Trauma-informed training and service redesign

What is it?

Trauma occurs when an event or set of circumstances causes physical or emotional harm which leads to lasting adverse effects on wellbeing. Research on trauma has often focused on Adverse Childhood Experiences (ACEs). ACEs are a set of negative childhood experiences. They have a long-term relationship with children’s development, including their involvement in crime and violence. ACEs can include experience of abuse or neglect, having a close family member in prison, or witnessing violence in the home.

This summary focuses on training and other workforce changes whose primary aim is to improve staff understanding and response to trauma. There are many interventions that are informed by an understanding of trauma but are not included in the scope of this summary. For example, this summary does not include specialist interventions which support individual recovery from trauma, such as trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing. There are other interventions which are informed by knowledge of trauma but do not primarily focus on developing understanding of trauma as their core component. For example, anti-bullying programmes often support teachers to understand that trauma could negatively affect pupils’ ability to cope with school, but this is just one of many important components in these programmes.

Typically, the activity covered by this summary supports organisations and their staff to:

• Realise the impact that trauma can have on children;
• Recognise the signs and symptoms of trauma;
• Respond to trauma by integrating knowledge and research on trauma into policies, procedures and practices; and
• Prevent retraumatisation by avoiding practices that could inadvertently trigger painful and traumatic memories.

Much of the activity examined in this summary has focused on workforce development, including:

• Training staff on the impact of trauma and how to recognise its signs and symptoms
• Ensuring that staff have the knowledge and skills to respond effectively to trauma and avoid retraumatisation.
• Attempting to address and reduce trauma amongst staff
• Assessing and monitoring staff knowledge and practice

There have also been many attempts at broader redesign of services, policies, and procedures to address trauma explicitly and directly. For example:

• Writing organisational policies which provide support for the principles of trauma-informed practice.
• Modifying the physical environment to reduce possible trauma triggers such as loud noises.
• Introducing screening and assessment tools to assess children’s trauma history and symptoms.
• Attempting to increase access to specialist services for children who have experienced trauma and need additional help.

Is it effective?

There is very little research on the impact of training staff and redesigning systems with the primary aim of recognising and responding to trauma. There is insufficient evidence to calculate an estimate of the impact of this activity on crime and violence.

There is insufficient evidence to calculate an estimate of the impact of this activity on crime and violence.

It is important to note that an understanding of trauma is likely to be an important component of many successful approaches and programmes. It is central to the rationale for many other approaches in the Toolkit, including many anti-bullying programmes and focused deterrence. But these programmes are out of scope for this summary – they combine an understanding of trauma and a desire to respond effectively with many other components.

How secure is the evidence?

The research on the impact of trauma-informed training and service redesign is very weak. There is not sufficient evidence to describe the average impact on crime and violence.

We found two existing systematic reviews on this topic. The first review focused on activity in schools but included no evaluations. The second review focused on activity in child welfare services and found 17 evaluations. However, this review concluded that the available studies could not support an overall judgement about the impact of this approach. All of the evaluations in the second review were based in the USA. We also found a narrative review of programmes in the criminal justice system. However, this review also found very few impact evaluations and did not conduct a systematic analysis.

How can you implement it well?

Ensure the approach is clearly defined

Recent work has raised concerns that much trauma-informed professional development can lack specificity and clear recommendations for improvements to practice. If you are commissioning or designing training, does the training give clear guidance on what you expect practitioners to do differently?

Develop an evidence-informed and preventative approach

Organisations can use their developing awareness of trauma to motivate investment in evidence-based interventions that could prevent trauma occurring in the first place. This can include intensive home visiting for vulnerable parents. See this EIF report for more guidance on the interventions available.

Ensure that children have access to specialist support if they need it

The evidence base for interventions which support individual recovery from trauma, such as trauma-focused cognitive behavioural therapy, is more established. Trauma-informed organisations should ensure that these interventions are available for children who need them. Unfortunately, there are still long waiting times for CAMHS support and it can be very difficult for children to access psychological therapy.

How much does it cost?

Currently, we do not have enough evidence to provide a headline cost rating. The costs are likely to vary widely depending on the approach taken.

Topic summary

• Research into trauma and adverse childhood experiences (ACEs) has raised awareness of the impacts of adversity on later outcomes. Developing awareness of trauma amongst practitioners working with children might support kinder practice and more careful consideration of children’s contexts and previous experiences.  
• However, we do not fully understand whether training or service redesign that explicitly focuses on understanding or responding to trauma is sufficient for reductions in crime and violence.  
• Trauma-informed organisations should invest in evidence-based interventions that could prevent trauma and ensure that children have access to specialist support if they need it. See this EIF report for more guidance on the interventions available.   
• Organisations introducing trauma-informed training should be clear about the practices they seek to change and assess whether these aims are being met. 
• Future research should focus on clearly specifying and rigorously evaluating models of trauma-informed training and service redesign.  

Take away messages

• Don’t prioritise trauma-informed training over provision of evidence-based trauma-specific therapies.  
• Be clear about the practices you seek to change and assess whether these aims are being met.  

External links

Adverse childhood experiences: What we know, what we don’t know, and what should happen next
A rigorous and detailed overview of the research relating to the prevalence, impact and treatment of ACEs.

Substance Abuse and Mental Health Administration (SAMSHA) guidelines on trauma informed practice
Guidelines on how organisations can implement a trauma informed approach.

Trauma-informed practice briefing
A highly accessible and brief overview of thinking on trauma and ACEs, published by HM Inspectorate of Probation