Electronic Thesis and Dissertation Repository

Thesis Format



Doctor of Philosophy


Health Information Science


Dr. Nadine Wathen


For the past several decades, social and health services have increased their efforts to enhance service delivery and close the ‘science-to-service’ (or ‘evidence-to-practice’) gap by implementing effective interventions. At the same time, there has been growing recognition of the prevalence of trauma and violence in the lives of those served and those providing care and the impact of these experiences on service needs and interactions. This study explored the implementation of trauma- and violence-informed care (TVIC), a complex intervention focused on providing safety and choice for service users in the context of their life experiences and conditions, exploring factors that facilitate or prevent successful implementation in health and social services. Following a Pragmatic theoretical orientation, Active Implementation Frameworks (AIFs), an established implementation science model, was used as a guide to study the TVIC implementation process to further understanding of implementing a complex intervention in multiple complex contexts.

The study had two phases. In phase 1, six organizations interested in the implementation of TVIC participated. In-depth interviews were conducted to understand how organizations develop awareness of TVIC and its potential fit for their needs, and what motivates them to consider implementing TVIC. In phase 2, three of the six organizations were invited to participate as cases to explore TVIC implementation across time and learn about the facilitators and barriers of sustainable implementation. Data were collected by conducting interviews with key informants and reviewing relevant documents. Interpretive description methodology guided data analysis and interpretation to elucidate indicators and practical strategies during TVIC implementation.

Findings indicate that TVIC was a good fit for participating organizations interested in enhancing service delivery to meet the needs of individuals experiencing trauma and violence, but not all organizations have the required resources (time, money, etc.) to sustain implementation. In the two case sites able to continue implementation, the adaptability and applicability of TVIC principles were an important feature supporting leader and champions engagement in the implementation process, including providing ongoing support for their staff. Increasing the knowledge and understanding of the impact of exposure to trauma and violence helped staff understand how to provide care and receive support for their own wellbeing. This study also showed that the implementation of TVIC requires patience, ongoing attention and resources as the integration of TVIC within a complex context creates uncertainty and can be unpredictable. Further, external support from the community and other organizations were key implementation drivers to facilitate moving through the implementation process.

TVIC, while a complex intervention, was successfully integrated by two of the three cases examined, with emerging benefits noted by these organizations. AIFs are robust implementation science frameworks that fit well with the processes undertaken by these case organizations, and these findings will further enhance the AIFs by suggesting new implementation drivers. Implications focused on strategies to embed TVIC into organizational policy and practice are presented.

Summary for Lay Audience

Health and social service enhance their service delivery by implementing new knowledge generated from research into their practice. This study explored how specific service organizations become interested in improving their service delivery by implementing trauma and violence informed approaches in their organizations. Trauma and violence informed care (TVIC) focuses on increasing service provider knowledge about trauma and violence, including structural and systemic violence, and creating safe spaces for clients and service providers to collaborate, building on client strengths and providing them with realistic choices.

This study was conducted in two phases. In phase 1, I interviewed organizations interested in bringing TVIC into their organizations. The interviews clarified how TVIC can support the needs of organizations and what motivates them to integrate TVIC into their service delivery. In phase 2, I selected three organizations as cases and followed their TVIC implementation process across time. Interviews with key informants were conducted, and relevant documents were analyzed.

The key goal was to examine the implementation process to find practical strategies to assist other interested organizations in taking up TVIC. The findings showed that all participating organizations in this study were motivated to implement TVIC to enhance service delivery and provide extra care and support for their staff and clients. External support from the community and others also played an essential role in TVIC implementation. Significant changes and ongoing supports, including funding, are needed to help staff to incorporate TVIC into their practice, and organizations to embed TVIC thinking into their policies and protocols. These findings are important to support other organizations in taking up TVIC, which improves care experiences for everyone involved, and enhances our understanding of implementing complex interventions more generally.