Delivering trauma-informed treatment in a women-only residential rehabilitation service: Qualitative study

Abstract

Aim: This article explores the delivery of trauma-informed residential treatment, focussing on factors that affect how it is provided by staff and received by clients, particularly the challenges encountered. Methods: Semi-structured qualitative interviews were conducted with stakeholders (n = 3), staff (n = 15) and clients (n = 19) of a women-only trauma-informed residential rehabilitation service in the UK. Interview data were systematically coded and analysed using iterative categorisation (IC). Findings: Trauma-informed treatment delivery was affected by: “recruiting and retaining a stable and trained staff team”; “developing therapeutic relationships and working with clients”; and “creating and maintaining a safe and stable residential treatment environment”. Clients’ complex needs and programme intensity made trauma-informed working demanding for staff to deliver and for clients to receive. Staff working in the residential service needed sufficient training, support and supervision to work with clients and keep themselves safe. Clients required safety and stability to build trusting relationships with staff and engage with the treatment. Conclusions: Trauma-informed residential treatment seems a valuable way of working with women with co-occurring substance use and trauma. However, it is challenging to deliver and likely to require significant resource investment. These findings appear relevant given increasing international interest in trauma-informed approaches within the addictions.

Keywords:

• Substance use
• substance use treatment
• trauma
• trauma-informed
• women
• qualitative

Acknowledgements

We would like to thank the service where the research was conducted, in particular, the female staff and clients who were interviewed. We would also like to acknowledge the Pilgrim Trust for funding the study, Professor John Strang as PI for the broader work programme, and Dr Caral Brown for conducting some of the interviews. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or the Pilgrim Trust.

Declaration of interest

Joanne Neale is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. Charlotte Tompkins has no interests to declare.