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Early Intervention Foundation warns trauma-informed care may not be achieving what is hoped

Inconsistent approaches point to lack of clarity

Published by Professional Social Work magazine, 28 January, 2022

Trauma informed approaches to working with children are inconsistently applied and often fail to deliver evidence-based treatment for their service users, a study has found.

Trauma-informed care (TIC) is widely perceived to add value to children’s social work, leading to a wide range of benefits. One of the key aims is to avoid retraumatising children and to provide effective interventions.

But the report Understanding the use of trauma-informed approaches within children’s social care’by the Early Intervention Foundation sounds an alarm bell over the rapid expansion of TIC across schools, child protection services and the criminal justice system.

No single model

The survey of children’s social work teams and principal social workers found TIC is rarely leading to treatments shown to reduce trauma, which was its original purpose. Treatments can include trauma-focused CBT and child–parent psychotherapy, both of which have an established evidence base.

No single model of TIC currently exists within children’s social care teams in England, the report also found.  And there is a high degree of overlap between TIC activities and standard children’s social care practice.

Nearly 90 per cent of respondents were found to be using TIC within teams.

Most (96 per cent) used strengths-based approaches, or training (86 per cent). Only half (53 per cent) screened for trauma or adverse childhood experiences, and only 37 per cent used cross-agency collaboration and referral - and this rarely led to evidence-based treatment of trauma like psychotherapy. Only a fifth of respondents said they had adopted a trauma-informed ethos with written policies.

Respondents instead highlighted their 'trauma-informed approach' where children 'can develop trust'. They emphasised the need for children to process trauma, detailing listing the symptoms as part of trauma awareness.

Others defined TIC as recognising the presence of trauma and 'the role it may play' in service users' lives, or responding to 'the impact of trauma.'

Only one team provided Dyadic Developmental Psychotherapy to help foster carers and professionals. Another stated the need for 'some form of therapeutic input.'

The report authors state: “Our study observed that trauma-informed care led to evidence-based treatments in only two instances. More often, TIC activities were offered alongside social work practices that had a less established evidence base.”

Most common interventions

The Early Intervention Foundation (EIF) is an independent charity that champions and supports the use of effective early intervention to improve the lives of children and young people at risk of experiencing negative outcomes.   

The survey received feedback from 58 CSC teams. In addition, 12 social workers or directors of children’s services representing 10 CSC teams also took part in a one-hour long depth interview. In two instances, the interview was attended by two social workers from the same team.

The research posed four questions:

  1. How prevalent is trauma-informed care within CSC teams?
  2. What activities do children’s social care teams offer under the guise of trauma-informed care?
  3. How are TIC activities perceived to add value to children’s social care, particularly in terms of their benefits for children and parents?
  4. Do specific models of trauma-informed care exist within children’s social care and are they amenable to rigorous evaluation?

The study found TIC activities were prevalent in 89 per cent of the teams participating in the study. Activities cited included strengths-based methods for engaging families, trauma-informed training, trauma screening, and service redesigns.

Participants considered TIC activities to provide a wide range of benefits, with better treatment decisions and improved family engagement listed as the most prominent.

But no core or consistent TIC model was found to exist. The report authors continue: “TIC practice was highly varied across CSC services, with no two teams offering the same components, or attending the same training.”

The Early Intervention Foundation is concerned that few TIC activities appear to have undergone rigorous evaluation, meaning the specific benefits are unknown. The charity also warns that trauma-informed care was not designed to reduce the symptoms of trauma or improve outcomes for children who experience it.

History

Trauma-informed approaches have become increasingly popular over the past 20 years as a means of reducing the negative impact of childhood adversities and supporting child and adult mental health outcomes.

The core components were first established in the late 1990s as part of an American study considering how comprehensive trauma-informed approaches might benefit women who were exposed to high levels of trauma through sexual or domestic abuse.

A key element was considering how services may retraumatise service users, and how clients should be offered more choice and involvement in service design. Trauma survivors were instrumental in creating the ‘3Es and 4Rs’ framework used today, which encourages practitioners to ask ‘What happened to you?’ rather than ‘What is wrong with you?’.

Expansion

Over the past 10 years, TIC activities have increasingly been adopted by schools, child protection services and the criminal justice system as a means of identifying practices that might inadvertently traumatise children. The aim is to reduce vulnerable children’s experiences of trauma.

This expansion has, the report notes, far outpaced any evaluation.

The report authors continue: “Trauma-informed approaches were originally developed to increase engagement in evidence-based, trauma-specific treatments offered through mental health services. However, trauma-informed principles have since been adopted by schools, the police and other frontline services to improve service quality more generally.

“Studies show that practitioners are often quite enthusiastic about trauma-informed principles and believe that awareness of them will substantially improve their ability to engage clients. However, studies also show that there is a notable lack of consistency in how trauma-informed principles are applied in practice, and their value to practitioners and clients is yet to be rigorously evaluated.”

Treatment is key

The charity says social work teams who are relying on these approaches as a key part of their local strategy to prevent child trauma may be being over-optimistic about what these approaches can achieve. More needs to be done to ensure children are receiving services that have a track record of addressing trauma.

Donna Molloy, director of policy & practice at the Early Intervention Foundation commented: “The growing focus on doing more to reduce and mitigate experiences of trauma across a range of public services is to be welcomed, but it is important we respond in the right way. 

“The expansion of TIC has far outpaced its evaluation and work is urgently needed to clarify the specific contribution of these approaches, so that we can be sure that the money being invested in these approaches is being used to best effect.

“We owe maltreated children access to treatments with the strongest evidence of reducing the impact of trauma and improving their overall wellbeing. Whilst trauma-informed care has a contribution to make here, it is unlikely to be a sufficient solution in itself.”

Recommendations

The Early Intervention Foundation has produced a set of recommendations:

  • Government should work to develop a core definition of TIC
  • The benefits of trauma-informed care must be identified and evaluated
  • The Home Office and Department for Education should prioritise robust evaluation of models of TIC training and practice in different service contexts
  • Trauma-informed care should never be used as a replacement for evidence-based, trauma-specific treatments 
  • The availability of effective, trauma-specific interventions should be prioritised and linked to any future investment in trauma-informed care.

More information on the full recommendations can be found on the Early Intervention Foundation website here.