Home > Implementing trauma-informed practice across services to support people experiencing multiple disadvantage: a mixed method study.

Farr, Michelle and Eyles, Emily and Stone, Tracey and Redaniel, Maria Theresa and Traub, Thomas and Burrowes, Jason and Halsley, Rebecca and Williams, Katherine and Edwards, Aileen and Redwood, Sabi (2025) Implementing trauma-informed practice across services to support people experiencing multiple disadvantage: a mixed method study. BMC Health Services Research, 25, 1266. https://doi.org/10.1186/s12913-025-13339-8.

External website: https://bmchealthservres.biomedcentral.com/article...

BACKGROUND: People facing multiple disadvantage have often experienced extensive trauma. Changing Futures Bristol was part of a national programme to improve outcomes for people who face multiple disadvantage, such as combinations of homelessness, substance misuse, mental ill-health, domestic violence and abuse or contact with the criminal justice system. Aims were to understand how services could be improved, with more trauma-informed approaches at individual, service and system levels. An in-depth mixed method evaluation of Changing Futures Bristol examined how trauma-informed approaches were implemented and linked across services supporting people experiencing multiple disadvantage.

METHODS: The study followed a participatory action research approach, involving research conducted in collaboration with people who have experienced multiple disadvantage, and staff partners. Collaborators actively contributed to securing funding, research design, data analysis, and write-up. A staff survey was conducted using existing measures and some tailored questions, to assess perceptions of trauma-informed approaches, equality, diversity and inclusion, and co-production. One hundred and seventeen staff responded, with 30 staff completing the survey again after one year to track any changes. Twenty-three staff members were interviewed. Qualitative data were analysed thematically, guided by trauma-informed principles and implementation domains.

RESULTS: Movement toward more trauma-informed approaches was detected, although these changes were not found to be statistically significant after one year. Barriers included short-term funding and commissioning cycles and difficulties in staff retention, due to short-term contracts, vicarious trauma, stress and pressures of the job. Managers had to hold contradicting drivers to deliver targets and manage finances whilst creating space for relational support and trauma-informed practice. To create psychological safety, staff needed to feel trust and transparency. 73% of staff reported lived experience of at least one domain of multiple disadvantage or trauma. Support for staff is needed at all levels of the organisation.

CONCLUSIONS: A long-term, collaborative, and trauma-informed approach is needed at all levels, including leaders, managers, policymakers, and central government. Government and public service reforms that focus on cross-sector collaboration and devolution of power will support trauma-informed practices. Stable, long-term funding and planning will help create a motivated, skilled workforce that can build on existing good practice.


Item Type
Article
Publication Type
International, Open Access, Article
Drug Type
All substances
Intervention Type
Treatment method, Harm reduction, Psychosocial treatment method, Rehabilitation/Recovery
Date
1 October 2025
Identification #
https://doi.org/10.1186/s12913-025-13339-8
Volume
25
EndNote
Subjects
B Substances > Substances in general
F Concepts in psychology > Psychological stress / emotional trauma / adversity
F Concepts in psychology > Psychological stress / emotional trauma / adversity > Adverse childhood experiences (ACE)
G Health and disease > State of health > Mental health
G Health and disease > Substance use disorder (addiction)
G Health and disease > Substance related disorder > Substance related mental health disorder > Dual diagnosis / comorbidity (mental health)
J Health care, prevention, harm reduction and treatment > Treatment and maintenance > Provider / worker / staff attitude toward treatment
J Health care, prevention, harm reduction and treatment > Type of care > Mental health care (Psychiatry / Psychology)
J Health care, prevention, harm reduction and treatment > Health care delivery
MA-ML Social science, culture and community > Social condition
MA-ML Social science, culture and community > Social condition > Homelessness > Homeless services
MM-MO Crime and law > Crime and violence > Crime against persons (assault / abuse) > Intimate partner abuse (domestic violence)
MP-MR Policy, planning, economics, work and social services > Organisational development / co-operation > Workforce / staff skills and training
T Demographic characteristics > Substance or health care worker / provider
T Demographic characteristics > Prevention / youth worker
T Demographic characteristics > Social worker
T Demographic characteristics > Homeless / unhoused person
T Demographic characteristics > Person who commits a criminal offence (offender)
VA Geographic area > Europe > United Kingdom > England

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