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Article

Sue Holttum

This paper aims to highlight emerging research relating to the need to recognise and address trauma in mental health service users.

Abstract

Purpose

This paper aims to highlight emerging research relating to the need to recognise and address trauma in mental health service users.

Design/methodology/approach

The author searched for papers on trauma-informed care, published in the past two years.

Findings

One paper reports ideas of service users and family members for trauma-informed mental health services. A second paper describes an online survey seeking agreement between staff and service users of early intervention services for psychosis about practices of trauma-informed care. Both papers feature themes about safety and staff having training and support for asking about and responding to trauma. A third paper reports on specific therapies for trauma with people who experience psychosis. It found some evidence for talking therapies but noted that people with a psychosis diagnosis are rarely offered such therapies.

Originality/value

These papers highlight an emerging consensus about essential components of trauma-informed care and the need for staff training and support to realise it. The exclusion of people with a psychosis diagnosis from specific trauma therapies might begin to be addressed if services were more able to recognise trauma. There is some evidence that talking therapies for childhood trauma can be helpful for people who have a psychosis diagnosis. However, evidence reviews should be broadened to include a range of distressing experiences recognised to follow childhood trauma irrespective of whether the person has a psychosis diagnosis.

Details

Mental Health and Social Inclusion, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2042-8308

Keywords

Abstract

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 34 no. 2/3
Type: Research Article
ISSN: 0964-1866

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Article

Angela Sweeney, Sarah Clement, Beth Filson and Angela Kennedy

The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health…

Abstract

Purpose

The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK.

Design/methodology/approach

The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK.

Findings

There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed.

Originality/value

This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike.

Details

Mental Health Review Journal, vol. 21 no. 3
Type: Research Article
ISSN: 1361-9322

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Article

Charlotte Gill, Denise Gottfredson and Kirsten Hutzell

The purpose of this paper is to describe Seattle’s School Emphasis Officer (SEO) program, a distinctive approach to school policing that aims to connect at-risk students…

Abstract

Purpose

The purpose of this paper is to describe Seattle’s School Emphasis Officer (SEO) program, a distinctive approach to school policing that aims to connect at-risk students with services and has potential to incorporate a trauma-informed approach.

Design/methodology/approach

Using qualitative data collected from a process evaluation of SEO, including interviews, observations, and analysis of activity logs and program documentation, the authors explore elements of the program that could be adapted for the development of a trauma-informed policing (TIP) model and highlight some potential pitfalls.

Findings

SEO activities align well with trauma-informed principles of safety, promoting collaboration, and impulse management and are delivered in a context of trust-building, transparency, and responsivity. However, the program is poorly defined and has limited reach, has not been rigorously evaluated, and faces serious threats to sustainability.

Research limitations/implications

This study does not assess the effectiveness or appropriateness of TIP. A rigorous evaluation is needed to improve upon and test the model to ensure that increased contact between police and youth is effective and does not contribute to the school-to-prison pipeline.

Originality/value

To the authors’ knowledge, this paper is the first to describe a potential framework for TIP and lay out an agenda for further research and policy development around this idea.

Details

Policing: An International Journal of Police Strategies & Management, vol. 39 no. 3
Type: Research Article
ISSN: 1363-951X

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Article

Deborah J. Morris, Elanor Lucy Webb, Emma Parmar, Grace Trundle and Anne McLean

People with developmental disorders are significantly more likely to experience adverse childhood experiences (ACEs), although the impact of ACEs on this population is not…

Abstract

Purpose

People with developmental disorders are significantly more likely to experience adverse childhood experiences (ACEs), although the impact of ACEs on this population is not well understood. Furthermore, considerably less is known about the exposure to, and impact of, ACEs in detained adolescents with complex developmental disorder needs. This paper aims to explore the exposure to ACEs in an adolescent population detained in a secure specialist developmental disorder service.

Design/methodology/approach

A retrospective file review was used to explore ACEs and placement histories within a specialist developmental disorder inpatient service. Data was collated for a convenience sample of 36 adolescents, 9 of whom were female, aged 13–20 years (M = 17.28 years).

Findings

A total of 33 participants (91.7%) had experienced at least 1 ACE, with 58% experiencing 4 or more ACEs and 36% experiencing 6 or more ACEs. The most common ACEs reported were physical abuse (61.6%), parental separation (58.3%) and emotional abuse (55.6%). The majority of participants had also experienced high levels of disruption prior to admission, with an average of four placement breakdowns (range 1–13, standard deviation = 3.1). ACEs held a significant positive association with the total number of placement breakdowns and total number of mental health diagnoses.

Practical implications

Adolescents detained in specialist developmental disorder secure care had, at the point of admission, experienced high levels of adversities and had been exposed to high levels of experienced and observed abuse. The level of exposure to adversity and ongoing disruptions in care suggests that Child and Adolescent Mental Health Services’ developmental secure services should consider adopting dual treatment frameworks of developmental disorder and trauma-informed care.

Originality/value

This study explored the early-life and placement experiences of a marginalised and understudied population.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 14 no. 6
Type: Research Article
ISSN: 2044-1282

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Article

Joanne Prestidge

– 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.

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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

Practical implications

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.

Originality/value

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.

Details

Housing, Care and Support, vol. 17 no. 4
Type: Research Article
ISSN: 1460-8790

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Article

Lorana Bartels and Patricia Easteal

The purpose of this paper is to explore the incidence and impact of exposure to sexual victimisation for women in the criminal justice system. Key ongoing vulnerabilities…

Abstract

Purpose

The purpose of this paper is to explore the incidence and impact of exposure to sexual victimisation for women in the criminal justice system. Key ongoing vulnerabilities in respect of mental health and substance abuse, and their contribution to women’s offending, are examined. Treatment responses to address these women’s trauma in custodial settings are then discussed. It is argued that a therapeutic approach is required to provide a holistic response to victimised women offenders. Unfortunately, instead of doing so, many prisons’ ethos and approaches may actually produce a further layer of vulnerability. The paper concludes with commentary on future directions for research and practice.

Design/methodology/approach

The researchers undertook a desk-based literature review, using search terms such as “women”, “corrections”, “sexual abuse and/or victimisation” and “trauma”. The literature was analysed through a feminist framework, adopting a vulnerability paradigm.

Findings

The paper analyses the incidence and impact of sexual victimisation on women prisoners and notes that comprehensive trauma-informed care in custodial settings is needed but highly problematic within a prison context.

Research limitations/implications

The researchers focused primarily on Australia, and the conclusions may therefore be of more limited relevance to imprisoned women in other countries.

Practical implications

The paper suggests good practice requirements for delivering trauma-informed care to victimised women prisoners. Non-custodial alternatives to imprisonment are likely to be more sensitive to many female offenders’ layers of vulnerability.

Originality/value

This paper highlights the relationship between women offenders’ sexual victimisation histories, substance abuse, mental illness and offending behaviour, and demonstrates the need for and challenges in delivering trauma-informed care. The originality derives from the examination of the three rules of abuse (and prisons) and how they correlate with multiple vulnerabilities, which leads to the conclusion that prison is not the best place for rehabilitation of most women.

Details

Journal of Criminological Research, Policy and Practice, vol. 2 no. 3
Type: Research Article
ISSN: 2056-3841

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Article

Jenny Taylor, Lisa Shostak, Andrew Rogers and Paul Mitchell

The purpose of this paper is to outline the challenges to achieving positive outcomes for young people within the secure estate in England, and introduces a…

Abstract

Purpose

The purpose of this paper is to outline the challenges to achieving positive outcomes for young people within the secure estate in England, and introduces a psychologically informed framework, SECURE STAIRS (SS), aimed at improving outcomes.

Design/methodology/approach

The paper argues that there is a need for a fundamental shift in the way care and intervention for young people within the secure estate is delivered. It gives an overview of current challenges and needs and summarises the theoretical concepts and evidence base which can guide practice and form the foundations of the SS framework.

Findings

The framework recommends that intervention shift from focussing primarily on individual assessment and treatment to a greater emphasis on supporting the work of the wider system of care. Recommendations include promoting trauma-informed care, a focus on the system dynamics within institutions and how these impact on the care young people receive, and on the collaborative development with residential staff and young people of formulation-led care plans that include a focus on issues of sustainability after leaving the secure estate.

Practical implications

These include the establishment of discrete residential groupings with truly integrated and trauma-informed work across residential, mental health, education and criminal justice agencies. This involves addressing governance issues around shared record keeping, and challenges to sustainability and the accompanying need for local implementation plans for each establishment alongside central support at a strategic level.

Originality/value

This paper describes a new and innovative way of working within secure settings to ensure children and young people’s needs are better met.

Details

Safer Communities, vol. 17 no. 4
Type: Research Article
ISSN: 1757-8043

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Article

Theresa Maureen Williams and Geoffrey Paul Smith

The purpose of this paper is to describe the impact of a trauma-informed care (TIC) training programme on practice at the individual and workplace level in mental health…

Abstract

Purpose

The purpose of this paper is to describe the impact of a trauma-informed care (TIC) training programme on practice at the individual and workplace level in mental health and drug and alcohol services and to examine the implications of using training alone as a strategy for achieving system-level practice change.

Design/methodology/approach

A total of 271 clinicians and managers from public mental health and drug and alcohol services in Western Australia who had undertaken TIC training were invited to complete an on-line survey 12 months after training. Individual survey items were based on a five-point Likert scale with opportunity being provided for additional comments from respondents.

Findings

One year post-training, both clinicians and managers reported that training had increased their awareness and knowledge and had a positive impact on their attitudes towards TIC. Clinicians reported a moderate impact on their individual practice and both groups reported very limited success in bringing about change in their workplaces. Workforce development and organisational factors were identified by both clinicians and managers as being barriers to implementation.

Research limitations/implications

Only 30 per cent of the training participants responded to the survey and it is not possible to determine whether they differed from non-respondents. Findings were based on a self-report survey with no objective measure of behaviour change.

Originality/value

This “naturalistic” study examines the longer-term impact of training, from the perspective of clinicians and managers, on changing practice at the individual clinician and workplace level. It highlights the critical importance of understanding and addressing contextual factors where collective, coordinated behaviour change is needed in order to effect organisational change.

Details

The Journal of Mental Health Training, Education and Practice, vol. 12 no. 3
Type: Research Article
ISSN: 1755-6228

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Article

Danielle Every and John Richardson

The purpose of this paper is to propose a practice framework for disaster resilience education (DRE) with homeless communities.

Abstract

Purpose

The purpose of this paper is to propose a practice framework for disaster resilience education (DRE) with homeless communities.

Design/methodology/approach

A survey with 163 homeless service providers together with 45 interviews with people with a lived experience of homelessness, homeless service providers and emergency services.

Findings

Key principles for DRE with the homeless community were: safe relationships, collaboration, strengths-based, empowerment, providing essential resources, and inclusivity. Recommendations for the design of DRE foregrounded partnerships and knowledge sharing between the homeless community and emergency services. Locally relevant risk information and material supports, together with sharing stories and eliciting values were important considerations for developing DRE content. Preferred delivery methods were outreach to build on trusted relationships and existing services, together with written material in large font emphasising images for distribution through drop in centres, food vans and new tenancy packages.

Practical implications

The key principles, together with the detailed suggestions outlining ways to translate the principles into actions, can be used by emergency and homeless services to develop effective DRE materials and programmes.

Social implications

The proposed DRE framework aims to not only enhance disaster risk knowledge, but also address the exclusion, isolation and disempowerment experienced by people who are homeless. By building on an effective intervention models within homeless services (Trauma-Informed Care) DRE can enhance the social connection, self-confidence and well-being goals of homeless services and clients.

Originality/value

The DRE framework is based on the first comprehensive Australian research with homeless services, clients and emergency managers on best practice for improving extreme weather preparedness in the homeless community.

Details

Disaster Prevention and Management: An International Journal, vol. 27 no. 2
Type: Research Article
ISSN: 0965-3562

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