The Co-production of the Roots Framework: A Reflective Framework for Mapping the Implementation Journey of Trauma-informed Care

Abstract

Background: The trauma-informed care programme at the Tees, Esk and Wear Valleys Foundation NHS Trust identified a need to evaluate the ongoing service-wide trauma-informed care implementation effort. An absence of staff, service user and system-related outcomes specific to trauma-informed care presented barriers to monitoring the adoption of trauma-informed approaches and progress over time across the Tees, Esk and Wear Valleys Foundation NHS Trust. This paper describes the co-production of a new self-assessment tool, Roots, a discussion-based framework that facilitates learning and improvement by reflecting on positive or negative examples of trauma-informed services. Methods: Using secondary data obtained from an affiliated national trauma summit and instruments found in literature, domains and items were co-produced with the help of trauma-informed care leads, NHS staff and service users. The research design consisted of community-based co-production methods such as surveys, focus groups, and expert consultations. Results: Adopting trauma-informed care requires enthusiasm and commitment from all members of the organisation. Services must adapt to meet the dynamic needs of staff and service users to ensure they remain trauma-informed; this must be done as a community. Conclusions: Following an extensive co-production process, the Roots framework was published open-access and accompanied by a user manual. Roots can provide both qualitative and quantitative insights on trauma-informed care implementation by provoking the sharing of experience across services.

Co-design and evaluation of a youth-informed organisational tool to enhance trauma-informed practices in the UK public sector: a study protocol

“…As stimuli for Workshop 2, and if Workshop 1 data indicates relevance and need, we will share in advance with participants two existing UK toolkits for organisations to become more trauma-informed 37 . These toolkits are recent and evolving but are not yet youth-informed and are resource-intensive to implement.…”

Co-design and evaluation of a youth-informed organisational tool to enhance trauma-informed practices in the UK public sector: a study protocol

“…However, despite an organisation’s commitment to ideology of a TIA, they can, like any complex intervention, be hard to implement and sustain 24 25. They require change at a systemic level to support paradigm shifts across policy, procedures and practices, finding ways to in trauma-informed ways in every interaction and to prioritise the building of trusting, mutual relationships 26. Organisations need support to become TI.…”

“… 24 25 They require change at a systemic level to support paradigm shifts across policy, procedures and practices, finding ways to in trauma-informed ways in every interaction and to prioritise the building of trusting, mutual relationships. 26 Organisations need support to become TI.…”

“…27 28 Toolkits have begun to emerge in the UK. For example, the Roots framework 26 is a self-assessment tool facilitating organisational reflection on current and possible practice, including in National Health Service settings. The Scottish government has produced a Trauma-Informed Practice Toolkit for sector-wide organisations to self-evaluate and plan action across 10 implementation domains.…”

Doing Trauma-Informed Work in a Trauma-Informed Way: Understanding Difficulties and Finding Solutions

“…Increasingly trauma-enhanced practice is being explored in physical healthcare domains such as sexual healthcare, 8,9 while paediatrics and primary care are also seeking to embrace and research trauma-aware and trauma-informed practices. 10 Services wishing to become trauma-informed will usually undertake activities such as trauma-informed training for staff teams, utilising tools 7,11,12 to explore current practice and identify strategies for improvement, running workshops and 2 Health Services Insights stakeholder events and/or forming working groups (sometimes with patients and other service providers) to co-produce plans for trauma-informed service delivery and evaluate their implementation. Communities of practice also offer useful spaces for networking, shared learning and reflection.…”