Mental Health Staff's Understandings of the Barriers and Facilitators to ‘Trauma Informed Services’

Prof Doc Thesis

Clark, S. 2021. Mental Health Staff's Understandings of the Barriers and Facilitators to ‘Trauma Informed Services’. Prof Doc Thesis University of East London School of Psychology
AuthorsClark, S.
TypeProf Doc Thesis

Background: The concept of trauma-informed services has been developed over the past twenty years and is growing in popularity. Trauma-informed approaches to service-delivery work on the understanding that a large proportion of the population have experienced trauma. There is substantial literature outlining the benefits of trauma-informed services to both clients and clinicians. Several authors and organisations have produced literature outlining how services can become trauma-informed. Much of the literature emphasises that trauma-informed changes must be led from the top-down. However, as not all services have made the ‘shift’ to become trauma-informed there are many staff who work to advocate for trauma-informed changes in, currently, trauma uninformed services. The barriers that they have encountered in advocating for trauma-informed services have not previously been studied.
Aims: This research explores the perceptions of staff who are advocating for trauma-informed changes. It aims to explore how these staff perceive traumainformed services and their perceptions of the barriers and facilitators to their development.
Methods: Semi-structured interviews were carried out with fifteen mental-health staff working in NHS and non-NHS services. A range of services and professional
orientations are represented in this study. Interviews were analysed using Thematic Analysis. A non-standardised questionnaire about the barriers to trauma-informed services was also completed by participants to provide supplementary descriptive information.
Results: Four main themes were generated, ‘Defining qualities of traumainformed services’, ‘Individual-level factors’, ‘System-level factors’ and ‘Advice for change advocates’. Sixteen sub-themes were categorised under these themes.
Conclusions: The themes extracted from interviews highlight the personal investment that participants have made in their efforts to develop traumainformed services. The barriers and facilitators to trauma-informed services were often seen as interacting and overlapping. The work of these participants was facilitated by individual-level factors such as participants’ persistence, passion for the work and the inspiration gained from clients. Connections with allies both inside and outside of services were also perceived to be a facilitator. Managers were perceived as both barriers and facilitators but gaining management buy-in is suggested to be an important role of change-advocates. Additionally, sharing research with managers and colleagues was perceived to be a helpful strategy.
Perceived barriers included the prevalence of the medical model, misunderstandings about what the trauma-informed model is and staff burnout. Participants shared advice and encouragement for individuals wishing to make trauma-informed changes to their services. This advice can be summarised by eight points: 1- Don’t give up, 2- Look after yourself, 3- Get management on board 4- Stay connected to allies, 5- Be patient, 6- Be tolerant of different opinions, 7- Make use of research, 8- Be strategic.

KeywordsTrauma-informed; trauma-informed services; service development; mental health service
PublisherUniversity of East London
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Publication dates
Online30 Nov 2021
Publication process dates
Submitted08 Oct 2021
Deposited30 Nov 2021
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