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This paper aims to explore an integrated therapeutic care approach for a group of children and young people who have experienced chronic and enduring interpersonal trauma.

This paper aims to emphasise the need to routinely assess for that which could have been relationally traumatic, as this is the context in which many looked‐after children's and young people's developmental experiences occur. In particular, it explores the need to have trauma‐informed assessments, clinically effective interventions based on this knowledge, and the need to ensure that a therapeutically enabling environment and organisational functioning is maintained, in order to improve outcomes. It builds on existing work on trauma systems theory, both within an organisational context and within a holistic completely integrated (therapy/assessment, care, education) residential child care treatment process.

This research raises consideration of the manner in which interpersonally traumatic experiences with the child's primary attachment figures (accommodation complex) may create the context in which children employ dissociative coping. This also may have possible helpful connections for those working with adults diagnosed with borderline personality disorder.

The paper provides a systemic model based on three strands of understanding, namely trauma, attachment and dissociation, which can provide an underpinning assessment and interventions model for children in residential care.

The purpose of this paper is to explore the role of trauma experience in pathways to self-harm or attempted suicide in female prisoners who died through self-inflicted death in England and Wales.

Quantitative study using the Prison and Probation Ombudsmen’s independent reports on deaths in custody. In total, 32 cases of female self-inflicted death in custody were coded on the presence of direct or interpersonal trauma, presence of superficial self-harm (SSH), near-lethal self-harm (NLSH), suicide attempts and recent significant life event. The number of previous suicide attempts (PSAs) and age at time of death was recorded.

Direct trauma is linked with repeated suicide attempts but recued the likelihood of SSH prior to suicide. Neither interpersonal trauma nor age increased likelihood of pre-suicide behaviours. NLSH was not predicted by either traumatic experience. Amongst these completed suicide cases, 56 per cent were not reported as having experienced trauma, 46 per cent had no recorded PSAs and 12 per cent also had no previous self-harm reported.

The small sample limited statistical power and specificity of classifications. Provides support for direct trauma in developing capacity for repeated suicidal behaviour as indicated in theoretical models of suicide (Joiner, 2005; O’Connor, 2011).

Different pathways to suicide likely to exist for female prisoners and importance of trauma intervention services.

Using cases of completed suicide in female prisoners to investigate the pathway to suicide from trauma through previous self-harm and attempted suicide.

The purpose of this paper is threefold: to summarize data on rates of sexual abuse and interpersonal trauma in people with intellectual disability (ID); to demonstrate the relationship between such trauma and psychological distress; and to describe a promising treatment technique for such exposed individuals.

A review of the literature on rates of abuse and trauma among people with ID is presented with particular attention paid to the role of developmental level in both the experience and impact of trauma. Drawing from this understanding of the phenomenology of traumatic exposure in people with ID, the authors present a theoretical framework for psychotherapeutic intervention.

This paper establishes the inverse relationship between the higher‐than‐average rates of trauma and interpersonal violence in the ID population, co‐occurring with lower‐than‐average access to treatment, and lower‐than‐average treatment model development for this population. Further, this paper provides a description of a theoretically based therapeutic intervention with preliminary research efficacy.

This paper documents three key areas in need of attention in order to reduce the suffering of people with ID: the need to address the high rates of exposure to abuse; the importance of taking into account developmental level when assessing the impact of potentially traumatic experiences; and the efficacy of the interactive‐behavioral model of group psychotherapy for people with ID who have trauma‐related distress.

This paper points to the need for systematic efforts to reduce the rate of traumatic exposure to which people with ID are disproportionately exposed. Moreover, it establishes how important the role of developmental level is in understanding how exposure to abuse may result in the development of psychological disorders. Finally, this paper provides a clear understanding of a targeted therapeutic approach and the need for a system of accessible care so that afflicted individuals may have the benefit of such therapy.

Serious juvenile delinquency is a significant and costly problem in the society. However, custodial environments often exacerbate current problems and promote recidivism. Girls’ delinquency, in particular, may call for trauma-informed approaches within organizations that serve the most serious offenders. The purpose of this paper is to explore whether implementation of a trauma-informed intervention that aims to change the therapeutic stand of the organization, the Sanctuary Model®, corresponded with improved indicators of physical and psychological safety of staff and youth at a female secure juvenile justice facility.

This study utilizes quantitative administrative and performance-based standards (PbS) data routinely collected at the facility.

Findings suggest that the facility was a safer place for both residents and staff after implementation of the model. Its safety indicators also compare favorably to those of the juvenile justice correctional field in general.

This study was constrained by a number of limitations, including lack of some desirable detail on the PbS measures and on a comparable field group of girls’ facilities. It is also hard to assess the impact of other concurrent changes in the facility. Future research that addresses these issues would be useful in further determining the utility of the model.

This study is the first to examine the impact of a structured trauma-informed organizational change intervention based on therapeutic communities principles, namely the Sanctuary Model, on staff and youth in a secure juvenile justice facility. Findings may be of value to practitioners, administrators, policy makers, and researchers in the corrections field.

What is happening in the perceived world of young people who have non-suicidal self-injury? The answer to this question explains many quantitative research findings in the field of NSSI. The current qualitative research design is Husserl's descriptive phenomenology.

The participants included 17–29-year-old youths with self-injury and were selected with a targeted sampling approach and a conspicuous sampling method based on the theoretical saturation criterion of 21 people. Data were collected in a semi-structured interview and analyzed in the MAXQDA2022 software using the Attride-Stirling (2001) method. Validation of data was done by the method of simultaneous review of colleagues and simultaneous review of participants.

The themes emerging from the analysis of the findings are the three organizing themes of “vulnerable temperament” which includes height and head, high pain sensitivity threshold and desire for nothingness, “traumatic family” which includes disorganization, crisis and devaluation in the family and “developmental injuries” that are associated with physical, sexual and emotional abuse and neglect. The content of these themes seriously harms a person's self-perception through the emotions of fear, shame, anger and despair and is integrated into the overarching theme of “damaged self”.

“Damaged Self” provides causal explanations related to the formation of self-injurious behaviors and these behaviors are in harmony with the damage that a person observes in his perception of himself.

From the authors’ personal and professional experiences, they have observed that autistic women are uniquely at risk of interpersonal trauma. Given the tendency for autistic women to be overlooked in research and practice, this study aims to rectify this by exploring the relevant literature and including the voices of autistic women throughout this paper.

This study completed a literature review of quantitative and qualitative data relating to exposure to interpersonal trauma in autistic women. This study also reviewed relevant discursive evidence available on in memoirs and reports. This study also included dialogue between us as authors from an auto/“Autie”-ethnographic position.

Both clinical literature and discursive evidence support the idea that autistic women are uniquely at risk of interpersonal trauma, in particular, sexual victimisation. Explanatory factors are considered. Studies exploring rates of post-traumatic stress disorder (PTSD) were less consistent. Further evidence is required to better understand how autistic women experience and express PTSD and to inform assessment and treatment modifications.

To the best of the authors’ knowledge, this is the first paper to integrate clinical literature and discursive evidence on the topic of interpersonal trauma in autistic women. It provides useful insights into the experiences of autistic women in this space, directions for urgently needed future research and modifications to clinical practice.

Antisocial personality disorder (ASPD) and psychopathy are similar, but distinct, psychiatric conditions that are common in male and female inmates; a segment of the population with high rates of trauma exposure. It is unclear whether specific types of lifetime trauma are associated with ASPD and psychopathy in incarcerated women and men. Furthermore, the unique roles of post-traumatic stress disorder (PTSD) symptom severity and trauma victimization in antisocial personality disturbance are not well-understood. The paper aims to discuss these issues.

This study investigated associations between trauma variables (different kinds of traumatic experiences and PTSD) and antisocial personality variables (ASPD and psychopathy) in a sample of incarcerated women and men who participated in a randomized clinical trial for major depressive disorder. In total, 88 incarcerated men and women were assessed for ASPD diagnosis, psychopathy severity, PTSD symptom severity, and history of physical, sexual, and crime-related trauma. Regression analyses predicted ASPD or psychopathy from trauma variables, controlling for gender.

Physical trauma was the only form of trauma that was significantly related to psychopathy. Physical trauma and crime-related trauma were associated with ASPD. PTSD symptom severity was not associated with psychopathy or ASPD.

There are associations between some kinds of lifetime trauma exposure and current ASPD/psychopathy in the target sample, but these associations do not appear to be mediated through current PTSD symptoms.

In the previous chapter, I introduced trauma-informed care as an approach to organisational change and a shift in culture to recognise that many employees and people attending services have past trauma experiences. In this chapter, I recast servant leadership (SL) as a trauma-informed leadership model that naturally operationalises some of the principles discussed in the TIA literature. The first section of this chapter addresses the societal need for a more ethical and moral leadership approach, before briefly outlining the prevalence of trauma experienced by service users and employees. The next section provides an overview and definition of SL in a general sense, before articulating a trauma-informed model of SL and its characteristics. Finally, some of the outcomes associated with SL are discussed with a key focus on how this approach operationalises the principle of psychological safety, trust and empowerment found in trauma-informed approaches, as they relate to employees.

Lengthy and complex routes to specialist care may negatively affect clinical profiles of trauma survivors accessing mental health services. The purpose of this study was to describe the characteristics and referral pathways of a cohort of clients accepted by a specialist trauma service in England; and investigate the associations between referral pathways and clients’ clinical profiles, namely, pre-treatment levels of post-traumatic stress, depression, anxiety, stress and post-traumatic growth.

Data on 117 consecutive, accepted referrals were extracted from clients’ clinical records. Information on demographics, trauma histories, clinical presentations and referral pathways was synthesised through summary statistics. Correlational analyses were conducted to test associations with pre-treatment scores.

Clients accessing the service were highly complex and mostly experienced prolonged, interpersonal trauma. Pathways to the service varied, but 50% of the sample had at least four “steps” in their referral histories and seven previous clinical contacts. The average time between trauma and specialist referral was 16.34 years. The number of referral steps positively, significatively and moderately correlated with anxiety and stress at pre-treatment.

Limitations include issues around collecting past referral information, the small sample size for clients with available pre-treatment data and the lack of post-treatment scores.

This evaluation provides an informative overview of the characteristics and referral pathways of clients accessing a specialist trauma service. It also offers preliminary insights on the relationship between clients’ routes into the service and their clinical profiles. Practice, commissioning and research implications are discussed.

The purpose of this paper is to present insights into how and why the Sanctuary and SELF models are effective in decreasing trauma symptoms with a population of court-committed male adolescents in a residential treatment program. The Sanctuary model is a trauma-focussed, trauma-sensitive, organizational change model, and treatment protocol approach to working with clients who have experienced trauma, loss, and toxic stress to the degree that they interfere with social and personal functioning. The SELF model within Sanctuary is a treatment protocol that is an acronym for the organizing categories of safety, emotion management, loss, and the future. In essence, Sanctuary’s purpose is to create therapeutic community.

Qualitative research methods of observation of groups and meetings, content analysis of existing quantitative data and agency documents, focus groups with staff and residents, and individual interviews with staff were utilized.

Data show that the Sanctuary model ameliorates the symptoms of complex trauma. The substantive theory that emerges is that relational and neurological integration and recovery occur in the lives of residents as shaped first by the therapeutic community that supports the level of interpersonal relationships experienced with staff within a therapeutic milieu, along with shaping the organizational culture.

As a complex intervention, it is evident that reducing the Sanctuary model into its component parts cannot capture fully the essence of the intervention. A complex system can never be understood fully by observing it at single points in time.

It is suggested that future research and programmatic planning within this therapeutic community need to demonstrate how to continue enhancing staff-resident relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement.

It is suggested that future research and programmatic planning within this agency need to demonstrate how to continue enhancing staff-resident trauma-informed therapeutic milieus and relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement.

This is a unique study in that it employs qualitative methods to explore how and why the Sanctuary model contributes to its working in a residential treatment facility. The Sanctuary model is the only trauma-informed organizational intervention of its kind, with limited published evaluations in the current literature (Esaki et al., 2013). This study used focus groups with residents and staff that allowed them to influence the research and its processes. The residents expressed their views about the experience of being placed outside of their homes and of living in a therapeutic community within the Sanctuary Network. Staff spoke of aspects of working in a trauma-informed milieu and its effect on clients, colleagues, and the organization as a whole.