DDN Sept_2022 September 2022 | Page 14



Rather than being overwhelmed by the challenge of completely reshaping services to provide traumainformed care , there are countless small changes that can make a real difference . DDN reports

One of the challenges of trauma-informed care is it can feel that everything has to change ,’ clinical psychologist at Nottingham charities Framework and Opportunity , Dr Anna Tickle , told the RCGP and AP Managing drug and alcohol problems in primary care conference earlier this year . Often this led to nothing happening in services because ‘ no one knows where to start ’, she said . ‘ But I would say there are a lot of very easy , very quick things that you can do to work towards this kind of approach .’

Trauma-informed care was an amorphous term , but essentially meant everyone in the organisation having knowledge of trauma and its impact on individuals – ‘ that ’ s your reception staff , your professionals , your volunteers , potentially even your cleaners . Anyone who ’ s going to be around when the service is being used .’ It was also ‘ much easier to claim than it is to achieve ’.
Many aspects of traumainformed care were simply good practice , she pointed out , but among the key principles were recognising that trauma happens , and the impact it can have – and that it can be very hidden . It was also vital to consider how a service ’ s processes and power differentials might have an impact , as people who ’ d been in care ‘ may well view all services with suspicion and believe that services harm them . Because that ’ s been their learning experience ’. Different types of power in services included coercive power ( threats , sanctions ), incentive power ( such as scripts ) and informational power – ‘ what you write about people , how you talk about them , has a real influence on how other services see them , particularly in relation to risk ’.
The key goal of trauma-informed practice is to raise awareness among all staff about the wide impact of trauma and to prevent the re-traumatisation of clients in service settings that are meant to support and assist healing .
A programme , organisation or system that is trauma-informed , as defined by the US Government ,
... realises the widespread impact of trauma and understands potential paths for recovery
... recognises the signs and symptoms of trauma in clients , family , staff and others involved in the system
... responds by fully integrating knowledge about trauma into policies , procedures and practices
... seeks to actively resist re-traumatisation . napac . org . uk
‘ Genuinely trauma-informed care is also about trying to create a sense of safety , being trustworthy and transparent , trying to be as collaborative as possible ...’
Genuinely trauma-informed care was also about trying to create a sense of safety , being trustworthy and transparent , trying to be as collaborative as possible , and trying to give as much empowerment , trust and control as possible – which was ‘ easier said than done ’, she acknowledged . It was not about ‘ referring everybody to see a psychologist . I often say that an hour a week with me will make very little difference for somebody if none of the other stuff is in place for them .’
While more and more organisations were now using the language of trauma-informed care , and there was good correlational evidence of increased number of adverse childhood experiences ( ACEs ) and problematic substance use , ‘ I would really caution against looking for the number of ACEs , although that ’ s very popular for some services ’, she said . ‘ One significant adverse childhood experience can significantly impact you for all of your life .’
There was ‘ an ideal implementation , which I ’ d love to see happen ’ and then there was the reality of day-to-day work , she said . Organisational and culture change took time , but there were simple things that services could do around the physical environment to make people feel safer , for example , or asking people who ’ d experienced domestic abuse which services they wanted to be available . ‘ Rather than be overwhelmed , I hope you can see it as lots of different opportunities . I ’ d love to see whole-system change but you ’ re more likely to be chipping away for years , and that ’ s OK .’
While the temptation was ‘ just to train everybody in trauma ’ – and training was , of course , vital – it wasn ’ t enough on its own , she stated . It was also important to think about policies and procedures . ‘ How can you implement them flexibly where possible , for example service exclusion . That ’ s an example of not very trauma-informed practice .’ Asking every patient about trauma as a routine enquiry was also dangerous , she pointed out – ‘ it ’ s about who asks , when , and how do you do it sensitively ’. It was also about keeping people involved in their key decisions , and informing people about what was available locally . ‘ That ’ s not just statutory services – there ’ s loads of good third-sector work , lots of survivor groups and more community-based interventions .’
Ultimately , it was about ‘ what can we do differently , rather than why won ’ t they change ’, she said . It was vital to bear in mind that often it ’ s ‘ years of bad experience you ’ re working against ’. Building trust first was more important than trying to get all the information straight away – and invariably led to better information – while understanding and responding differently to aggressive behaviour was also key . ‘ It ’ s easy to just exclude people and call the police , but my experience of the police is that they ’ re not particularly trauma-informed , although some are excellent .’
Be persistent and don ’ t give up , she stressed . ‘ It might take someone many weeks , months , even years to make use of an offer . So that persistence is really important .’ DDN