Prevention and early help
Ideally, the preferred response to the issue of childhood trauma is eradicating it with a proactive focus on prevention. There are several key areas where services can support young children and their families, and actively reduce the risk of traumatic experiences.
Preventative approaches to trauma might range from providing practical support such as food, clothes and shelter, to supporting the attachment relationship between parents and infant and in so doing helping children, young people and their families to build resilience and develop coping skills to address the adverse experiences they are facing.
Where trauma has already occurred, either for the child directly or for their parent or carer, specialist services are required to address the immediate impact, and support the recovery process. In addition, TIP approaches can help shift the discussion away from “what is wrong with you?” to “what has happened to you?”.
In its TIP in Early Child Development report, the National Children’s Bureau explains that TIP provides an opportunity for practitioners across all services, from universal to specialist, to approach all those who use their services “through a lens of potential trauma”.
“This is not just relevant in the health and social care sector, but across education, justice, public services and across communities more widely,” it states.
Principles of a trauma-informed approach
An evidence review by New Philanthropy Capital (NPC) in 2020 set out five key principles that describe a trauma-informed approach to care. These are:
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Recognise and respond to trauma – ensure all staff recognise where trauma may have occurred, the impact this may have, and how policies and processes can be tailored to meet the needs of service users.
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Avoid retraumatising – spaces should be safe and comfortable so that service users feel empowered to make informed choices about their care.
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Focus on strengths – build on service users’ skills and strengths so they devise their own solutions rather than trying to solve problems for them.
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Build relationships – sometimes service users’ trauma will be linked to a power imbalance so building trusting relationships with practitioners is crucial to avoid triggering similar feelings.
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Promote equality of access – services must be accessible to all and be adaptable to the unique experiences and needs of the individual.
It also identified a series of common elements to models of TIP, including trauma-informed approaches being embedded at all levels of an organisation, particularly senior leaders; a commitment to providing training and knowledge sharing for all members of staff; and supporting staff welfare – such as ensuring appropriate debriefing and supervision sessions are in place – to protect against secondary trauma for those supporting service users.
Common barriers to delivering effective trauma-informed services include confusion around terminology which in turn can hinder development of a trauma-informed organisational culture; fears over retraumatising resulting in defensive practice; the potential impact on staff; unrealistic expectations on the pace of change; and unclear referral pathways to additional support.
Policy developments
Across the four nations, the increasing recognition of the role of ACEs in all life outcomes is beginning to influence policy development, with further work to come. Central to each nation’s response is professional development of the workforce to ensure they have the appropriate skills, knowledge and confidence to work in a trauma-informed way.
In England, the recent Early Years Healthy Development Review Report highlights the potential impact of ACEs in the first 1,001 days. The report calls for significant investment in preventative early years services to support the best possible start in life for all children, and particularly the most vulnerable.
The all-party parliamentary group for the prevention of adverse childhood experiences was established in 2018 and is calling on the government to adopt a comprehensive early years strategy to prevent ACEs. The NHS Mental Health Implementation Plan also notes the potential impact of ACEs on adult mental health, and the roll-out of personalised and trauma-informed care is prioritised.
Scotland is leading the way in developing a trauma-informed and responsive workforce and is one of the first countries in the world to develop a knowledge and skills framework for psychological trauma. This sets out the requirements for trauma-informed, trauma-enhanced and trauma-specialist levels of practice, along with recommended training resources. A National Trauma Training Programme has been established to lead the implementation of this work, and this will be informed by people with lived experience.
The Welsh government and the Home Office are funding the development of a public health approach to tackling ACEs with the aim of supporting a multi-agency collaborative response country-wide. The approach is also underpinned by several government priorities, including recognition within the Welsh Programme for Government “Taking Wales Forward” of the impact of ACEs for child outcomes, and creating an ACE Aware nation.
The recently launched Mental Health Strategy for Northern Ireland reflects a commitment to developing trauma-informed services and approaches, with training for workforce a key priority in achieving the vision.
The UK Trauma Council, run by the Anna Freud Centre and funded through the National Lottery Community Fund, brings partners together across the UK to address child trauma. The centre develops and disseminates evidenced-based resources, provides expert guidance and advice, and acts as a central hub of knowledge and expertise.
Programme examples
The Fulfilling Lives Programme is an eight-year £112m project working in 12 partnerships across the country and aiming to provide intensive support to those experiencing multiple disadvantage to understand and access the services available to support them. The programme also aims to change the system, making services more accessible and aware of the challenges facing their users, and facilitates service user engagement to ensure better-informed services.
Each of the 12 Fulfilling Lives partnerships addresses the differing needs of their local communities and takes a different approach to tackling trauma. For example, the partnership in Lambeth, Southwark and Lewisham is working to improve access to services by sharing learning across organisations on the impact of trauma, particularly for women facing multiple disadvantages.
Trauma-informed Wales Early Action Together Programme brings together public health, policing and criminal justice to address the root causes of criminal behaviour by identifying and supporting vulnerable people through early intervention. A key activity is the training of frontline police officers and prison staff to recognise the impact of ACEs, identify vulnerable people and help them to get the support needed.
A Better Start is a 10-year, £215m programme set up by the National Lottery Community Fund to support families to give their babies and young children the best start in life. The National Children’s Bureau is supporting the five A Better Start partnerships – in Blackpool, Bradford, Lambeth, Nottingham and Southend – by developing a programme of shared learning. It’s most recent piece of work found that the partnerships have embedded an awareness of the impact of ACEs within their work and supported the development of TIP within their partnerships and wider networks.
Although in their relative infancy, trauma-informed ways of working are playing an increasingly important role in how agencies and service providers address the needs of vulnerable children and families.
Expert view: Implementing a trauma-informed approach
By Dr Asha Patel, clinical psychologist and founder of Innovating Minds CIC (pictured below)
Frontline practitioners such as educational staff, early help teams, victim support and youth workers often provide early intervention and support to children and families within the heart of the community. These practitioners are supporting our most vulnerable children that have been affected by domestic abuse, “honour”-based abuse, criminal and sexual exploitation, children at risk of school exclusion and gender-based violence. At this moment in time, it is important for us to reflect upon the sheer responsibility these practitioners are carrying and the significant impact they have on enabling children to access early help to prevent vulnerable children becoming a victim of the “system”.
Frontline practitioners are generally not clinically trained professionals; however, they are skilled at developing therapeutic relationships that foster safety and connection through empathy and compassion. These practitioners may be the only safe adult in a child’s life, and they can help the child to feel safe, seen, soothed and secure (Sigel and Bryson, 2020). In essence, a majority are already on their journey to implementing a trauma-informed approach to support children and families; however, to further develop their practice a systemic approach is required. A systemic approach acknowledges that strategic organisational changes need to be implemented to foster a culture that is based upon relational and neuroscientific approaches.
Systemic approach
An organisation that has a culture centred around trauma-informed practice provides wraparound support which includes access to ongoing training, resources to deliver trauma-based interventions and the support for practitioners to reflect upon their work and the impact it is having on their mental health. Trauma-informed practice requires practitioners to be grounded, self-aware and come from a place of empathy. Consequence and reward-based systems are typically not implemented as these approaches are viewed as shaming, humiliating, and re-traumatising.
Trauma-focused interventions are focused upon body-based approaches as opposed to cognitive-based interventions (i.e. cognitive behaviour therapy). For decades it was believed that talking about trauma will help; however, trauma-informed practice acknowledges that children retelling their trauma stories can be re-traumatising.
The literature demonstrates that the brain is always listening to the body and therefore when the body is feeling unsafe the brain will flick into safety survival mode to keep us safe (Dr Daniel Siegel, hand-brain model). Body-based interventions focus on children learning about how their body and brain work together when they are feeling safe and unsafe. Carefully, children learn how to pay attention and acknowledge how the body is physically feeling so they can implement strategies (i.e. breathing and grounding techniques) to send signals of safety to the brain.
Healing Together
With the increased focus on the impact of childhood trauma, schools and community services are implementing trauma-informed practices to ensure children’s emotional and neurological needs are met.
Innovating Minds is training frontline practitioners nationally and providing the wraparound support to equip them to deliver the Healing Together programmes. These are trauma-informed programmes that provide children access to early trauma-informed help by the people they trust, and in a space they feel safe.
The effectiveness of the Healing Together programme has been measured by the Emotional Awareness Questionnaire, research methodologies and statistical calculations (paired t-tests and ANOVA). The data demonstrates that the Healing Together programme has a statically significant difference for children aged five to 16 on the measures “differentiating emotions”, “not hiding emotions” and “verbal sharing of emotions”.
The ANOVA analyses measures whether there has been any interaction on reason for referral, delivery method (groups or one-to-one), or age of the children to the overall effectiveness of the programme. It has found that there are some significant interaction effects of referral reason, age and delivery method on verbal sharing of emotions.
The paired t-test also demonstrated that there is a statistically significant difference in facilitator’s knowledge, understanding and confidence in implementing a trauma-informed approach after completing the Healing Together facilitators training.
The wider impact
One of the first academies to take up the Healing Together training was Orchard Hill College & Academy Trust. The trust was successful in gaining funding from the Youth Endowment Fund to train 18 of their staff. The fund prioritised work that supported vulnerable young people at risk of youth violence.
The outcomes demonstrated that children for the first time had started to engage with the pastoral team, engagement in learning had improved and children had started to communicate more openly with the educational staff.
The results demonstrated that access to trauma-informed practice can impact a child’s emotional and mental health, but this experience can also have a positive impact on other aspects of their life.
Further reading:
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The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma, Bessel A. van der Kolk, Penguin Books Ltd, 2019
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The Power of Showing Up: how parental presence shapes who our kids become and how their brains get wired – Mindful Parenting, Sigel, D., and Bryson, T., Scribe: London, 2020
What is trauma-informed practice?
Trauma is most commonly described as an exposure to an extraordinary experience that presents a physical or psychological threat, and that provokes feelings of helplessness and fear.
In 2001, drawing on their own experiences of working in mental health services, Maxine Harris and Roger Fallot proposed that services should utilise a “trauma-informed” approach to improve outcomes for traumatised people and the practitioners working with them.
Trauma-informed practice (TIP) is used across a range of disciplines to help professionals avoid pathologising trauma and instead emphasise a person’s resilience and ability to recover.
It is particularly relevant for young people who have experienced emotional, physical, sexual and relational trauma because of exposure to extra-familial risks.
Professionals utilising trauma-informed approaches prioritise safety, trust, collaboration, choice, and empowerment in their interactions with traumatised young people. They work with young people, prioritising the building of relationships, and working to avoid re-traumatising whenever possible. They understand the ways in which trauma responses can manifest and ensure that the young people they work with feel physically and emotionally safe before, during and after any interactions.
A growing body of research indicates that working in a trauma-informed way does effectively reduce trauma symptoms and lead to positive behaviour change. This has led to increasing interest in TIP in the UK from a range of sectors including health, social care and criminal justice.
Source: A Brief Introduction to Trauma-informed Practice, Kristine Hickle, the University of Sussex, November 2020
