Implementing trauma-informed care across child systems of care – benefits and challenges: A systematic review of the evidence

Research output: Contribution to conferenceAbstractpeer-review


Background Trauma-informed care (TIC) is a whole-system organisational change process which seeks to embed coherent practice models across settings (SAMHSA, 2014). It emerged from the Adverse Childhood Experiences (ACE) study in the US (Felitti et al., 1998) with subsequent international research establishing a strong graded relationship between the number of childhood adversities and negative outcomes across multiple domains over the life course (e.g. Hughes et al., 2017). Childhood adversity is known to be exacerbated by wider social conditions, with the relationship between poverty, community violence, precarious housing, discrimination and poorer life chances well established (Bywaters & McLeod, 2012). TIC strives to build collaborative relationships with children and the important adults in their lives, as well as improve care consistency across organisations and sectors. It aims to mitigate the impact of adversity by enhancing child and family capacity for resilience, and reduce organisational practices that may exacerbate the detrimental effects of trauma and adversity, and constrain engagement. It is proposed that the increasing recognition of the significance of early social experiences offered by ACE research represents a paradigm shift for health and welfare systems. TIC implementation presents therefore an opportunity to harness this momentum for whole-systems change, embedding social justice and human rights values in contemporary social work practice by taking account of adverse childhood experiences and adverse community environments (Ellis & Dietz, 2017). ACE-awareness and TIC is, however, not without challenges (e.g. Atwool, 2018; Holland, 2018), including the potential to stigmatise service users by insufficient attention to social and economic drivers of childhood adversity, and organisational and systemic constraints. TIC is gaining momentum across the US, UK, Europe, Australia and New Zealand with a growing body of initiatives and context-specific implementation guidance. Systematic reviews have focused on residential and inpatient care (e.g. Bryson et al., 2017), as well as organisational-level training initiatives (e.g. Purtle, 2018). To date, there has been no systematic review of organisation-wide TIC implementation in child systems of care. Methods Social work academics in Queen’s University Belfast were commissioned by the Safeguarding Board for Northern Ireland to undertake a rapid evidence review of trauma-informed implementation in child welfare, health, education and juvenile justice using systematic search, screening and review procedures. Review outcomes would be used to inform the regional cross-departmental Early Intervention Transformation Programme. Findings Almost eighty papers reporting on TIC implementation at state/regional and organisational/agency levels were identified. The review found considerable commonality with the broad implementation domains of workforce development, trauma-focused services and organisational change reflected across settings. A narrative synthesis is presented of TIC implementation strategies across systems of care, together with associated evidence of effectiveness. Key research gaps and methodological challenges are identified. Conclusions and implications ACE-awareness and TIC implementation is growing across settings and jurisdictions. This opportunity must be seized by social work to avoid the pitfalls of a reductionist understanding of childhood adversity, and maximise the potential for welfare systems change grounded on the principles of social justice and human rights. Reviewing the evidence is one way to achieve this outcome.
Original languageEnglish
Number of pages1
Publication statusPublished - 2019
Event9th European Conference for Social Work Research - Leuven University, Leuven, Belgium
Duration: 10 Apr 201912 Apr 2019


Conference9th European Conference for Social Work Research
Abbreviated titleECSWR 2019
Internet address


  • Trauma-informed care
  • Adverse childhood experiences
  • evidence review


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