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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Implementing trauma-informed practice across services to support people experiencing multiple disadvantage: a mixed

Michelle Farr1,2, Emily Eyles3,4, Tracey Stone3,4

  • 1The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK. m.farr@bristol.ac.uk.

BMC Health Services Research
|October 2, 2025
PubMed
Summary

Implementing trauma-informed approaches for individuals facing multiple disadvantage requires long-term commitment and collaboration. Stable funding and supportive organizational structures are crucial for sustained progress in improving services and staff well-being.

Keywords:
AddictionCo-productionHomelessnessMental healthMultiple disadvantageTrauma-informedViolence or abuse

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Area of Science:

  • Social Sciences
  • Public Health
  • Psychology

Background:

  • Individuals facing multiple disadvantage often have histories of extensive trauma.
  • Changing Futures Bristol aimed to enhance services for those with complex needs like homelessness, substance misuse, mental ill-health, domestic abuse, and criminal justice involvement.
  • The project focused on improving service delivery through trauma-informed approaches at individual, service, and system levels.

Purpose of the Study:

  • To evaluate the implementation and linkage of trauma-informed approaches within services supporting people with multiple disadvantage.
  • To understand how to improve services by integrating trauma-informed practices.
  • To assess the impact of these approaches on both service users and staff.

Main Methods:

  • A participatory action research approach was employed, fostering collaboration with individuals with lived experience and staff partners.
  • A mixed-methods evaluation included staff surveys (n=117) assessing trauma-informed practices, EDI, and co-production, with a follow-up survey after one year.
  • Twenty-three staff members were interviewed, and qualitative data were thematically analyzed using trauma-informed principles.

Main Results:

  • Progress towards more trauma-informed approaches was observed, but not statistically significant after one year.
  • Key barriers included short-term funding, commissioning cycles, and staff retention challenges (vicarious trauma, stress).
  • Managers navigated conflicting demands of targets and relational, trauma-informed care; staff require psychological safety, trust, and transparency, with 73% reporting lived experience of disadvantage or trauma.

Conclusions:

  • A sustained, collaborative, trauma-informed approach is essential across all organizational and governmental levels.
  • Public service reforms emphasizing cross-sector collaboration and devolved power can bolster trauma-informed practices.
  • Stable, long-term funding is vital for developing a motivated, skilled workforce and sustaining good practice.