Trauma-Informed Leadership in Primary Care Health Centers: A Quality Improvement Study

Trauma-informed care is now seen as a key systems-oriented approach to enhancing the provision of primary care within Community Health Centers (CHC) where large volumes of patients, workforce strain, and complex organization are very common. In this quality improvement study, the researchers assessed the application of a trauma-informed leadership training program that is aimed at developing an organizational capacity to provide trauma-informed care in a primary care CHC. The intervention involved an educational program that was structured into a series of sessions aimed at the leadership of the health center and the interdisciplinary staff, the main purpose of which is the improvement of trauma-informed knowledge, the use of a common language, and awareness at the system level throughout the organization. Anonymous surveys with a mixedmethods, pre- and post-training evaluation design were used to evaluate the results of self-reported changes about self-understanding, confidence, and changes in perceptions regarding the impact of trauma-informed principles, organizational culture, and clinical work environment. Aggregate data showed directional changes in the knowledge about trauma-informed care, confidence in its use, awareness of organizational variables affecting care delivery. Qualitative results suggested that there were more people able to align themselves with the ideas of trauma-informed care, that they began to see the impact of leadership more clearly, and that they believed that the culture of clinical practice was starting to change in the direction of emotional safety and reflective practice. Even though it was impossible to quantify change at an individual level, the findings indicate that trauma-informed leadership training can lead to an improvement in organizational preparedness, as well as play a role in making the care delivery setting in primary care CHC more supportive. The outcomes presented herein highlight the significance of leadership-based interventions in education to promote the development of trauma-informed systems in primary care limited by resources.