 2024 UK far-right riots. It investigates the challenges faced and lessons learned for enhancing care-delivery. Methods A mixed-methods design was employed, using an online survey completed by 31 staff members, including Clinical Psychologists, Psychological Practitioners, Psychotherapists, Trainee Psychologists and Assistant Psychologists. The survey consisted of Likert-scale, multiple-choice, and open-ended questions to gather quantitative and qualitative data. Descriptive statistics and thematic analysis were used to analyse the responses. Results Findings indicated that most staff engaged in race-related discussions but often relied on service users to initiate them. Key barriers included discomfort, lack of training, and uncertainty about appropriate responses. Organisational and peer support mechanisms, such as supervision and reflective practice, were valuable but constrained by time pressures. Participants highlighted the need for ongoing training and clearer protocols. Conclusions The study emphasises the importance of proactive race-related discussions, culturally responsive care, and structured organisational support within trauma-informed practices. Recommendations for practice, policy, and research are proposed to strengthen long-term efforts in addressing racial trauma and supporting staff in community mental health settings.

Background Adverse childhood experiences (ACEs) are common and can negatively affect the physical, mental, emotional, and developmental health of a child acutely and for a lifetime. Trauma-informed care (TIC) in the pediatric medical home helps counteract these effects by fostering supportive relationships and building skills that promote resilience. As key figures in the medical home, pediatric clinicians must understand adverse childhood experiences (ACEs) and TIC principles to effectively recognize, assess and intervene early in cases of childhood adversity, which ultimately promotes long-term health and well-being. Methods Pediatric clinicians who attended a virtual symposium were surveyed before and after eight one-hour educational sessions on TIC topics. To assess their knowledge of fundamental TIC principles, they were asked about their familiarity with the ACE study, the affiliative response, and the strength-based approach in pediatrics. Participants rated each sessions’ value using a 4-point Likert scale. In the post survey, they also shared how they would apply the knowledge gained clinically and suggestions to improve future education. Results Seventy-five out of the 82 participants (91%) who were pediatric clinicians completed a pre survey and of those pediatric clinicians who completed the pre survey, 47 (63%) also completed the post-education survey. Prior to the educational sessions, 81% of participants were familiar with the ACE Study but only 37.1% were familiar with the affiliate response and only 50.6% with strength-based care approaches to pediatrics. Of those who completed the post survey, 95.7% rated the education as “Useful” or “Very useful.” Statistically significant improvements were detected in scores relating to each of the three fundamental TIC principles: associations between childhood stressors and later life health and well-being ( p  = < 0.0001), familiarity with the affiliate response ( p  = < 0.0001), and familiarity with the concept of a strength-based approach to pediatrics ( p  = < 0.005). After the training sessions, a majority, 34/47 (72%), of participants stated they would apply concepts from the training in clinical care. Conclusions This study was able to demonstrate existing gaps in pediatric clinicians’ knowledge of TIC, the usefulness of pediatric TIC education, and practical steps in providing TIC education for pediatric clinicians and healthcare providers.

Background In April 2019, Texas Association of Community Health Centers launched the Trauma-Informed Care (TIC) program in community health centers across Texas. This initiative aimed to transform organizational culture for consistent delivery of TIC by providing training and coaching opportunities for Trainers and Champions in each health center. This study is an interim qualitative evaluation to gain participants’ insights into their experiences of and perceptions about TIC training as part of the TIC initiative. Methods We conducted semi-structured key informant interviews via Zoom with Trainers across four cohorts of participating health centers between February 2020 and April 2023. We used rapid assessment procedures to conduct analysis in tandem with data collection given the ongoing TIC training. We present salient quotes to illustrate the emergent themes. Results We interviewed a total of 36 Trainers and identified the following emergent themes from the interviews: (1) Perceived need for the TIC training, (2) Perspective shift in patient care, (3) Increased support for staff wellness, (4) Importance of equal involvement of staff at all levels, (5) Need for leadership buy-in, and (6) Lack of self-efficacy and empowerment to train others. Conclusions A trauma-informed environment in a healthcare setting can bolster patient-centered care as well as a culture of staff wellness. This qualitative evaluation revealed that after TIC training, Trainers had improved attitudes and behaviors to commit to organizational TIC transformation to prevent unintended consequences of trauma for both patients and staff. Trainers’ experiences with and suggestions for enhancing the TIC training should be considered for training future cohorts as they continue to strive for TIC transformation in their health centers.

Background There are no existing standards of care for integrating trauma-informed care into prenatal care in a patient-centered manner. This study aims to explore preferences of pregnant people regarding prenatal care, prenatal providers, resources, and trauma inquiry and response. Methods This study utilized a qualitative descriptive design as part of a longitudinal randomized controlled pilot trial. It was conducted at a university-affiliated federally qualified health center and multi-specialty clinic in a large metropolitan area among a purposive sample of 27 racially/ethnically diverse pregnant individuals. Eligible participants aged  ≥  18 between 10 and 24 weeks gestation were identified via medical charts and recruited in person and by email. Interview-administered structured interviews were provided at the post-intervention assessment. Qualitative data collection extended from June 2023 through April 2024. We performed inductive analysis to generate codes and identify emergent themes derived from participant responses. Participant preferences for prenatal care were interpreted through the lens of the six trauma-informed care principles. Results Participants had an average age of ( M  = 28, SD  = 4.5; range = 19–38) years old. Of the 27 participants interviewed, 21 self-identified as Black (77.8%) and 5 as Hispanic (18.5%). Three themes identified optimal prenatal care preferences, including: (1) Agency and Choice ; (2) Emphasis on Maternal and Child health and Wellbeing ; and (3) Universal and Personalized Provision of Information and Resources . Participants wanted their providers to be Familiar and Experienced ; Personally Engaging ; and Emotionally Safe and Supportive . Three additional themes focused on patient preferences for addressing trauma during prenatal visits, including: (1) Value of Addressing Trauma; (2) Approaches to Asking about Trauma; and (3) Sensitive and Empathic Inquiry and Response. Conclusions Patient preferences identified by this study underscore the need for prenatal care to address the psychological health needs of pregnant patients to deliver high quality, comprehensive prenatal care that is trauma-informed and culturally-responsive. Trial registration This study was registered at ClinicalTrials.gov ID: NCT05718479 on 08-02-2023.

Background The prevalence of trauma among individuals with HIV has prompted efforts to integrate trauma-informed care (TIC) into HIV care and treatment to improve health outcomes. A TIC Implementation Model, developed by a US capacity-building organization focuses on organizational changes, aligning cultural and physical environments, emphasizing values like safety and trustworthiness, engaging leadership, and training staff in skills-based TIC services. Despite growing research, gaps remain in understanding the relationship between organizational capacity, provider knowledge, and the dosage of technical assistance (TA) required to sustain TIC integration. Researchers investigated how the project team adapted the type and amount of TA based on initial Cultural Assessment scores (measuring core TIC values) and its impact on Implementation Status scores. Methods This study focuses on eight of 20 HIV care agencies in New Jersey that had largely met their TIC implementation goals by Spring 2022. As part of the TIC Implementation Model to measure agency capacity and implementation progress over time, agency staff and clients completed a Cultural Assessment ( n  = 72) and Physical Assessment ( n  = 43); staff completed a Pre/Post Training Survey ( n  = 296); and implementation teams at 8 agencies completed an Implementation Status Assessment Tool. Additionally, TA Logs capturing the details of TA meetings with the eight agencies were recorded by project staff. Data from these tools were analyzed in aggregate by agency using descriptive and correlational analyses. Results Results demonstrated responsive TA correlated with agencies’ baseline capacity. Agencies with lower capacity received significantly more frequent and extended TA encounters, which were associated with higher implementation scores and improvements in cultural environments for staff and clients (e.g., new protocols for staff response plans). Conclusions These findings underscore the importance of tailored TA in fostering diverse organizational cultures conducive to TIC implementation. For HIV care agencies, successful TIC implementation can impact health behaviors and outcomes for clients impacted by trauma. The TIC Implementation Model significantly advanced organizations’ ability to transform their culture and systems, increasing their capacity to implement and sustain TIC integration. These results align with existing research that emphasizes when time is invested to shift organizational culture and develop leadership, new practices can effectively be implemented and scaled-up.