An expanded Race and Equity-Centered Trauma-Informed Care (RECTIC) framework: crosswalk analysis of patient and clinician perspectives on structural and social barriers in perinatal care

Exposure to trauma is prevalent in historically under-resourced and marginalized communities because of persistent structural and social conditions rooted in systemic inequities. Trauma-informed care (TIC) has been proposed as an approach to improving perinatal care, yet less is known about how social determinants of health (SDOH) shape the implementation and experience of TIC. This study aims to examine the role of SDOH within a race- and equity-centered trauma-informed care (RECTIC) framework by exploring convergence and divergence between patient and clinician perspectives on perinatal care. Descriptive qualitative study using a crosswalk analysis to bridge patient and clinician perspectives. From June 2024 through October 2024, purposive sampling was used to recruit perinatal patients and clinicians from a predominantly medically underserved urban healthcare system. Semi-structured interviews were conducted using Braun and Clark’s six-step reflexive thematic analysis approach. A crosswalk analytic structure guided comparison of patient and clinician themes, and representative excerpts were used to assess the degree of convergence across perspectives. Thirty perinatal patients and 23 clinicians participated. All patient participants identified as Black or African American and were Medicaid recipients. Clinicians included Certified nurse-midwives ( n = 12), obstetrician-gynecologists ( n = 8), advanced practice registered nurses ( n = 2), and a family physician ( n = 1). Patients described the lived experience of navigating intersecting social and structural vulnerabilities, whereas clinicians articulated the clinical and systemic mechanisms underlying these experiences. Strong convergence emerged around the impact of discrimination, trauma sequelae, social support, communication, and structural resource gaps. Shared TIC perspectives emphasized safety as foundational to care, avoidance of retraumatization, and the need for systemwide implementation across the perinatal continuum. Areas of partial convergence revealed that trauma-informed care was often described as aspirational rather than consistently embedded in routine practice, with gaps between clinician intent and patient experience. Findings suggest that trauma-informed care is structurally contingent, with experiences of safety, trust, accessibility, and empowerment shaped by intersecting social and structural determinants of health. A RECTIC framework extends trauma-informed care beyond interpersonal clinical interactions by highlighting the need for organizational, community, and policy-level investments to address structural inequities, strengthen trust, and advance equitable maternal and infant health outcomes.