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Creating safer, more inclusive services: towards trauma-informed practice

9 May 2024
By Georgina Beadon Ekers and Kerry Mayers
Georgina Beadon Ekers and Kerry Mayers

Back in 2020, commissioners and clinicians came together in South East Essex to discuss how to address the underpinning themes of trauma and adversity that people with mental health needs experience. 4.4% of adults have PTSD, and adverse childhood experiences are thought to be even more common, leading to poor health and social outcomes throughout people’s lives if they don’t receive the right support. We knew that colleagues working in other parts of our local public services system were also working with trauma but that there were varying levels of knowledge on what it is and how to respond to it. We set out to change this, and to better support our colleagues and the people we serve, by creating the South East Essex Trauma Alliance.

The Trauma Alliance is a small core team (a psychotherapist, an assistant psychologist and a half-day a week of a consultant psychologist) based in our local mental health trust that promotes trauma-informed practice to create safer, more inclusive and empowering services. Ultimately this is about changing organisational and systemic cultures – and it felt both exciting and daunting to take on the task of influencing such an important culture shift.

We work with a membership made up of teams and organisations that have pledged their commitment to becoming trauma-informed. Our work spans health and social care, charities, social enterprise groups and emergency services. Our community approach seeks to remove what so easily become barrier lines between services and instead unite as a collective to progress working approaches.

To support this, the alliance’s work involves undertaking a review of the organisation’s current levels of trauma-based knowledge and practice using a measure called the ROOTs framework, as well as working with staff to find out their level of secondary trauma, i.e. traumatisation experienced by staff due to the work that they do. This might be witnessing traumatic experiences, as some of our blue light service colleagues have done, or hearing stories from clients of the traumatic experiences they have faced. Awareness of staff’s own responses to traumatic events, in turn, leads to a change in their practice with clients:

“It has been made apparent that change for the clients I work with starts with change in myself and my way of thinking.” – Trauma Alliance member

Our team offers advice and guidance on how to improve trauma-responsive practice and processes. We deliver training on trauma-informed care and approaches, from adapting the language we use to developing compassionate leadership. And we provide reflective practice spaces with individual teams and for the whole membership, to embed the coproduced values that unpin all of our work.

We use the “Four R’s” approach to trauma-informed care which originated in the US. These state that an organisation and its staff:

1. Realise what trauma is and how it affects individuals, groups, families, communities and organisations

2. Recognise the signs and symptoms of trauma which may be age-, gender-, culture- or setting-specific

3. Respond by applying the principles of trauma-informed care to all areas of their functioning

4. Resist re-traumatising people that they work with, as well as their staff, through adapting the way that they work.

We then invite our members to review their organisation’s journey after about a year of working with us. Our membership is made up of 34 teams and organisations from health, social care, the third sector and social enterprises. This includes GP surgeries, sex working support centres, social work teams, housing officers, food banks, hospices and substance use centres to name just a few. We differentiate our offer and advice based on the level of trauma knowledge already existing in teams; for example, a domestic violence organisation is likely to have greater experience not only of working with trauma, but of being aware that this is the primary issue that clients are struggling with. An understanding of the impact of traumatisation on people accessing food banks or council services may be less obvious, and may require a different starting point on the trauma-informed practice/care journey.

This work with our members has led to some significant outcomes. One council has signed our Memorandum of Understanding to commit to becoming a wholly trauma-informed organisation. The work that we have done to support a local sex working charity, alongside the local council, led to a presentation on our work at a King’s Fund conference on women’s health inequalities. We have also set up and facilitated a national Community of Practice for practitioners interested in, or tasked with actively creating, trauma-informed systems. Our biggest outcome is the difference being made in the lives of service users and staff:

“Attending the training has helped our understanding of [the] survival value of a service user’s coping strategies as a result of their adversity or trauma history.” – Trauma Alliance member

This year we’re focusing on supporting carers, social care and primary care teams, as well as coproducing new levels to our training offer. We are constantly evolving – we learn so much from our membership every time we meet and iterate our offer in response. We aim to take a trauma-informed approach in the way that we support our members, aiming to walk the walk and not just talk the talk. We promote the message that becoming trauma-informed is a journey and not a destination: we focus on what good enough looks like, rather than perfection. Ultimately, we strive to improve the experience of people living with trauma in our local area, in personalised and hopeful ways.

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