Teaching Trauma Informed Care (TIC) to healthcare staff in the perinatal setting: a scoping review.

Background and Rationale Trauma Psychological trauma is highly prevalent (Benjet et al., 2016), specific to the individual (Substance Abuse and Mental Health Services Administration (SAMHSA), 2014) and deeply impacts individual’s functioning, relationships, and physical and psychological health. An international sample of over 68,000 adults identified that 70% had experienced at least one TLE, 30.5% had experienced four or more and the average number was 3.21 (Benjet et al., 2016). Psychological trauma is associated with inequality; while anyone can be impacted by a traumatic event, minority groups are disproportionally affected (Law et al., 2021). Trauma in the perinatal period Psychological trauma in the perinatal period is common. A meta-analysis of 154 studies estimated rates of PTSD following childbirth of 4.7%, with 12.3% reporting significant sub threshold PTSD symptoms (Heyne et al., 2022). The authors highlighted the wide range of prevalences in the included studies, with some reporting rates as high as 50%. They also underscored the need for preventative work including TIC. This analysis only included studies where childbirth itself was the stressor, excluding many potential causes of trauma in the perinatal period. Also of note, PTSD and it sub threshold symptoms do not capture the full range of consequences of psychological trauma, which may also include depression, anxiety and substance misuse. The perinatal period is a unique window in which multiple specific TLEs can occur, including: infertility, early pregnancy loss, guarded antenatal diagnoses, intimate examinations and procedures, stillbirths, terminations, traumatic deliveries, involvement of child services, adoption, surrogacy, intimate partner violence, congenital defects, neonatal ICU admission, or early neonatal loss (Law et al., 2021; Sachdeva et al., 2022). These TLEs may be compounded by many things, inter alia prior trauma, ACEs, a history of sexual trauma or experiences in a previous pregnancy (Isobel, 2023). Many individuals also experience trauma symptoms due to personal feelings of failure relating to the birth, lack of autonomy, absence of dignity, and poor communication (Bhagawan et al., 2025). Trauma informed care The concept of TIC developed in the 1990’s (Purtle, 2020). However, SAMHSA have greatly enhanced its adoption by coalescing the key concepts into six key principles (2014). The six key principles are: 1. Safety 2. Trustworthiness and transparency 3. Peer support 4. Collaboration and mutuality 5. Empowerment, voice and choice 6. Understanding cultural, historical and gender issues (SAMHSA, 2014) These principles should be applied universally by all staff in keeping with their specific roles (Goodard et al., 2022). While TIC is being widely implemented, objective evidence of its effectiveness remains limited (Nguyen-Feng et al., 2025). This may be due to the varied nature of what is implemented and how it is evaluated. Berring et al. (2024) highlight how little consistency there is in the literature about implementing TIC; the interventions and outcomes are highly heterogeneous. Trauma informed care in the perinatal setting Law et al. (2021) have condensed the six core principles (SAMHSA, 2014) into four specific to the perinatal setting: 1. Compassion and recognition 2. Communication and collaboration 3. Consistency and continuity 4. Recognising diversity and facilitating recovery (Law et al., 2021) Law et al. (2021) suggest that TIC training is often lacking in a perinatal setting. However, TIC has been examined in elements of perinatal care, for example, Sachdeva et al. (2022) explored how it can influence perinatal mental health teams. They conceptualised the perinatal psychiatrist as supporting obstetricians in caring for patients with trauma; this appears to be a reactive model, rather than the more established universal model. TIC has demonstrated an ability to be beneficial in the management of some specific vulnerabilities that arise in the perinatal period, for example intimate partner violence (Chin et al., 2024; Chu et al., 2024) and perinatal bereavement (Berry, 2022). Teaching trauma informed care A review by Purtle (2020) highlighted that the literature on TIC training is sparse, the interventions vary widely, the study designs are often unsophisticated and the endpoints do not always map onto patient outcomes. Despite these limitations five of the studies included in the review reported patient level benefits. Broad scoping reviews have been carried out in relation to TIC education. Burns et al. (2023) identified that the majority of studies have occurred in a medical field rather than with allied health professionals; the focus of the educational content was on identification and response to trauma; and the areas that needed development included cultural sensitivity, mandated reporting, medical documentation, and vicarious trauma. Jackson and Jewell (2021) identified how varied training models were across disciplines; they discussed how courses with multiday training, collaborative learning and post course follow up had potentially enhanced outcomes. Other authors have focused reviews on specific areas including mental health (Berring et al., 2024), primary care (Gundacker et al., 2021), medical students (Bell et al., 2025) and oral healthcare (Mahood et al., 2024). A scoping review in a mental health setting identified the wide variety of ways TIC has been incorporated into practice and the challenges in synthesising knowledge (Berring et al., 2024). Mahood et al. (2024) discussed the challenges of defining specific terms relating to TIC and the degree of subjectivity present in the analysis. Bell et al. (2025) found that medical students wanted practical interactive training in TIC and that inclusivity and cultural factors were the areas that required the most development. There has not been a scoping review of teaching TIC in the perinatal setting. Long et al. (2022) conducted an integrative review of TIC education for midwives, none of the included papers exclusively focused on midwives. Participants had little knowledge of TIC and did not feel confident in providing such care. Justification of a scoping review A systematic scoping review will be used to answer the research questions, this approach is effective at answering broader questions compared to standard systematic reviews, and can describe the nature of the evidence on a topic, identify key concepts and theories, highlight knowledge gaps and summarise a field with heterogenous research (Tricco et al., 2018). This is the best option for the research questions as the existing literature is still emerging, there are significant research gaps, and much of the existing research on TIC education is highly variable with regard to definitions, interventions and outcomes. Objectives Our primary question that we plan to answer in this scoping review is: • What educational interventions and strategies have been used to teach trauma informed practice in clinical and non-clinical staff working in a perinatal setting? Our secondary questions are: • What pedagogical models influence the interventions that have been used in this context? • How have these interventions been evaluated?