Systematic review of trauma informed care model use and trauma specific treatment in U.S. inpatient psychiatric settings.

BACKGROUND: Individuals with serious mental illness (SMI) experience disproportionately high rates of trauma exposure and trauma-related symptoms relative to the general population, yet many receive treatment in acute psychiatric settings that may inadvertently contribute to replication of traumatic experiences. Trauma-informed care (TIC), has emerged as a framework to mitigate and address trauma-related responses by implementing systems and individual level clinical interventions to improve patient care and reduce adverse outcomes. While research on TIC implementation in psychiatric settings is growing internationally, the unique features of the U.S. mental healthcare system warrant a focused examination of TIC practices including systems level models and trauma specific treatments. To our knowledge, this is the first systematic review examining trauma informed models and trauma specific interventions in U.S. inpatient psychiatric settings. METHODS: A systematic review of articles published between January 2014 through November 2024 following PRISMA 2020 guidelines using a PROSPERO-registered protocol (ID 600061) with PubMed and SCOPUS databases, and supplementation through Google Scholar. Included studies examined TIC models or trauma-specific treatments or interventions in U.S. inpatient psychiatric settings and reported clinical or system-level outcomes. RESULTS: Of 2269 identified records, six studies met inclusion criteria, and all were conducted in child or adolescent inpatient psychiatric units. Five studies examined TIC systems level implementation while only one study described a trauma-specific therapeutic intervention (Brief STAIR-A). CONCLUSIONS: There is a substantial gap in the literature on TIC implementation, and trauma specific treatments in U.S. inpatient psychiatric settings. Findings center around pediatric populations with an absence of literature in adult acute care. The quality of evidence of most studies was limited and focused on implementation of milieu level TIC but not on clinical symptom assessment or outcomes. Development and evaluation of brief, scalable trauma-focused treatments or interventions may be a more flexible implementation strategy that can directly influence measurable inpatient outcomes.