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Using trauma theory to design service systems. New directions for mental health services.

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Abstract

Mental health practitioners are becoming increasingly aware that they are encountering a large number of men and women who are survivors of sexual and physical abuse. An understanding of trauma, its sequelae, and the impact that it has in shaping a consumer's response to subsequent experience is essential for providers working in the human services field, regardless of whether they are asked to deliver specific services intended to address the effects of abuse. This book identifies the essential elements necessary for a system to begin to integrate an understanding about trauma into its core service programs. The basic philosophy of trauma-informed practice is examined across several specific service components: assessment and screening, inpatient treatment, residential services, addictions programming, and case management. The modifications necessary to transform a current system into a trauma-informed system and the approaches that may become contraindicated are identified. The changing roles of consumers and providers in a trauma-informed system are also discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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... The resurgence of interest in trauma can be traced, in part, to the introduction of trauma-informed care (TIC) in the early 2000s (Harris & Fallot, 2001). This framework draws together earlier feminist work on trauma, which shifted focus from individual expressions of symptoms to the broader social context promoting violence against women (Herman, 1992), and growing recognition that common practices in psychiatric settings had the potential to re-traumatize service participants (Frueh et al., 2000). ...
... This framework draws together earlier feminist work on trauma, which shifted focus from individual expressions of symptoms to the broader social context promoting violence against women (Herman, 1992), and growing recognition that common practices in psychiatric settings had the potential to re-traumatize service participants (Frueh et al., 2000). TIC is distinguished by its emphasis on cultural change within helping organizations (Brown et al., 2013) as it requires reshaping administrative practices, policies, and services to reflect core values of safety, trust, choice, collaboration, and empowerment (Elliott et al., 2005;Harris & Fallot, 2001). While TIC supports adoption of specific evidence-based practices for trauma, it is broader in orientation. ...
... Links between PTSD and IPV victimization are well-established (Dillon et al., 2013). Female survivors are several times more likely to experience PTSD (Helfrich et al., 2008;Woods et al., 2008) and complex PTSD (Mertin & Mohr, 2001) than those who have not experienced IPV. Across studies, IPV survivors identify untreated trauma as a barrier to their recovery from violence (Baird et al., 2020;Gezinski et al., 2021). ...
Article
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Purpose Intimate partner violence (IPV) and substance use disorder (SUD) frequently co-occur and are rarely addressed together despite evidence indicating benefits of combined interventions. Both are linked to trauma. Scholars have theorized attention to trauma may facilitate engagement with IPV and SUD but have not studied this potential empirically. Methods Using service system level quantitative data on organizations focused on IPV or SUD (n = 281) in a midwestern city in the United States and semi-structured interviews with policymakers, funders, and practitioners in both areas (n = 27), this paper uses grounded theory to explore whether attention to trauma facilitates attention to IPV and SUD. Results While quantitative data suggest addressing trauma and both IPV and SUD are associated at the service system level, analysis of interview data indicates greater complexity. Despite consensus on trauma-informed care’s potential, competing understandings of temporality (when trauma occurs in relation to IPV or SUD), different liabilities associated with addressing trauma, and different intervention approaches combine to limit engagement by both IPV and SUD organizations. Rather than adopting trauma-informed care, both types of organizations more typically engage trauma selectively, offering discrete services rather than holistic intervention. Findings have implications for addressing co-occurring IPV, SUD, and trauma and for practice, policy, education, and research. Conclusions There is need for greater consensus about what it means to address trauma, increased investments in practitioner education and training around intersections of IPV, SUD, and trauma, and additional supports to incentivize movement from a trauma services approach towards meaningful implementation of trauma-informed care.
... As part of this reconceptualisation of services, organisations will need to reframe complex behaviours as potential responses to trauma related triggers and will be required to prioritise the building of trusting, mutual relationships above all else. A rich body of work on trauma-informed practice points the way in this respect (Harris & Fallot, 2001;Azeem, Aujla, Rammerth, Binsfeld, & Jones, 2011;Chandler, 2008;Domino, Morrissey, Chung, & Nadlicki, 2006;Gatz, et al., 2007;Greenwald, et al., 2012;Messina, Calhoun, & Braithwaite, 2014;Morrissey, et al., 2005;Weissbecker & Clark, 2007;Bloom S., 2013), identifying the direction of travel for new models of service delivery: "from fear to safety, from control to empowerment, and from abuse of power to accountability and transparency" (Concetta, 2018). Scotland became the first country to recognise and respond to this need by implementing a National Trauma Training Programme (NTTP), led by NHS Education for Scotland. ...
... The development of Trauma-informed Practice (TIP) can be traced to the USA and to the ground breaking work of Maxine Harris and Roger Fallot (Harris & Fallot, 2001), and Sandra Bloom (Bloom S., 2013). Based on the models they developed, TIP is now widely understood as follows (Paterson, 2014): ...
... Adapting an analogy used by Harris & Fallot (Harris & Fallot, 2001), the development of organisations that are trauma-informed is akin to the development of organisations that are disability-informed. The Disability Discrimination Act of 2005 states that organisations must make reasonable adjustments to their services and premises to ensure that disabled people can access them. ...
... Trauma-informed care represents an ecological approach to trauma intervention based on the understanding that (a) environmental factors influence well-being; (b) health is, at least in part, socially-determined; and (c) interventions must target individual, interpersonal, and community systems (Bronfenbrenner & Morris, 1998;SAMHSA, 2014;Saxe et al., 2006). This approach reflects a heightened awareness of context and the role that providers play in hindering or fostering recovery for trauma survivors (Harris & Fallot, 2001;Jennings, 2008). From an ecological perspective, organizations and systems are seen as critical targets of trauma intervention. ...
... As such, the focus of interventions expands beyond the individual therapy hour into the larger environment. As the paradigm shifts from asking survivors "what's wrong with you," to "what happened to you" (Harris & Fallot, 2001;SAMHSA, 2014), trauma-informed care broadens the approach to intervention from "how can I fix you" to "what do you need to support your development and recovery?" ...
... A range of established models and tools have been developed to help organizations become trauma-informed. In Using Trauma Theory to Design Service Systems, Harris and Fallot (2001) articulate a comprehensive array of strategies that organizations can take to adopt trauma-informed care. To accompany this book, Community Connections developed Creating Cultures of Trauma-Informed Care (CCIT), a model that includes (a) a trauma-informed services self-assessment and planning protocol; (b) a trauma-informed self-assessment checklist; and (c) a trauma-informed services implementation form (Fallot & Harris, 2011). ...
... Identifying trauma-informed organizational experiences was done by assessing seminal research outlining the tenets of trauma-informed practice. This research builds from a highly cited (Hales et al., 2017;Lang et al., 2016;Levenson et al., 2016;Martin et al., 2017;Wolff et al., 2015) model by Harris & Fallot (2001), which is comprised of five core values including safety, trust, empowerment, choice, and collaboration. Fallot and Harris (2009) also indicate that trauma-informed practice can be applied to service users and staff alike and has been confirmed in research such as a study by Izzo et al. (2016), which found that the development of trauma-informed care at the staff and organizational levels led to improved well-being for youth at a residential child care center. ...
... Safety in trauma-informed practice refers to the physical, psychological, and emotional comfort of service users (Harris & Fallot, 2001). Safety can be developed at the individual, social, and cultural levels of an organization (Shier & Turpin, 2017;Wilson et al., 2015) and often includes both interpersonal and structural dynamics (Kusmaul et al., 2019). ...
... Choice is generally defined as providing the service user with control and input over the services they receive (Harris & Fallot, 2001). Choice is found to follow an empowering approach, as service users are better informed and better equipped to make decisions regarding the level and type of service they need (Hunt et al., 2018). ...
Article
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Purpose: To test an empirical model of the effects of a trauma-informed organizational environment on service user outcomes in the context of concurrent disorder treatment. Methods: Service users (n ¼ 172) were surveyed while in treatment to determine the effects of trauma-informed organizational dynamics (i.e., safety, trust, choice, collaboration, and empowerment) on service user intrapersonal development outcomes (i.e., self-awareness, outlook, coping ability, self-worth, and self-determination) and improvements with concurrent disorder behaviors. After testing for validity and reliability of latent factors, data were analyzed using multivariate analysis. Results: As a concise analytical model, the trauma-informed organizational environment was found to significantly positively predict all service user intrapersonal outcomes as well as a reduction in concurrent disorder behaviors. Conclusions: This study informs developments in the design and implementation of trauma-informed practice frameworks for concurrent disorder treatment and emphasizes the importance of adapting organizational environments to support improved client outcomes.
... As outlined in Table 1, a "trauma informed" individual or system uses that understanding to design service systems that accommodate the vulnerabilities of trauma survivors and allows services to be provided in such a way that will avoid unintentional retraumatisation while expediting patient and caregiver participation in treatment. It also demands, as much as possible, closely knit collaborative relationships with other service systems assisting these patients and the local network of private practitioners with specific clinical expertise in trauma-related conditions and trauma recovery (Harris and Fallot, 2001b). ...
... Taken together, trauma-informed care and practice for the treatment of eating difficulties is a timely and compassionate integration of available data and practices that promises to improve the treatment and outcomes of those suffering with severe eating difficulties. Harris, 2001, Harris and Fallot, 2001b, Harris and Fallot, 2001a) ...
Chapter
This chapter briefly explains the principles of trauma-informed care and its relevance for individuals experiencing eating difficulties, including the systems of care that may support them. Clinical research evidence has demonstrated significantly higher rates of childhood maltreatment and other severe lifetime traumatic events in those eating difficulties compared to those without, particularly amongst those experiencing binge eating and/or purging. An array of adverse consequences from traumatic experiences, ranging from clinical diagnosis of post-traumatic stress disorder (PTSD) to trauma-related difficulties with mood, anxiety, and substance use have been established. The rational, concurrent integration of existing evidence-based treatments for both eating difficulties and experiences of trauma are recommended that move beyond sequentially delivered therapies, e.g., therapies with different goals delivered one after the other by different providers or programs. Although the need for such integrated treatment is clear, the roadblocks and obstacles to achieving such goals for individuals with eating difficulties and experiences of trauma are significant. Nevertheless, improved outcomes are anticipated where trauma-informed care and trauma-focused treatments are embraced by clinicians and treatment programs alike.
... Good practice guidelines recommend the implementation of TIC and training of psychological concepts to support staff (Homeless Link, 2017;Pathway, 2012). Wider organisational training is recommended to support general knowledge instead of a few specialist "champions" (Harris and Fallot, 2001). ...
... The findings indicate issues with the wider system and culture within services being the moderating factor for TIC uptake, rather than individual staff. However, training is still needed for all staff to help in the adoption of these changes (Harris and Fallot, 2001): it may be seen as necessary, but not sufficient, for the implementation of TIC. It is therefore important that organisations do not simply see the provision of training to staff (even at all levels) as indicative of becoming "trauma informed". ...
Article
Purpose Implementing trauma informed care (TIC) for individuals facing homelessness and multiple disadvantage is proposed to help both service users and staff work effectively and therapeutically together. However, the effectiveness of implementing TIC via training is debatable. This study aims to explore the effects of a four-day TIC and psychologically informed environments training package in such services. Design/methodology/approach The analysis explores the effect of this training on the degree of TIC as measured by the TICOMETER, a psychometrically robust organisational measure of TIC. The study examines group and individual level changes from before training and again at six-month and one-year follow-up time-points. Findings At the group level analysis, three of the five TICOMETER domains (knowledge and skills, relationships, and policies and procedures) were higher when compared to pre-training scores. The remaining two domains (service delivery and respect) did not improve. Individual-level analysis showed some participants’ scores decreased following training. Overall, the training appeared to modestly improve the degree of TIC as measured by the TICOMETER and these effects were sustained at one-year follow-up. Research limitations/implications Findings are limited by the design and low response rates at follow-up. Practical implications Training is necessary but not sufficient for the implementation of TIC and needs to be complemented with wider organisational and system-level changes. Originality/value This paper is the first UK study to use the TICOMETER.
... Travma bilgilendirilmiş bakım (TIC), 1990'lı yıllarda çocukluk çağı biyolojik, psikolojik ve sosyal yaşantılarının bütünleştirilerek anlaşılması için bir hizmet geliştirilmesini tarif etmek için kullanılan bir terimdir (Harris & Fallot, 2001). Travmatik deneyimler güçsüzlük, korku, umutsuzluk duygularının hâkim olmasına neden olur. ...
... Travma bilgilendirilmiş örgüt kültürü yaratmak için önerilen model ve süreçler incelendiğinde, temel olarak dört aşamalı bir süreci izlemenin etkili sonuçlar elde etmede yardımcı olacağı görülmektedir. Bu aşamaları şu şekilde açıklamak mümkündür (Harris & Fallot, 2001;Guarino, 2007;Fallot & Harris, 2009;Esaki vd., 2013;SAMSHA, 2014;Goldman, 2015;Yatchmenoff vd., 2017 ...
... In particular, the course covers the basic principles of the TI approach, including the overarching "4 R's": to realize that many clients who present to human service agencies, and many of the staff who provide services, have histories of traumatic exposures; to recognize common signs and symptoms of trauma for clients, families, as well as staff; to respond by integrating such knowledge into policies, procedures, and practices; and to resist retraumatizing clients and staff through the provision of services (Substance Use and Mental Health Services Administration; SAMHSA, 2014a). Specific TI principles that guide this include bringing attention to (1) safety (both physical and emotional) (2) trustworthiness and transparency (3) peer support (4) collaboration and mutuality (5) empowerment, voice, and choice, and (6) attention to cultural, historic, and gender issues (Harris & Fallot, 2001;SAMHSA, 2014a). ...
... For this, our content experts performed several literature searches for any articles that related to trauma informed care, trauma informed principles, and physical/environmental space. They also wrested into seminal guidance on the application of trauma-informed care (e.g., Harris & Fallot, 2001;SAMHSA, 2014aSAMHSA, , 2014b, as well as more recent guidance for instituting trauma-informed organizational change (e.g., Koury & Green, 2020;Menschner & Maul, 2016;Trauma Informed Oregon, 2018). The content experts also reviewed existing trauma-informed environmental walk-through tools (Koury & Green, 2020;Trauma Informed Oregon, 2016), and literature related to TI environments, including in juvenile institutions (Burrell, 2013;Hodgdon, Kinniburgh, Gabowitz, Blaustein, & Spinazzola, 2013), in prison environments (Jewkes, Jordan, Wright, & Bendelow, 2019), and in mental health facilities (Liddicoat, Badcock, & Killackey, 2020). ...
Article
This article details the creation of a Virtual Reality Learning Environment (VRLE) designed to educate students on how trauma-informed (TI) principles can be integrated into the physical environments of human service agencies. Virtual Reality (VR) technologies and characteristics that have the potential to improve student learning outcomes are reviewed. The integration of VR into a social work doctoral program is described, and the theoretical and pedagogical considerations that informed the creation of the TI VRLE are explored. Details of the process of developing and assessing the TI VRLE are discussed, together with lessons learned and directions for future research.
... Various authors have advocated that trauma-responsive interventions should adopt a phase-based approach (Ford, Cortois, Steele, van der Hart, & Nijenhuis, 2005;Harris & Fallot, 2001;Herman, 1992;van der Hart, Brown, & van der Kolk, 1989). Phase 1 has been conceptualized as consisting of 'psychoeducation' with respect to providing both relevant information and actively assisting clients to develop coping and emotion regulation skills, thereby promoting safety and stabilization (Mahoney, Karatzias, & Hutton, 2019). ...
... It is important also to give some consideration as to whether traumainformed psychoeducational interventions lead to temporary rises in depression and negative affect more generally. Certainly, both arms continued to return mean scores above the cut-off range considered (Harris & Fallot, 2001). It can be hypothesized that increases in emotional acceptance may be linked to increases in depression and that this may also be an important precursor to greater emotional regulation (Gratz & Roemer, 2004;Ratcliffe, 2018). ...
Article
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Although psychoeducational interventions are recommended as phase 1 interventions for complex trauma there is limited evidence on their efficacy. This pilot randomised control trial (RCT) investigated the efficacy of a pure psychoeducational intervention for complex trauma. A brief 10 session intervention was delivered to n=44 female prisoners in a compressed format to accommodate short sentence lengths and was compared to usual care (n=42). Results from an intent‐to‐treat (ITT) analysis indicated that there were no statistically significant differences between the two arms across the three assessment time points (including one month post intervention) for the main outcomes (Behavioural Assessment Checklist‐Revised, β= 4.60 [95%CI, ‐1.60 to 10.88], p= .148; PTSD Checklist, β= ‐1.47 [95%CI, ‐4.30 to 1.36], p= .303). Post hoc Reliable Change analyses suggested twice the number of AD participants made progress in addressing PTSD symptoms compared to usual care (30.3% vs 17.6%, OR 2.03 [95%CI, .64 to 6.43]). Whilst further work in this area is required, initial results, overall, suggest that psychoeducational group based treatment modalities achieve only small effect sizes in comparison to usual care.
... The concept of trauma-informed care has seen rapid development and application. The need for trauma informed care was first articulated by Harris and Fallot (2001) as part of an argument for universal trauma screening and assessment that they envisioned would have the benefit of minimizing retraumatization within human service environments. These researchers, along with others since, have drawn a clear and consistent distinction between trauma treatment, which is intervention designed to treat disorders/symptoms associated with having experienced a trauma, and trauma-informed care, which is an overarching framework that emphasizes the impact of trauma and guides systems of care to be sensitive to the specific needs of trauma survivors. ...
... In order to help move a service user toward making a choice to change their behavior, MI emphasizes the importance of skilled, empathetic, reflective listening to understand a person's feelings and perspectives without judging, criticizing or blaming and the need to support service users' self-efficacy and agency in deciding on and enacting change. These tenets are consistent with the TVIC principles of creating safe and trustworthy environments where choice and collaboration are emphasized (Harris & Fallot, 2001). MI is also consistent with the TVIC emphasis on maintaining a nonjudgmental stance and focusing on service user agency and choice. ...
... Feminist theory and feminist movements focus on empowerment, disruption of oppressive systems, and the acknowledgment of patriarchy as violence which provided a framework for domestic violence counseling and anti-violence movements (Brown, 2009;Shepard & Pence, 1999). Trauma-informed counseling requires the counselor to understand the presentation of mental health symptoms as adaptations to trauma, consider the usefulness of maladaptive behavior, and develop services with an assumption that safety and trust are built over time (Harris & Fallot, 2001). When working with survivors of intimate partner violence, this is especially important given that survivors often have ongoing relationships with their abusers in which dynamics of power and privilege are often incorporated into tactics of abuse (Breiding et al., 2014). ...
... While literature focused on clinical supervision of domestic violence counselors is limited, trauma-informed care is a well-established construct referencing the practice and organizations offering services to survivors (Harris & Fallot, 2001). A trauma-informed care approach includes four assertions in the setting in which it is employed: a) realizing the pervasiveness and impact of trauma; b) recognizing how trauma affects all individuals, families, or systems it occurs within; c) responding with policies and practices that integrate knowledge of trauma; and d) ensure individuals do not experience re-traumatization (Substance abuse and mental health services administration [SAMHSA], 2014). ...
Article
The domestic violence counselor provides counseling services focused on safety, empowerment, psychoeducation, and support. When domestic violence counselors are trained as professional counselors or social workers, they integrate clinical counseling services into their work. Clinical supervision offers these counselors opportunities to meet requirements for state licensure. This article provides an overview of findings of a qualitative study which explored seven domestic violence counselors’ experiences of clinical supervision. Interpretive phenomenological analysis methodology was utilized. Findings reveal that participants had experiences of simultaneous individual and relational development during clinical supervision. In order to support the specific needs of domestic violence, counselor’s recommendations are made for the use of relational-cultural theory as a framework for clinical supervision.
... It developed in response to the growing awareness of the prevalence and impact of adversity across the human experience and the knowledge that organizations can unintentionally perpetuate and reactivate trauma (Bloom & Farragher, 2013). Trauma-informed care is based upon five principles (i.e., safety, trustworthiness, choice, collaboration and empowerment) that are infused across an organization with implications intended for clients, staff and administration (Fallot & Harris, 2008;Harris & Fallot, 2001). Further, trauma-informed organizations recognize the voices and contributions of all members which may be different from traditional top-down organizational structures (Anheier, 2000). ...
Article
Background: Organizations supporting individuals with intellectual and developmental disabilities (IDD) are challenged with maintaining a viable workforce of direct support professionals (DSPs). Amid multiple factors, organizational culture based on trauma-informed care may promote DSP retention through increased satisfaction and decreased fatigue. Method: An online survey was used to gather data from DSPs (n = 380) across seven agencies and two online social media groups. Data were analysed using stepwise regression to identify the relationship between trauma-informed organizational culture and professional quality of life (i.e., satisfaction, burnout and secondary traumatic stress). Results: Trauma-informed organizational culture was associated with increased DSP psychological wellness. Regression models explained 7.3%-40.5% of the variance in professional quality of life. Conclusions: Although trauma-informed initiatives have lagged in IDD services, this study provides preliminary evidence to bolster its justification, highlighting it as a possible partial response to the current workforce challenges.
... However, over the past several years, there has been a significant upturn in the recognition of the needs of trauma survivors and a growing commitment to overcome this blind spot. Evidence of this shift is visible in the surge of trauma-informed articles and best practice guidelines being published (Harris & Fallot, 2001b;; Jean Tweed Centre, 2013;; Klinic Community Health Centre, 2013;; Poole & Greaves, 2012;; Schachter, Stalker, Teram, Lasiuk, & Danilkewich, 2008). A traumainformed framework that is founded on principles of safety, trust, collaboration, choice, and shared power underpin a primary intention of services to realize the prevalence and impact of trauma in the lives of service participants and providers and seeks to respond in ways that avoid retraumatization/traumatization in the routine processes of service delivery (SAMHSA, 2014;; Jean Tweed Centre, 2013). ...
... The six key principles of a trauma-informed approach based on the existing literature were safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; cultural, historical, and gender issues (Farragher & Yanosy, 2005;Harris & Fallot, 2001; Substance Abuse & Mental Health Service Administration, 2014). ...
Thesis
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The purpose of this hermeneutical, phenomenological study described the experience of university educators using trauma-informed instructional practices during a global education disruption for university educators at Southeast University (pseudonym). The theory guiding this study is Richardson’s metatheory of resilience and resiliency (which describes an individual’s natural flow between homeostasis, through disruption, and adjunct to the disruption as part of the natural order of adaptation. The study addresses the following questions: How do university educators describe their experiences with trauma-informed teaching during a global education disruption? What formal strategies have university educators implemented to build social and emotional skills for students during COVID-19? How do university educators describe their self-awareness of compassion fatigue during COVID-19? What types of self-care do university educators find effective in mitigating compassion fatigue? Through the collection and analysis of data, the themes that were identified were (a) job satisfaction, (b) organization culture, (c) compounding effect of stressors, (d) resilience, and (e) self-care strategies. This study provided a voice to university faculty who leverage trauma-informed practices in the university environment during education disruption.
... While some wrote about the recent wildfire, others wrote about past experiences that they had not previously disclosed. The findings of this study speak to the importance of providing trauma-informed care [55][56][57][58], particularly when dealing with individuals following a disaster. Since the immediate trauma may not be the primary concern faced by disaster survivors, it is imperative that individuals, specifically pregnant women, be screened for immediate safety, be treated with the assumption that there is a history of past trauma, and be screened for any potential impacts of previous and current trauma [59]. ...
Article
The worst disaster of natural origin in recent Canadian history occurred in May 2016 in the northern Alberta community of Fort McMurray Wood Buffalo (FMWB). Among the 88,000 people abruptly evacuated amidst a raging wildfire were approximately 1850 pregnant or pre-conception women. Based on the Allostatic Load and Preterm Birth Conceptual Framework (Olson et al., 2015) [1], a simple, cost-effective expressive writing intervention following Pennebaker's work (Pennebaker and Beall, 1986; Pennebaker et al., 2007) [2,3] was implemented in a primary study to help mitigate the negative effects of stress on a sample of these women and their unborn children. Journal writing served as an intervention in the primary study while the contents of the journal entries became the data analyzed in this qualitative study. This study utilized both inductive and deductive thematic analysis of journal entries completed by 54 women over four consecutive days (15 min/day). Deductive analysis followed a coding structure that was generated from two resilience scales. Themes that emerged during inductive analysis were also coded. The main themes that emerged described the women's challenging experiences: fears for themselves and their offspring, fire-related and past trauma, and relationship changes. Resilience characteristics and practices also emerged from the writings and mirrored those found in the literature: (a) post-traumatic growth, (b) adaptability, (c) emotional/social connectedness, (d) composure, and (e) reasoning. This paper highlights the challenging experiences of pregnant women exposed to a disaster and the resilience they demonstrated in the face of the tragedy.
... Trauma, be it isolated experiences or more complex, sustained abuse, family trauma and community trauma over time, has affected the majority of people presenting to services with mental distress. A trauma focus needs to permeate our response [31]. ...
Article
Psychiatry treats human problems expressed through bodily symptoms and aims to be person-centred, but is often not experienced as such. Experience of mental healthcare care can be profoundly traumatising. The aim of this article is to explore some of the barriers to person-centred care in psychiatry, and to explore ways of integrating the knowledge held by patients with that held by psychiatrists. Barriers include a lack of acknowledgement of the centrality of trauma experiences in the development of mental illness. Other factors include the effects of exposure to psychological trauma as a doctor, being unconsciously motivated by one's own early life experiences, and internalising the stigma around mental ill-health in patients and in clinicians, as a clinician. The discipline suffers from limitations on the knowledge base. Phenomenological accounts and lived experience research must have higher priority in psychiatric education in order for the discipline to gain both scientifically and ethically. One of the aims of this article is to explore philosophical ideas around reconciliation of apparently opposing narratives and explanatory models in psychiatry, ideas which have the potential to shift power relations and enable renewed focus on what is most meaningful to patients. There is an argument for subjecting psychiatry to ongoing critique of purpose as well as method. In conclusion the form of psychiatry most likely to deliver person-centredness is one that can attend to its own prejudice, its unconscious, its values and those of its subject.
... FEPs indicated that trauma-informed approaches and strengths-based perspectives were over-arching paradigms that both influenced their personal dispositions and guided their practice strategies. Trauma-informed approaches recognize the presence of trauma symptoms and contextualize a person's behaviors within the context of that person's history, which often involves experiences of trauma (Harris & Fallot, 2001). Although none of the existing practice models explicitly identify trauma-informed approaches, many suggest that practitioners consider families' histories in their practice (e.g., Minnesota Department of Human Services, 2014). ...
Article
Objective This study developed a practice framework to identify and explain family engagement practice for school‐based service delivery. Background School–family–community partnerships expand the possibilities for family engagement by providing comprehensive services to families and children. No research to date has explored practitioners' perspectives of family engagement practice, and few practice frameworks exist to guide family engagement efforts. Method In this grounded theory study, we used qualitative interview data from 18 family engagement professionals (FEP) within one district‐wide, school‐based agency to identify the practices FEPs used to engage families in services. Results Analyses revealed that FEPs used a specific set of engagement practice strategies that included providing immediate and ongoing support, establishing rapport, establishing trust, and empowering families. These strategies were situated within a broader paradigmatic context and rooted in a set of core personal dispositions that were reflected in the framework. Implications This framework may be used to guide professional development activities, refine existing practice, and inform programmatic policies shaping school‐based family engagement initiatives.
... A trauma-informed approach focuses on safety, trustworthiness, choice, collaboration, empowerment, and cultural competence. Applying these principles when working with individuals with co-occurring disorders has been shown to foster resilience and recovery [27]. ...
Article
Full-text available
Purpose of review: Although treatment algorithms and parameters for best practice are readily available for all major syndromes of psychiatric impairment, the occurrence of psychiatric syndromes in individuals with intellectual and developmental disability (IDD) invokes serious contextual challenges for interpretation of symptoms, diagnosis, and optimization of treatment, both for clinicians and for the service sectors in which care and support of individuals with IDD are delivered. Recognizing that there exist very few definitive resources for best practice under the circumstance of this form of "dual diagnosis," the Missouri Department of Mental Health convened an expert panel to conduct a focused review and synthesis of the relevant scientific literature from which to develop guidance in the form of decision support to clinicians. This article summarizes the findings for three of the most common and impairing clusters of psychiatric symptoms that co-occur with IDD-aggression, depression, and addictions. Recent findings: Individuals with IDD are at high risk for the development of psychiatric symptoms (PS), which often manifest uniquely in IDD and for which evidence for effective intervention is steadily accruing. Interventions that are commonly implemented in the IDD service sector (e.g., functional communication training and positive behavioral support planning) are capable of mitigating severe behavioral impairment, yet rarely invoked when dual diagnosis patients are seen in the psychiatric service sector. Conversely, state-of-the-art interventions for traumatic stress, pharmacotherapy, and psychotherapy have proven capable of improving behavioral impairments in IDD but are typically restricted to the psychiatric service sector, where there exist significant barriers to access for patients with IDD, including limitations imposed by diagnostic eligibility and practitioner experience. Bridging these gaps in knowledge and clinical capacity across the respective IDD and PS service sectors should be of very high priority in strategizing the care and support of IDD patients with serious co-occurring psychiatric conditions.
... Hier bietet sich der sog. Trauma-Informed Approach an (Harris et al. 2001), also die Entwicklung von Trauma-Informed Communities durch eine umfassende Wissensverbreitung und Bewusstseinsbildung hinsichtlich der Prävalenz traumatischer Störungen. Diese Bewusstseinsbildung sollte Professionist/inn/en bzw. ...
... More useful engagement with parents may evolveaddressing perceived deficits in social work practice with parents involved with Social Services reporting confrontational interactions which leave them feeling powerless and unsupported, and a lack of concern and understanding for parents as individuals in their own right (Buckley et al., 2011;Bunting et al., 2017;Featherstone et al., 2014). In short, increasing awareness of ACEs and their impact over the life-course has the potential to move from a language of pathology, dysfunction and disorder -'what's wrong with you?'and encourage a curiosity about the lives of children, parents and families involved with child welfare social work -'what happened to you?' (Harris and Fallot, 2001). ...
Article
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This article describes the development of the ‘Family Life Stories’ practice workbook. The initiative emerged from a pilot social work strategy in Northern Ireland to utilise the Adverse Childhood Experiences (ACEs) research in frontline practice. ACEs research is currently having a significant impact on health and social care policy and practice across the UK. This article proposes that ACEs-awareness has potential benefits for child welfare social work, encouraging consideration of parent/caregivers’ and children's lives beyond presenting referral concerns, with many parents involved with child welfare services known to have experienced multiple adversities themselves. However, when applied in a reductionist manner, ACEs-informed practice risks amplifying parental powerlessness, exacerbating feelings of shame and blame, and rendering structural inequalities invisible to assessment. Based on systemic and narrative therapeutic principles, the Family Life Stories workbook and guidance seeks to address concerns by using participative mapping activities. These assist practitioners to have purposeful conversations with parents in ways that promote engagement. The workbook aims to provide opportunities to consider with parents how previous experiences have influenced their life stories, the impact on their current situation, and their wishes for their children – maximising the benefit for parental wellbeing and engagement, while maintaining a focus on child safety. Although lacking a rigorous independent evaluation, feedback from social workers involved in the pilot demonstrates provisional acceptability to practitioners and parents. This novel practice approach provides one example of how to use the ACEs research to promote sensitive relationship-based practice within a social justice framework.
... 'Trauma-informed perspective' referred to the negative effect of exposing to traumatic experiences revealed by clients on the workers (Harris & Fallot, 2001). Secondary traumatic stress has also been included in the Diagnostic and Statistical Manual of Mental Disorder (American Psychiatric Association (APA), 2013). ...
Article
After the COVID-19 outbreak, Social Workers across Borders (SWAB) was invited to organise crisis intervention training and supervisions for volunteer counselling teams. By reviewing the supervision records this paper found that the steps of ‘Sensitisation, Education, Scanning, Choice of Opting Out, and Recovery Facilitation’ (S-E-S-C-R) are useful to structure Trauma-Informed Supervision. Analysis indicated that volunteer counsellors have gone through three different stages, namely confusion, coordination and adaptation to changing crisis situations.
... This practice can be foundational in a former cult member's recovery. The Five Guiding Principles (safety, choice, collaboration, trustworthiness, and empowerment) help the psychotherapist partner with the former cult member as well as model a benign, reciprocative relationship (Harris & Fallot, 2001). These principles are an antidote to a culture that promotes absolute devotion to a traumatizing leader. ...
... This practice can be foundational in a former cult member's recovery. The Five Guiding Principles (safety, choice, collaboration, trustworthiness, and empowerment) help the psychotherapist partner with the former cult member as well as model a benign, reciprocative relationship (Harris & Fallot, 2001). These principles are an antidote to a culture that promotes absolute devotion to a traumatizing leader. ...
... TI approaches share conceptual congruence with theories of organizational culture and complexity, in that they each emphasize decentralization, collaboration, and autonomy as critical components of creating responsive organizations. The literature on TI care refers to these constructs by the verbiage of "collaboration" and "choice," but are defined by the extent that staff members throughout the organizational hierarchy experience autonomy and flexibility in their work roles and are able to participate in organizational activities and decision-making (Harris & Fallot, 2001). While the constructs amongst these theories are similar, the distinguishing features of the TI approach that differentiates them from "best organizational practices" is the motivation and intended consequences of their implementation. ...
Article
As an approach to organizational change, trauma‐informed care is contextualized within the broader organizational literature by examining the associations between organizational conditions (i.e., psychological experiences of choice and collaboration in the work environment) with precursors to organizational effectiveness (i.e., affective commitment and burnout). The study occurred within a large public hospital's behavioral health department located in the Western New York region (N = 197). Structural regression analyses were conducted, and the primary findings, while nuanced, include support for choice and collaboration's prediction of employee commitment and burnout. Organizational interventions that improve worker's experiences of choice and collaboration may result in increased commitment, reduced burnout, and possibly improved effectiveness. Future research should employ longitudinal designs to further examine the condition–performance relationship and include direct measures of clinical effectiveness.
... Whereas TIC is an overarching framework that is incorporated in all aspects of service delivery, treatments of trauma are specific to treating symptoms of mental health issues stemming from exposure to trauma. Although related, treatments of trauma can be supported by TIC or as a stand-alone practice (Harris and Fallot 2001). Despite empirical support for TIC and treatments of trauma for people with SMI, trauma and trauma-related issues are rarely addressed by mental health practitioners (Read et al. 2018;Salyers et al. 2004). ...
Article
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Assertive Community Treatment (ACT) is the most widely used evidence-based community mental health intervention for people with severe mental illness (SMI). Despite research showing that the vast majority of those with SMI have traumatic histories, the ACT service model does not have consistent guidelines on how to address trauma in their client population. This study employed thematic-analysis through interviewing ACT providers to better understand their perspectives on working with trauma in clients. Five overarching themes with 21 sub-themes emerged: the role and scope of ACT teams and model regarding trauma, discussions of trauma with clients, current treatment of trauma, barriers to working with trauma, and recommendations for enabling trauma discussions and treatment. Some examples for recommendations were: a need for more training regarding trauma, increasing resources like including a psychologist and trauma specialized professionals on the team, more support from leadership, and a cultural change from medicalization. Implications of the barriers and suggestions are discussed.
... This can be understood in the context of the damaging effects of trauma alongside the need and wait for therapy. We situate our findings in the context of trauma-informed approaches which can help to mitigate these effects [23][24][25]. 'Respect for the journey' is partly an expression of the profound ambivalence often felt about opening up and sharing as against withholding and 'heeding the natural tendency to protect oneself due to the implicit vulnerability that opening oneself up to others entails' [page 89 [26]]. It also reflects the weight of expectation brought to the assessment, characterised by the strength of emotions described and the need to feel safe to trust the assessor with their stories, their lives. ...
Article
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Purpose Psychotherapy assessments are key decision points for both clients and services, carrying considerable weight on both sides. Limited research indicates that assessments have immediate and long-term impacts on clients, particularly where trauma has been experienced, affecting engagement with therapy. Understanding assessments from clients’ perspectives can inform service development and improve client experience. Methods This is a survivor-led exploration of clients’ experiences of undergoing assessment for talking therapies. Interviews were conducted with seven people who had undergone assessment for psychological therapies in third sector and NHS services. Interviews were recorded, transcribed and analysed thematically. Results The core theme was ‘respect for the journey’ reflecting the need expressed by participants for their life experiences prior to the assessment to be given full respect and consideration. Six sub-themes were identified: trauma and desperation, fear of judgement, search for trust and safety, sharing and withholding (a balancing act), feeling deconstructed, and finding hope. Conclusions The findings highlight the heightened emotional power surrounding psychotherapy assessments, reflecting the journey participants had undertaken to reach this point. The dilemma facing clients at the heart of an assessment—how much to share and how much to withhold—demonstrates the importance for services and assessors of treating the journey a client has made to the assessment with care and respect. Findings indicate the value of services and practitioners undertaking a trauma-informed approach to assessment encounters.
... To be trauma-informed is to understand how traumatic experiences may have impacted the lives of individuals involved and to apply that understanding to every aspect of your service provision in order to meet and accommodate for the needs of trauma survivors (Butler et al., 2011;Carello & Butler, 2014;Harris & Fallot, 2001). Those who are trauma-informed understand that the primary goal is to ensure individual safety by minimizing possibilities for "inadvertent retraumatization or secondary traumatization" in the delivery of their services (Carello & Butler, 2014, p.156). ...
Article
Recent worldwide events have led to a dramatic increase in reported levels of anxiety in college students and individuals aged 18-29. If there is currently a marked increase in anxiety and stress responses in college age students and traumatic events negatively impact an individual’s ability to participate in their education, it is reasonable to assume that the occupational disruption that students are currently experiencing negatively impacts their ability to participate adequately in their education. This study explored the impact of trauma on graduate occupational therapy students (OTS) from entry-level programs. A mixed-methods survey was utilized to gain the perspectives of graduate OTS (n=74) currently attending programs in the Northeastern portion of the United States who have experienced acute, chronic, and/or complex trauma. Participants completed an online survey consisting of 26 Likert-style, true/false, and open-ended short answer questions. Results indicate that trauma is highly impactful on all areas of occupation, including education. Additionally, students indicated that they are fearful of stigma when discussing trauma and informing educators of its impacts on education, therefore benefiting from open and communicative educators. Further, results support previous research that trauma influences many aspects of academic performance, such as attention, memory, and volition. The information gathered indicates that educators should be aware of the likelihood of students being impacted by trauma and understand how to successfully support students universally through trauma-informed strategies.
... The term "trauma-informed" was introduced by Harris and Fallot in 2001 as a means to integrate an understanding of trauma and its aftereffects into mental health services, following the evidence that a significant number of individuals accessing mental health services were survivors of physical and sexual abuse (Harris and Fallot, 2001). Adopting a TIA attempts to embed an understanding of how experiences of trauma can become central to an individual's life course and life outcomes, having a profound negative effect on social outcomes, emotional wellbeing, mental and physical health, along with health-relevant behaviour (Poole and Greaves, 2012), impeding an individual's ability to seek out and engage with health and social services that are designed to help them (Barrett, 2019). ...
Article
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In this article, we outline and define for the first time the concept of shame-sensitivity and principles for shame-sensitive practice. We argue that shame-sensitive practice is essential for the trauma-informed approach. Experiences of trauma are widespread, and there exists a wealth of evidence directly correlating trauma to a range of poor social and health outcomes which incur substantial costs to individuals and to society. As such, trauma has been positioned as a significant public health issue which many argue necessitates a trauma-informed approach to health, care and social services along with public health. Shame is key emotional after effect of experiences of trauma, and an emerging literature argues that we may ‘have failed to see the obvious’ by neglecting to acknowledge the influence of shame on post-trauma states. We argue that the trauma-informed approach fails to adequately theorise and address shame, and that many of the aims of the trauma-informed are more effectively addressed through the concept and practice of shame-sensitivity. We begin by giving an overview of the trauma-informed paradigm, then consider shame as part of trauma, looking particularly at how shame manifests in post-trauma states in a chronic form. We explore how shame becomes a barrier to successful engagement with services, and finally conclude with a definition of the shame-sensitive concept and the principles for its practice.
... Strategies for doing so were first developed in order to provide trauma-informed healthcare services for patients with histories of trauma (esp. in Harris and Fallot 2001). That theoretical framework has since been applied to fields outside of medicine. ...
Article
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Should university instructors teach works with immoral content? What if the works are by deeply immoral thinkers? This guide is intended to help us answer these sorts of pedagogical questions by articulating the pertinent moral issues and then suggesting strategies for navigating them.
... Traumatic events include violence, abuse, neglect, loss, natural disasters, war and other harmful experiences (Copeland et al., 2007). Exposure to trauma is correlated to long-term psychological, cognitive, emotional and health challenges (Anda et al., 2006;Felitti et al., 1998) and is also known to impact on people's interactions with services (Harris and Fallot, 2001;New South Wales Agency for Clinical Innovation, NSWACI, 2019). TICP directs services to deliver care in ways that recognise the possibility of trauma in people's lives and minimises harm occurring in the course of service provision, through the integration of knowledge about trauma into policies, procedures and practices (SAMHSA, 2014). ...
Article
Purpose Trauma-informed care and practice (TICP) has gained international attention since the mid-1990s, but its recent adoption in Australia has been met with various barriers, including a lack of training and education opportunities to enhance professional knowledge and practice. This paper aims to identify and further understand what is occurring in TICP training and education for health and human service professionals in Australia; specifically, what is known about TICP content and training strategies being used. Design/methodology/approach A scoping methodology was used to undertake a systematic search of the literature to identify and map the scope and nature of research activity on TICP training and education for professionals in Australia. Based on the predetermined inclusion and exclusion criteria, removal of duplications, abstract review and full-text screening, six studies met the inclusion criteria for content analysis in this review. Findings The studies showed that TICP training and education was occurring predominantly in the Australian health sector for nursing professionals and improved knowledge, confidence to respond to disclosures of trauma and approaches to care. Training was commonly delivered through one-day workshops and brief Web-based approaches. The findings suggested that there is a need for consensus on TICP content to ensure that fidelity to the principles of TICP is promoted in unique workplace settings and for ongoing commitment by relevant stakeholders and funding bodies. Originality/value To the best of the authors’ knowledge, this is the first review exploring what is happening across disciplines and sectors for trauma-informed education. The findings have implications for clinicians, professionals, educators and researchers.
... The stories and experiences of women under COVID-19 are not new; the pandemic has exposed deep-rooted processes of exclusion. Acknowledging trauma and women's right to control, empowerment, and safety is vital to helping survivors heal (Herman, 1992;Harris and Fallot, 2001). ...
... Also, the 6 principles of the trauma-informed approach, namely: safety, trustworthiness and transparency, peer support, collaboration and mutuality, cultural, historical, and gender issues were taken into cognizance. [51][52][53] The intervention comprehensively assessed the risk factors that contributed to the psychological problems. The risk factors include poor mental health of the participants before and during the COVID-19 event, affected family members, other lifethreatening issues, fears, panic, family size, and level of household income. ...
Article
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Background: The outbreak of COVID-19 manifests in peoples' mental health and psychological dispositions and may also result to acute distress, depression, anxiety and post-traumatic stress disorder (PTSD) on victims. The objective of this study was to support business educators' and students' mental health against coronavirus trauma using trauma-focused cognitive behavioral therapy (TF-CBT). Methods: The participants (n = 74 - educators and students) who indicated PTSD symptoms based on the self-reporting questionnaire they filled, were randomly assigned to treatment and waitlist control groups. The TF-CBT manual was used for the intervention. The intervention was a 14-week treatment with 2 weeks follow-up meeting. Using repeated measures of Analysis of Variance, we determined the level of improvement of each participant in the treatment group against Coronavirus trauma at the end of the intervention. Results: The study established that gender has no significant difference in determining the effects of Coronavirus trauma on participants. Through intervention, the PTSDs and depression arising from Coronavirus event were significantly reduced in the treatment group. Again, there was a significant improvement in the participants' general mental health at the end of the intervention. Hence, we established the implication for research and practice in line with the outcome of the study. The study advocates that TF-CBT should be employed by educational institutions in Nigeria to cushion the traumatic effects of coronavirus and future disasters on both workers and students. Conclusion: We conclude that mental health problems remain a serious challenge among business educators and students in this COVID-19 pandemic era. The study established that low educational qualifications, PTSD symptoms and negative coping strategies are the factors aggravating the general low mental health of the study participants. Finally, we advocate that the educational institutions in Nigeria should adopt TF-CBT interventions to support staff and students' mental health against adverse effects of COVID-19.
... Given the current findings that demonstrate high prevalence rates of comorbid symptomology rates in prison personnel in relation to trauma, and that these are consistent with findings in other countries (Denhof & Spinaris, 2016;Konda et al., 2013;Spinaris et al., 2012) there is substantial evidence to propose taking active and ongoing steps through policy recommendations, to counter its effects as a necessity in prison organisations, as addressing individual symptoms alone is ineffective in bringing about lasting positive and collective change. Trauma informed approaches are one such recommendation (Harris & Fallot, 2001;SAMHSA, 2012) and have been implemented in various prison establishments but not always collectively in organisations. When implementing such an approach, all components of the organisation receive ongoing education regarding the prevalence of trauma and the nature of its impact, and the ways in which trauma can affect operation, and the various complex ways in which people recover from trauma. ...
Article
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Objective The aim of the study was to identify meaningful subtypes of anxiety, depression, and PTSD symptomology amongst Prison Personnel. A further aim was to estimate the association between anxiety, depression and PTSD class membership and typology of Prison Trauma Exposure (Self-Harm/Death, Violent, Environmental) age and years of service, and differentiations between male and female personnel. Method A non-probability convenience sample of 1995 Prison Personnel in the UK completed the Prison Personnel Trauma Measure (PPTM), Hospital Anxiety and Depression Scale (HADS) and the Posttraumatic Stress Disorder Checklist – Civilian Version (PCL-C). Results Latent profile analysis revealed seven distinct classes in male personnel including a ‘heightened symptom’ (16.8%) and a ‘high symptom group’ (10.3%) and five distinct classes in female personnel including a ‘above moderate symptom group’ (28.4%) and a ‘high symptom group’ (18.1%). Multinomial logistic regression showed that male prison personnel in the ‘moderate with increased PTSD-C and low PTSD-B group’ and the ‘heightened symptom group’ were more likely to be exposed to environmental trauma, whereas male prison personnel in the ‘high symptom group’ were more likely to be exposed to environmental trauma, self-harm/death in prison and have significantly less years of service. Female prison personnel in the ‘moderate symptom group’ were more likely to be exposed to environmental and violent trauma, whereas in the ‘high symptom group’ females were more likely to be exposed to violent trauma. Conclusion Findings suggest distinctions between anxiety, depression and PTSD symptomology amongst male and female prison personnel and typology of prison trauma exposure. The significance of the present findings is discussed in relation to past and future research as well as policy implications and practice.
... steps to promote healing from past trauma (Harris & Fallot, 2001). TIC is used in multiple service systems, including health care, behavioral health, education, and child welfare (National Child Traumatic Stress Network, n.d.). ...
... The perspective of accepting a 'different' understanding of mental health could be a starting point for professionals' respectful exploration of migrants' cultural belief systems to reach a shared understanding of problems (Karageorge et al., 2017;Procter, 2016). A person-centered approach that shifts from the perspective of "what's wrong with you?" to "what happened to you?" (Harris & Fallot, 2001) may be particularly helpful for professionals trying to make sense of presentations that may differ from the host country's social norms. Adopting an open and curious approach to exploring differences further facilitates culturally competent practice (Bansal, 2016;Epner & Baile, 2012). ...
Article
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Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals’ attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals’ emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants’ needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.
... The key principles of trauma-informed care are safety, collaboration, empowerment, trustworthiness, and choice (Harris & Fallot, 2001). Each principle offers insight in systems design and highlights areas wherein we can attend to the patient experience. ...
Article
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OBJECTIVE To raise awareness and understanding about the role of trauma in the development of substance use and to define and clarify the need for trauma-informed care within the treatment of patients with substance use disorders (SUDs). METHOD This article reviews the up-to-date literature on how and why traumatic life experiences promote a neurobiological vulnerability to development of SUDs and combines this with a discussion of the principles of trauma-informed care for SUDs, as well as a review of the role of stigma and structural violence as foundational concepts in the implementation of trauma-informed care for people with SUDs. RESULTS Shifting to a trauma-informed care paradigm in treating SUDs more effectively serves patients by improving patient experiences and accounting for a chronic disease model, wherein multiple episodes of SUD care are often necessary. CONCLUSIONS This article reviews the ways in which nurses and other service providers can increase SUD patient retention and decrease recurrence by understanding the role of trauma in the development of SUDs, exploring the role of stigma, and identifying and interrupting structural violence as it relates to SUDs. This article also offers actionable steps that all nurses can take now as well as areas for further inquiry into trauma-informed care substance use services.
... In our previous research, many in the sector spoke to us about the importance of trauma-informed care (Gerard et al. 2019), a central tenet of which is a focus on the individual rather than their behaviour (Harris & Fallot 2001). Although many of our respondents recognised the traumatic histories of care-experienced children, it appears the management of their problematic behaviour was prioritised over a holistic understanding of their individual circumstances. ...
Book
The current study examines the factors underlying pathways from out-of-home care into the criminal justice system. Using a multi-method approach—specifically, court observations, file reviews and qualitative interviews—we found evidence of how histories of trauma and situational factors relating to the care environment interact to increase criminalisation. While many policy initiatives have been developed to address this criminalisation, in all parts of our study we found little evidence these are having an impact on practice in relation to care-experienced children. Some innovations we observed in our United Kingdom case study offer potential solutions to address this serious and ongoing problem.
... Trauma-informed teaching and learning is a valuable pedagogical practice, even when there is no community-level crisis, but becomes even more relevant when campuses are facing disruptions. Developed out of trauma-informed approaches to improve clinical practice and social service delivery (Harris & Fallot, 2001), a trauma-informed approach to teaching assumes that many students have been affected by trauma, recognizes the signs and symptoms of trauma, responds by integrating knowledge of trauma into policies and practices, and actively works to resist retraumatization (Substance Abuse and Mental Health Services Administration, 2014). Trauma-informed education is defined as understanding the ways in which violence, victimization, and other forms of trauma can affect all members of the campus community, using that understanding to inform policy, practices, and curricula to minimize trauma and to maximize educational success (Carello & Butler, 2015). ...
Article
The COVID-19 pandemic of 2020 resulted in major disruption for social work education, as many teachers and programs shifted from on-campus classes to remote or blended teaching using digital technologies. Social work educators have an opportunity to apply the lessons learned from the COVID-19 pandemic to meet the needs of students and communities in ways that are grounded in our professional values. Due to the pandemic, many students and faculty were learning and teaching via online education for the first time and managing personal and community trauma. The purpose of this article is to provide social work educators with a practical, theory-informed approach that supports an unexpected switch to crisis teaching in times of extended crisis, to maintain quality education, and move toward best practices gleaned from trauma-informed approaches. We describe theoretical frameworks that can inform educational practices and decision making in times of disruption. Then we offer trauma-informed teaching and learning principles and technology-mediated strategies for best practices in crisis course design and delivery. We share practical strategies for the delivery of social work education that are especially needed in times of disruption.
... The stories and experiences of women under COVID-19 are not new; the pandemic has exposed deep-rooted processes of exclusion. Acknowledging trauma and women's right to control, empowerment, and safety is vital to helping survivors heal (Herman, 1992;Harris and Fallot, 2001). ...
Book
Full-text available
This two-volume set of Rapid Responses explores the urgent need to put co-production and participatory approaches at the heart of responses to the pandemic and demonstrates how policymakers, health and social care practitioners, patients, service users, carers, and public contributors can make this happen. The first volume investigates how, at the outset of the pandemic, the limits of existing structures severely undermined the potential of co-production. It also gives voice to a diversity of marginalised communities to illustrate how they have been affected and to demonstrate why co-produced responses are so important both now during this pandemic and in the future.
... These therapies focus on healing aspects like not being able to see painful images or how to cope with PTSD, through therapies such as desensitization. 148 Cognitive Behavioral therapies have been proven to have amazing results in treating PTSD for trauma patients. 149 This technique focuses on "the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains." ...
... The principles of trauma-informed practice. Adapted from SAMHSA (2014) andHarris and Fallot (2001). ...
Article
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This paper presents a unique school-based programme that harnesses the benefits of both trauma-informed practice (TIP) and outdoor environments to support children’s social and emotional wellbeing throughout the pandemic and beyond. In the opening sections of the paper, we discuss the extant literature and conceptual underpinning of TIP and outdoor learning, and highlight why both are needed, particularly in the context of Covid-19. We then chart the design of a six-week outdoor trauma-informed programme, devised to support children’s emotional regulation and overall sense of wellbeing. The programme activities are aligned to the Northern Ireland curriculum, and are tailored to make use of the outdoor spaces available in the first author’s place of work – a primary school in South Belfast. We conclude the paper by highlighting the importance of trauma-informed curriculum and pedagogical innovations and note future directions for trauma-informed schools. Whilst there are many generic guidelines on trauma-informed care in schools, this paper makes a distinct contribution to the field; firstly by demonstrating how teachers can use their craft – teaching – as a component of TIP; and secondly by infusing trauma-informed principles within outdoor learning environments.
... A trauma-informed care framework was also chosen to specifically guide the debriefing component of this study. Traumainformed care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of traumatic events that emphasizes physical, psychological, and emotional safety for both providers and survivors and creates opportunities for provision of services that assists survivors in rebuilding a sense of control and empowerment (Harris & Fallot, 2001). ...
Article
Background: Palliative simulation is a beneficial bridge between theory and practice; however, it can be emotionally laden. Often overlooked during a debrief session of a palliative simulation is ensuring that participants have the skills to process the feelings they may experience. Method: The purpose of this mixed-methods concurrent triangulation study was to understand the perceived value and usefulness of debriefing in palliative simulation process feelings and emotions. Results: The simulation modality affects the intensity of feelings. A debriefer who is skilled in both debriefing simulation and coping with emotionally stressful situations allowed students to feel prepared to cope with their own feelings about palliative care. Having other students talk about their feelings in debriefing helped students to normalize their feelings. Conclusion: The debriefing in palliative-based simulations requires additional considerations regarding modality and the skill set of the debriefer to adequately assist students to process feelings and emotions. [J Nurs Educ. 2019;58(10):569-576.].
Article
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Background: Agencies and clinical practices are beginning to provide trauma-informed care (TIC) to their clients. However, there are no measures to assess clients' perceptions of and satisfaction with the TIC care they have received. A 20-item questionnaire, the TIC Grade, was developed, based on the National Center for Trauma-Informed Care principles of TIC, to assess the patient or client perception of the TIC provided in settings that serve adolescents and emerging adults. Objective: The goal of this project was to evaluate the psychometric properties of the TIC Grade instrument and to make recommendations for use of the full measure and its short form-an overall letter grade. Study design: The TIC Grade questionnaire was administered to youth over the age of 18 years from four community partners providing care to vulnerable young adults. Potential participants were offered questionnaires at the end of their visit. Those interested in participating left their completed anonymous questionnaire in a locked box to maintain confidentiality. Questionnaires were collected from 100 respondents; 95 were complete enough to include in analyses for psychometric evaluation. Results: The findings of this project support the reliability and usability of the 20-item TIC Grade measure to assess youth's perceptions of the quality of TIC they received. Conclusions: This TIC-specific, behaviorally worded client report measure can assist service delivery organizations to assess their success at implementing TIC and to identify areas where further staff training and support are needed.
Article
In elementary general music, the need for culturally responsive pedagogies and trauma-informed practices may coexist. Creating an environment and developing instruction in ways that are both culturally responsive and trauma-informed may be possible, because both approaches share common theoretical underpinnings and practices. In this article, we review the research on culturally responsive music education and trauma-informed practices and make practical suggestions for implementing these pedagogies in elementary general music classes.
Article
A growing body of literature indicates that individuals who commit sexual offences have significant histories of childhood trauma. Clinicians who provide sex-offending treatment (SOTX) are increasingly asked to integrate trauma-informed principles into their work with these clients. However, no research has been conducted exploring how SOTX clinicians are integrating either trauma-informed care (TIC) and/or trauma-focused treatments (TFTs) into their work with clients. This mixed-method study used two parallel surveys (one for SOTX clinicians (n = 66) and another for clients (n = 146)) to capture their perceptions regarding how trauma work is incorporated into SOTX. Independent samples t-tests indicated that on every item designed to measure TIC, clinicians rated themselves significantly higher than the clients rated clinicians. The results also indicated that clients perceive SOTX therapists to neglect the therapeutic value of understanding trauma histories. Some clients reported that they were discouraged from discussing childhood adversity in treatment. Implications for TIC SOTX practice are discussed.
Chapter
Direct practice is the application of theory and/or methods to the resolution and prevention of psychosocial problems experienced by individuals, families, and groups. In this chapter, I discuss trauma-informed care as a direct practice intervention for disasters. I focus on natural disasters such as fires, hurricanes, and floods, acknowledging that some disasters are man-made and some are a combination. Trauma-informed care is not intended to diagnose or treat trauma-related conditions. Instead, trauma-informed care is a universal precautions approach (Kusmaul & Anderson, 2018) that treats all survivors as if they might have adverse effects from traumatic events that are both known and unknown but may be affecting survivors and responders either way (Bloom, Creating sanctuary: Toward the evolution of sane societies (Revised Edition). New York: Routledge, 2013). This chapter begins with disaster risks in specific communities and globally, trauma-related psychological conditions, and the components of trauma-informed care: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues (SAMHSA, SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014). Then existing evidence on the benefits of trauma-informed care is reviewed. The conclusion focuses on the need for trauma-informed approaches in disaster response and recovery. Trauma-informed care is important for improving psychosocial outcomes of everyone impacted by disasters, including those with past traumatic experiences.
Article
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Background: Foreign-born children rarely use traditional school mental health services. Comprehensive programs that combine mental health services with academic, economic, and socioemotional supports reach more foreign-born children and improve wellbeing. However, little practical guidance exists regarding how to best combine these diverse services. Methods: To identify essential service components and their organization, we interviewed 92 parents, school staff, mental health providers, and community agency staff from 5 school-linked mental health programs designed specifically to serve immigrant and refugee youth. Results: Foreign-born parents did not distinguish between academic, behavioral, and emotional help for their children; these western categorizations of functioning were not meaningful to them. Consequently, programs needed to combine 4 components, organized in a pyramid: family engagement, assistance with basic needs, assistance with adaptation to a new culture, and emotional and behavioral supports. Family engagement was the foundation upon which all other services depended. Assistance with economic and cultural stressors directly promoted emotional wellbeing and helped parents trust clinical mental health interventions. Conclusions: Specific strategies to implement the 4 essential components include home visits by program staff, a one-stop parent center located in the school to help with basic needs, working with cultural brokers, and informed consent procedures that clearly explain recommended care without requiring immigrant and refugee parents to internalize western conceptualizations of psychopathology. Future evaluations should assess the cost and effectiveness of these strategies. These data are essential to advocate payment for these nonclinical services by traditional funding mechanisms.
Article
The Rivers Centre in Edinburgh, Scotland (United Kingdom) operated for nearly 20 years as a traditional specialist trauma service, delivering psychological therapies to an adult population affected by trauma. Embedded in a health and social care system whose characteristics were unhelpful for people with histories of insecure attachment experiences, the Rivers Centre aimed to find a different way of working, and in January 2017, it relaunched with a new model of service. The aim of this paper is to describe the new service model from an organizational perspective in the context of attachment theory. At the heart of the model is the premise that to be effective, a trauma service needs to provide people with an alternative model of attachment. Early signs from service audit data indicate that an attachment-based way of working can improve engagement and can provide a supportive and responsive environment in which people can learn to recover. © 2019 International Society for Traumatic Stress Studies.
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