Trauma Informed Practice - an introduction
We know that stressful events in childhood (Adverse Childhood Experiences) may cause immediate and long-term trauma.
When a child has no safe space or trusted adult, the biology in the brain changes. The continuous anticipation of danger triggers constant flight/fight/freeze responses and ramps up levels of stress hormones. For some children, this means their perceptions of reality are forever altered.
Trauma, especially when it goes unrecognised, untreated or treated inappropriately, has a long-term, wide-ranging and destructive impact on the adult’s life.
The impact central to our work is: How adults who were traumatised in childhood parent their own children and how we can support them to achieve the best long-term outcomes for their children and themselves.
"There is also evidence that ACEs are ‘transmitted’ across generations – so that the children of parents who experienced ACEs in their own childhood are also more likely to experience ACEs."
"Positive parenting is likely to be passed down through generations and can break cycles of adversity." (UCL 2015)
A complex issue
The way adults were parented is only one influence on their own parenting style but multiple other factors come into play. This is why our approach is holistic.
" Building Consensus on what should happen next shows that so much more needs to be done to understand ACEs, their impact and what works.
It is not enough to count the number of ACEs someone might have experienced and attempt to draw conclusions, we need to understand children's needs in a more holistic way. We should be including for example the impact of poverty and racism."
Sue Pettigrew, Director, St Michael's
"Recent studies show that low family income may be a stronger predictor of poor physical health outcomes than many of the original ACE categories...ACEs are far more prevalent amongst those living in deprived circumstances." (EIF 2020)
The parents St Michael's works with are, almost without exception, economically disadvantaged. In 2021, 44% of outreach parents had no recourse to public funds.
Trauma Informed Practice at St Michael’s
Trauma-informed care is defined in different ways and current practice varies widely across different settings. Here we explain St Michael’s position.
If parents are to reflect on their behaviour and parenting style, they first need to feel safe and trust staff working with them. For many parents, this is difficult. They may be reluctant to work with us because of their previous life experience. Parents may have had to tell their stories again and again to different professionals, an experience that may in itself be re-traumatising.
In our residential centres, the focus is on creating a safe environment and building trust so that staff can then explore parents' perceptions of parenthood, child development, and what their child needs to be safe and nurtured. In our work in the community, our outreach team will initially focus on the most pressing needs of the family. These are often practical issues such as food, safety, housing, financial stability. From there, they can start to build a relationship based on trust, gradually exploring deeper issues that can also be a revelation to parents themselves.
Creating a safe and welcoming space
Our residential centres are set up to be as welcoming as possible. New families receive a Welcome Bag of essentials to make their start feel a little less daunting, an idea which came from our centre specialising in supporting young mothers. Trauma triggers different responses and staff try to adapt an individual's environment to deal with their distress.
Resident parents share a communal kitchen, with their own fridge and cooker. At one centre, a mother, older than the others, found herself intimidated by the younger mothers staying there. She felt judged for her appearance and, having been homeless for many years, was fearful of others in her physical space. Staff at the centre arranged for her to use their kitchen instead.
Another mother who had been sexually abused as a child was terrified of using the bathroom. Staff supported her to find techniques to manage these fears.
The sensory room is also calming and an alternative space to have difficult conversations.
In our community work, we initially meet young parents where they suggest and are most comfortable. This could be their home, our office, a cafe or a park.
Our contact centre Jigsaw is all about creating a safe space - a homely environment where a small team knows individual children, mothers, fathers and foster carers.
"I was incredibly anxious; I didn't want to see Ben's dad at all... I didn't want to be in confrontation with him. I would panic, 'What if they let him go too soon.' Eventually, that started to subside as I trusted [the team at Jigsaw] more."
The difference between asking " What have you done to yourself?" and "What has happened to you?" is significant and just one example of how language can either support or retraumatise.
This can mean making sure parents have a voice in professional meetings, giving them the chance to speak and making sure their points are understood.
"And now you want to ask me questions about my personal life. In front of all these people that no one has told me about. I’ve not been told what I will be expected to say or how this meeting will go.’" Young father
"Lots of [residential parents] have been within the sphere of social services for a long time before they are referred to us. It is a challenge and also our strength; to be able to get parents on our side and then work with them." Residential service manager
Building a relationship of trust takes time. Families at our residential centres, who may not engage well with statutory services because of their previous life experience, are typically expected to stay for only 12 weeks. But work is intense as well as holistic, and many parents do come to trust their keyworker and understand that difficult conversations are to help them become the best parent possible. We aim to build respect and a working professional relationship even before the assessment begins - we insist that parents visit us for a greater understanding of what will happen and can ask questions.
Sometimes, change happens after a parent has left St Michael's. Rob is really thankful for what St Michael’s taught him, even if he didn’t realise it at the time. Some of it was going in, and it helped him to turn his life around.
"It can take time to build up trust with some of the parents, but once they see how our help can benefit them, trust will slowly begin to build. Often these parents are angry at the world. Once they realise we are only here to help, advise and assist trust begins to come." Securing Change practitioner
Building trust also requires staff to be honest.
"We need to be able to maintain the relationship we have with the parents because we need the work to continue. But they need to know honestly what our opinion is on the care of their children if the situation has a chance to improve. It’s not going to be helpful to them if we are not honest or if we understate our worries. So delivering bad news or feedback without creating a negative atmosphere is a challenge." Residential Practitioner
We are also clear with parents that they cannot disclose information to a member of staff they trust 'in confidence'. That information will be shared with the team and, where there are safety concerns, with the appropriate authorities. This is very hard for parents but, as a young parents practitioner explains, it also has a positive aspect. Young parents build a relationship with the whole team.
Interventions may be indicated, such as Caring Dads which helps fathers look at their own parenting in the context of their own father or general, such as some of the creative courses we run with partners.
Working 'in the moment' is very important. A young mothers practitioner describes how, for a young parent completing an AQA with us, a deep, personal conversation may emerge quite naturally, for example. This is a chance to talk through traumatic events at a time and pace of the mother's choosing.
The different groups we run for young parents at children's and community centres are also important to our trauma informed approach.
There is some evidence that parents who maltreat their children are more isolated, more lonely and have less social support than those who don’t. This may be in part because social isolation increases stress, and those who are isolated have a lack of positive parenting role models, or a lack of pressure from others to conform to positive parenting behaviours.
"I listened to the opinions of my peers and the workers and was able to have my opinions listened to. My eyes and heart were opened to other options on how we should talk to and treat our children. You can communicate with people who are going through the same as you."
We know that peer support is uniquely helpful. We run facilitated groups and also support peer mentors.
"You guys have helped a lot of people. You have even helped people make friends. Some people have friends and when they have a baby their friends disappear. "
A young father talks about how he is helping an 18-year old who reminds him of his younger self.
Trauma Informed Staff
"We wouldn’t be able to do our work if we didn’t have an intense focus on relationship building. My view is that relationship building is central to trauma informed practice, although in the past we may not have made that fundamental connection."
Staff receive external and internal training, and our reflective practice, teamwork and supervisions support further learning.
How trauma informed practice links to what we measure - the evidence
The outputs we measure include:
1. The number of parents moving into more stable accommodation which is more suitable for them and their baby and children. Homeless young people "are more likely to have experienced trauma, abuse and other adverse experiences" LGA 2017
2. Financial stablility - managing debt, accessing appropriate benefits, moving from precarious employment. Children in poverty are at greater risk of childhood traumas. UCL 2020
3. Helping parents access training, education and non-precarious work. The children of workless parents: Have a higher prevalence of recurrent health conditions and lower well-being, suffer higher rates of psychiatric disorders, are more likely to experience worklessness themselves during adult life. Healthy Working UK