Trauma‐informed co‐production: Collaborating and combining expertise to improve access to primary care with women with complex needs

Abstract

IntroductionHealth, social care, charitable and justice sectors are increasingly recognising the need for trauma‐informed services that seek to recognise signs of trauma, provide appropriate paths to recovery and ensure that services enable people rather than retraumatise. Foundational to the development of trauma‐informed services is collaboration with people with lived experience of trauma. Co‐production principles may provide a useful framework for this collaboration, due to their emphasis on lived experience, and intent to address power imbalances and promote equity. This article aims to examine trauma‐informed and co‐production principles to consider the extent to which they overlap and explore how to tailor co‐production approaches to support people who have experienced trauma.MethodsBridging Gaps is a collaboration between women who have experienced complex trauma, a charity that supports them, primary care clinicians and health researchers to improve access to trauma‐informed primary care. Using co‐production principles, we aimed to ensure that women who have experienced trauma were key decision‐makers throughout the project. Through reflective notes (n = 19), observations of meetings (n = 3), interviews with people involved in the project (n = 9) and reflective group discussions on our experiences, we share learning, successes and failures. Data analysis followed a framework approach, using trauma‐informed principles.ResultsCo‐production processes can require adaptation when working with people who have experienced trauma. We emphasise the need for close partnership working, flexibility and transparency around power dynamics, paying particular attention to aspects of power that are less readily visible. Sharing experiences can retrigger trauma. People conducting co‐production work need to understand trauma and how this may impact upon an individual's sense of psychological safety. Long‐term funding is vital to enable projects to have enough time for the establishment of trust and delivery of tangible results.ConclusionsCo‐production principles are highly suitable when developing trauma‐informed services. Greater consideration needs to be given as to whether and how people share lived experiences, the need for safe spaces, honesty and humility, difficult dynamics between empowerment and safety and whether and when blurring boundaries may be helpful. Our findings have applicability to policy‐making, funding and service provision to enable co‐production processes to become more trauma‐informed.Public ContributionBridging Gaps was started by a group of women who have experienced complex trauma, including addiction, homelessness, mental health problems, sexual exploitation, domestic and sexual violence and poverty, with a general practitioner (GP) who provides healthcare to this population, alongside a support worker from the charity One25, a charity that supports some of the most marginalised women in Bristol to heal and thrive. More GPs and healthcare researchers joined the group and they have been meeting fortnightly for a period of 4 years with the aim of improving access to trauma‐informed primary care. The group uses co‐production principles to work together, and we aim to ensure that women who have experienced trauma are key decision‐makers throughout our work together. This article is a summary of our learning, informed by discussion, observations and interviews with members of the group.

Improving access to general practice for and with people with severe and multiple disadvantage: a qualitative study

“…The investment in doing this properly should not be underestimated: the project described in this study has been 4 years in the making and started from already established trusted relationships. 28 , 29 A more feasible strategy might be to use or adapt the strategies developed in this study, as outlined in Table 2 , with important contextual understanding contained in the results and discussion. The authors would encourage others to strive for a level of meaningful engagement with people with SMD, perhaps in collaboration with a local support organisation, as part of adapting these interventions locally.…”

“…Workers from One25, a charity that aims to support some of Bristol’s most marginalised women, helped to recruit and support participants with lived experience of SMD to the co-production group. 29 Participants with lived experience of SMD were separately offered opportunities and informed decision-making processes for being a lived experience collaborator on the project, for being a research participant (governed by ethics approvals), and/or for being a co-author, respecting International Committee of Medical Journal Editors recommendations. 32 Individual members of the co-production group could, and did, make different informed decisions on each of these opportunities based on what was right for them, with the support of a support worker.…”

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

“… 8 , 9 There also exist a number of frameworks in the grey literature, and empirical work has sought to explore the nature of trauma-informed co-production, finding particularly that for co-production to be trauma-informed there must be extra attention to issues such as power dynamics and boundaries. 22 …”

Series: Public engagement with research. Part 3: Sharing power and building trust through partnering with communities in primary care research

“…Your community may also include clinical and non-clinical staff employed by public, private, charitable or VCSE providers of primary care services. Any partnership bringing together an individual patient and doctor with a clinical therapeutic relationship needs to be managed with care [ 16 ]. Attention should be given to power and ethical collaboration issues, which may also affect the therapeutic relationship.…”