Forensic females' perceptions of a trauma-informed care approach
Research type
Research Study
Full title
To explore the perceptions of service users residing within a female forensic inpatient hospital in relation to what impact a trauma-informed care approach has had on them.
IRAS ID
320060
Contact name
Sandeep Chatha
Contact email
Sponsor organisation
University of Birmingham
Duration of Study in the UK
2 years, 0 months, 3 days
Research summary
Summary of Research
Trauma is defined as “any event that overwhelms a person’s capacity for positive coping”. Trauma is prevalent in society, particularly across Forensic settings. A study by Howard et al (2017) found that 85% of female inmates had experienced some form of childhood trauma. Further research by SAMHSA (2014) found that women residing in a forensic setting are more likely to have experienced physical and sexual abuse compared to males and women in the general population. There are five core values of trauma-informed care that have been identified and developed based on the knowledge of what is known about common responses to physical, sexual and emotional abuse, as well as what survivors need for recovery. Trauma Informed Care is proposed as a new model of care which adopts these principles into their service, avoiding triggering reactions and potentially re-traumatising the individual. It facilitates healing, recovery and empowerment as well as emphasising collaboration, and recognising the effects that trauma can have not only on service users, but also staff (Fallot and Harris 2009).
Trauma-informed care is a proposed new model of care. It has now been implemented in a women's service. The following research will investigate whether the women's experiences are congruent with the proposed model. Participants will include female participants over the age of 18 years who are residing on a mixture of low and medium-secure wards. A mixture of age groups and ethnicities as well as stages of treatment and recovery will be included. Participants should also have been residing at the hospital for a minimum of six months to allow participants to have had a sufficient experience of a trauma-informed model of care. The following study will be qualitative using Thematic Analysis (TA) and interviews will include between 10-15 participants. Each participant will be interviewed for 45 minutes - 1 hour.
Summary of Results
Introduction Trauma-Informed Care (TIC) is an approach that recognises the presence of trauma and incorporates knowledge about trauma into its procedures and practices. The intention of TIC is to provide support services that are accessible for individuals with a history of trauma. TIC follows five guiding principles that serve as a framework for how services can work to reduce the likelihood of traumatisation. The five principles are: (1) Safety: ensuring that individuals feel physically and psychologically safe, (2) Choice: ensuring individuals have choice and control in their care, (3) Collaboration: ensuring that decisions are made collaboratively with individuals, and they are involved in the decision-making processes, (4) Trustworthiness: ensuring that services are consistent and transparent as possible, and (5) Empowerment: ensuring that individuals feel and supported in their decisions. A review of the literature suggests that trauma is prevalent within forensic settings, with females in particular. Trauma that females experience within the forensic mental health system has therefore been a recent priority.
Aim
The aim of this study was to gain knowledge about the perceptions of female service users of the impact a trauma-informed care approach has had on their recovery in a forensic inpatient hospital.Method
The study was conducted in secure forensic inpatient hospitals for female service users. These hospitals were designed to support females with complex mental health difficulties, and a history of offending. These hospitals had also recently embedded a TIC approach across the wards. Eleven clients took part in the study. All participants were residing within different wards across the hospitals. Participants were interviewed individually about their experiences in hospital. Clients’ data was analysed using Reflexive Thematic Analysis (RTA). RTA is an approach that uses qualitative research to analyse the narrative accounts of individual’s experiences to understand their experiences, views, and perceptions of TIC.Findings
Three themes were identified as important factors in participants’ experiences of a TIC approach. Participants expressed whether they felt they had choice in hospital, which formed the basis of the first theme ‘is my voice heard?’. Within this theme, two sub-themes also emerged: ‘individuality’ included aspects of participants’ identity that were important to them in hospital. For example, one participant made some suggestions regarding adaptations that could be made within hospital regarding individuality: “on the other ward there was a few times one of the girls would say things like I would not say racist but ignorant and not very nice directed towards me”. The second sub-theme of ‘collaboration’, referred to whether participants felt they had adequate involvement in their care in hospital. Secondly, participants expressed opposing views regarding the environment of a secure inpatient hospital. This formed the second theme of ‘environment matters’.
Within this theme, two sub-themes emerged: ‘restrictions’ was centred around restrictions within the hospital environment, which can be challenging and impact on risk behaviours, and the ‘physical setting’ which included the physical setting of the environment itself. This was described both positive and negative impacts on their physical feelings of safety from harm. For example, one participant highlighted that as patients become accustomed to the security of the building, then leaving this environment to go on leave, for example, can then be anxiety inducing. “It’s a bit like anxiety provoking but it’s quite nice to go outside and not be stuck in these 4 walls. I prefer to be escorted, it makes me feel more safe”.
The final theme emerged as participants expressed the importance of ward relationships within hospital, and the differences in trust and feelings of physical and psychological safety that they experience with staff as opposed to patients. This formed the final theme of ‘the importance of ward relationships are important for recovery’. Two sub-themes also emerged within this theme, which included ‘Trust’, which highlighted differences between staff relationships, which were described as more trusting and meaningful, in comparison to patient relationships, which varied with some participants experiencing them as supportive, but others describing them as more superficial in nature, with limited feelings of trust. The second sub-theme of ‘Safety’ highlighted various factors that impacted on participants’ feelings of safety, which included regular staff, staff gender, staff discipline, and conflict with other patients on the wardConclusions
This study highlighted findings which corroborated the existing research regarding TIC within female forensic settings. However, the principles of ‘Safety’, ‘Collaboration’ and ‘Choice’ showed greater importance, with the additions of ‘Cultural Considerations’, and ‘Trust’ as additional important principles from existing TIC models. This research also highlighted the importance of being aware that everyone has their own needs regarding a TIC approach within a secure setting. Of note, this research highlighted the importance of adhering to a trauma-informed care approach when working with individuals and ensuring that a greater awareness and understanding of the approach is held by all individuals residing and working within services.REC name
North of Scotland Research Ethics Committee 2
REC reference
22/NS/0136
Date of REC Opinion
14 Nov 2022
REC opinion
Favourable Opinion