Planning the Implementation of a Trauma-Informed Care Intervention at a Pediatric Hospital: An Integrated Knowledge Translation Approach

Abstract

Purpose. To facilitate the implementation planning process of a trauma-informed care (TIC) program at an acute care pediatric hospital, while observing aspects of the process in a naturalistic setting. My specific thesis objectives were to: 1. Examine current literature relating to TIC interventions used in pediatric mental health inpatient and residential settings, the intervention components, and the implementation goals and implementation strategies used. 2. Explore knowledge-user (youth, caregiver, and staff) perspectives on their vision of TIC, and identify potential implementation considerations. 3. Describe and reflect upon a trainee's experience using an integrated Knowledge Translation (IKT) approach to TIC implementation planning. Methods. Three studies informed by tenets of critical realism and complexity theory, taking an IKT approach guided by Implementation Roadmap: a) a scoping review of TIC interventions and implementation strategies used; b) a qualitative exploration of youth, caregiver, and staff perspectives on their vision of TIC in the local context and implementation considerations; and c) a description of the IKT approach from my perspective as a trainee. Findings. In Study 1, I identified 49 articles reporting on 21 distinct TIC interventions, which ranged in detail pertaining to intervention aims, ingredients, delivery, and related implementation goals and strategies used. These findings affirmed the complexity of TIC and of TIC interventions, and the importance of clearly identifying and reporting components. In Study 2, twenty-five individuals participated in individual or group interviews, which revealed five key domains to consider when implementing TIC: the centrality of relational engagement, TIC core program components, factors that may support or limit success in implementing TIC within the mental health unit and hospital-wide, and the importance of intersectoral collaboration. In Study 3, I reflected on the value of an IKT approach. Facilitating this process highlighted the value of an action-based implementation framework in guiding and structuring the implementation process, and the congruency between TIC principles and the application of an IKT approach. Furthermore, leadership support, knowledge-user empowerment, and organizational enthusiasm and perseverance were vital in advancing implementation. Conclusions. The Implementation Roadmap was complementary to guiding IKT. TIC principles may help inform not only the delivery of TIC but also the complex process of implementing TIC.