Trauma-informed care (TIC) in low- and middle-income countries: A scoping review of organisational implementation efforts.

Due to an increased awareness of the prevalence and impact of trauma, "trauma-informed care" (TIC) was developed as an organisational framework aiming to centre the needs of survivors of trauma. TIC proposes that organisations can reduce trauma exposure by embedding specific principles (e.g., safety and trust) at every level of an organisation, improving the organisation for both service users and providers. Recent reviews of TIC implementation efforts have demonstrated its use in diverse settings; however, studies are overwhelmingly situated in high-income, predominantly English-speaking countries. Rather than reflecting a lack of TIC efforts in low- and middle-income countries (LMICs), these findings may be a result of the newness of the term TIC. To create a more inclusive evidence map, the current review captures efforts conducted in LMICs that may or may not use the label of TIC but align with the organisational approaches and key principles of TIC. A search of four databases and review of relevant references yielded 3,091 results, of which 255 met the inclusion criteria. Implementation efforts took place across 39 LMICs. The vast majority included involvement of another country, most commonly the United States. Approximately 90% of efforts were implemented within medical settings, and 69% focused on the TIC principle of cultural, historical and gender issues. The results of the current review have both theoretical and applied implications for TIC research. They query how and by whom TIC is conceptualised and defined, and how TIC aligns with other global research approaches. Results also highlight the need for organisational TIC interventions to conduct comprehensive baseline assessments of current efforts before implementing new efforts to avoid unintentional duplication. As the adoption of TIC frameworks becomes more widespread, it is imperative to increase research efforts aimed at developing a more thorough and inclusive definition of TIC.