Journal Article

Implementing trauma-informed practice across services to support people experiencing multiple disadvantage: a mixed method study

Edwards, Aileen, Redwood, Sabi, Stone, Tracey, Halsley, Rebecca, Burrowes, Jason, Farr, Michelle, Traub, Thomas, Eyles, Emily, Redaniel, Maria Theresa, Williams, Katherine

2025

Overview

Background People facing multiple disadvantage have often experienced extensive trauma. Changing Futures Bristol was part of a national programme to improve outcomes for people who face multiple disadvantage, such as combinations of homelessness, substance misuse, mental ill-health, domestic violence and abuse or contact with the criminal justice system. Aims were to understand how services could be improved, with more trauma-informed approaches at individual, service and system levels. An in-depth mixed method evaluation of Changing Futures Bristol examined how trauma-informed approaches were implemented and linked across services supporting people experiencing multiple disadvantage. Methods The study followed a participatory action research approach, involving research conducted in collaboration with people who have experienced multiple disadvantage, and staff partners. Collaborators actively contributed to securing funding, research design, data analysis, and write-up. A staff survey was conducted using existing measures and some tailored questions, to assess perceptions of trauma-informed approaches, equality, diversity and inclusion, and co-production. One hundred and seventeen staff responded, with 30 staff completing the survey again after one year to track any changes. Twenty-three staff members were interviewed. Qualitative data were analysed thematically, guided by trauma-informed principles and implementation domains. Results Movement toward more trauma-informed approaches was detected, although these changes were not found to be statistically significant after one year. Barriers included short-term funding and commissioning cycles and difficulties in staff retention, due to short-term contracts, vicarious trauma, stress and pressures of the job. Managers had to hold contradicting drivers to deliver targets and manage finances whilst creating space for relational support and trauma-informed practice. To create psychological safety, staff needed to feel trust and transparency. 73% of staff reported lived experience of at least one domain of multiple disadvantage or trauma. Support for staff is needed at all levels of the organisation. Conclusions A long-term, collaborative, and trauma-informed approach is needed at all levels, including leaders, managers, policymakers, and central government. Government and public service reforms that focus on cross-sector collaboration and devolution of power will support trauma-informed practices. Stable, long-term funding and planning will help create a motivated, skilled workforce that can build on existing good practice.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Action research / Addiction / Adverse childhood experiences / Care and treatment / Central government / Collaboration / Commissioning / Community health services / Criminal justice / Criminal justice system / Data analysis / Data collection / Decentralization / Domestic Violence / England / Equality / Female / Funding / Futures / Health Administration / Health aspects / Health Informatics / Health services / Homeless people / Homelessness / Humans / Ill-Housed Persons - psychology / Long term / Male / Medicine / Medicine & Public Health / Mental health / Mental health care / Mental health services / Mixed methods research / Multiple disadvantage / National programmes / Nursing Research / Occupational stress / Participatory action research / policy and research / Policy making / Polls & surveys / Psychic trauma / Psychological distress / Psychological safety / Psychological trauma / Public Health / Qualitative Research / Racial discrimination / Research design / Short term / Social aspects / Social service / Socially handicapped / Substance abuse / Substance-Related Disorders / Surveys and Questionnaires / Transparency / Trauma / Trauma-informed / Trauma-informed approaches: Implications for practice / Vicarious trauma / Violence or abuse / Vulnerable Populations - psychology / Workforce