Home > Resilience in the face of trauma: implications for service delivery.

Kennelly, Helen (2019) Resilience in the face of trauma: implications for service delivery. Drugnet Ireland, Issue 69, Spring 2019, pp. 21-22.

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Psychological trauma, such as adverse childhood experiences (ACEs), can have significant effects on an individual’s physical and emotional health. There is a relationship between exposure to childhood trauma/ACEs and future negative health outcomes as well as increased risk of alcoholism, drug abuse, depression, and homelessness.


Recent research examined the role of trauma and the implications for those affected on how they interact with services in Ireland.1 The study enrolled a group of women utilising a number of different services in Limerick. The women were profiled through research commissioned by the PALLS (Probation and Linkage in Limerick Scheme) project, as having considerable resilience and capacity for survival. The women all had significant experiences of childhood adversity and trauma. The aim of the work was to better understand the role of trauma, particularly how it affects the women’s interaction with service providers, and how service providers could incorporate this knowledge into service delivery.


The objectives of this research were to gain a better understanding of the needs and experiences of the women utilising local drug, homeless and criminal justice services. The research was conducted through semi-structured interviews of female service users in eight different service providers in Limerick. The interviews used two frameworks to inform their questions: the National Drugs Rehabilitation Implementation Committee’s standards for care planning2 and the ACE study and definitions provided by the Centers for Disease Control and Prevention.3


An online survey was also part of the research, which was distributed to frontline staff in the different drug and alcohol services, homeless services, and the Probation Service.



The women answered questions on ACEs, with the majority having experienced high rates of ACE when compared with the general population. The women interviewed were frequently affected by nearly all forms of childhood trauma and to a far more significant degree than the general population. For example, these women were seven times more likely to have grown up in a household where there was a family member incarcerated and 3.6 times more likely to have grown up in a household where there was domestic violence. Overall, these women were 10 times less likely to have no ACE at all, when compared with the general population.


The findings were then examined in relation to the needs of these women. Particular themes emerged from the interviews, where women expressed concerns about a range of issues. These included concerns over parenting, such as the fear of losing custody of their children, which resulted in a reduced willingness to engage with a service. In relation to problem drug and alcohol use, some women expressed the need for gender-specific services and for safe accommodation to aid in the recovery from problem substance use. Self-reported mental health issues were high among this group of women and they identified a number of barriers to accessing appropriate services. These included fear of child protection services, lack of trust in the service provider, and a need to access mental health services quickly.


Differing views emerged between the service providers and the service users on the perceptions of the services provided in relation to factors of trauma-informed care, such as feeling valued, respected, safe, cared for, understood, and trusted. The service users and providers were both asked to rate services on these qualities. Service providers marked themselves higher for all the factors than the clients did, with the biggest difference observed in the value of respect.


By acknowledging the role of trauma in individuals who go on to develop substance abuse, criminality and homelessness issues, and their subsequent interactions with these services, new evidence-informed strategies can be developed. These would be of use to services that are engaging with trauma survivors. Services can examine how they themselves interact with trauma survivors in order to improve how they deliver care to these women. This is to include an assessment of themselves as an organisation and to implement practices that create an environment where service users can engage, heal and grow. 



1  Dermody A, Gardner C, Davis S, Lambert S, Dermody J and Fein M (2018) Resilience in the face of trauma: implications for service delivery. Irish Probation Journal, 15: 161–78. https://www.drugsandalcohol.ie/30005/

2  National Drugs Rehabilitation Implementation Committee (2011) National protocols and common assessment guidelines to accompany the National Drugs Rehabilitation Framework. Dublin: Health Service Executive. https://www.drugsandalcohol.ie/16717/

3  Further information is available at https://www.cdc.gov/

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