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This integrative literature review aims to explore themes within higher education that may be applicable to leadership education including: descriptions of trauma, trauma-informed practices and trauma-informed practitioners.

Integrative, systematic literature review.

The results suggest that trauma and trauma-informed practices may have a place in leadership education pedagogy.

There is no work being done in trauma informed practice in leadership education. This study provides future direction for both research and practice.

The goal of this review is to conduct an exploratory literature review on trauma-informed approaches in libraries to understand how librarians are discussing trauma-informed approaches and their integration into professional practice.

The author reviewed materials indexed in selected EBSCOHost databases. Included materials from selected EBSCOHost databases were available to the author in full text, in the English language and about trauma-informed approaches in libraries. Items were excluded from this review if they were a review of another work, a thesis or dissertation, or letters to or from the editor.

Twenty-five publications were included in this analysis. Publications included described approaches in school libraries, academic libraries and public libraries. Key topics are racial trauma-informed practices, trauma-informed teaching, resisting re-traumatization, social work and the effects of workplace trauma on the library workforce.

Trauma-informed approaches are gaining popularity in a variety of disciplines as the world copes with the turbulent events of recent years. The practical implications of this review are to explore the emergence of trauma-informed approaches in libraries to understand the current publishing landscape on this topic.

While librarians are writing about this approach and some are incorporating it into their practice, an analysis in the form of an exploratory literature review to summarize this work has not been done. Understanding how libraries are incorporating this trauma-awareness and trauma-informed principles into the work is crucial for identifying the future approach to library services.

People in prisons have a high prevalence of poly-traumatisation throughout their life span. The behavioural and emotional sequalae of trauma are likely to be managed across the whole organisation. However, there is still a lack of clarity about the key components of a trauma-informed approach within the custodial context. This study aimed to gather in-depth knowledge of staff views on the components of an optimal trauma pathway in a prison and the organisational factors that influence its implementation.

The authors’ research design is qualitative, involving in-depth, semi-structured interviews with eight members of staff from different professional backgrounds at a single prison in the UK that houses sentenced and remand prisoners. Data was analysed using reflexive thematic analysis.

Three super-ordinate themes were identified within the data. Firstly, components of a trauma-informed pathway included sub-themes of asking about what has happened and knowing how to respond; providing specialist approaches; enabling residents to cope; screening and detection; and a compassionate relational approach. Secondly, organisational factors were associated with sub-themes of culture and leadership, resources and systems and processes. Thirdly, staff factors were associated with sub-themes of skills development and training, staff well-being and support and staff attitudes.

Post-traumatic stress disorder (PTSD) and complex PTSD in prisons are under-detected, and there are complex psychosocial factors within prisons that mediate the effectiveness of psychological therapies.

To the best of the authors’ knowledge, this study represents the first exploration of staff perspectives on the components of a trauma-informed pathway within custodial settings. Future directions should involve the piloting and evaluation of the components of the trauma-informed pathway, with a focus on longer-term outcomes and exploration of the organisational factors that impact on effectiveness.

Knowledge about the prevalence and impact of Adverse Childhood Experiences (ACEs) is pivotal to trauma-informed approaches, yet the impact of ACEs training is rarely investigated. This study reports a qualitative investigation of police perceptions of ACEs training in relation to conceptualisations of ACEs and trauma-informed working, practical applications of ACE knowledge and service-level support.

Four focus groups were conducted with 29 police officers, who had participated in an ACEs-awareness training. Based on the qualitative data, themes were generated using reflexive thematic analysis (Braun and Clarke, 2019).

Analysis generated seven themes, conceptualised into three domains of conceptual understanding, police culture and operationalising ACEs.

The sample is limited to Scottish police officers and is ethnically non-diverse. Further evaluation of higher quality interventions is warranted.

The study highlighted that a lack of conceptual framework, officer concerns and police culture may present barriers to officers incorporating ACEs knowledge into their day-to-day work. Future trainings should address these issues to achieve maximum benefits.

To the authors’ knowledge, this is the first in-depth qualitative study of police officers' perceptions of ACEs training. Focus groups facilitated the expression of cultural norms. The results provide insight into tailoring trauma-informed interventions in police in future, as well as raising broader service-level issues.

Collective political traumas emerge from human behavior as a result of political motivation. These events include destructive and intense violence that disrupt the biopsychosocial processes of people in general. A study was conducted on individuals involved in the conflict between the Kurds in southeastern Turkey and security forces. This study aims to determine whether perceived social support, assumptions about the world, psychological resilience and psychological symptoms predict post-traumatic growth (PTG). In addition, the study examines whether differences existed between the participants’ PTG and the four cited variables according to the type of trauma and major sociodemographic variables.

This study recruited 324 individuals who completed the PTG Inventory, Multidimensional Perceived Social Support Scale, World Assumption Scale, Brief Psychological Resilience Scale and Symptom Checklist-90-R Symptom Screening List. Data were analyzed using regression analysis, ANOVA and t-test for independent groups.

Analysis revealed that assumptions about the world, perceived social support and level of psychological symptoms significantly predicted PTG level. The level of psychological symptoms was significantly higher among individuals exposed than those not exposed to prison. Moreover, participants with low levels of education and income displayed low levels of social support and psychological resilience but high levels of psychological symptoms. When working with victims of collective political trauma, the fact that people who are exposed to prison and torture experience and those with low socioeconomic levels pose serious risks in terms of psychological problems must be considered.

This research is important because it collects data on the effects of collective political traumas.

This paper aims to discuss the utility of eye movement desensitization and reprocessing (EMDR) therapy as a treatment for children with intellectual disabilities (ID) who have experienced trauma.

Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide support for the use of EMDR as a treatment for trauma in children with ID.

There is a growing body of evidence which demonstrates that EMDR therapy is successful for the treatment of trauma in adults and children. However, for children with ID, the research is limited despite those with ID being more likely than non-disabled peers to experience trauma such as abuse or neglect.

EMDR can only be facilitated by trained mental health nurses, psychiatrists, psychologists (clinical, forensic, counselling or educational) or occupational therapists or social workers with additional training. Finally, general practitioners who are experienced in psychotherapy or psychological trauma and have accreditation. Therefore, this highlights that there may be a lack of trained staff to facilitate this intervention and that those who are generally working with the client closely and long term such as learning disability nurses are not able to conduct this intervention.

This paper presents an account of NICE guidance and evidence of the efficacy of EMDR as a treatment for adults, children and those with ID.

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.

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.

The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

Recent years have seen significant policy and practice interest in how to best respond to the impact of childhood maltreatment and adversity on young people’s contact with youth justice systems. In Australia, this has resulted in increasing pressure to implement trauma-informed practice, although this is a term that has different meanings for different stakeholders, and little is known about the perspectives of justice-involved young people. This paper aims to review what is currently known about co-production in youth justice and discuss ways in which young people can be meaningfully involved in the development of trauma-informed practice frameworks.

A narrative approach is used to present a contextual overview of youth justice in Australia, introduce key concepts underpinning trauma-informed practice and consider the barriers and facilitators of co-production and participatory approaches to the development and implementation of trauma-informed practice.

Youth justice in Australia is widely viewed as in urgent need of reform, with broad interest in developing more trauma-informed practice in these systems. Co-production and participatory approaches are fundamental to the reform process and can help to ensure that the views and aspirations of the children for whom these systems are responsible are embedded in efforts to implement trauma-informed practice.

This paper presents an argument for implementing trauma-informed practice in Australian youth justice that is based on consultation and collaboration with young people. It does not present evidence about the potential effectiveness of such an approach.

This paper has direct implications for youth justice practice, in terms of both service philosophy, design and delivery.

The work discussed in this paper offers possibilities for new and different ways of responding to youth crime and maintaining community safety.

Whilst the need to re-imagine youth justice is widely recognised, there are few resources available to support efforts to co-produce trauma-informed practice. This paper synthesises what is known about these approaches and offers some suggestions and possible ways forward.