A crucial part of the puzzle: finding the right role for trauma-informed approaches in public services
Donna Molloy, EIF director of policy and practice, summarises three key lessons from EIF research into the application of trauma-informed approaches, particularly the latest work on trauma-informed training in Violence Reduction Units (VRUs).
The growing popularity of developing services to become ‘trauma-informed’ has been hard to miss in recent years. Trauma-informed practice and wider approaches have expanded beyond the mental health services where they originated into other service contexts, including schools, child protection and the criminal justice system. This expansion reflects widespread enthusiasm for the principles of trauma-informed care and optimism that their use will lead to measurable benefits for children and adults who come into contact with public services.
Understanding trauma has been a particular focus within policing and public health agencies as part of attempts to reduce offending and youth violence. This makes complete sense when we consider the high prevalence of traumatic experiences among young offenders and those involved in the criminal justice system. Police forces, violence reduction units (VRUs) and local partnerships across the country are investing in supporting their workforces to become ‘trauma informed’, and see this as a key element of local crime prevention strategies.
This week we publish the second EIF report on the impact of trauma-informed approaches in different public services. Previously, we looked at the use of trauma-informed practice in children’s social care, and are pleased to build on this with new research – commissioned by the Home Office and conducted in partnership with Dartington Service Design Lab – that explores how trauma-informed training is being applied within a number of VRUs across England.
Three points emerge from this work that we think are worth highlighting, with lessons for how trauma-informed approaches are used in all public services.
We need to be realistic about what trauma-informed approaches are likely to achieve
The VRUs involved in our latest study were hoping that trauma-informed training and care would deliver a variety of outcomes, from building workforce understanding of trauma and strengthening individual practice, to reducing the impact of trauma on practitioners, through to improving services, local systems and young people’s outcomes.
Based on the evidence, it is hard to avoid the conclusion that some of these outcomes are more feasible than others. While trauma-informed training has the potential to add significant value to staff knowledge and increase their awareness of trauma, and to encourage more person-centred, empathetic practice, some of the other objectives feel more of a leap.
For example, it is unlikely that trauma-informed training will in itself reduce the impact that working with vulnerable populations can have on practitioners’ own mental and physical health. Similarly, while trauma-informed training may contribute to more positive interactions between practitioners and young people – something which could lead to better onward referrals – there is currently no empirical basis to suggest that trauma-informed training can, on its own, result in improvements in young people’s longer-term outcomes or life chances.
Trauma-informed training (and care) undoubtedly has a contribution to make, but it is important that we don’t expect too much of it or view it as a solution in itself – for example, as a primary mechanism through which to reduce youth violence. We should bear in mind that it is a fairly light-touch intervention, and one which is unlikely by itself to lead to significant changes in long-term outcomes.
We really need to evaluate the specific impact of trauma-informed approaches
The spread of trauma-informed approaches has far outpaced their evaluation. At present, few trauma-informed activities have undergone rigorous testing, and so the specific benefits remain largely unknown. As we have said previously in relation to children’s social work, a programme of evaluation of models of trauma-informed training and practice is much needed, so that we can be sure that the money being invested here is being used to best effect.
Through our latest work, it was good to see the work that VRUs are doing to evaluate their training and wider trauma-informed activity. However, as we set out in the report, the current evaluations taking place are local process evaluations, which means they are limited in their ability to provide evidence on the impact such activities have on young people’s outcomes, and won’t allow us to compare the results between different places or approaches.
It is crucial that trauma-informed training and related activities are robustly evaluated to confirm if the short- and medium-term outcomes that VRUs are aiming to achieve are actually being achieved. To this end, it is good to see the funding round recently launched by the Youth Endowment Fund (YEF) to fund and evaluate trauma-informed practice in order to better understand if it can keep children safe from violence.
Let’s not forget what we already know
Finally, it is important to remember that trauma-informed approaches were developed to increase people’s engagement with therapies or interventions which support recovery from trauma. Crucially, they weren’t designed to replace such treatments or to work in their absence.
Trauma-informed care has a vital contribution to make in this respect, by supporting families to access services with established evidence of reducing the negative impact of child trauma (such as Child-Parent Psychotherapy and Trauma-focused CBT). We need to enable trauma-informed services to make this contribution by ensuring that these effective interventions are available. As set out in the YEF Toolkit, for services seeking to reduce youth violence, these interventions are a strong option.
In the end, the contribution of trauma-informed training is perhaps best understood as one part of a wider trauma-informed system of support. Trauma-informed training has the potential to build staff understanding of trauma and improve practice. We should avoid undue optimism about what it can achieve in isolation, but when combined with high-quality services with good evidence of preventing or reducing trauma then it does have an important role to play in a whole-system approach that seeks to improve outcomes for young people.