Describe the concept of 'Trauma-Informed Care' (TIC) in Corrective Services. Explain the origins and rationale for this kind of approach to the treatment of prison inmates. Identify the main strengths and possible shortcomings of this approach. Discuss what changes are required to implement TIC in the Australian context (see especially Module 10).
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What is trauma-informed practice? Towards operationalisation of the concept in two prisons for women https://doi.org/10.1177/17488958221094980 Criminology & Criminal Justice 1 –23 © The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/17488958221094980 journals.sagepub.com/home/crj What is trauma-informed practice? Towards operationalisation of the concept in two prisons for women Katherine M Auty , Alison Liebling , Anna Schliehe and Ben Crewe University of Cambridge, UK Abstract A cultural initiative, ‘Becoming Trauma-Informed’, was introduced into prisons in England and Wales from 2015 based on the work of American clinical psychologist, Dr Stephanie Covington, and as part of a more general trend towards the recognition and treatment of trauma-related conditions in the community and in mental health settings. Becoming trauma-informed training for Prison Officers in England and Wales was carried out in all 12 women’s prisons during 2015–2017 and began in the long-term high-secure male estate from May 2018. The becoming trauma-informed work is based on considerable expertise, and a deep commitment by experts and practitioners to the development of trauma-informed practice. The authors welcome this ‘trauma-turn’ in thinking and practice and describe an extended pilot attempt to operationalise and measure its impact on the prison experience. The results were disappointing. By highlighting challenges, and exploring meaning-in-practice, we hope to contribute to the improvement of these initiatives. Keywords Care, prison, recovery, trauma *Anna Schliehe’s is now affiliated to University of Oldenburg (Germany). Corresponding author: Katherine M Auty, Prisons Research Centre, Institute of Criminology, University of Cambridge, Sidgwick Avenue, Cambridge CB3 9DT, UK. Email:
[email protected] 1094980 CRJ0010.1177/17488958221094980Criminology & Criminal JusticeAuty et al. research-article2022 Article https://uk.sagepub.com/en-gb/journals-permissions https://journals.sagepub.com/home/crj mailto:
[email protected] http://crossmark.crossref.org/dialog/?doi=10.1177%2F17488958221094980&domain=pdf&date_stamp=2022-05-25 2 Criminology & Criminal Justice 00(0) A cultural initiative, ‘Becoming Trauma-Informed’ (BTI), was introduced into prisons in England and Wales (and elsewhere) from 2015 based on the work of American clinical psychologist, Dr Stephanie Covington (2016) and as part of a more general trend towards the recognition and treatment of trauma-related conditions in the community and in mental health settings. Research on the impact of trauma has not only increased significantly in the fields of psychology, psychiatry and neuroscience but also in the practice-based fields of social care, education and criminal justice (Becker- Blease, 2017). King (2017) describes trauma as an individual’s experience of an event that considerably negatively affects their ability to cope with or recover from it, evoking emotions such as fear, hopelessness and a sense of violation. Randall and Haskell (2013) differentiate between acute (time-limited), chronic (multiple or ongoing) or complex (a mixture) trauma, all of which can have long- lasting effects, particularly when experienced during developmental years. Trauma can affect people from all backgrounds, but there is a strong correlation between levels of marginalisation and risk of exposure. Prison populations are especially likely to include disproportionate numbers of individuals exposed to trauma from a young age (Crisanti and Frueh, 2011). Covington (2003) defines trauma-informed services as ‘services that have been cre- ated to provide assistance for problems other than trauma, but in which all practitioners have a shared knowledge base and/or core understanding about trauma resulting from violence’ (p. 95). Trauma-informed training interventions promote awareness of the sig- nificance of trauma in an individual’s everyday life in order to support recovery (King, 2017; Miller and Najavits, 2012). This is important in criminal justice settings where inadvertent re-traumatisation through seemingly unthinking staff or poor cultural prac- tices may be more likely than support for recovery (Covington, 2003), particularly among female prisoners (e.g. Eastel, 2001). BTI training for Prison Officers in England and Wales was carried out in all 12 women’s prisons during 2015–2017 and began in the long-term high-secure male estate from May 2018. The BTI work is based on considerable expertise (see Covington, 2008) and is supported financially by a charitable organisation, One Small Thing, led and funded by prison philanthropist, Lady Edwina Grosvenor.1 The aim of this organi- sation is, cultural change in the criminal justice system: to shift the question away from ‘what’s wrong with them?’, towards ‘what happened to them?’ . . . We aim to humanise the process for individuals caught up in a cycle of crime by training front line staff and those who are caught up in the Justice Saystem to understand trauma and its impact on both a systemic and an individual level. We support staff to ensure the systems within which they work run concurrently and complement the process of self–discovery. Our ultimate aim is . . . to transform cultures and systems and – crucially – to change people’s lives for the better, one small thing at a time. (Website) The training modules delivered in prisons in England and Wales are based on Covington’s model and include courses on, ‘Becoming Trauma Informed: A Training for Correctional Professionals’ (an initiative that aims to bring about organisational change Auty et al. 3 towards trauma-informed practice), and ‘Healing Trauma – a Brief Intervention for Women’ (a specific trauma-informed intervention that is delivered in prison and other settings (Covington, 2019). The materials include an ‘Implementation Plan and Goal Attainment Scale’ to facilitate change including training packages for the ongoing assess- ment and training of staff (Covington and Fallot, 2015). Across the women’s custodial estate at least 4000 members of staff (and some prisoners) have been trained in trauma- informed practice. This involves staff being aware of the backgrounds and vulnerabilities of those in their care, being sensitive, protective, offering help, affirmation and safety, and looking after their own health and well-being at work in order to provide the right kind of environment for prisoners. The BTI training attempts to embed trauma-informed practice through all levels of the prison and includes regular consultations (and bi-annual ‘top-up’ training where appropriate) with Governors, Prison Officer BTI Leads, Guide Teams and prisoner resident peer monitors. The training is very well-received by staff, who find it informative, relevant and useful. Two women’s prisons have declared them- selves to be wholly ‘trauma-informed’. This welcome ‘trauma turn’ – a movement in language and practice – is linked to broader changes in the community and in professional circles as the significance of trauma or adverse childhood events in later life struggles including offending, violence and suicide, is increasingly recognised (e.g. Wolff and Baglivio, 2016). The trend has been for much of the work to begin in settings for women and young adults, and then for it to be extended to adult men. This is related to the extremely high prevalence of traumatic forms of adversity, such as sexual abuse and neglect, among young women who find their way into mental health and criminal justice settings (Randall and Haskell, 2013: 508). The work, in general, is characterised as ‘gender-sensitive’. According to Kubiak et al. (2017: 96), ‘a trauma-informed correctional organisation is one in which administration have committed to creating a trauma-informed setting and will facilitate an infrastructure to initiate, support and guide changes’ which requires long-term commitment and guiding ‘champions’. This description, like much of the available literature, is about ‘inputs’ or provision. It does not set out what a trauma- informed setting might feel like for those who live in it. What does it mean for a prison to be ‘trauma-informed’? The authors’ research in prisons has been largely driven by a preoccupation with the meaning-in-practice to prisoners of important words, or ‘concepts that matter’, such as humanity, respect, safety and trust (Liebling and Arnold, 2004; Liebling et al., 2011) and good uses of authority (Crewe et al., 2014). As might be expected, insufficient attention is paid to the challenging translation into practice of these key concepts in prison set- tings, and all too often official claims about ‘treating prisoners with humanity’ are not matched by prisoners’ experiences. Perhaps surprisingly, but important for our develop- ing understanding of the complex inner life of prisons, there are significant differences in the extent to which individual establishments operationalised or ‘deliver’ what prison- ers understand by humanity, respect, safety or authority (see Liebling, 2015) despite the best intentions of officials who launch such well-meant initiatives with increasing fre- quency (other examples include Rehabilitative Culture, Enabling Environments and Every Contact Matters). It was difficult not to approach the newly emerging 4 Criminology & Criminal Justice 00(0) ‘trauma-informed’ terminology in prisons with these interests and concerns in mind. The development of trauma-informed work is important and promising, and reflects enor- mous effort, undertaken in good faith and organised around several individuals’ expertise and engagement, as well as deep practitioner relevance and need. We fully support the intention and values underlying this development. We wondered what is meant by the concept, as well as what difference trauma-informed training, or claims, made to the treatment and experience of prisoners. As we routinely carry out investigations of the ‘moral quality of life’ of individual prisons using a well-developed survey, and other methods, we were invited to carry out such an exercise in a prison that declared itself ‘wholly trauma-informed’, and to use our usual methodology to ‘pilot’ relevant items.2 This possibility was welcomed by prison service managers, who were both excited by, and curious about, the impact of this work in the female estate in particular. At the request of the organisation, we devel- oped an additional set of items intended to operationalised the concept of trauma- informed practice, which we were also able to test in a second prison for women. We used Factor Analysis to develop and evaluate survey items that we though captured the experience of trauma-informed practice. In this article, we describe this process and report on the findings. The results were, in many ways, disappointing. Only two of 22 relevant items were scored by prisoners at or above neutral; most were scored nega- tively. These results, discussed in more detail below, suggest that ‘trauma-informed practice’ might be both desirable and achievable – and our findings should not be interpreted as a criticism of its goals – but there is much work to be done in understand- ing what it is, how best to put it into effect or how staff know when they are ‘getting it right’. Its delivery does not necessarily coincide with adoption of the label (which raises the question of whether other terms might be more appropriate), as we have discovered in subsequent research. In this article, we describe the development of the 22 new items and present the results from the two women’s prisons: our first, and most systematic, attempt to explore this term and develop a measure. We argue, based on our experiences in the field, that a different language – of care and engagement – may help to make ‘trauma-informed’ practice real. We do this without professional expertise in trauma work, but with considerable experience in exploring the lived experience of imprisonment. Our aim is not to undermine the often outstanding initiatives that are going on, but to create a dialogue, based on empirical evidence, that might enhance it, supporting more sensitive or appropriate work with vulnerable populations and a better fit between aspirations and reality. The underlying principles of TI practice One of the key features of trauma-informed services is that they do not treat symptoms related to traumatic histories of abuse, but the services they offer are provided in a way that is sympathetic to the needs of service users with histories of abuse. Harris and Fallot (2001) were the first to call for such a ‘paradigm shift within service delivery systems’ (p. 21). They identified two distinct aspects of an organisation becoming ‘informed about trauma’; first, having knowledge of the abuse histories of their service users, and second, Auty et al. 5 understanding the role that such histories play in their lives. They should then use this knowledge to reconfigure their service systems, taking these vulnerabilities into account in a way that would encourage the service user to engage with them. Recent research has shown that there is relative consensus around the core domains of trauma-informed care (TIC). Branson et al. (2017) identified 10 core domains of trauma- informed practice in their systematic review, and organised them into the following three areas: 1. Clinical services. (1) Screening and assessment, (2) services and interventions, (3) cultural competence. 2. Agency context. (4) Youth and family engagement/involvement, (5) workforce development and support, (6) promoting a safe environment, (7) Agency policies, procedures and leadership. 3. System level. (8) Cross-system collaboration, (9) system-level policies and proce- dures, (10) quality assurance and evaluation. The Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) have produced a framework for the behavioural health speciality sectors that can be adapted to other settings that have the potential to ease or exacerbate individuals’ capac- ity to cope with traumatic experiences, such as prisons. They identify the following six key principles which are fundamental to their approach: 1. Physical and Psychological Safety. 2. Trustworthiness and Transparency