Table 4.

Qualitative Interviews: Barriers and Facilitators to Implementation of Trauma Support Services

	Barrier/Facilitator	Example Quote
Providers and Staff	Organizational Support of TIC Implementation	“You never know who is going to come through that door and if you’re trained and have the knowledge to help that patient, I think that would really benefit the clinic and that patient as well.” (Staff)
	Integrated Service Delivery Model	“We have programs and support groups and tools in place so that when clients identify trauma needs or violence or what have you, we have tools in place. We have peer counselors, we have mental health that can address those needs. We have our case management team that can support and help identify places where people can get the assistance they need.” (Staff)
	Lack of Services Dedicated to TIC	“I think that we probably have some very good therapists who help with that. I don’t know that we have a trauma-specific group.” (Provider)
	Unclear Procedures for Linking Patients to External Trauma Support	“If I do ask about [trauma], then I’m still at a loss of where to send people, which informs if I asked or not, because…you don’t wanna ask a question you don’t know the answer to.” (Provider).
	Lack of Training on TIC	“If you are not a skilled and trained counselor or provider, then it’s almost a disservice. Like you say, ‘where you raped recently?’ then you check a box and move on.” (Provider)
	Resource Constraints	“There are so many people that are coming through with HIV. There are far more beyond than our resources- than what we can do.” (Provider)
Patients	Satisfaction with Current On-Site Support	“I speak to the psychiatrist and working on my previous traumas and issues, I’m able to talk about it more openly and freely, and sometimes we’ll sit and talk for an hour. And it’s a release, ‘cause it’s not bottled up anymore.”
	Strong Patient-Provider Relationship	“I do feel comfortable communicating ‘cause [my doctors] seem very nonjudgmental, very helpful…they do seem like they have a concern about helping you.”
	Need for a Broader Range of Trauma Services	“I feel like they could be more useful in the simple fact of more therapy offers or something like that. I feel like a lot of people really need somebody to talk to in here.”
	Lack of Awareness of Available Services	“[I wish] you could go to a site or something that lists different support groups that’s going on and what you could take advantage of, ‘cause I would like to do something like that.”
	Difficulties Navigating the Healthcare System	“Some people come in with pre-existing barriers, and not only just learning about their diagnosis. They have other issues that they may need addressed, but they don’t know whom to ask or which direction to be pointed in.”
	Access Barriers	“I attend group every other Wednesday of the month…I just typically take off of work for those Wednesdays.”