ISQUA17-2571‘CLIENTS TELL US IT WORKS’: USING PRINCIPLES OF TRAUMA INFORMED PRACTICE TO DELIVER HIGH QUALITY CARE

Abstract

Objectives: Trauma informed practice (TIP) - based on the principles of safety, trust, collaboration, empowerment, and choice - is efficient and has merit for clients, and professionals, across public and social services. Implementation of TIP is, however, a challenging undertaking for individuals and organisations. The study aimed to: attain the level of use of principles of TIP; and determine the motivators, barriers and enablers for changing work practices towards increasing its use at an organisational system level. Methods: Participants were working in community health services attached to a large hospital network in Sydney, Australia. Ethics approval was obtained from the health network. The services were directed at clients who are marginalised or experiencing disadvantage. Focus groups were conducted with 24 front-line workforce and managers, from medicine, allied health and health promotion. Focus groups were facilitated using a semi-structured interview guide to determine motivators, barriers and enablers. Participants completed a validated, TIP checklist to identify practices undertaken. Data was digitally recorded, independently transcribed and thematic analysis conducted. Checklist data was reported using descriptive statistics. Results: Participants reported the willingness and consistent actual use of the five principles of TIP with clients. Practices included: open and respectful communication (96% n=23); sharing decisionmaking (92% n=22); providing a gender sensitive service (92% n=20); supporting client goals and interests (92% n=22); and proving a physically safe environment (88% n=21). Fewer principles of TIP were reported in regards workforce, particularly regarding worker self-care and development. Almost three quarters reported only 'sometimes' or 'never' attending regular supervision where preventing vicarious trauma is discussed (72% n=17). Just over half reported having attended training on the impacts of trauma (54% n=13) and just under half reported attending training about developing a safety or crisis plan (46% n=11). Common motivators for using TIP included: professional philosophy; evidence based; positive client outcomes; service model; and positive feedback received from clients. Three key enablers for changing work practices were identified: working in a flexible community setting; having a highly skilled, multidisciplinary workforce; and having a supportive team. Perceived barriers included: budget constraints; inability to back-fill positions and access training; and funding pressure. Conclusion: Clients are receiving safe, collaborative and consultative services, based on the principles of TIP. As with previous studies, worker safety was identified as an area for improvement. There were multiple strategies identified to enhance service quality and embed the use of TIP principles into services and the wider organisation. These include: ensuring TIP is built into service models; ensuring flexibility in planning service delivery; establishing organisational guidelines for worker safety; creating a supportive team environment; ensuring access to relevant training; creating multidisciplinary teams or collaborations; and ensuring performance measures are aligned with the actual time required to undertake clinical work in this complex field. The benefits of undertaking these improvements will potentially flow through the organisation and deliver higher quality care into the future.