The Nature of the Beast: Exploring Challenge and Complexity in the Implementation of Trauma-Informed Care

Abstract

This thesis explores the empirical, experiential, and contextual dimensions of trauma-informed care (TIC) and its implementation across three papers. The first paper presents a comprehensive bibliometric analysis of 5,439 articles and reviews published between 2001 and 2024, illustrating that the global landscape of TIC research was characterised by exponential growth that is primarily driven by a few high-income, Western nations. Its intellectual foundations were predominantly defined by conceptual discourses rather than empirical evaluation. Despite significant scholarly and clinical interest, findings emphasised conceptual ambiguity, fragmented terminology, and limited international collaboration, highlighting the need for greater definitional clarity and operationalisation, methodological rigour, and research collaboration. The second paper presents a constructivist grounded theory of the tensions that NHS staff in a Welsh community adult mental health context experienced in the implementation of TIC. Analysis of 11 semi-structured interviews resulted in the construction of the core category, risking change, which highlighted the complex tension of balancing the risks and opportunities of enacting trauma-informed change with the consequences of maintaining the status quo. Together with six other categories (locus of change, conceiving of the need for change, defining the dimensions of change, continuing with the status quo, embracing and enacting change, and contextually mediated outcomes and consequences), the Risking Change model described a dynamic and iterative process that illustrated the emotional complexities, moral dilemmas, and systemic constraints of change in complex and fraught systems. The final paper synthesises and contextualises further insights from the preceding papers by utilising Bronfenbrenner's Process-Person-Context-Time model as well as exploring their implications for research and clinical practice. Collectively, these papers provide a critical examination of the challenges and complexities of implementing TIC, illustrating that trauma-informed systems change holds the potential to create tension as well as transformation.

Date of Award	2025
Original language	English
Supervisor	Michaela Swales (Supervisor) & Nick Horn (Supervisor)