Trauma informed care
There is no single agreed-upon definition of trauma-informed care in practice worldwide. Evidence must support the implementation of trauma-informed approaches in the UK.
What does the evidence tell us?
Currently, it varies between regions and is driven by local experts, rather than through national standards.
For example, the Office for Health Improvement & Disparities identifies 6 fundamental principles for trauma-informed practice. They are safety, trust, choice, collaboration, empowerment and cultural consideration.
The Scottish Government defines trauma-informed practice as ‘A model that is grounded in and directed by a complete understanding of how trauma exposure affects service user's neurological, biological, psychological and social development’.
The Wales Trauma Framework defines a trauma-informed approach that addresses Adverse Childhood Experiences (ACEs) through 5 principles and 4 practice levels. It aims to help Welsh society understand that behaviour is a form of communication and recognise the impact of historical inequalities and social injustice on trauma. The ultimate goal is to promote the implementation of a trauma-informed approach across various levels of society.
A concept analysis using Walker and Avant’s model identifies four defining attributes: recognition, knowledge, concern and respect. Another concept analysis using the same model proposes a working definition of trauma-informed care in nursing to provide a framework for clinical care and research.
This paper argues that a comprehensive, multi-disciplinary approach to trauma through trauma-informed care requires universal recognition and screening. Targeted interventions create a system of healing through empowerment, relationship building and a reduction in trauma triggers.
What is trauma-informed care in nursing? Podcast with Vanessa Garrity and Zoe Dodd
A conversation between Vanessa Garrity and Zoe Dodd, where they share their thoughts on trauma informed care. At the time of recording this podcast, Vanessa worked as the national head of mental health for health in justice and this reflects some of the thoughts shared.
How can a trauma-informed approach help us understand and address inequalities?
What does the evidence tell us?
Research highlights that the experience of trauma is unequally distributed in society. The Scottish Government's Trauma-informed practice toolkit cites evidence that traumatic events are more frequently experienced by people in low socio-economic groups and from black and minority ethnic communities.
Additionally, people who are homeless are more likely to have experienced trauma than the general population. Trauma-informed care and Psychologically Informed Environments align with the goals of the homeless sector and move towards long-term solutions that support an individual’s needs.
Evidence also suggests that the development of trauma-informed care within learning disabilities services would ‘allow the use of interventions that consider the importance of trauma in clinical presentations and limit diagnostic overshadowing’.
Several reviews have found limited evidence for the effectiveness of the trauma-informed approach framework. There is a need for the development of an evidence base around the treatment of traumatic stress in people with learning disabilities.
Various studies show that ACEs have a connection to negative health outcomes. Research on ACEs has been and remains a crucial driver of trauma-informed approaches.
The advantages of trauma-informed practice for the NHS include successful preventative intervention and support. These reduce the financial and social impact of late intervention, cost to society and social exclusion.
How a trauma-informed approach can help us understand and address inequalities Part 1. Podcast with Hannah Cadogan and Tim Coupland
Tim and Hannah first worked together on the parity of esteem project at the Royal College of Nursing and now together in this podcast they explore the perspectives on trauma informed care, including the origins of trauma, impact of adverse childhood experience, social inequalities, and perspectives on nurse supervision.
A trauma-informed approach as a universal language for nurses to promote supportive cultures
Regardless of the lack of a standard definition, professionals have different understandings of trauma-informed approaches. Here at the RCN, we believe that there needs to be more clarity about trauma-informed approaches and potential pitfalls. Additionally, studies highlight a need for training or education for health professionals.
Staff involved in providing trauma-informed care should also receive better support. For example, studies have revealed elevated ACE scores for direct care staff working in settings for people with learning disabilities.
An organisational and systems-level change is necessary to achieve trauma-informed care. The SAMHSA guidance for implementing a trauma-informed approach includes 10 domains for organisational change:
- Governance and leadership
- Policy
- Physical environment
- Engagement and involvement
- Cross-Sector collaboration
- Screening, assessment, treatment Services
- Training and workforce development
- Progress monitoring and quality assurance
- Financing
- Evaluation.
There is a risk of mental health service users being re-traumatised if services fail to identify and recognise their systemic traumas. To achieve trauma-informed care, we need to fund clinical supervision and rotate mental health nurses out of acute inpatient environments more frequently.
Initial steps for health care organisations interested in adopting a trauma-informed approach include supporting a culture of staff wellness. Organisations without safeguards in place to allow staff to process their emotions safely may be exposing employees to secondary traumatic stress, vicarious trauma and burnout. These may inhibit their ability to provide high-quality care and increase staff turnover.
In the UK, trauma-informed care has been implemented inconsistently, with visible national strategy and leadership Scotland and Wales. However, things are more disjointed in England.
NHS Education for Scotland has developed a range of learning resources, including a knowledge and skills framework for transforming psychological trauma (PDF) and an associated training plan. A coordinated central strategy and increased funding for evaluation and education would contribute to implementing evidence-based trauma-informed approaches in the UK.
How a trauma-informed approach can help us understand and address inequalities Part 2 . Podcast with Hannah Cadogan and Tim Coupland
Tim and Hannah are keen to work in a coproduced way so that different perspectives of nurse and patient are explored. In part two of this podcast the themes are emotional intelligence, retraumatised experiences with mental health care, reparative and restorative practice, peer support, woman’s trauma, male trauma, recognising and addressing inequalities.
Page last updated - 17/06/2024
