Trauma-informed approaches

Key terms

When trying to understand and learn more about trauma-informed approaches, there are some common terms you might come across:

Trauma – Trauma affects people differently, and there are many ways to define it. The Trauma-Informed Wales Framework (2022) describes trauma as any experience that’s “unpleasant and causes, or has the potential to cause” distress and anxiety. Alternatively, the Substance Abuse and Mental Health Services Administration (SAMHSA) (2014) defines it as an event or series of events that have “lasting adverse effects” on a person’s functioning.

Trauma-informed approaches – Ways of working that recognise the impact of trauma on individuals and families and understand potential paths for healing (Trauma-Informed Wales Framework, 2022).

Strengths-based approach – A way of working that’s incorporated into trauma-informed approaches. It focuses on an individual’s strengths, abilities and resources, rather than their problems or things they can’t do or don’t have.

Adverse Childhood Experience (ACE) – ACEs are stressful experiences that happen during childhood that either harm a child directly (like abuse and neglect), or affect the environment they live in (like living in a household with domestic violence or drug abuse). People with ACEs are more likely to develop health-harming behaviours than people without ACEs (Bellis et al., 2015).

The risks relating to ACEs aren’t definitive and can be reduced. There’s evidence that having access to a trusted adult in childhood can reduce the impact of ACEs, making it less likely that a person will develop health-harming behaviours and lower mental well-being in adulthood (Bellis et al., 2017). There’s also evidence that compulsory education can play a significant role in reducing the effects of ACEs (Hardcastle et al., 2018).

Secondary trauma – People who work with individuals suffering abuse and neglect can be exposed to frightening and stressful situations. This can lead to secondary trauma, sometimes called vicarious trauma. This can also be caused by listening to accounts of abuse and neglect. Understanding secondary trauma and supporting members of staff appropriately is a key part of trauma-informed approaches, which can then improve working environments for staff and increase job satisfaction (Sweeney et al., 2018).

Do trauma-informed approaches work?

Benefits for people receiving care and support

Despite trauma-informed approaches being a relatively new concept, there are some examples of positive outcomes for people who use care and support.

One example is the Barnardo’s Baby and Me service in Newport, which has reduced the number of babies under 14 days old entering care by 48 per cent since 2019 (Research in Practice, 2022). The Baby and Me service uses a trauma-informed and relationship-based approach to supporting pregnant mothers who are at risk of losing care of their baby in public family law proceedings. Mothers using the Baby and Me service have an individual support worker who supports them to overcome barriers to successful parenting and offers help to engage with other services. The service also involves a group-based parenting programme, where parents have the opportunity to meet others who’ve had similar experiences to them (Barnardo’s, 2022).

There are benefits for people who access care and support in taking a trauma-informed approach, including:

• improved well-being and engagement with services (Asmussen et al., 2022)
• When practitioners have a deeper awareness of trauma and a better understanding of people’s needs, people who use care and support are happier with the service they receive. They feel less judged and more motivated to engage with services. In the longer term, people are more resilient and there’s a permanent reduction in trauma
• improved family relationships (Bunting et al., 2019)
• Trauma-informed approaches support relational and emotionally intelligent practice. They support positive communication with children and families and encourage practitioners to take a more informed view of behaviour that can be seen as 'challenging'. This then reduces caregiver stress. Trauma-informed approaches can also improve caregivers’ ability to support their child and improve general family safety and well-being, leading to better relationships between parents and their children
• minimised risk of re-traumatisation (Gaffney et al., 2021)
• Trauma-informed approaches make sure people who use care and support don’t have to re-tell their story too many times to different people unnecessarily, avoiding the triggering of painful emotions. Trauma-informed approaches also make sure people who use care and support don’t feel judged when explaining their experiences. This can help avoid the negative emotions that can come with telling people about traumatic events, such as shame.

While these studies find some benefits for people who use care and support from trauma-informed approaches, there’s limited robust evidence that shows improved outcomes for people in the UK (Asmussen et al., 2020).

Benefits for practitioners

Trauma-informed approaches can improve practitioners’ experiences of their work. A study of the use of trauma-informed approaches in youth offending teams in Wales showed that training in trauma-informed practice increased workers’ confidence in identifying trauma and providing the right support. Workers also felt more supported by their organisation to apply trauma-informed practice to their work (Glendinning et al., 2021).

Trauma-informed approaches can also improve practitioners’ experiences by leading to:

• higher job satisfaction (Asmussen et al., 2022)
• Knowing the principles of trauma-informed approaches and putting them into practice can improve the quality of practitioners’ work and their job satisfaction. This is because when work is more effective it’s also more rewarding, and practitioners feel more supported in their practice.
• better relationships between colleagues (Asmussen et al., 2022)
  
• Knowledge and use of trauma-informed approaches help practitioners develop empathy and improve trust between colleagues. Learning about trauma-informed approaches can also be a reflective experience, encouraging practitioners to reflect on their work relationships and organisational culture.
• knowledge development (Jupp Kina and Stevens, 2022).
• Learning about and putting trauma-informed approaches into practice provides an opportunity for practitioners to expand their expertise and improve their practice. Using trauma-informed approaches significantly improves practitioners’ confidence to help address and support children’s behaviours and emotions.

What do trauma-informed approaches involve?

Understanding practitioners’ own trauma

An important part of trauma-informed approaches is understanding the impact of practitioners’ own experiences of trauma. Working with people who use care and support and listening to their stories of trauma can trigger a secondary trauma experience involving negative emotions and memories for practitioners. Trauma-informed approaches recognise that practitioners can use their trauma experiences to develop deeper levels of empathy with people who use care and support and improve their practice (Jupp Kina and Stevens, 2022).

Relationship building

Building relationships between practitioners and people accessing care and support is an important part of a trauma-informed approach. A positive, trusting relationship is key in providing a safe space where people using care and support feel able to open up about their experiences and begin to heal (Jupp Kina and Stevens, 2022).

There are three principles for building relationships in a trauma-informed way (Christie, 2018):

• Trust – practitioners should do what they say they’ll do, fulfil commitments and stay in regular contact with people who use care and support. This makes sure people using care and support feel that they won’t be forgotten, and that they can share their feelings in their own time.
• Respect – practitioners should listen actively, show they understand, and share control of the conversation with people who use care and support. This leads to people feeling they’re valued, empowered and in control of their own support.
• Person-centred – practitioners should give support over a long enough period to build a long-term relationship, where possible. Practitioners should support people to be ‘equal partners’ when setting the agenda for their support, and respond proactively when their needs change (Social Care Wales, 2022; Caulfield et al., 2022). This can help people feel prioritised and valued.

Use of peer support

A key aspect of trauma-informed approaches is including other people with lived experiences of trauma in providing care and support. This is also known as peer support. It’s related to the coproduction principle that’s central to the Social Services and Well-being (Wales) Act 2014, encouraging individuals to become involved in the design and delivery of services.

Ideally this should happen at all levels of service provision: from programme design to delivery. An example of how this can work in practice is the Barnardo’s Baby and Me service, where parents can meet other parents in a similar position to them at group parenting meetings.

What don’t we know about trauma-informed approaches?

As trauma-informed approaches are a relatively new and developing area of research, there are still things we don’t know. For example:

• we have limited evidence from research studies about the outcomes of people who’ve received trauma-informed services. This makes it difficult to know how effective trauma-informed approaches are. A review of interventions to support people with ACEs found significant gaps in the evidence base. Where evidence was available, it showed a focus on reducing psychological harm, and not on wider circumstances that can help to reduce the impacts of ACEs, such as improving social relationships (Lorenc et al., 2020)
• trauma-informed approaches are done differently in different organisations and settings (Asmussen et al., 2022). This makes it harder to compare and evaluate the overall effectiveness of trauma-informed approaches
• we don’t yet know how practitioners’ own experiences and identities affect how trauma-informed approaches are delivered. Anecdotal feedback from colleagues and wider communities is supportive of trauma-informed approaches.