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Mental health services have changed significantly in the past few decades. Currently, our services are transforming from one that was biomedically led to one that encompasses a recovery orientation. Additionally, a new field of study as it related to mental health care is emerging that of trauma-informed care. In this chapter, we explore briefly what we mean by the terms trauma and trauma-informed care. This is followed by a critical examination of how co-production and servant leadership can work together to support individuals through their trauma towards recovery and well-being. From which, we suggest that peer support workers are suitable candidates to co-produce trauma-informed services as they embody the connecting principles of choice and empowerment needed for all three concepts to converge and work together to enhance recovery and well-being. While I focus on using co-production in the mental health space in this chapter, the principles and practices can equally apply to other health and social care services.

The purpose of this paper is to explore crisis management in terms of the spiritual aspects of victim recovery. The paper focuses, in particular, on victims of serious crime.

The paper reviews the available literature on crisis management, serious crime, spirituality and pastoral support to determine their impact on trauma recovery. Semi-structured interviews were also conducted with a number of police chaplains and a hospital chaplain, in addition to police family liaison officers and witness care officers, who have in-depth involvement with victims of serious crime, to explore the support available and identify gaps against existing theory.

Spiritual/pastoral support is available to police officers in the form of police chaplains. Their support is reported to be valuable in the crisis recovery process. Hospital patients report such support as integral to mental and emotional well-being and recovery. Victims of serious crime are not offered such pastoral services through the criminal justice system, though other more practical needs are provided for. This gap could have implications for the effectiveness of the criminal justice process.

The research is an exploratory study and seeks to open up debate in this arena. The research is localised to a specific region and may not generalise nationally/internationally.

The paper evaluates the role and import of spiritual support in trauma recovery, makes a number of recommendations to plug the gap in current provision to victims of serious crime and suggests directions for further research in this area.

There are limited social implications.

There has been very limited research conducted in this specific area and this paper seeks to redress this gap and suggests opportunities for further research to enhance victim crisis recovery and participation in the criminal justice process.

The purpose of this paper is to assess unit manager perspectives on the introduction of a group-based trauma-specific programme delivered across Scotland’s secure estate. As this was the first time such an estate-wide initiative had occurred, it was important to identify the benefits/challenges at a strategic level.

An exploratory qualitative case study was utilised involving semi-structured interviews with five senior unit managers in three secure units to discover their perceptions of the benefits and challenges of implementing Teaching Recovery Techniques (TRT). A quasi-qualitative analysis was used to quantify and give meaning to manager responses. Inter-rater reliability of analysis was assessed.

Unit managers perceived gains in trauma-informed knowledge for themselves, and knowledge and skills gains for programme workers, care staff and adolescents. Challenges involved: managing a shift in paradigm to include a trauma-specific programme; the limiting context of competitive tendering; short duration placements; and the need for psychoeducation for staff, parents and agencies.

Large sample sizes are likely to identify further issues for unit managers. Manager perceptions need directly compared with staff and adolescent perceptions and included in randomised control trials of trauma-specific programmes.

Managers perceived that TRT needed to be delivered within trauma-informed organisations and identified the need for manager training in traumatisation, trauma recovery and organisational implications to guide strategic planning. Managers emphasised the need for psychoeducation for families, staff and agencies.

The current study is the first in Scotland to explore unit manager experience of introducing a trauma-specific programme across the secure estate.

Nutrition plays a key role in the recovery of pediatric trauma patients. A catabolic state in trauma patients may hinder recovery and inadequate nutrition may increase morbidity, mortality and length of hospital stay. The purpose of this paper is to review the current nutrition support practices for pediatric trauma patients at McMaster Children’s Hospital (MCH), describe patient demographics and identify areas to improve the quality of patient care.

A retrospective chart review was conducted on pediatric trauma patients (age<18 years) identified through the trauma registry of MCH. Pediatric trauma patients admitted from January 2010 to March 2014 with an Injury Severity Score (ISS)=12 and a hospitalization of =24 hours were included.

In total, 130 patients were included in this study, 61.1 percent male, median age ten years (range: 0-17 years) and median ISS of 17 (range: 12-50). Blunt trauma accounted for 97.7 percent of patients admitted and 73.3 percent had trauma team activation. In total, 93 patients (71.5 percent) had ICU stays. The median time to feed was 29 hours (interquartile range: 12.5-43 hours) from the time of admission. An increased hospital length of stay was associated with longer time to initiation of nutrition support, a higher ISS and greater number of surgeries (p<0.05).

Local nutritional support practices for pediatric trauma patients correspond with recommended principles of early feeding and preferential enteral nutrition. Harmonization of paper-based and electronic data collection is recommended to ensure that prescribed nutritional support is being delivered and nutritional needs of pediatric trauma patients are being met.

Peer support work is increasingly recognised as an adjunct support across various systems of health and social care, and is a core principle in trauma-informed care. Those accessing a wide range of human and social services may have experienced prior trauma. As such, trauma-informed care is a universal organisational model that seeks to realise, recognise and respond to trauma, while limiting possible re-traumatisation when individuals are engaging with systems of care. Peer support can play an integral role in supporting those who have experienced prior traumas. However, trauma does not exist in isolation and the wider environment influences, moderates and contributes to how an individual experiences and heals from trauma. Peers can play an important role helping to alleviate some of the environmental influences by helping to build the capacity of those that use health and social care services.

The purpose of this paper is to share knowledge and observations of the Trauma-Informed Care (TIC) approach being used to engage “chronically” homeless people in the USA.

This paper describes a placement with an organisation in New York City observing how the TIC approach is being implemented across outreach, housing and support services. The author then reflects on the lessons, for the work in the UK context.

TIC empowers staff and clients to understand psychological trauma and its effects and to use this knowledge to create safe, supportive environments for all involved; improving relationships and nurturing recovery. It appears that clients use services more effectively, with staff stating that they behave more appropriately and move towards independence more quickly. Staff consider the emotional needs of the individuals they support and it was reported that they are less reliant on managers and have a higher tolerance to their clients.

TIC is an easily replicable and seemingly cost-effective way of empowering frontline staff to deliver holistic services to survivors of trauma.

Psychologically informed practice is gaining momentum within the homelessness sector in the UK, and whilst TIC has many similarities to it, this approach specifically focuses on providing a pre-therapy approach for trauma survivors to prepare them to engage appropriately with mainstream services.

Although there is no quantifiable data, it seems that the approach improves the well-being of service users and may ultimately reduce the cost in public spending of ineffective service use.

To outline the critical role of the sporting context in traumatic experiences, exploring sport as a catalyst to traumatic experiences and as part of the recovery process. In doing this, the chapter also aims to review the qualitative literature on trauma and provide recommendations for future research directions.

The chapter begins by asking two key questions: what silences some stories of trauma in sport and what stories are valued above others? In answering these questions, the qualitative literature is discussed with particular reference to how voice is given to stories of trauma.

Trauma may be silenced by the particular norms and values that exist within sport, creating a culture in which athletes and coaches alike fear to speak out. As a consequence, trauma stories are not voiced but avoided, a strategy that is not conducive to good mental health. The difficulties in coping with trauma may then become ameliorated by the dominance and expectation of stories of growth through adversity.

Creative strategies for allowing athletes to voice stories of trauma are discussed, including the use of visual and written methods.

Previous literature suggests that exposure to trauma has both positive and negative impacts on leadership and leadership development, although there is a lack of empirical research. This exploratory study compared military leaders’ use of transformational leadership styles (TLS) before and after trauma exposure from the followers’ perspective. This study used a retrospective pretest design to survey veteran and active duty military personnel. Significant differences were found between pre- and post-trauma exposure TLS ratings, with a mean decline in the TLS after trauma exposure. The analysis of the open-ended questions indicated a reduction in the use of the TLS after trauma, but identified positive changes in some cases. There was no evidence that changes in the TLS were concentrated in any of the five styles.

The purpose of this paper is to examine community based, trauma informed to support refugee mental health and wellbeing, recognising that refugee status is met through forced displacement in which refugees have experience of personal human rights abuses and have survived atrocities in which family and community have been lost.

A co-production approach was taken to review existing literature and policy to produce a position statement on how to better meet the needs of people who experience mental distress who are refugees. The co-production was between refugee and mental health researchers and refugee representatives.

Understanding the mental health needs of refugees has conventionally focused on incidence of mental illness such as post-traumatic stress disorder and depression. If mental health and illness are understood as a continuum, diagnosis of mental illness indicates a significant problem, and furthermore access to services is predicated on risks associated with mental illness. When accessing mental health services, refugees have an added issue in a lack of communication availability and recognition of the trauma that they have survived.

In this paper, a different position is advocated, that understanding the mental health of refugees can be framed more effectively as a process of recovery from trauma that emerges during resettlement, and over a long period of time before people are able to talk about the trauma they experienced. Community-based responses that enable recovery from trauma are more readily able to meet the mental health and wellbeing needs of refugee communities.