Research evidence: Trauma-informed approaches within children’s social care

Trauma informed approaches within children’s social care

Dr Kirsten Asmussen, Thomas Masterman, Tom McBride, Donna Molloy, Early Intervention Foundation - January 2022 

The study aimed to consider how trauma-informed care (TIC) is used by English children’s social care teams so that its key components and intended benefits can be better understood, with the aim of informing future evaluations. It set out to answer four specific questions:

1. How prevalent is trauma-informed care within children’s social care teams?

2. What activities do teams offer under the guise of trauma-informed care?

3. How are TIC activities perceived to add value to children’s social care, particularly in terms of their benefits for children and parents?

4. Do specific models of TIC exist within teams and are they amenable to rigorous evaluation?

Methods

This study combined a web-based mapping survey with qualitative in-depth interviews. The survey was sent to 149 English local authorities and was completed or partially completed by representatives from 58 teams. Twelve principal social workers or directors of children’s services (representing 10 teams) also took part in a one-hour in depth interview.

An 87-item mapping survey was used to consider the extent to which teams engaged in 10 of the 15 TIC components described in table below.

Findings

How prevalent is TIC in care teams?

Eighty-nine per cent of the local authorities responding to this question (50 out of 58) reported that they engaged in at least one of the 11 TIC components listed in the survey. By contrast, only 11 (22 per cent) said their team had a shared definition of TIC.

Approximately half of these definitions are consistent with the definition provided by the US Substance Abuse and Mental Health Services Administration (SAMHSA), which recognises that exposure to trauma can negatively impact individuals’ daily functioning. One third of the responses also referenced adverse childhood experiences (ACE) in the definitions, with some viewing ACEs and trauma-informed care synonymously.

What components of TIC do care teams offer?

A primary aim of the survey was to consider the use of TIC components in English teams. Nearly all 39 respondents stated that their teams engaged in some form of strengths-based working. The most common TIC components used were:

• Strengths-based approach 96 per cent
• Training 81 per cent
• Increasing the safety of the physical environment 57 per cent
• Recording the child’s history of trauma in their case files 56 per cent
• Screening for trauma or adverse childhood experiences 53 per cent
• Support for secondary trauma 47 per cent
• Increased within agency collaboration 47 per cent
• Cross-agency collaboration and referral systems 37 per cent
• Adopting a trauma-informed ethos and written policies 20 per cent
• Trauma-informed leadership 15 per cent
• Additional trauma-informed activities 15 per cent

A second aim of the survey was to consider the extent to which a specific model of TIC practice could be identified based on the combination of components delivered. Most teams offered at least two of the TIC components, with the most frequent combination being strengths-based practice combined with TIC training. Three-quarters of the respondents indicated that they engaged in at least three of these activities, with the most frequent combination involving strengths-based practice, training and improved inter-agency working. Only one area stated that they delivered all of the TIC components.

How are trauma-informed activities perceived to add value?

In-depth interviews were conducted with leads of 10 teams to better understand the benefits of TIC from the perspective of social workers. Participants worked with the interviewer to identify the following elements:

Why were TIC activities needed?

At the beginning of the in-depth interviews, participants were asked to describe how TIC activities were first introduced to their team. In several cases, TIC practices were initiated to address a specific issue that had been identified through a service audit or Ofsted review. Examples of these issues included higher numbers of looked-after children, high levels of referrals to children’s social care, or high numbers of Section 47 enquiries. Issues with staff retention were also commonly mentioned.

Why might TIC add value to children’s social care practice?

Most interview participants felt that an increased awareness of the impact of trauma on children’s development would result in better treatment decisions - not only by addressing the behaviour but also underpinning issues driving this. Additionally, many respondents believed that adopting trauma-informed principles could potentially rectify power imbalances between families and social workers, which would in turn facilitate trust.

Training activities

The in-depth interviews made clear that social workers engaged in a wide variety of training activities on a regular basis, with participants identifying between five and 12 different activities taking place within their teams. It was also clear that TIC/ACE principles were only one of many different topics covered during the training.

Practice activities

In-depth interview participants identified a variety of practice activities that they considered to be a form of trauma-informed care. These activities included the 11 TIC components covered in the survey, as well as changes to thresholds, caseloads and time spent working with families. In some interviews, it was clear that these activities were viewed as a core part of children’s social care, and not necessarily specific or unique to TIC.

Therapeutic work with families including trauma-specific treatments

Participants also mentioned other social work activities aimed at changing problematic parent and child behaviours. For example, systemic family therapy was frequently identified as a strengths-based activity aimed at reducing child maltreatment and other problematic family interactions. Common solutions include strategies for improving family communication and resolving ongoing conflicts.

Benefits of TIC principles and activities

All in-depth interview participants agreed that TIC principles and activities had been beneficial for their team and identified a range of short-, medium- and long-term outcomes for their staff, service and clients.

Recommendations

• Government departments, including the Department for Education, the Home Office, the Department of Health and Social Care, and the Department for Levelling Up, Housing and Communities, should work together to agree a core definition of trauma-informed care. This definition should be rooted in the original definition developed by SAMHSA, with a clear understanding of its relationship to trauma-specific treatments. Local areas should then be encouraged to use this definition when commissioning trauma-informed training and delivering services.

• Government departments should prioritise robust evaluation of models of trauma-informed care training and practice in different service contexts. Departments should build on the current work they are doing to support trauma-informed practice by working to get a robust evaluation of the strongest models off the ground in the different settings in which these models are being used. Any future funding of trauma-informed approaches should be linked to this and designed and delivered in a way that enables robust evaluation of impact.

• The availability of effective, trauma-specific interventions should be prioritised and linked to any future investment in trauma-informed care. Traumatic experiences have negative, long-term consequences, particularly when they involve maltreatment behaviours that are frequent and intense. Maltreated children need access to treatments with the strongest evidence of reducing the impact of trauma and improving their overall wellbeing.

Study from www.eif.org.uk/report/trauma-informed-care-understanding-the-use-of-trauma-informed-approaches-within-childrens-social-care

Common components of trauma-informed care

• Workforce development
• Training of all staff on the impact of abuse or trauma
• Use of standardised trauma screening/assessment measures
• Within agency collaboration/service co-ordination
• Measuring staff knowledge/practice
• Availability of evidence-based, trauma-specific practices
• Trauma-focused services
• Outside agency collaboration/service coordination
• Strategies/procedures to address/reduce traumatic stress among staff
• Trauma history is always included in case/service plan
• Organisational environment and practices
• Positive, safe physical environment
• Reduce risk of re-traumatisation
• Knowledge/skills in accessing evidence-based services
• Strengths-based/promote positive development
• Defined leadership position for trauma services
• Written policies that include trauma
• Consumer engagement/input in system planning

Innovate Project examines trauma-informed approaches in children’s social care provision

By Kristine Hickle, senior lecturer in social work and social care at the University of Sussex (pictured below)

Trauma-informed practice is a multi-disciplinary framework that provides a way of understanding the impact of traumatic experiences on people’s lives and responding in ways that increase safety and facilitate healing.

The concept has been around for a couple of decades but in the last several years we have seen it adopted with fervour and enthusiasm throughout the UK. As a framework, it aligns well with other evidence-based and widely adopted approaches to practice with children and families, including relationship and strengths-based approaches and restorative practice models.

More recent interpretations have recognised its relevance for understanding and addressing the impact of structural and historical violence, expanding its application for professionals committed to engaging in anti-oppressive and anti-racist practices. However, the flexible and adaptable nature of the framework also means it is open to multiple interpretations and can quickly become too amorphous for practice systems (and those working within them) to grab a hold of and understand exactly what it means for them, in their particular context. This also means it is difficult to demonstrate outcomes associated with trauma-informed practice or to identify the barriers and facilitators within practice systems that influence their capacity to innovate using a trauma-informed framework in meaningful and measurable ways.

Identifying practices

Through the Innovate Project, a four-year Economic and Social Research Council-funded project led by the University of Sussex (with partners at Durham University, Research in Practice, and the Innovation Unit), we are working to identify how trauma-informed practice is being used to innovate services for young people affected by extra-familial risks and harms (EFRH). These harms include exploitation, abuse or criminality, which may be both a cause and consequence of trauma. In recognition of this, many children’s social care departments have sought to cultivate more effective responses to EFRH through developing new organisational systems and practice approaches.

Trauma-informed practice is one of three innovations (alongside Contextual Safeguarding and Transitional Safeguarding) being examined in six sites around the country and through a wider learning and development network of statutory and voluntary social care organisations. In the last three years, we have observed professional meetings, conducted interviews, and analysed case files for young people and organisational policy documents to help better understand what happens when practice systems seek to innovate using trauma-informed practice. While the project has more than a year left until completion, the data is telling us a couple of interesting things about how trauma-informed practice is effectively implemented, and along with some of the challenges facing both statutory and voluntary sector organisations.

Organisational culture

The first thing we’ve observed is perhaps unsurprising to those who have embarked on innovation journeys or observed them unfold over time: innovation isn’t about uncovering a perfect formula for change but about relationships, adaptability, flexibility, and organisational culture change. For those adopting a trauma-informed approach, understanding the organisational culture before identifying a training programme to roll out among staff is essential.

Maintaining a capacity for curiosity, persistence, and flexibility are foundational features of a system able to facilitate trauma-informed engagement across the organisational hierarchy, and so understanding the degree to which the system is already characterised by these features is important. Asking questions like: How are families and young people viewed? What do we think and feel about teenagers? How strong is our collective knowledge of adolescent development? How do we understand risk taking in adolescence? Is there a risk-averse culture or do we feel collectively held by each other and so feel able to hold risk, alongside young people? Do we feel a responsibility to them - as well as for them? Our research on the project is revealing that if these underpinning values are not articulated at the individual and organisational levels, then even excellent trainings on trauma-informed practice will be less effective and perhaps less likely to sustain any early changes over time.

Having an organisational culture supported by a strong value base in relation to work with young people at risk of EFRH is important, but it’s also just a starting point. Healthy, robust practice systems committed to innovating using a trauma-informed practice framework face an additional challenge when approaches to change foreground incremental service improvement and at the expense of scrutinising structural problems that may need to change. Within these systems, we might identify good practices among practitioners, a carefully considered wellbeing plan for staff, and some tangible changes to physical environments that foster safety for staff and service users alike. These changes are important and meaningful, but we can easily identify these incremental changes as evidence that the system has “arrived” at being trauma-informed when this journey was always meant to be reflexive and iterative, uncovering new challenges and shedding light on previously unrecognised harms – particularly those inflicted by the safeguarding systems meant to prevent harm.

For these practice systems, questions might look like: Do our thresholds for intervention and timeframes for assessment meet the needs of people with complex trauma? Do they account for how long it can take people to feel physically, emotionally, and relationally safe? Does the wider partnership share an understanding of trauma and what might foreshorten the positive impact we’ve made when interactions with other systems remain traumatising? Are young people and their families involved in contributing to the system change in meaningful ways? In what brave, new ways do we need to rethink the impact of historical trauma and ongoing forms of structural violence to work towards a system that is holistically trauma informed? These kinds of questions might result in a more disruptive, unsettling innovation, but one that aligns with the original well-intentioned aims of those committed to a trauma-informed journey.

Kristine Hickle leads the Contextual Safeguarding strand at the University of Sussex, providing thematic expertise on the Trauma-Informed Practice strand of the Innovate Project

• Read more in CYP Now's Trauma-Informed Services Special Report