Trauma-informed practice: toolkit

Key Principle 2: Trustworthiness

This principle refers to the degree to which organisational operations and decisions are conducted with transparency, with the goal of building and maintaining trust among clients and their family members, and among staff and others involved in the organisation.

Screening, assessment and treatment services

Service users reported high levels of trust in the staff providing these services. They explained that feeling safe, being treated with respect and being listened to, led to the development of a trusting relationship. Interviewees stressed the importance of professionals realising that trust from service users needs to be "earnt", especially if they have had negative experiences with services before.

"...being able to...you know, being able to open up about things that, you know, I haven't told anyone else in the world. Anyone else in the world. Feeling safe enough to be able to do that...that's really special. What I mean to say is, that's the level of safety and trust that was there, you know." (Addictions)

"I know...they've got my best interests at heart and that, unless I need to speak to them, they'll guide me, they'll give me guidance, and I know that a lot of the women trust them and that. I know at first quite a lot of the women don't trust them, they say the same here, because social work, social work, social work, and quite a lot of us have had bad experience with social work, and it's not fair that they tar them all with the same brush." (CJSW)

Toolkit

? How is transparency and trust among staff and clients promoted?

Trauma-informed Lens

Getting Lived Experience on Board

Asking about trauma

? How do the organisation's staffing policies demonstrate a commitment to staff training on providing services and supports that maximise trust and transparency?

? How do the organisation's written policies and procedures include a focus on trauma and issues of safety and confidentiality?

Policy and Procedures Review

Interviewees spoke about the need for clarity and transparency in service delivery. From their initial contact onwards, service users emphasised the need to know what a service could and could not do for them. Interviewees gave a clear message that if a member of staff says they're going to do something, they should follow it through, and if they cannot follow it through they should take the time to explain why.

"...make sure that you're making eye contact with them, and you're letting them like talk. You're not just interrupting them every two minutes to say to them, this is how we'll fix it, this is how we'll deal with it. Let that person you're talking to gain your trust that way."

They also highlighted the need for clarity with regard to the boundaries of confidentiality and the circumstances under which these boundaries would be breached.

"We're pretty tight on boundaries as well. So, in terms of like, people should know what they can and can't do in the Centre….expectations of them and their expectations of us." (CJSW)

Staff acknowledged that the issue of data-sharing was of particular concern to service users and several case study services described the routine use of formal data-sharing agreements. One case study service described efforts to create a transparent system of data recording, where staff checked the accuracy of information directly with their clients prior to its documentation in formal records. Consent was routinely sought from clients before the information was shared with other professionals, and clients were asked to identify any information that they wished to keep confidential. This was then omitted from the formal record.

"…the biggest part […] is trying to give women as much transparent trust and control…by being really clear with her about what our roles and responsibilities are, and how we're going to do that…" (CJSW)

Interviewees talked about circumstances where they believed trauma survivors were likely to experience a breach of trust in their relationship with individual staff members or with services generally, for example detention under the Mental Health Act, the execution of an arrest warrant by police officers, citation of an individual as a witness in a court case, or the removal of children from their family due to welfare concerns. Staff felt that breaches of trust could be mitigated to some extent by transparent dialogue in advance of any intervention, and a client's sense of attachment to the service as a whole.

"…there are some tensions here with trust…there are certain things, you know, certain restrictions on services safety. So sometimes, for example, you have to detain somebody under the Mental Health Act. Sometimes you might have to breach confidentiality…and I think there are some genuine tensions there…so it's not as simple as being nicer to people, although it's not to be undervalued that…I think it's about boundaries and being clear and being really straightforward. I think sometimes we try too hard to be nice or popular." (Mental Health).

"Quite specific but clarifying boundaries with trust – I'm not…you can come here, you know, and I will not be telling them…I'll be crystal clear…I give you my guarantee I will not let the UK border agency know that you are here. I would not do that." (GP)

Toolkit

? How is information recorded and how is it passed on, respecting the collaborative and trusting relationship which has been built between staff and survivors?

Policy and Procedures Review

? How does the organisation ensure all staff (direct care, supervisors, front desk and reception, support staff, housekeeping and maintenance) receive basic training on trauma, its impact, strategies for trauma-informed approaches across the agency and across personnel functions?

? How does on-going workforce development/ staff training provide staff supports in developing the knowledge and skills to work sensitively and effectively with trauma survivors?

Trauma Training

Training and workforce development

Staff felt it was essential to have an understanding of the ways that traumatic experiences, particularly pervasive interpersonal trauma, can erode an individual's capacity for trust in others.

They suggested that workforce training should routinely incorporate the impact of trauma on relationships, in order to highlight the importance of treating service users with respect, honesty, transparency and consistency.

A common theme among interviewees was the importance of trust: the impact a trusting relationship can have on an individual, and also the impact when trust in not there or a service user feels it has been breached.

"we need to try to change the path…we're only going to change it by building the relationship and trust and then providing the support of guiding them towards the support that's going to change that path." (Police)

"Trust, if you don't have trust, you've got nothing…there's no point you trying to work with people if you can't trust them. There's no point trying to get help for yourself if you don't trust that person because you're they're not going to open up to you, so you are just wasting your time, basically. You'll just keep going round in circles at the same thing, 'til somebody has trust and opens up about it."