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Trauma-informed care: a vital concept imperfectly applied


20 Jan 2022

Isabelle Trowler, chief children’s social worker for England, sets out why children’s social workers need greater clarity around which practice frameworks are effective, for whom and under what conditions, and why – in the case of trauma-informed approaches – we need to ensure that frontline practice is aligned with the evidence on when and how they should be applied.

Children’s social care, and the array of services designed to support families and protect children and young people, are under immense scrutiny. Thousands of people work hard in dedicated service to their local communities and the families living difficult lives that they see every day.

Still, quite rightly, there are always questions about how the system can work more effectively. And sustaining the good faith of communities and families in children’s social care as a vital support, rather than a punitive machine, has never been more important.

When it comes to supporting vulnerable children and families, I have argued for some time that there needs to be greater clarity about who is doing what and why. While we know that practitioner skill is crucial to achieving improved outcomes, there is often a lack of clarity about which practice frameworks are most effective, or what level of practitioner skill is needed to provide the different types of support that children and families might need.

We need greater precision about the practice frameworks that social workers and wider practitioners use and what these different frameworks can achieve. And when a new idea comes along, rapidly gathering popularity and traction, it must be tested and examined to ensure it delivers on its promises.

Which is why the findings from EIF’s new report should give us pause. Trauma-informed care is a very popular approach: 89% of teams involved in the EIF study are using these methods. But yet, somewhat soberingly, we aren’t clear either about what it is or how it helps.

Clearly there is no single model of trauma-informed care. It has become an amorphous term, meaning different things to different people. Indeed, EIF found that trauma-informed practice varies hugely across children’s social care services, with no two teams offering the same components. Furthermore, the extent to which ‘trauma-informed’ activities are even distinct from standard social work practice is unclear, with several practitioners commenting that it may amount to little more than a rebranding of standard social work practice.

Perhaps of most concern is the absence of any common understanding as to how trauma-informed practice might help, in terms of improving lives or reducing harm. In responding to EIF, people agreed that trauma-informed activities are beneficial for children and families, but disagreed about what these benefits might be or how they would best be achieved.

There are two general views at play here. Respondents felt that a deeper awareness of trauma would help practitioners to better understand the needs of the families they work with, which would mean families would feel less judged and therefore more motivated to engage in support that is offered. But trauma-informed practices are also being used as a route to improving outcomes, including reductions in trauma, improvements in child and parent functioning, better placement decisions and increased child wellbeing. While the first view seems plausible, the second – in the absence of stronger evidence – feels like more of a statement of faith.

The EIF report makes clear that trauma-informed care was never intended to replace access to evidence-based, trauma-specific treatments, or improve important family outcomes in their absence. But this seems to be what is happening: something that started out as a well-intentioned extra layer of care and empathy risks becoming a substitute for these other, more evidence-based approaches to supporting families out of vulnerability and harm.

Children’s social work teams toil in good faith, in challenging conditions, in the best interests of the children and families they work hard to support and protect, and few would disagree that we owe maltreated children access to treatments with the strongest evidence of improving their overall long-term wellbeing. Nevertheless, we still see a wide gap between what has been shown to work and what is being delivered. As we ask ourselves whether our current family support and child protection system is designed to have the greatest possible impact, this report adds to the evidence which suggests that perhaps it is not.

Again, this highlights to me that we need to be much clearer about the practice frameworks we’re using and what they can achieve. The national system has a crucial role to play in supporting this kind of investigation, sharing the results, and incentivising effective practice at all levels.

By retaining the best of approaches like trauma-informed care, and marrying its principles with evidence-based treatments, we can work towards a vital and optimistic goal: to build a more generous, respectful, public service response to vulnerability and neglect, to help people who have difficult lives to lead less difficult lives. However, the evidence on trauma-informed care is too slim to suggest that, by itself, it can be our plan A for child protection or family support.