Advancing Health Equity through Trauma-informed Implementation Science

Background: The field of implementation science has advanced in recent years due to efforts from health equity experts who have worked to integrate issues of equity and social justice. Despite notable innovation, one area where guidance is lacking relates to the implementation process and how researchers can meaningfully engage providers/participants and participants in this work. Given that socially and economically marginalized populations are also likely to be affected by trauma, integrating guidance from the Trauma-Informed Care (TIC) field can enhance implementation with the overarching goal to improve equitable outcomes in health. Accordingly, the purpose of this commentary is to suggest ways that implementation science and TIC can be integrated to mitigate disparities and improve the science of implementation. Main text: We introduce the term Trauma-Informed Implementation Science (TIIS) with the goal of seeking alignment between these fields and acknowledging the wealth of guidance developed in TIC that can be incorporated into the process of implementation, especially when working with trauma-affected communities. To begin this narrative shift and build on our collective experiences as researchers and practitioners working in populations who have high prevalence of trauma, we propose extensions to the Consolidated Framework for Implementation Research (CFIR) implementation process domain that reflect the six central tenets of Trauma-Informed Care: 1) safety, 2) trustworthiness and transparency, 3) peer support, 4) collaboration and mutuality, 5) empowerment, voice, and choice, 6) cultural, historical, and gender issues. Specifically, we have aligned each of the implementation process constructs with one or more of the six tenets of TIC, provided recommendations for implementers/providers of case, and listed critical questions and considerations for researchers as they begin to apply tenets of TIC into their implementation work. Conclusions: We envision this commentary as the launching point for TIIS, with the goal that scholars with expertise in implementation science and TIC can deepen the integration of these two fields. Engagement with groups who have lived experience related to health inequities and trauma will be an important component of that process. With further development, TIIS holds promise to help reduce health disparities, especially among individuals and populations affected by trauma.