The Urgent Need for a New Approach
Trauma is highly prevalent in the populations already accessing mental health services and wider health and social care systems.Many people referred to services have lived experience of complex trauma, meaning trauma-informed practice must be understood as everyone’s business. Care teams are already supporting people affected by significant trauma histories, but without recognition, services risk re-traumatising people. Unfortunately, current structures often unintentionally re-traumatise and block access through rigid pathways, multiple handoffs, coercive measures, and a lack of privacy. These systematic issues have a widespread impact on individuals, families, staff, and services, contributing to repeated crises that constantly re-trigger trauma and increase pressure on already stretched systems.
People need a new and urgent way of approaching trauma, mindful and compassionate connections to reduce anxiety, and re-triggering past traumatic events, to reduce harm, and support people’s recovery and mental and physical health. When services are trauma-informed, people who have experienced trauma achieve better long-term outcomes, reduce repeat crisis presentations, especially in times when services face high demands and limited capacity. Care workers in frontline services are exposed to traumatic material and secondary trauma. This considered, providing trauma-informed organisational supports (supervision, reflective spaces, appropriate measures to support staff well-being) supports health improvement, reduces burnout and improves retention. It’s clear that the whole sector needs to make changes to service delivery and implement a trauma-informed care approach and its models, such as the Trauma Recovery model.
Stage 1: Awareness and Engagement
Stage 1 of trauma-informed implementation focuses on one essential goal: creating a shared foundation of understanding across the entire workforce. This is because at the heart of the trauma-informed approach are positive, supportive relationships between care workers and supported people, colleagues across and within organisations, and the compassionate connections people develop in their local communities. This early phase is about raising awareness, increasing engagement, and ensuring that every staff member, regardless of role, sector, or seniority, understands what trauma is, how it affects people, and how everyday interactions can either support healing or unintentionally cause harm.
Trauma-informed, relationship-based models should be part of one’s care provider organisational culture and strong leadership, designed to improve people’s capability to make and maintain meaningful connections. At this first stage, all staff receive introductory trauma-informed training, covering:
- what trauma is and how it shows up in people’s lives,
- how trauma can influence behaviour, communication, and emotional regulation,
- how staff actions can either soothe or trigger,
- the importance of curiosity, non-judgment, and emotional safety.
Sussex Health&Care offers one of the strongest regional examples of effective Stage 1 implementation. Their Sussex Transformative Model of Training for Trauma-Informed Practice is delivered in partnership across councils, NHS trusts, ambulance services, and lived experience collaborators. At the awareness level, Sussex successfully deployed:
- Tier 1 Trauma-Informed Awareness training to large numbers of practitioners, self-awareness and compassionate practice, engagement through co-production and storytelling and cross-sector involvement from the start,
- shared language and foundational understanding across sectors,
- engagement activities through newsletters, podcasts, and a system-wide Practice Network,
- reflective spaces where frontline workers can explore early concepts like “ending well” and “vicarious trauma.”
Stage 2: Preparation and Planning
Stage 2 marks the transition from awareness to intentional, structured action. Having established a shared understanding of trauma in Stage 1, organisations now begin preparing their systems, workforce, and practices to respond in trauma-informed ways consistently. This stage is about embedding trauma-informed thinking into care planning, assessment processes, appropriate training and everyday decision-making. Preparation ensures that trauma-informed practice is not left to individual goodwill, but is designed into how services operate.
Care planning in Stage 2 is co-produced and grounded in empowerment and agency.
This involves:
- actively involving people (and families where appropriate) in shaping their support,
- prioritising choice, transparency, and shared decision-making,
- clearly identifying triggers, early warning signs, and preferred responses,
- building plans that support emotional safety, predictability, and trust.
Trauma-informed care plans move away from compliance-focused models and instead:
- recognise distress as communication,
- support self-regulation and autonomy,
- reduce reliance on crisis-driven or restrictive interventions.
This stage also introduces trauma-informed assessment approaches, ensuring that information-gathering does not cause harm or overwhelm.
Key principles include:
- asking what has happened rather than what is wrong,
- avoiding unnecessary repetition of traumatic histories,
- respecting readiness, consent, and pacing,
- focusing on strengths, coping strategies, and protective factors.
Assessments become collaborative rather than interrogative, flexible rather than rigid, and responsive to personal needs, culture, and lived experience. Where trauma screening is used, it is done thoughtfully, with clear pathways for support and follow-up.
Stage 3: Implementation and Integration
At this stage, trauma-informed principles are no longer aspirational, but they are actively implemented and integrated into daily care delivery, organisational processes, and multi-agency working. The focus shifts from learning about trauma-informed practice to doing it well, consistently, and together. It requires trauma-informed practice to be formally integrated into:
- Organisation’s policies and procedures,
- Clinical and social care pathways,
- Safeguarding and risk management frameworks,
- Behaviour support, crisis and escalation plans.
This includes ensuring policies do not unintentionally reinforce control or re-traumatisation, aligning trauma-informed care practices with statutory duties and professional standards, and embedding trauma-informed language and expectations into documentation and guidance.
Leadership plays a central role in Stage 3 by:
- modelling trauma-informed behaviours in communication and decision-making,
- responding to incidents with learning rather than blame,
- reinforcing psychological safety within teams,
- visibly prioritising staff wellbeing alongside performance.
Trauma-informed leadership ensures that values such as trust, transparency, and collaboration are reflected at every level of the organisation.
Culture change becomes evident when:
- staff feel safe to raise concerns,
- learning is prioritised over punishment,
- people with lived experience are treated as partners.
Stage 4: Continuous Improvement and Sustainability
Stage 4 focuses on ensuring that trauma-informed practice is maintained, strengthened, and evolved over time. At this stage, trauma-informed care is an integral part of organisational identity, culture, and system functioning. The emphasis shifts to learning, reflection, and long-term sustainability. So what does Stage 4 require?
- Ongoing learning and development (Regular refresher training, reflective practice, and access to specialist input ensure skills remain current and responsive to emerging needs.)
- Continuous feedback and improvement (Insight from people with lived experience, staff, and partners is actively used to refine practice, improve pathways, and address unintended harm.)
- Workforce well-being and retention (Sustained supervision, support for vicarious trauma, and psychologically safe leadership protect staff and reduce burnout.)
- Embedded governance and accountability (Trauma-informed principles are integrated into quality assurance, commissioning, performance measures, and organisational strategy.)
- Communities of practice and system learning (Learning networks, peer spaces, and cross-sector collaboration continue to support shared ownership and innovation.)
Continued improvement and sustainability ensure trauma-informed care remains alive, adaptive, and sustainable, creating lasting benefit for people who use services and those who deliver them.
Stage 5: Organisational Self-Assessment
Stage 5 focuses on reflective evaluation and accountability. It enables organisations to understand how effectively trauma-informed principles are embedded in practice, culture, leadership, and health systems, and to identify priorities for further improvement. Rather than a one-off audit, organisational self-assessment is a continuous, learning-focused process that supports growth, transparency, and quality improvement.
By Stage 5, organisations are able to:
- clearly articulate their level of trauma-informed maturity,
- demonstrate learning and improvement over time,
- evidence impact for commissioners and regulators,
- maintain momentum and accountability,
- ensure trauma-informed practice remains intentional, consistent, and responsive.
Stage 5 closes the loop, ensuring trauma-informed care is not assumed, but continually examined, strengthened, and renewed.
Sustaining a Trauma-Informed Culture
Sustaining a trauma-informed culture means moving beyond episodic implementation (e.g., training one cohort) to making trauma-informed ways of working the enduring norm in organisations and systems. It is a continuous process of reinforcement, reflection, adaptation, and evaluation, not a one-off project. Trauma-informed cultures are resilient, self-reflective, and embedded in daily routines, policies, leadership behaviours, and relationships.
Organisational commitment to trauma-informed practice must be ongoing and visible. A sustainable trauma-informed culture:
✔ is visible in leadership decisions and organisational strategies,
✔ ensures trauma-informed language and behaviours are standard practice,
✔ supports ongoing learning and reflection for staff,
✔ uses evaluation and feedback to drive improvement,
✔ centres the experiences of people with lived experience,
✔ protects and strengthens staff wellbeing, and
✔ weaves trauma-informed principles into structures, systems, and everyday routines.
People’s Path to Recovery Through the Lens of Trauma-Informed Practice
Recovery from trauma is neither linear nor identical for everyone. A trauma-informed pathway foregrounds safety, choice, collaboration and strengths at every step, supporting people to move from surviving to living with agency, meaning and connection.
We discussed the Trauma Recovery Model with George Rickard, our Restrictive Practice Lead, and how the way we write people’s stories around trauma deeply affects each dimension of their lives.
‘’A key example that made me think deeply about this was reading an article written by a young woman who, after leaving care and becoming an adult, went back to read the records written about her. She said the language was cold and clinical, showingnocareorlove. It reduced her to a set of behaviours: “She had a meltdown,” “She did not do what I asked,” and so on. She described the experience of reading those records as re-traumatising. This highlighted the need for a more compassionate, trauma-informed approach to record-keeping.
Our staff write records as though they are speaking directly to the child. For example,George, this morning you were having a difficult time because you had not slept much. I tried to help by doing X, and when that didn’t work, I tried Y. We will keep working on this together.” This is a much more trauma-informed way of recording, and it shows that we are putting the principles into practice.’’ – shares George.
Speaking of the Trauma Pyramid framework used to track the stages of recovery following early trauma, neglect, abuse, or chronic stress, Georgina shares many insights on how we use it as a care organisation, and how positive outcomes are achievable when our specialists’s focus is directed in securing the supported person with a basic need of safety and regulation followed by trusting relationships.
‘’In terms of positive outcomes through the Trauma Recovery Model, one of the most important areas has been working on the young person’s health needs, especially sleep, physical health, and emotional wellbeing. At the same time, it was essential to focus on the positive aspects of the person’s life and the things that bring him joy and engagement. To structure this, we used the PERMA Wellbeing modeldeveloped by the well-known Psychologist Maurice Seligman.I worked one-to-one with him and his staff team, and together we explored examples of positive emotions, engagement, relationships, meaning, and accomplishments, which Seligman’s model tells us are the foundations of wellbeing. We chose to focus particularly on the young person’s accomplishments, strengths, and achievements because this builds confidence and emotional resilience…”
To read more about what George has to say on working in a trauma-informed environment and the right ways of support, please read the entire blog:
– Developing not just a care plan, but a life plan, written by the person living it. – Leaf Complex Care
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