The CARE implementation study: scaling group-based psychoeducational trauma therapy across healthcare organizations in Canada

Background: Access to trauma-focused mental health care is often limited by shortages of specialized HCPs, high training costs, and resource constraints. Research on the real-world implementation of scalable training and intervention models remains limited.Objective: To evaluate the implementation of the Community Access to Resourced & Resilient PsychoEducation (CARE) intervention across healthcare organizations in Ontario, Canada, using an implementation science framework.Methods: This prospective, mixed-methods implementation study used Proctor's Implementation Outcomes Framework to assess the CARE intervention across five healthcare organizations from February 2022 to October 2023. CARE includes asynchronous healthcare HCP training, delivery of an 8-week trauma-focused psychoeducation and skill-building group, and weekly virtual supervision for group facilitators. Feasibility, acceptability, and sustainability were assessed using recruitment and adherence data, post-group interviews with HCPs (n = 15) and supervisors (n = 7), post-intervention acceptability questionnaires, and follow-up surveys with participating sites at 6 and 12 months. Pre- and post-intervention measures of PTSD symptoms (PCL-5) and depression, anxiety, and stress (DASS-21) were compared using paired t-tests.Results: All five sites successfully implemented the intervention, demonstrating high feasibility and acceptability. Forty-eight multidisciplinary HCPs completed training, 24 co-facilitated at least one therapy group. Thematic analysis of interviews highlighted positive learning experiences and skill development. Adult patients (N = 163; mean age 46; 84.0% female) with a history of trauma prior to age 18, were enrolled in the study, with 64.4% attending at least 6 of 8 group sessions. Significant reductions in PTSD symptoms were observed post-intervention (d = 0.49) alongside improvements in depression (d = 0.36), anxiety (d = 0.40), and stress (d = 0.39). All sites sustained the implementation of the intervention at one-year follow-up.Conclusion: The successful implementation of the CARE intervention across diverse healthcare settings underscores its scalability and promise as an accessible model for delivering trauma-focused care.