Why good intentions are never enough: what we have learned (and haven’t learned) about trauma-informed care
EIF director of policy & practice Donna Molloy highlights one of the key implications from our latest report on trauma-informed approaches: "Trauma-informed care has a vital contribution to make in supporting families to access services with established evidence of reducing the negative impact of child trauma. We need to enable it to make this contribution by ensuring these interventions are more widely available."
One finding of the EIF report published today – that trauma-informed practices are widely implemented in children’s social care teams, and perceived by many to add value to their work – is unlikely to surprise anyone. The growing popularity of these approaches has been hard to miss. Over the past 10 years, trauma-informed approaches have expanded beyond mental health services where they originated into schools, child protection services 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.
TIC is an approach that is hard to disagree with. As one article puts it: “Trauma-informed social work incorporates core principles of safety, trust, collaboration, choice, and empowerment and delivers services in a manner that avoids inadvertently repeating unhealthy interpersonal dynamics in the helping relationship.” There’s nothing there that’s not to like.
While practitioners’ views on the value of these methods is clear, the lack of clarity about what TIC is or how it helps does feel problematic. In our survey of local authorities, only a fifth of respondents reported that their team had a clear definition of trauma-informed care, and there was a high degree of variation across teams in terms of how TIC was defined and in views of its intended benefits.
This lack of clarity is problematic. As the popularity of TIC grows, there is a risk we can become overly optimistic about what services in which these approaches are embedded are likely to achieve. The use of TIC has far outpaced its evaluation. Few TIC activities have undergone rigorous testing, and so the specific benefits for children and families remain largely unknown.
One of the main aims of trauma-informed training or workforce development is to increase awareness of how trauma can affect children and adults, so that practitioners can avoid practices that could inadvertently retraumatise those they are working with. While it is reasonable to assume that being trauma-informed in this way will improve services, the extent to which these improvements will actually reduce symptoms of trauma or lead to improvements in family outcomes is much less clear.
It is also important to remember that TIC activities were developed to increase engagement with treatments or interventions that had evidence of reducing trauma and improving other child outcomes. They were not intended to be a replacement for such treatments, or work in their absence. Yet our study shows that this is largely how they are being used. We found little evidence that TIC activities were leading to evidence-based treatments. Again this gives us a reason to be cautious, to question how plausible it is that these approaches can improve outcomes in and of themselves.
This is important beyond children’s social work. Preventing trauma is also an area of increasing focus from policing and public health agencies, given the high prevalence of traumatic experiences amongst young offenders. Police forces, violence reduction units (VRUs) and local partnerships across the country are investing in supporting their workforces to become ‘trauma informed’, and seeing this as a key element of local crime prevention strategies.
It feels like time to collectively pause and draw breath. Whilst the current consensus and commitment around the need to reduce and mitigate experiences of trauma is to be welcomed, it is important it is channelled in the right way.
As originally intended, TIC has value and work is needed to clarify the specific contribution of these approaches. 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. Ideally, this should go beyond just children’s social work and also cover wider settings, such as agencies involved in preventing youth offending and potentially schools as well.
But there is, of course, little point using scarce resources to evaluate a concept that is being misapplied. First of all we need to return TIC to its rightful place, ensuring it is used as it was originally intended: as a mechanism for engaging families in evidence-based treatments. TIC has a vital contribution to make here in 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 TIC to make this contribution by ensuring these interventions are more widely available.
Few would disagree that we owe maltreated children access to treatments with the strongest evidence of reducing the impact of trauma and improving their overall wellbeing. Whilst trauma-informed care has a contribution to make here, let’s make sure we aren’t expecting too much of it and seeing it as a solution in itself.