Evening Seminar

Understanding and use of trauma informed

practice

Dr Kieran McCartanProfessor of Criminology│ University of the West of Englandand

Lisa RowlesDirector of Innovation & Evidence│ Khulisa

13 February, 2019

@academyjustice

Academy for Social Justice

Commissioning

Academy Overview

• The Academy’s mission is to bring people together to share knowledge, skills

and practice and to promote excellence in social justice commissioning

• The Academy was created in 2007 and now has over 4400 cross sector

members

• Services are designed to support the development of social justice

commissioning and include nationwide events, eLearning, commissioning

themed learning groups and web pages offering commissioning information

UNDERSTANDING AND USE OF

TRAUMA INFORMED PRACTICE

PROFESSOR KIERAN MCCARTAN

KIERAN.MCCARTAN@UWE.AC.UK

13TH FEBRUARY 2019

People who commit crime are quite diverse, although there are some character traits

and lifestyle variables that many offenders have in common

Risk factors vs Protective factors

Antisocial values and beliefs (criminal thinking)

Antisocial peers

Personality traits

Family dysfunction

Low self-control

Substance abuse

There are factors, warning signs and issues that can alert us to potentially problematic

behavior

AETIOLOGY

ACE’S

Bellisi M et al. Adverse Childhood Experiences and their impact on health harming behaviour in the Welsh

adult population. Cardiff: Public Health Wales NHS Trust; 2015.

www2.nphs.wales.nhs.uk:8080/PRIDDocs.nsf/7c21215d6d0c613e80256f490030c05a/d488a3852491b

c1d80257f370038919e/$FILE/ACE%20Report%20FINAL%20(E).pdf

http://www2.nphs.wales.nhs.uk:8080/PRIDDocs.nsf/7c21215d6d0c613e80256f490030c05a/00c40b58ce773d5e80257f3700390f65/$FILE/ACE%20Infograph%20FINAL%20(E).pdf

ACES IN ENGLAND & WALES

IMPACT OF ACES 1

IMPACT OF ACES 2

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IMPACT OF ACES 3

Couper S and Mackie P. ‘Polishing the Diamonds’ Addressing Adverse Childhood Experiences in Scotland. Edinburgh: Scottish Public Health Network (ScotPHN); May 2016.

www.scotphn.net/wp-content/uploads/2016/06/2016_05_26-ACE-Report-Final-AF.pdf

IMPACT OF ACES 4

ACES

PREVENTION…

In the simplest terms, the concept of trauma-informed care is

straightforward. If professionals were to pause and consider the

role trauma and lingering traumatic stress plays in the lives of the

specific client population served by an individual, professional,

organization, or an entire system, how would they behave

differently? What steps would they take to avoid, or at least

minimize, adding new stress or inadvertently reminding their

clients of their past traumas? How can they better help their

traumatized clients heal? In effect, by looking at how the entire

system is organized and services are delivered through a “trauma

lens,” what should be done differently?

Wilson, Pence, and Conradi (2013)

http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199

975839.001.0001/acrefore-9780199975839-e-1063

TRAUMA INFORMED CARE

ACES & TRUAMA

NEED AN INTEGRATED MODEL

An a holistic approach that

emphasises health, wellbeing,

welfare, psychology and behaviour.

We need a model that emphasis an

inter-relationship between health

and criminal justice systems.

Need to use a preventative

approach.

Wellbeing at the heart of

support

A trauma informed model for

the CJS

Lisa Rowles, Director of Innovation & Evidence, Khulisa

Khulisa(Zulu: ‘to nurture’)

Award-winning UK charity (established 2007)

Programme heritage Khulisa South Africa (established 1997)

Helped 3000+ young people (school, prison, community)

address root cause of challenging behaviour, improve well being, resilience, agency

Impact

• Only 7% reoffend

• 98% report positive impact on behaviour

• 76% report developing stronger, social

connections , increased motivation

• 92% reduction in prison-based violence

• 90% report reduced violent tendencies

Building on the evidence:

A new approach needed

Answering the questions posed: (Wilson, Pence, and Conradi (2013)

How would we behave differently

o to avoid (or at least minimize) adding new stress or

inadvertently reminding clients of past traumas?

o to better help traumatized clients heal?

… through a “trauma lens,” what should be done differently?

Adopting a trauma-informed approach –

‘minimising new stress,

helping clients heal’

Bruce Perry – Neurosequential model

1. Regulate: Emotionally and physically settling

2. Relate: Giving space to feel connected & comfortable

3. Reason: Supporting capacity & motivation for higher level of

cognitive processes

Even 1 supportive ECD adult-child relationship can blunt ACEs

impact

(Shonkoff et al, 2015)

Arousal

levels

Time Low

High

Anger

Fear

Denial

Sadness

Why me?

Making meaning

Acceptance

Contribution

References:

Elizabeth Kebler Ross (Grief cycle)

Daniel Siegel (Window of Tolerance)

Grief & Trauma – the impact on body & mind

FIGHT / FLIGHT - Rage, agitation, flashbacks, sleep disruption, outbursts

FREEZE / FLOP - Disassociation, numbing, depression, self-harm, suicide

A trauma-informed approach – 1st regulate

LEARNING

ENGAGEMENT

MOVEMENT

SAFETY

Trauma-informed CJS practitioners –

the impact

Staff need support too (prisons, courts, other CJ

agencies):

84% suffered ACE’s – 29% with 4 or more

92% suffered secondary trauma – 48% with 4 or more

51% exposed to trauma in day-to-day duties

Implementation of a trauma-informed environment:

62% decrease in inmate assaults on staff [13]

54% decrease in inmate on inmate assaults [13]

60% decline in suicide attempts [13]

David’s story

https://www.youtube.com/watch?time_continue=49&v=Qqd96hVzlP4

Top tips for engaging with commissioners

1) Contract vs Grant

contract is earned income

some grants’ stringent reporting requirements feel like a contract

2) Use Contracts Finder to seek opportunities and engage buyer

personally through supplier events etc

3) Search Contracts Finder for awarded contract details

(Contract Notices) to benchmark pricing with successful suppliers

4) Simple but strong E&I

Creating a trauma-informed environment

1) Be actively trauma-informed with staff procedures:

measure wellbeing, retention, absenteeism;

Safeguarding all (reflective practice, supervision, debriefing)

2) Evidence trauma-informed service user processes:

Treatment plans/case management

Transparent, collaborative, empowering choice, building trust

Needs-based, developmentally & culturally aware

Consistent routines, boundaries

Role-model trust, collaboration, co-regulation

Minimise restraint – maximise community (staff-resident relations)

Relational repair builds readiness

for societal reintegration

Dysregulation prevents cognition

Co-regulation builds positive attachment

Asset-based / restorative language (self & others)

builds social emotional wellbeing & self-worth

Moving from

‘What’s wrong

with you?’ ‘What

happened

to you?’

Thank you!

Any questions?

Lisa Rowles

Khulisa

lisa@khulisa.co.uk

References[1] Association of School and College Leaders & National Children’s Bureau (2016). Keeping young people in mind – findings from a survey of schools across England, UK.

[2] Future in mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing. (2015). Department of Health.

[3]Children’s Commissioner, Vulnerability Report (2018)

[4] Gill, K. et al., Making The Difference Breaking The Link Between School Exclusion And Social Exclusion [London: IPPR, the Institute for Public Policy Research, 2017]

[5] Permanent and fixed-period exclusions in England: 2016 to 2017. Department for Education

[6] McAra, L. & McVie, S, (2010). Youth Crime and Justice: Key Messages from the Edinburgh Study of Youth Transitions and Crime.Criminology & Criminal Justice, Vol.10(2), pp.179-209 [7] Plumb, J., et al., ""Trauma-Sensitive Schools: An Evidence-Based Approach"" Vol.40 (2) (2016) School Social Work Journal pp37-60

[8] Improving young people’s mental fitness, June 2017

[9] Goodman, A., Joshi, H., Nasim, B., and Tyler, C., "Social and emotional skills in childhood and their long-term effects on adult life" (2015) Early Intervention Foundation

[10] Gutman L and Vorhaus J (2012). The Impact of Pupil Behaviour and Wellbeing on Educational Outcomes. London: DfE.

[11] Layard, R., et al., "What Predicts a Successful Life? A life-course model of well-being" Vol. 124 (580) (2014) Economy Journal pp1-22

[12] Fancourt, N., and Sebba, J., “The Leicestershire Virtual School’s Attachment Aware Schools Programme: Evaluation Report” (2018) University of Oxford