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Barriers and Enablers to Scaling Trauma Recovery Center Care: A Scoping Review Protocol

Scoping review protocol identifying barriers and facilitators to scaling the Trauma Recovery Center model of care for survivors of violent crime in the United States.

GIST

This scoping review protocol aims to identify and map barriers and facilitators to implementing the Trauma Recovery Center (TRC) model of care, an evidence-based, trauma-informed, multidisciplinary program for underserved survivors of violent crime. Although the TRC has been adopted in 53 U.S. settings, there is limited synthesized evidence on implementation challenges and enablers to guide scale-up and adaptation across diverse systems. The review will follow Joanna Briggs Institute methods and report findings per PRISMA-ScR guidelines. Eligible studies are English-language, USA-based, published 2001–2026, and examine implementation-related barriers or facilitators for at least one core TRC element or analogous psychosocial support within comprehensive trauma-informed care. A two-stage screening with Covidence will determine eligibility, with independent assessment by reviewers. Data will be extracted and mapped to the Consolidated Framework for Implementation Research (CFIR) and synthesized narratively across CFIR's five domains, supplemented by summary tables linking findings to the review objective. Knowledge gaps will be identified. Ethics approval is not required. Engagement with NATRC experts will aid dissemination through publications and professional meetings.

Clinical Editorial

A structured map of factors shaping the scale-up of Trauma Recovery Centers: framing, scope, and anticipated learnings Contextualizing the TRC model and the impetus for synthesis: - The Trauma Recovery Center (TRC) is an evidence-based, interdisciplinary model designed to meet the mental health and psychosocial needs of underserved survivors of violent crime. It originated in the United States and has been adopted by a growing number of hospitals and outpatient sites across the country. - The core aim of TRCs is to promote equitable access to comprehensive wraparound services through an integrative approach that spans medical, behavioral health, social work, and public health disciplines. Services typically include crisis intervention, psychotherapy (individual and group), medication management, case management, and assertive outreach. Case management may extend to accompaniment to medical appointments or court proceedings, assistance with Victim Compensation Board processes, housing and financial entitlements support, and facilitation of linkages to medical and social services. - Although the TRC model’s principles remain consistent internationally, there is limited synthesized evidence describing barriers and enablers to implementing TRCs in diverse health systems. The current scoping review protocol explicitly targets this gap by mapping factors that influence the practical deployment of TRCs, with attention to scale-up and adaptation in varied contexts of care for survivors of violent crime. Design, methods, and analytical lens: - Objective and scope: The project seeks to systematically identify and map implementation-related barriers and facilitators associated with core TRC elements or analogous psychosocial support programs within comprehensive, trauma-informed care for survivors of violent crime. It explicitly focuses on the implementation landscape, rather than solely on programme outcomes. - Design framework: The study adopts a scoping review design guided by established methodological standards. It aligns with the Joanna Briggs Institute (JBI) approach to scoping reviews and plans reporting consistent with guidelines applicable to scoping syntheses (PRISMA-ScR). The stance is to produce a narrative synthesis that describes how contextual determinants relate to TRC performance. - Timing and workflow: The review was initiated in May 2025 with an anticipated completion in May 2026. An initial search in PubMed occurred in June 2025, and the final search strategy will be applied to multiple bibliographic databases: PubMed, Embase, PsycINFO, CINAHL, and Scopus. - Study selection and eligibility: A two-stage screening process, implemented via Covidence, will determine study eligibility. To be included, studies must examine barriers or facilitators related to implementation of at least one core TRC element or an analogous psychosocial support program within the context of comprehensive, trauma-informed care for survivors of violent crime. The inclusion is constrained to studies conducted in the USA, published in English, within 2001–2026. - Data extraction and synthesis: Data will be extracted and mapped using the Consolidated Framework for Implementation Research (CFIR). The extraction will inform a narrative synthesis that is organized around the five CFIR domains: Innovation (the TRC model itself), Outer Setting (the broader policy, funding, and community context), Inner Setting (organizational environments where TRCs operate), Individuals (providers and recipients of TRC services), and Implementation Process (strategies and actions supporting TRC deployment). The output will include summary tables illustrating how findings align with the review objective and will identify gaps in knowledge. - Evidence deposition and dissemination: The protocol notes that ethics approval is not required for a scoping review. Engagement with subject-matter experts—the National Alliance of Trauma Recovery Centers (NATRC)—is planned to provide feedback and to aid dissemination. Planned dissemination channels include peer-reviewed publications and conference or professional forums, including NATRC events. Scope, limitations, and translation of findings: - Population and setting constraints: The review is limited to studies conducted in the USA and published in English, focusing on TRCs or closely related psychosocial care models implemented within the national context. This restriction informs generalizability, especially to non-US settings, and constitutes a notable limitation for international applicability. - Evidence base and prior scoping activity: A prior scoping inquiry identified only a single prior scoping work focused largely on programme outcomes across a small number of TRC sites, with limited generalizability. The current effort explicitly shifts emphasis toward implementation science questions—barriers and facilitators to scale-up and adaptation—bacing a broader set of contextual determinants rather than outcomes alone. - Reporting and synthesis plan: The intended outputs include descriptive mapping of barriers and facilitators, structured within the CFIR framework and accompanied by tables that detail context-specific determinants. The approach emphasizes systematic organization of determinants across domains, with explicit attention to how factors may enable or hinder scale-up and sustainability. - Open questions and uncertainties: The protocol acknowledges uncertainty about the translatability of TRC experiences from five early California sites to a wider national or international scale. It also recognizes that the breadth of contexts (urban versus rural, funding environments, policy landscapes) may influence the relevance and applicability of identified barriers and enablers. Key contextual signals about the TRC model and scale-up potential: - Population health rationale: The TRC model addresses a substantial public health burden associated with violent crime in the United States, a burden characterized by heightened risks for mental health conditions such as PTSD, acute stress responses, depression, anxiety, substance use disorders, and other related sequelae. The model aims to mitigate these outcomes by delivering a coordinated package of mental health and supportive services designed to reduce barriers to care for high-need, underserved survivors. - Evolution and proliferation: Since its inception in 2001 at the University of California, San Francisco, the TRC model expanded from a restricted footprint to a broader nationwide presence, with 53 TRCs reported as operating across the United States at the time of the protocol. This growth trajectory underscores demand for scalable structures that can maintain fidelity to core principles while adapting to varied care settings. - Core elements and mechanisms: The TRC’s interdisciplinary design integrates medical, behavioral health, social work, and public health expertise. Core service modalities include crisis response, psychotherapy, pharmacotherapy management, and case management, with a focus on facilitating practical access to benefits, housing, and social services in addition to clinical care. The wraparound approach is intended to lower practical and systemic barriers—such as navigation challenges, logistical hurdles, and coordination gaps—that can impede survivors’ engagement and continuity of care. - Rationale for implementation-focused inquiry: There is an apparent need for structured understanding of the outer and inner contextual influences that shape TRC performance when scaled. The scoping review is positioned to illuminate how funding mechanisms, policy environments, organizational readiness, and provider and recipient factors interact to influence successful implementation and sustainable operation. Operational and methodological insights for readers: - CFIR as a unifying lens: The Consolidated Framework for Implementation Research (CFIR) is used to guide data extraction and thematic synthesis. The five CFIR domains provide a comprehensive map to categorize determinants: innovation characteristics, external context, internal organizational context, individuals involved, and the process of implementation. This framework supports a systematic exploration of contextual determinants that influence TRC performance in national and state-level contexts. - Data synthesis plan: Findings will be synthesized narratively across the CFIR domain constructs, balancing specificity with generalizable insights. The researchers indicate that summary tables will accompany the narrative, linking identified determinants to the review’s objective of understanding barriers and facilitators to TRC implementation and scale-up. - Ethics and stakeholder engagement: Ethical considerations for the scoping review are straightforward, given its design. Engagement with NATRC is anticipated to add practical perspective and help translate findings into dissemination-ready outputs for practitioners and policymakers. Interpretation and value for practice and policy: - Open questions for scale-up: The protocol implies that a synthesized map of barriers and enablers will inform future decisions about where and how TRCs can be implemented, adapted, and sustained in diverse care settings. This includes consideration of funding and policy contexts, organizational capacity, workforce readiness, and the alignment of TRC principles with existing care pathways and trauma-informed care standards. - Practical relevance: By detailing determinants across CFIR domains, the review aims to provide a structured evidence base that can guide decision-making for jurisdictions contemplating TRC replication or expansion. The emphasis on implementation determinants seeks to support more effective planning, resource allocation, and adaptation to local health system contexts. - Evidence gaps and future directions: The synthesis will identify knowledge gaps where empirical data on TRC implementation determinants are sparse or absent. The explicit articulation of gaps is intended to drive targeted research, multi-site collaborations, and the development of implementation supports to facilitate scale-up. Reporting gaps and acknowledged limitations: - Absence of non-US and non-English studies: The restricted inclusion to English-language studies conducted in the United States limits the breadth of generalizable lessons about TRC implementation across different health system architectures and sociopolitical contexts. Findings will therefore be most applicable to the U.S. setting and to settings with similar health system characteristics. - Scope of included evidence: Given that the prior literature on TRCs has focused largely on outcomes at a small number of sites, the current scoping review will depend on the availability of sufficiently detailed implementation-oriented documentation in eligible studies. If such data are sparse, the resulting synthesis may depict limited deployment intelligence, with consequent implications for the robustness of implementation recommendations. - Evolutionary stage of TRCs: The rapid expansion of TRCs in the United States over the past decade means that the implementation landscape may be dynamic, with newer sites encountering different external pressures (policy shifts, funding modalities, regional health priorities) than earlier sites. The review design assumes the ability to capture a coherent set of determinants across sites and time, but real-world heterogeneity may present interpretive challenges. Explicit statements about missing or uncertain elements: - The protocol notes that only studies examining TRCs or analogous psychosocial programs within trauma-informed care for survivors of violent crime in the USA will be included. It explicitly states that generalizability beyond the US is limited by design. - The anticipated outputs are narrative syntheses organized around CFIR domains, supplemented by summary tables that relate findings to the review objective. The protocol acknowledges potential gaps in the literature and intends to highlight existing knowledge gaps and areas necessitating further research. Synthesis of implications for researchers, funders, and program implementers: - For researchers: The scoping exercise represents a structured opportunity to map contextual determinants of TRC implementation and to clarify where evidence exists versus where gaps persist. The CFIR framework provides a coherent scaffold to classify determinants and to compare determinants across domains and contexts.

Original source: http://bmjopen.bmj.com/cgi/content/short/16/4/e107117?rss=1