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Part 3A: Responding to abuse and neglect

Trauma-informed practice

“Trauma results from an event, a series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. The experience of trauma can cause lasting adverse effects, limiting the ability to function and achieve mental, physical, social, emotional or spiritual well-being.”

—Working definition of trauma-informed practice - GOV.UK

Definition of trauma-informed practice:

“An approach to health and care interventions which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological and social development.”

—Working definition of trauma-informed practice - GOV.UK

Trauma-informed practice requires practitioners, organisations and systems to look beyond presenting behaviour and ask ‘what happened to this person?’ rather than ‘what is wrong with this person?’.

Experience of trauma can:
  • impact physical and mental health
  • impact education
  • impact behaviour
  • lead to behaviour which is perceived as ‘challenging’ or ‘difficult’
  • impact accessing healthcare, such as: making appointments, keeping appointments, expressing yourself, having invasive investigations, use of language
  • lead to fear of other services becoming involved
  • impact ability to care for self and others
  • impact ability to regulate own emotions
  • impact family support
  • lead down a path to criminal activity.
How can we be trauma-informed and carry out trauma-informed practice in general practice?
  • Be aware how common trauma related to abuse is.
  • Be mindful that current or past trauma may impact any of your patients.
  • Understand that examinations and investigations may be particularly triggering for those who have experienced trauma. The Survivors Trust have a campaign ‘Check with me first’ which highlights three small actions to help survivors of sexual abuse to feel more comfortable and empowered if being examined during healthcare appointments. While these are about examination, the principles could be applied to all aspects of a healthcare consultation:
    • CHECK. Ask the individual if they are comfortable before and during each step of the examination.
    • EXPLAIN. Help the service-user feel at ease by explaining each step of the examination before you do it and encourage them to ask questions.
    • REASSURE. Remind the individual that they can stop the procedure at any time – they are in control.
Trauma-informed practice is:
  • asking about abuse/trauma in a sensitive way
  • providing opportunities for disclosure of abuse when appropriate
  • listening
  • giving choice
  • empowering
  • taking a strengths-based approach
  • giving control back
  • not putting everything down to abuse/trauma.
Principles of trauma-informed practice:
Safety Trustworthiness
The physical, psychological and emotional safety of service users and staff is prioritised, by:
  • people knowing they are safe or asking what they need to feel safe
  • there being reasonable freedom from threat or harm
  • attempting to prevent re-traumatisation
  • putting policies, practices and safeguarding arrangements in place.
 Transparency exists in an organisation’s policies and procedures, with the objective of building trust among staff, service users and the wider community, by:
  • the organisation and staff explaining what they are doing and why
  • the organisation and staff doing what they say they will do
  • expectations being made clear and the organisation and staff not overpromising.
Choice Collaboration
Service users are supported in shared decision-making, choice and goal setting to determine the plan of action they need to heal and move forward, by:
  • ensuring service users and staff have a voice in the decision-making process of the organisation and its services
  • listening to the needs and wishes of service users and staff
  • explaining choices clearly and transparently
  • acknowledging that people who have experienced or are experiencing trauma may feel a lack of safety or control over the course of their life which can cause difficulties in developing trusting relationships.
 The value of staff and service user experience is recognised in overcoming challenges and improving the system as a whole, by:
  • using formal and informal peer support and mutual self-help
  • the organisation asking service users and staff what they need and collaboratively considering how these needs can be met
  • focussing on working alongside and actively involving service users in the delivery of services.
Empowerment Cultural consideration
Efforts are made to share power and give service users and staff a strong voice in decision-making, at both individual and organisational level, by:
  • validating feelings and concerns of staff and service users
  • listening to what a person wants and needs
  • supporting people to make decisions and take action
  • acknowledging that people who have experienced or are experiencing trauma may feel powerless to control what happens to them, isolated by their experiences and have feelings of low self-worth.
 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
  • leveraging the healing value of traditional cultural connections
  • incorporating policies, protocols and processes that are responsive to the needs of individuals served.
References
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