Within Health and Social Care Practice the importance of recognising the critical impact of trauma on both those accessing and providing services, can be seen in the attention of policy makers in central government and National Health Services being focused on the concept of Trauma Informed Practice. In Scotland, for example there is a recently developed Trauma Informed Practice Toolkit and this year in Wales a Trauma Informed Framework has been issued.
This piece will focus on the basic principles of Trauma Informed Practice as presented by both the UK government and the devolved administrations and firstly will refer to the guidance document issued in England in November 2022 which seeks not only to define Trauma Informed Practice, but also sets out the key principles of it.
The guidance provides a working definition of Trauma:-

Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. While unique to the individual, generally the experience of trauma can cause lasting adverse effects, limiting the ability to function and achieve mental, physical, social, emotional or spiritual wellbeing

The Guidance also sets out what signs to look out for in those using or working in our services, and also how to prevent re-traumatisation of those individuals using our services. Trauma informed practices is not about general services treating trauma, but making services and workplaces safe and accessible to everyone, irrespective of background and lived experience.

The guidance sets out the 6 principles of Trauma Informed Practice:

1. Safety – people feeling safe or feeling confident in asking for what they need to make this happen whilst working or visiting somewhere which sets out not to re-traumatise and puts safeguarding first

2. Choice – allowing staff and service users a role in decision making within the organisation, organisations explaining decisions and also recognising that those who have experienced trauma may lack a feeling of safety or fundamental trust in others

 3. Collaboration – an organisation seeking opinions of staff and those using the services, as to what they need and acting on these opinions and ideas whilst involving them in service delivery.

4. Empowerment – helping people to make decisions that affect their lives, but also supporting them in doing this by recognising their potential lack of self-confidence and self-efficacy

5. Cultural consideration – Organisations offering services that are inclusive to everyone, refusing to engage in stereotypes based on age, race, ethnicity, gender, sexual orientation and where you live.

The evidence of how trauma, experienced when young, affects not only the physical but psychological health of individuals as they mature into adulthood has already been the subject of much research and discussion and Adverse Childhood Experiences or ACEs as they often known are recognised more and more as being the context within which many adult behaviours have to be considered. It is from this base that the document ‘Trauma-Informed Wales: A Societal Approach to Understanding, Preventing and Supporting the Impacts of Trauma and Adversity’[1]has been developed as part of the Welsh Government’s Adverse Childhood Experiences Plan.  

The framework sets out 5 main principles which contribute towards a Trauma Informed Wales:

• Universally providing services which do not unintentionally harm those using them
• That the person is at the centre of service delivery
• Trusting relationships are at the heart of the interaction
• Building resilience is a cornerstone of the approach
• Inclusivity is key

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The framework also details levels which are part of a fully trauma informed approach throughout Wales. These levels move from services and a society in general that are Trauma Aware, It is predicated upon the basic premise that we need to move away from a society where people’s past trauma is ignored or stigmatised, through to specialist services which either work specifically with individuals who have experienced trauma or working with organisations to provide trauma informed practice.

The Trauma Informed Toolkit[1], issued in Scotland reflects and builds upon the principles and practices detailed in the respective approaches in England and Wales and provides practical examples of where organisations can make improvements to public spaces and working environments to move closer to the overall aim of providing safe and secure, environments which allow universal access for all irrespective of background.

This focus on being trauma informed will no doubt mean a major transformation of services throughout not only health and social care but throughout society as a whole if it is to be realised, however it is critical and long overdue and will help towards making service provision universal not only in name but also in action.

For more information on the content and booking process for the half-day session delivered by Allan Johnston which looks at what the move towards trauma informed practice would mean for existing and new services, please follow this link.

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In the year 2021 there were 2.4 million victims of Domestic Abuse in England and Wales. Around one third of these were men (CSEW). This is an epidemic and why domestic abuse training is so important.

The Domestic Abuse Act

The Domestic Abuse Act was signed into law on the 29th April. The Act provides protections to survivors of domestic abuse and strengthen measures to tackle those who perpetrate this behaviour.  

The Domestic Abuse Act ensures there is a legal definition of domestic abuse which incorporates a range of abuses beyond physical violence, including emotional, coercive or controlling behaviour, and economic abuse.

Following this, the Government introduced Statutory Guidance in July 2022 to support practitioners in the identification and response to domestic abuse and promoting best practice. The guidance identifies signs of domestic abuse, explores the impact on children and survivors with differing needs and experiences. It also explores multi-agency response to domestic abuse both to support the survivors of Domestic Abuse and also to hold those who perpetrate this behaviour to account.

Some of the key provisions of the Act are:

• Statutory gender-neutral definition of domestic abuse, emphasising that domestic abuse is not just physical violence, but also includes coercive and/or controlling behaviour which affects adults and children.
• Establish in law the office of Domestic Abuse Commissioner and set out the Commissioner’s functions and powers.
• Placing a duty on local authorities in England to provide support to victims of domestic abuse and their children in refuges and other safe accommodation as a priority without a vulnerability assessment.

Practice Implications for those who perpetrate abuse

Rather than just focusing in protecting victims of Domestic Abuse, we must hold those who perpetrate abuse to account to prevent more victims. The Act is providing this opportunity. For example:

• Provide for a new Domestic Abuse Protection Notice and Domestic Abuse Protection Orders to enable restrictions and positive requirements on those who perpetrate Domestic Abuse. This gives police the powers to remove an alleged perpetrator from the property and they can be compelled to undertake, for example, offending behaviour programmes, undertake a mental health assessment or wear a GPS tag.
• Enable domestic abuse offenders to be subject to polygraph testing as a condition of their licence following their release from custody. In practice this means that perpetrators can be asked questions pertaining to risk such as, if they have formed new relationships, had contact with their children, entered an exclusion or consumed alcohol
• Clare’s law is now on a statutory footing. People have the right to ask whether a current or ex-partner has an abusive past. Police are required to disclose within 28 days to make a disclosure if they feel it is necessary to keep people safe.
• Prohibit perpetrators of abuse from cross-examining their victims in person in the civil and family courts in England and Wales. This ensures that those who perpetrate abuse do not use the court system to continue to abuse the victim.

This, along with other key legislation such as specific offences of revenge porn and non-fatal strangulation, are helping to prevent those who perpetrate abuse from evading prosecution.

This important piece of legislation is shaping our practice. It is vital as frontline practitioners that we recognise the signs and symptoms of domestic abuse so that we can produce reliable risk assessments and offer support and signposting to help prevent future victims.

As a practitioner within the Criminal Justice System, I have seen increasing numbers of convictions for revenge form and coercive and controlling behaviour. Police are becoming more skilled in noticing the signs and symptoms of non-physical abuse and persuing convictions, even if a witness is unwilling or unable to come forward.

Polygraph testing has been piloted for several years and used widely across the Probation Service. This is resulting in many of those who perpetrate abuse to disclose even before they take the test, helping to manage the risks that they pose.

Claire’s Law

More people are using Claire’s Law and the police are responding quickly. There were over 12,000 applications up to March 2021, a huge increase in the year before. Police disclosed information in more than half of these cases. This is enabling people to make informed choices about relationships to better protect themselves, often their children and other vulnerable people in the family.

16 Days of Action

This annual initiative runs for 16 days from 25 November 2022. It is aimed at businesses, to support them to take action against domestic abuse and fulfil their legal obligation to support the safety and wellbeing of their employees. I have worked with a number of private sector organisations to help them assess the risks faced by some of their employees and offer signposting for support.

All of this work underlines the ubiquitous nature of Domestic Abuse. It is an epidemic.

Talking Life’s Domestic Abuse Training

For information on our domestic abuse training to broaden understanding, risk factors and how to respond to domestic abuse, please click here.