Why are we doing this study?

Trauma can be caused by harmful experiences such as childhood mistreatment, domestic abuse and community violence. Experiences of trauma can be made worse by social inequalities like racism, sexism, and poverty. COVID has caused additional trauma and increased inequalities. Current UK health care services do not acknowledge trauma when treating patients. This can result in patients and staff being re-traumatised by the health care system.

A trauma-informed approach is a new way of providing health care services. It aims to involve patients and staff to create an environment where everyone feels safe, can develop trusting relationships, and can engage in treatment. Many policies and guidelines recommend that health care organisations take a trauma-informed approach. However, there is not a lot of evidence to show whether this approach actually helps patients and staff have a better experience of health care.

What are we doing?

We are working with people with lived experience of trauma, and health care professionals, to understand if a trauma-informed approach is better than “business as usual” and how a trauma-informed approach could be implemented in the UK health care.

We have reviewed existing studies to find out:

• the effectiveness of a trauma-informed approach in health care (see also the study protocol and further information on the NIHR Bristol Biomedical Research Centre website).
• whether a trauma-informed approach is acceptable to patients and health care staff.
• the effectiveness of staff training programmes on a trauma-informed approach
• the policy landscape for trauma-informed health care.

We are carrying out a study in GP practices to help us understand what might make it easier or more difficult to implement a trauma-informed approach.

What did we find?

In the review of existing studies, we found that:

• Health care organisations implemented trauma-informed approaches through various components. These included: allocated budget, ongoing staff training and support, identification of patients affected by trauma, improvement of environment, cross-sector collaboration, engagement of people with lived experience, support from management, written policies and procedures, and ongoing evaluation.
• There was evidence that combining all of these components together could create a safe health care environment for patients and staff, leading to improvements in patients’ health and satisfaction.
• There was some evidence that training health care staff in a trauma-informed approach had some positive short-term effects. There was no evidence of any long-term effects.
• None of the studies evaluated the health and wellbeing of health care staff, or cost-effectiveness.

In the policy review we found that some staff had concerns about the feasibility of implementing a trauma-informed approach in the current UK health care system.

There were different interpretations of a “trauma-informed approach” and that different organisations implemented the approach in different ways.

In the interviews we identified some ways that it might be difficult to implement a trauma-informed approach in the UK health care system:

• It is difficult to get ongoing funding.
• Health care organisations may not have enough staff to implement the approach, and existing staff are already under a lot of pressure.
• There is no national or NHS policy or guidance, nor is there an explicit commitment to provide trauma-informed health care.

What needs to happen next?

• We need evidence-informed guidance from the government on how and when health care organisations should implement a trauma-informed approach.
• We need an explicit commitment from the government to implement a trauma-informed approach in health care.
• Every organisation that implements a trauma-informed approach needs: experts in this topic, allocated budget, ongoing staff training and support , safe physical and psychological environments, cross-sector collaboration, engagement of people with lived experience, support from management, written policies and procedures, and ongoing monitoring and evaluation.
• Any framework for a trauma-informed approach should be tailored to the specific needs of each individual organisation and its patients.
• We need evidence on the effectiveness and cost-effectiveness of trauma-informed approaches in the UK. Every trauma-informed initiative should have funding for an evaluation that uses the same evidence-based measures.
• Local working groups, experts in the trauma-informed approach and people with lived-experience need a way to share resources and learning across all of the UK to prevent ‘re-inventing the wheel’, for example, through a national forum.

Where can I find out more?

We are collaborating with The Survivors Trust and PolicyBristol to share our findings with policy makers, health professionals and the public.

We have created or are in the process of creating:

• A webinar (19 July 2022), which was attended by 280 health care professionals, researchers, policy makers, people with lived experience, funders and others.
  
  • webinar recording (YouTube)
    
  • webinar transcript (Office document, 37kB)
  • ‌webinar slide set (PDF, 1,299kB)
  • webinar Q&As (Office document, 39kB)
• An animation
• Infographics illustrating key findings: TAP CARE Study infographics (PDF, 368kB)
• A policy briefing

See also this news story announcing the launch of the TAP CARE study and this reflection on patient and public involvement in the study by one of the patient and public involvement (PPI) members. 

The team

University of Bristol: Natalia Lewis, Shoba Dawson, Elizabeth Emsley, Joshua Smith, David Martin, Chloe Gamlin, Umber Malik, Gene Feder, Katrina Turner, Stan Zammit, John Macleod, Esme O’Brian, Barbara Piecha, Scarlett Whitford-Webb.

The Survivors Trust: Claudia Williams, Kate Hardy, Fay Maxted.

Funders

• NIHR Biomedical Research Centre
• University of Bristol
• NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (now Integrated Care Board).
• NIHR School for Primary Care Research.

Contact

For more information about the study contact Natalia Lewis: nat.lewis@bristol.ac.uk

Sources of help and support

The Survivors Trust runs a free, UK helpline (0808 801 0818) and online Live Chat Service for people affected by sexual violence or abuse. We provide confidential, emotional support and information to survivors of all genders, their supporters and professionals. For further details, please visit - www.thesurvivorstrust.org/our-helpline

Other sources of help and support, including for survivors of domestic violence and abuse.

Related project

How to evaluate trauma-informed care in community mental health services (TAP CARE Mental Health study)

Informing development of an organisational intervention to strengthen primary care readiness to provide trauma-informed care: a multimethod qualitative study (TAP CARE GP Study)