Moving towards trauma informed care. A model of research and practice.

Abstract

Context: Cork Simon Community offers care, accommodation and support for almost 1200 people annually. The current unprecedented housing crisis is pushing people into homelessness and preventing people from leaving homelessness. With increasing demands on resources those who are often the most vulnerable struggle to navigate systems and services and thus consideration of service design and delivery is required in order to maximise a service user’s ability to engage effectively. There is a growing body of research that argues that trauma informed care (TIC) improves outputs for both staff and the people they serve. Aims & Method: The aim of this project is threefold; (a) establish the prevalence of trauma within Cork Simon Community (b) assess Cork Simon Community’s capacity for Trauma Informed Care (c) ascertain the implications of the findings for clinical and non-clinical interventions within homeless settings. This aim was addressed by completing three research studies. Trauma awareness training was also delivered to 120+ staff and data regarding capacity for TIC was collected at 6 training dates. 1. Establish service users’ levels of early childhood trauma (ACE’s) 2. Establish staff/volunteers levels of vicarious trauma (ProQOL) 3. Complete agency trauma informed assessment The model (Fig. 1.0) offered an integrated exploration of the experiences of service users, and staff in parallel with the organisation they operating within. The information gained from these micro and macro perspectives informed the content of the trauma training as a means of amplifying existing strengths while shoring up skills and service deficits. Fig 1.0 Model of TIC Implementation vi Findings & Conclusions: The results of the ACE study revealed that there are significant levels of childhood trauma in the Service Users who participated in the research and that SU’s were experiencing a range of negative health related behaviours as a result of substance misuse, homelessness and associated behaviours. The results of the staff audit for secondary trauma revealed that there is considerable satisfaction with the work among staff but that there is a trauma contagion effect and that one quarter of the staff surveyed reported signs of secondary traumatic stress with 12% reporting indicators of burn out. The implementation of TIC and a re-evaluation of staff supervision and self-care processes can mitigate this. An agency self- assessment for capacity for TIC revealed that in the main many of the organisations existing policies and procedures are operating from a place that provides for working with deeply traumatised people. There were some areas for improvement and these were mostly constrained by resource issues. There were a number of issues identified that are beyond the organisations control as they are dictated by national policies such as intake paperwork that is not strengths based and a policy of ‘centre of interest’1 that disregards a persons’ choices which may well be dictated by an avoidance of memories of trauma situations. Organisations that work with people experiencing homelessness should advocate for greater resources and changes to national policies that conflict with strengths based trauma informed approaches. A number of recommendations have been provided