Using the Consolidated Framework for Implementation Research (CFIR) to Understand Trauma-Informed Care Implementation

Introduction

Traumatic stress and adverse childhood events negatively impact individuals’ physical and psychological well-being. Members of underserved populations are especially vulnerable to these exposures and impacts. Trauma-informed care (TIC) is a system-level intervention with the goals of understanding the prevalence and impact of trauma; integrating this knowledge with policies, practices, and procedures; preventing re-traumatization; and improving client outcomes. Though TIC is gaining in popularity, little is known about the barriers and facilitators of successful TIC implementation across systems. This presentation summarizes barriers and facilitators of TIC implementation and suggests strategies to overcome those barriers by synthesizing three projects: 1) a content analysis of the TIC implementation literature; 2) survey data gathered from mostly mental health staff familiar with TIC; and 3) qualitative data gathered from school staff implementing TIC.

Methods

First, the content analysis (inclusion criteria: recent [2000-present], empirical, peer-reviewed, reporting on TIC implementation) resulted in 11 studies, from which information on barriers and facilitators of TIC implementation were extracted. Second, survey data on 35 individual- and system-level indicators of TIC were gathered from mostly mental health care staff (N=760) employed in high- and low-TIC implementing workplaces. Third, qualitative comments about barriers and facilitators of TIC were gathered from school staff (N=197) working in 5 schools implementing TIC. All findings were then mapped onto the domains and constructs of the Consolidated Framework for Implementation Research (CFIR; interrater reliability > .90).

Results

First, the content analysis identified 5 barriers and 22 facilitators classified across 5/5 CFIR domains and 24/39 CFIR constructs. Second, the survey data revealed 1 barrier and 10 facilitators that mapped onto 3/5 CFIR domains and 10/39 CFIR constructs. CFIR mapping for the school staff qualitative data is currently underway. Facilitators derived from the content analysis most commonly fell within the “Inner Setting” and “Process” domains, while facilitators from the survey data most commonly fell within the “Inner Setting” and “Characteristics of Individuals” domains. Preliminary analyses of the qualitative school data suggests that facilitators of TIC in schools fell within the “Inner Setting,” “Process,” and “Intervention Characteristics” domains. Few facilitators from the “Outer Setting” domains were identified. Barriers were infrequently identified and were scattered among the 5 CFIR domains.

Conclusions

This study elucidates key facilitators and barriers to the successful implementation of TIC across systems, identifying factors that should be considered when implementing TIC to both leverage the success of implementation and address barriers that may stand in the way.