Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment

BMC Health Serv Res. 2017 Nov 21;17(1):750. doi: 10.1186/s12913-017-2695-0.


Background: While there is increasing support for training youth-serving providers in trauma-informed care (TIC) as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers' professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training.

Methods: Government workers and nonprofit professionals (N = 90) who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16) was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods.

Results: Analysis of survey data indicated significant improvements in participants' organizational culture and professional satisfaction at training completion. Participants' perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including "Implementation of more flexible, less-punitive policies towards clients," "Adoption of trauma-informed workplace design," "Heightened awareness of own traumatic stress and need for self-care," and "Greater sense of camaraderie and empathy for colleagues."

Conclusion: Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and individual factors including providers' compassion satisfaction, burnout, and secondary traumatic stress, to better support TIC implementation.

Keywords: Mixed methods; Organizational culture; Secondary traumatic stress; Trauma-informed care.

MeSH terms

  • Adult
  • Aged
  • Awareness
  • Baltimore
  • Burnout, Professional / prevention & control
  • Cities
  • Empathy
  • Female
  • Government Employees / education*
  • Government Employees / psychology
  • Health Personnel / education*
  • Health Personnel / psychology
  • Humans
  • Male
  • Middle Aged
  • Organizational Culture
  • Organizations
  • Perception
  • Personal Satisfaction
  • Quality of Life
  • Self Care
  • Surveys and Questionnaires
  • Traumatology / education*
  • Young Adult