Within Health and Social Care Practice the importance of recognising the critical impact of trauma on both those accessing and providing services, can be seen in the attention of policy makers in central government and National Health Services being focused on the concept of Trauma Informed Practice. In Scotland, for example there is a recently developed Trauma Informed Practice Toolkit and this year in Wales a Trauma Informed Framework has been issued.
This piece will focus on the basic principles of Trauma Informed Practice as presented by both the UK government and the devolved administrations and firstly will refer to the guidance document issued in England in November 2022 which seeks not only to define Trauma Informed Practice, but also sets out the key principles of it.
The guidance provides a working definition of Trauma:-
Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. While unique to the individual, generally the experience of trauma can cause lasting adverse effects, limiting the ability to function and achieve mental, physical, social, emotional or spiritual wellbeing
The Guidance also sets out what signs to look out for in those using or working in our services, and also how to prevent re-traumatisation of those individuals using our services. Trauma informed practices is not about general services treating trauma, but making services and workplaces safe and accessible to everyone, irrespective of background and lived experience.
The guidance sets out the 6 principles of Trauma Informed Practice:
1. Safety – people feeling safe or feeling confident in asking for what they need to make this happen whilst working or visiting somewhere which sets out not to re-traumatise and puts safeguarding first
2. Choice – allowing staff and service users a role in decision making within the organisation, organisations explaining decisions and also recognising that those who have experienced trauma may lack a feeling of safety or fundamental trust in others
3. Collaboration – an organisation seeking opinions of staff and those using the services, as to what they need and acting on these opinions and ideas whilst involving them in service delivery.
4. Empowerment – helping people to make decisions that affect their lives, but also supporting them in doing this by recognising their potential lack of self-confidence and self-efficacy
5. Cultural consideration – Organisations offering services that are inclusive to everyone, refusing to engage in stereotypes based on age, race, ethnicity, gender, sexual orientation and where you live.
The evidence of how trauma, experienced when young, affects not only the physical but psychological health of individuals as they mature into adulthood has already been the subject of much research and discussion and Adverse Childhood Experiences or ACEs as they often known are recognised more and more as being the context within which many adult behaviours have to be considered. It is from this base that the document ‘Trauma-Informed Wales: A Societal Approach to Understanding, Preventing and Supporting the Impacts of Trauma and Adversity’[1]has been developed as part of the Welsh Government’s Adverse Childhood Experiences Plan.
The framework sets out 5 main principles which contribute towards a Trauma Informed Wales:
- Universally providing services which do not unintentionally harm those using them
- That the person is at the centre of service delivery
- Trusting relationships are at the heart of the interaction
- Building resilience is a cornerstone of the approach
- Inclusivity is key
The framework also details levels which are part of a fully trauma informed approach throughout Wales. These levels move from services and a society in general that are Trauma Aware, It is predicated upon the basic premise that we need to move away from a society where people’s past trauma is ignored or stigmatised, through to specialist services which either work specifically with individuals who have experienced trauma or working with organisations to provide trauma informed practice.
The Trauma Informed Toolkit[1], issued in Scotland reflects and builds upon the principles and practices detailed in the respective approaches in England and Wales and provides practical examples of where organisations can make improvements to public spaces and working environments to move closer to the overall aim of providing safe and secure, environments which allow universal access for all irrespective of background.
This focus on being trauma informed will no doubt mean a major transformation of services throughout not only health and social care but throughout society as a whole if it is to be realised, however it is critical and long overdue and will help towards making service provision universal not only in name but also in action.
For more information on the content and booking process for the half-day session delivered by Allan Johnston which looks at what the move towards trauma informed practice would mean for existing and new services, please follow this link.
