Can Do Healthcare - Thinking Differently Together About Trauma Informed Care

poverty then acting as a further source of trauma. Not having a trauma informed approach, as currently is seen in relation to long term unemployment in most of the UK, where it is viewed as being a consequence of motivational deficits or people of bad character making bad choices, re-creates the dynamic around the abuse of power which may have been the original source of harm. Using sanctions that threaten shame and potentially starvation, compound rather than address the issues the individuals already have. Effective intervention needs a very different narrative and approach. The literature tells us that if we can create a relationship based around respect, trust and empowerment we can successfully support people into education, training and employment and the benefits of connection, structure, purpose, self-esteem and hope that it can bring to people and transform their lives. To do this we need to adopt an approach that says relationships are key. We need to focus on how we provide services in ways which acknowledge what has happened to individuals and promote relationships with job seekers of respect, warmth, psychological and cultural safety and dignity that empower people. If we don’t, we may trigger, resurface and reactivate feelings of mistrust stemming from previous experiences and preventing us establishing the trust we need to underpin collaboration. To do this we need to think about how we train and enable staff to engage with people. We need to think about the core themes of trauma informed practice in choice, empowerment and respect that creates a place of safety for individuals. JobLink Plus have integrated clinical services within the employment support service. They employ a number of clinical staff who, as part of access to employment support, may offer support around the issues of sleep, anxiety, or addiction. One of the things Joblink has found in doing so is that it engages with population who might, in the past, have been described as ‘hard to reach’ by services. The emerging narrative from these individuals is a powerful, and eloquently expressed one - that it is not that these individuals are hard to reach, it’s that services have been hard to reach for them – they haven’t persisted, they haven’t used a relationship-based model, they haven’t worked with people respectfully, they haven’t provided opportunities for choice. These individuals have accessed services but opted out because of these factors. If we take a trauma informed approach and create an integrated service that looks at the individuals strengths and needs and treats them holistically and respectfully it works. If we don’t do that feelings and the power imbalance are resurfaced and reactivated, and this prevents the trust needed to support people successfully, from being established. A major take-away message is that it is connections that make the difference. In any setting, if we can make people feel that their value and worth are recognised, it enables them to experience a sense of safety and wellbeing where they can grow and flourish. If we can create positive and safe connections and sustain those connections over time, and Joblink have worked with some individuals over a number of years and though a number of crisis we can achieve success. If we don’t do that and revert back to that default approach around sanctions and shame and victim blaming, we simply damage people further – we do not help them on their journey and that is not good enough. We have to understand and respond to the root causes of unemployment for some and pursue approaches that enjoy psycho-political validity. JobLink have also been successful in looking at support for parents, at programmes around gender, and in working with communities to address some of the root cause issues. They work extensively with indigenous communities, and the literature on the health and wellbeing of indigenous communities in Australia is startling. Undoing the harm caused by racism and economic and social exclusion will take generations, but if we start form a position of respect and we start from a position of connection, we are in a good place to start undoing that harm, one person, one family and one community at a time. Fundamentally trauma informed practice in any context is about collaboration and engaging with root causes: If we can do that successfully then we can work more effectively and help undo some of the harm. In our efforts we need to recognise resilience and celebrate post-traumatic growth. Trauma does not necessarily just leave people scarred; it sometimes also leaves people stronger – they are survivors not victims. When we remember that and can engage those strengths in working with individuals respectfully we can create new opportunities and new hope. 15 | Suffolk and North East Essex Integrated Care System

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