Trauma Informed Practice in Safeguarding

Trauma-informed practice in safeguarding

Trauma-informed practice develops from the understanding of how trauma exposure can affect our neurological, biological, psychological and social development.

Trauma-informed approaches are founded on the understanding and acceptance that symptoms and experiences related to trauma are coping strategies established by people to manage traumatic experiences.

Trauma-informed practice seeks to avoid re-traumatisation by using the principles of safety, trustworthiness, choice, collaboration, empowerment and cultural consideration.  There is a natural crossover with this approach from the principles of adult safeguarding, which are empowerment, prevention, proportionality, protection, partnership and accountability.

As well as more broadly, the approaches and practice outlined in Making Safeguarding Personal (ADASS, 2014). To understand trauma-informed practice, practitioners must recognise that the effects of trauma affect individuals, groups and communities.

In November 2022, The Office of Health Improvement and Disparities created a working definition of trauma-informed practice.  

Through the Derbyshire Safeguarding Adults Board’s quality assurance activity, including audits, feedback from adults, safeguarding adult reviews and knowledge of the evidence base related to trauma-Informed practice, we know it is an essential element of practice within adult safeguarding and should be promoted by all partners who are invested in protecting people in Derbyshire from abuse and harm.

Why is it important to be trauma-informed?

For trauma survivors, trauma-informed services can bring hope, empowerment and support that is not re-traumatising.  Moreover, such services can help close the gap between the people who use services and the people who provide them (Filson & Mead, 2016).

Practitioners need to have an understanding that trauma exposure can impact an individual’s neurological, biological, psychological, and social development.

Trauma, particularly in early childhood, can have a severe impact throughout the life course.  For many children it can be expressed through behavioural issues, and often leads to having a severe effect on both mental and physical health.  During adulthood the person is more likely to be drawn into violence, criminal activity, and self-harm, as well as being more likely to engage in health-harming behaviours.  Evidence of this includes:

• Half of the people in contact with mental health services had experienced physical abuse
• More than one-third had experienced sexual abuse in childhood or adulthood, indicating rates that were significantly higher than the general population (Mauritz, Goossens, Draijer, & van Achterberg, 2015).
• People using mental health services are substantially more likely to have experienced domestic and sexual violence in the previous year compared to the general population (Khalifeh, et al., 2015).

These issues can continue to have effect on the way adults interact with others throughout their life, including with their relationship with their own children.  They are more likely to become a victim of abuse or become a potential perpetrator in their own relationships.

We often refer to these traumatic events in childhood adverse childhood experiences (ACES).  Almost half of the adult population of England has had some form of adversity within their childhood or adolescence.  These can include bereavement, neglect, violence, witnessing domestic abuse, sexual assault and substance use by parents and carers.  Trauma can also have lasting affects in adulthood.  Types of traumatic events that are known to cause long-lasting trauma include abuse, neglect, sexual violence, extreme poverty, homelessness and mental illness.

Trauma-focused alternatives to seclusion in an in-patient ward were found to reduce restraints and seclusions for young people in secure psychiatric care (Azeem, Aujla, Rammerth, Binsfeld, & Jones, 2011).  Furthermore, trauma-informed interventions for populations that professionals find difficult to engage were found to increase engagement with treatment, reduce substance misuse, and reduce trauma-related symptoms.

In safeguarding, the understanding of trauma-informed practice and adapting approaches to ensure that it informs safeguarding work from a clear evidence base is vital.  Some of this is linked to the understanding of similar effects of attachment and insecure attachments in childhood.  Trauma can affect people at any point in their life course and this should be recognised.  Making sure that the person is at the centre of practice and that practice empowers the person to make choices and to be the expert of their own care, support and safety planning.

Adults have told us the about the importance of understanding past trauma in safeguarding.

Sarah:

“Coming into safeguarding from Children's Services having been in care and children’s safeguarding can put you off.  In child protection safeguarding I didn’t feel listened to and didn’t feel as though I could speak.  I felt that I couldn’t explain myself and I wasn’t listened to as I was still a child.  My opinion of adult safeguarding changed because of the approach of the worker.”

Khalid:

“I’ve lived in over twenty placements and suffered abuse in most of them.  Since I’ve moved to my new supported living placement, I am happy.  The staff listen to me and when I get upset about the past, they talk to me.”

Practitioner’s view on trauma informed practice – Hannah Morris, Social Worker.  On trauma-informed practice working with adults with a personality disorder:

“Having worked on a Trauma Informed Personality Disorder pathway, patient experiences of feeling stigmatised and misunderstood by professionals are all too familiar.  Many patients reported a lack of understanding and compassion around the psychological suffering they had encountered, which underlies the challenges they present with.  Trauma informed practice ensures services are delivered in ways which prevent further harm and re-traumatisation.  The aim is to support people to feel safe in their interactions with services, which will helps create a therapeutic relationship based on trust, therefore increasing engagement and promoting recovery.

“Understanding the impact of traumatic experiences on a person and their communities, allows practitioners to tailor interventions to a person’s individual needs.  Working collaboratively, considering safety, promoting empowerment and by practicing with transparency, allows practitioners to gain an understanding of how adverse trauma impacts on the person’s ability to cope.  By strengthening resilience and getting patients to recognise their own strengths, enables changes in behaviour and improves outcomes for patients and their families.”

Key principles of trauma-informed practice in safeguarding

1. Safety.  Efforts made by practitioners and organisations to ensure the physical and emotional safety of people in safeguarding and those supporting adults in safeguarding is of paramount importance.  This includes ensuring reasonable freedom from threat or harm and attempts to prevent further re-traumatisation.  As well as the Care Act 2014, Article 3 of the Human Rights Act provides a duty not to be tortured, suffer degrading treatment or punishment, and Article 2 of the Human Rights Act gives a positive obligation to prevent a death.
2. Choice.  Adults and frontline staff have meaningful choice and a voice in the decision-making processes of safeguarding.  Making Safeguarding Personal embeds personal choice in safeguarding process.  Rights and responsibilities should be informed clearly and in away the adult understands.
3. Collaboration.  Organisations should recognise the value of people using services and frontline staff and their role in improving knowledge of how to overcome challenges and improving the system as a whole.  Adults have a significant role in planning and overcoming challenges and developing services. 
4. Trustworthiness.  Transparency exists in an organisation's safeguarding policies and procedures, with the objective of building trust among staff, clients and the wider community.  Recent feedback from a transitions audit clearly showed the trust that young people had in their Leaving Care Workers had a positive effect on safeguarding and the adult’s safety. 
5. Empowerment.  Skills of adults in services and empowerment should be prioritised by those working with them.  Efforts should be made by organisations and practitioners to share power and give adults a strong voice in addressing needs around safety, developing resilience and improving their lives.  Organisations should use this voice in service development and improvement, recognising trauma and how to work with its affects in structural improvements (Filson & Mead, 2016).
6. Cultural consideration.  Move past cultural stereotypes and biases based on, for example, gender, sexual orientation, age, religion, disability, geography, race or ethnicity by offering access to gender responsive services.  They understand the healing value of traditional cultural and incorporating policies, protocols and processes that are responsive to the needs of individuals served.

There are many models of trauma informed-practice, but this is a good starting point for practitioners to begin to understand principles that will help to improve trauma-informed practice.

Prevent re-traumatisation

Trauma-informed practice seeks to avoid re-traumatisation, which is the re-experiencing of thoughts, feelings or sensations experienced at the time of a traumatic event or circumstance in a person’s past.  Re-traumatisation is generally triggered by reminders of previous trauma, which may or may not be potentially traumatic in themselves.

The purpose of trauma-informed practice is not to treat trauma-related difficulties, which is the role of trauma-specialist services and practitioners; instead, it seeks to address the barriers that people affected by trauma can experience when accessing health and care services.

Trauma-informed support for frontline workers

It is important that frontline workers who work with adults in safeguarding understand trauma-informed practice and are prepared for working in a way that contemplates secondary traumatic stress from taking on their experiences.

Sharing emotional responses with colleagues can help you to feel like you are not alone and support accessing further support.  Take advantage of supervision or workplace counselling services that may be available in your workplace.  Taking time to develop a healthy work-life balance is important, as is ensuring that work does not occupy time that should be for family, and private life.

Good practice in this includes reflective practice sessions, and adequate supervision, team meetings, and to give them space to be addressed in a timely and non-judgemental way before the needs of staff escalate.  Promoting a culture of cohesion and group support is a key part of protecting staff mental health.

Trauma-informed post-incident conversations

Please be aware, post-incident debriefings where the person is required to re-live and explain what happened at the time of incident are potentially harmful and should be avoided.

Trauma-informed conversations are an important way of working with people who have been through past trauma which is affecting their life and preventing them from achieving their life goals and improving their mental health and wellbeing.  These conversations take place at times agreed with the adult following incidents to support the person’s understanding and to be a catalyst for change.

South Australia Department of Health and Wellbeing have developed a Trauma Informed Post Incident Conversation Guide.

Debriefing and support toolkit for adults with disabilities

The new Restraint Reduction Network post-incident debriefing and support toolkit was commissioned by NHS England in support of its work on the use restrictive practices.  Post-incident debriefing helps people in health care settings, and the staff that support them, to recover and learn from a crisis, reducing restrictive practices.

The post-incident debriefing and support toolkit aims to promote rights respected care by increasing and improving support provided to children and young people post-incident.  The resources include both guidance for healthcare staff working with autistic people and/or people with a learning disability, and guidance for healthcare staff working in in-patient settings.

While these resources were developed with young people in in-patient services, they may still have relevance for other settings and can be adapted.  The Restraint Reduction Network will be developing resources for adult services later in 2022.

More Trauma Informed Practice Resources

• Sowing Seeds: trauma-informed practice for anyone working with children and young people is an animation developed by NHS Education for Scotland, in partnership with the Scottish Government.  It aims to support staff to understand the impact of trauma and to know how to adapt the way they work to make a positive difference to the lives of children and young people affected by trauma.
• Opening Doors: trauma-informed practice for the workforce is an animation developed by NHS Education for Scotland, in partnership with the Scottish Government.  It aims to support staff to understand the impact of trauma and to know how to adapt the way they work to make a positive difference to the lives of children and young people affected by trauma.
• Professor Mark Bellis from Public Health Wales makes a presentation on adverse childhood experiences, resilience and equity.
• Watch providing trauma-informed care: a case study of Weave Youth and Community Services by the New South Wales Health Commission in Australia.
• The short, animated adverse childhood experiences (ACEs) film produced for Public Health Wales and Blackburn with Darwen local authority has been developed to raise awareness of ACEs, their potential to damage health across the life course and the roles different agencies can play in preventing ACEs and supporting those affected by them.