JMIR Publications

ABSTRACT

Background:

Trauma-informed care (TIC) is an organisational and clinical framework that integrates safety, trust, choice, collaboration, and empowerment into everyday practice. Although training can enhance TIC-related attitudes, implementation in European residential child and adolescent care remains inconsistent. Immersive technologies such as virtual reality (VR) may accelerate experiential learning but remain under-evaluated for TIC applications.

Objective:

To assess whether a VR-enhanced training programme improves attitudes toward TIC among professionals and trainees in residential child and adolescent care settings (including a child psychiatric ward) across several European countries, and to examine site-level heterogeneity and participant factors associated with change.

Methods:

A multi-site pre–post evaluation was conducted within the EU-co-funded Safe4Child project. Participants completed a standardised online TIC module (4 ECTS) followed by a mentor-led VR simulation (1 ECTS). Attitudes were measured immediately before and after training using the ARTIC-10 scale (7-point; higher scores = stronger TIC alignment). Analyses included descriptive statistics, Wilcoxon signed-rank tests, Cohen’s d, centre-specific comparisons, multivariable regression, and Bayesian estimation with sceptical priors. Internal consistency was evaluated via Cronbach’s α. Only matched responses were analysed (n = 79) from Bulgaria, Finland, and Germany.

Results:

Cronbach’s α improved from 0.839 (95% CI 0.792–0.886) pre- to 0.894 (0.863–0.926) post-intervention. Mean ARTIC-10 scores increased from 5.33 (SD 1.05) to 5.57 (SD 1.20), a significant change (p < 0.001) with a small effect (d = 0.22). Centre-level differences were evident: Germany showed a significant improvement (p < 0.001; d = 0.56), while Bulgaria (p = 0.796) and Finland (p = 0.186) did not. The proportion of participants with higher post-scores was 80% (95% CI 61.4–92.3%) in Germany, 60% (38.7–78.9%) in Bulgaria, and 54.2% (32.8–74.4%) in Finland. In multivariable models, the German site remained independently associated with greater gains (β ≈ 0.46). Bayesian estimation yielded a mean paired change Δ = 0.24 (95% CrI 0.11–0.37), with P(Δ > 0) ≈ 1.00 and P(Δ > 0.20) = 0.73. Prior trauma-related training suggested an additional but uncertain benefit.

Conclusions:

The VR-enhanced TIC programme produced a modest overall improvement in TIC attitudes, with a moderate, context-dependent effect in Germany. Findings indicate that immersive training may reinforce TIC learning when aligned with local educational and practice contexts. Site heterogeneity underscores the importance of foundational training before VR exposure. Limitations include the single-group pre–post design, immediate post-assessment, reliance on self-report, and a modest, predominantly female sample. Larger longitudinal and implementation-focused studies are needed to assess durability and behavioural translation of attitudinal gains.