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Becoming trauma-informed – a recommendation for the future of the Troubled Families Programme
MV’s Ed Stroud argues that new government investment in Family Hubs presents an opportunity to improve outcomes by adopting a trauma-informed model of care.
Trauma-informed models of care have a history of improving outcomes while reducing cost. Although not the norm for UK public services there is a clear demand for this kind of approach with 1 in 13 teenagers estimated to have Post Traumatic Stress Disorder. As the Troubled Families Programme is set to establish ‘Family Hubs’, there is the opportunity to deliver trauma-informed care at scale.
What is trauma?
The United States’ Substance Abuse and Mental Health Services Administration (SAMSHA) defines trauma as “an event, series of events, or set of circumstances that is experienced, by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” It found that Adverse Childhood Experiences (ACEs) including emotional abuse, physical abuse, sexual abuse, neglect, household exposure to substance abuse, household exposure to mental health issues, witnessing abuse, abandonment by a parent, or imprisonment of a household member, have a significant impact on behavioural health outcomes.
A recent study by SAMSHA found that the greater the number of ACEs experienced by the individual, the greater their risk of serious physical and behavioural health problems, including chronic disease, depression, alcoholism, drug abuse, smoking, severe obesity, poor anger control and attempted suicide. Between 9% and 12% of the UK population have experienced four or more ACEs.
Elsewhere, studies have shown that trauma is particularly prevalent amongst those in the criminal justice system and the child welfare system with the former also exhibiting high rates of substance misuse.
Looking at this we can see that the Troubled Families Programme is intended to tackle a number of the symptoms of trauma. However, doing so is made more difficult if staff are not trained to recognise the signs of trauma and to understand behaviour through this lens. Indeed, when services go wrong, they can actually play a contributory role ‘re-traumatising’ the individual. SAMSHA reports that:
The use of coercive practices, such as seclusion and restraints in the behavioural health system; the abrupt removal of a child from an abusing family in the child welfare system; the use of invasive procedures in the medical system; the harsh disciplinary practices in educational/school systems; or intimidating practices in the criminal justice system can be re-traumatizing for individuals who already enter these systems with significant histories of trauma.
Recognising this, we can understand better why some of the communities which have the most contact with local authorities , and often the most confrontational contact, don’t engage with universal services as much as other groups.
If Family Hubs are to play the role which government intends them to, “serving vulnerable families with the intensive, integrated support they need to care for children”, the first step is to get people to walk through the door. A trauma-informed model of care in which people feel safe and understood will be key to this.
What is a trauma-informed model of care?
A trauma-informed model of care would run throughout the way Family Hubs operate. Training delivered on how trauma can impact individuals will support staff to identify it when encountered. Coupled with resilience building techniques staff will be equipped to empower individuals in their ongoing relationship, building on their strengths while also supporting them to understand and heal from any past trauma.
Trauma-informed approaches can have a huge impact. In the USA, Washington State ran a major initiative moving services to this way of working. Over a ten year period it reduced instances of child abuse, family violence, youth violence, youth substance abuse, school exclusions, teenage pregnancy and youth suicide. Lowering caseload costs across child welfare, youth offending and reducing the public medical costs associated with births to teenage mothers saved over $600m.
Inspired by this, Manchester is aiming to become the country’s first trauma-informed city, and has piloted the approach in Harpurhey over the last year. It has already yielded impressive results with one school seeing exclusions drop by 88%. The programme is reported to have saved £633,000 to date from a £170,000 investment.
As the government considers the future of the Troubled Families Programme and the role Family Hubs might play, addressing trauma should be a key priority. It impacts a some of the most vulnerable families amounting to a massive social and financial cost. Whilst local authorities should be free to deliver outcomes in a way that works best in their locality, we need to recognise that the legacy of trauma is universal.
To hear more about this approach or comment on this article, you can contact firstname.lastname@example.org.