The initial impacts of the Covid-19 pandemic – serious illness, death of loved ones, isolation – have been a source of psychosocial stress for many. But for people already living with experiences of trauma, the isolation and uncertainty of the pandemic increased the risk of further psychological harm. At the same time, many services that in more normal times offer people support have been less available. Schools, voluntary organisations, and also many health and care services have frequently been closed, postponed or have moved to remote provision, changing the nature of how people engage with services.
These issues present key challenges for providers working in a rapidly changing context – how to support people who have experienced trauma, as well as supporting their workforces to deliver this support and responding to the trauma they may have experienced or witnessed. I spoke to two people involved in supporting and delivering trauma-informed approaches during the pandemic to find out about what they’d encountered and learnt from the past year.
According to Jonathon Tomlinson, a GP in Hackney, trauma-informed approaches can be ‘win-win’: paying attention to the experiences of people delivering health care as well as those receiving it. Jonathon’s guiding principles to create better access to health care for people who have experienced trauma are safety and trust. Safety involves looking at whether staff and patients feel safe and how to make them feel safer – paying attention to the culture and physical environment of a service. This means people who have experienced trauma are less likely to encounter triggers that activate their threat response, and more likely to feel safe enough to be open to receiving care. Safety is essential to building trust between patient and clinician. Trust can then be built by other elements that are part of person-centred care, such as looking together at a patient’s medical record and enabling them to feel more in control of the process.
During the pandemic, a trauma-informed approach has supported Jonathon and his colleagues to provide continuity of care and create a compassionate atmosphere for patients. This can be as simple as using phone triage to book patients with complex symptoms into evening slots, where he has more flexibility to offer a longer appointment and listen to their concerns. He highlights small changes that help create a compassionate atmosphere in a trauma-informed GP service: changing the language staff use to describe patients, in everyday conversations and in case notes, and taking care of colleagues. It’s something he says must be continually worked on – a process rather than a destination.
In Kent and Medway, an ‘ACE Ambassador’ programme has trained 38 local workers since 2019. Lara Hogan, the Programme Lead, told me about how this programme was developed to increase awareness of adverse childhood experiences (ACEs) and enable a trauma-informed approach across the local system. ACE Ambassadors come from across the local voluntary and community, local authority and health care sectors. They receive learning resources, coaching and access to a network of diverse professionals and organisations, all of which they can use to inform and develop practice back in their own organisations. Examples include social prescribers developing a trauma-informed approach in a local medical centre, and a community project to develop understanding around trauma and domestic abuse.
During the pandemic, the programme switched to online training and meetings, and similarly much of the day-to-day work ambassadors were involved in moved online. While some local ambassadors have had to focus their energies on emergency Covid-19 response work, others have managed to continue their local projects to develop understanding of trauma in community settings, increase resilience, and to directly support those affected. They are now rolling out the ACE Ambassador model more widely. Lara identified the programme’s underpinning of collective leadership and ownership as key to empowering local professionals to take forward trauma-informed approaches in their own organisations.
These are just two examples of trauma-informed approaches. To me, they highlight three important principles: the centrality of building safety and trust to support people who have experienced trauma, the mutually beneficial way a trauma-informed approach supports not only people accessing services but also the staff who provide them, and a system approach that enables staff with an interest in trauma to connect across services and sectors in their area.
As I’ve tried to keep up with vast amount of progress on trauma-informed care over the past year, one thing that’s struck me is how often trauma-informed approaches seem to be led from those at the ‘front line’ of health and care. While this ‘bottom up’ leadership is vital, it’s important that the burden for this work doesn’t fall on individuals alone. With the continuing fall-out from the pandemic, the need for trauma-informed approaches across the health and care system is likely to increase – and this will require support for practitioners to respond to the needs of people who have experienced trauma and to share good practice.