Integrated trauma-informed care brings together the elements of trauma-informed care and integrated care to improve the experiences of clients and staff. There are multiple overlaps between the principles of these two approaches and they are mutually reinforcing.
Trauma-informed care is a systems-level initiative where organisations are oriented towards understanding, recognising and responding to trauma. It aims to mitigate the impacts of trauma, avoid exacerbating trauma, and promote healing by considering how care is provided and creating a collaborative therapeutic environment.
Integrated care is the provision of seamless, effective and efficient care that responds to all of a person’s health needs, across physical and mental health in partnership with the individual, their carers and family.
These are referred to as the four Rs and apply to all areas of an organisation:
System-wide change is needed to ensure that children, young people, their families and carers, as well as staff within NSW Health, experience trauma-informed, integrated care.
The NSW Health Integrated Trauma-Informed Care Framework: My story, my health, my future brings together elements of trauma-informed care and integrated care to enhance the experiences of clients and their families and carers accessing NSW Health services. It provides guidance to staff, as well as a platform for the changes required to implement this type of care.
The framework includes key principles for the whole of the public health system, whether you deliver frontline care, are designing new health facilities, or are helping shape policy. These principles challenge us to consider how we can ensure our clients feel safe and have agency and choice in their healthcare journey.
Services are responsive to a client’s culture, gender, religious background, sexual orientation and ability, and recognise and address historical trauma, genocide and institutional racism. Services also leverage the healing value of traditional cultural connections.
It is understood that each individual and family is unique. Care and treatment should address unique needs and preferences.. However, it is also recognised that some population groups may be at increased risk of experiencing trauma, and trauma experienced within particular groups may be contextually different or manifest differently.
Service providers and clinicians work with clients to ensure they feel physically, culturally, religiously, socially and psychologically safe.
Service providers and clinicians are transparent, and seek to build and maintain trust among clients, staff and other services. Being trustworthy involves being reliable, accountable, respecting boundaries, and not sharing information that is not yours to share.31 It takes time and effort to build trust particularly where trust has been broken.
Staff recognise the importance of healing through relationships where power and decision making are shared. Collaboration occurs directly in client interactions and more broadly in service management.
The strengths and agency of children and young people, and their families, carers and significant others are recognised, built upon, and validated both in direct service provision and organisational management. Client voices and opinions are included in the development of resources, policies and procedures.
Clients and staff are supported to develop new skills as required — for example youth leadership training and training for staff in child and youth participation.
Service providers and clinicians aim to strengthen the experience of choice for children and young people, and their families, carers and significant others.
Care is seamless, effective and efficient, responding to all of a person’s health needs in partnership with the individual, their carers and family.32 It is person-centred, primary care based, continually improved and requires collective accountability and sharing of information.
The Ministry of Health will work with NSW Health stakeholders and other key agencies to identify specific projects and programs of work to implement the framework. These initiatives will be reflected in the implementation plan drafted by the Ministry of Health. A communications plan and accompanying resources will also be developed to facilitate the implementation of the Integrated Trauma-Informed Care Framework.
The framework is unique and, to the best of our knowledge, integrated trauma-informed care has never been systematically implemented across an entire public health system. For this reason, monitoring its implementation and evaluating the outcomes and benefits of the framework will be critical.
Over time, as implementation progresses and community needs change, elements of the framework may need to be amended to reflect learnings. A ‘knowledge to action cycle’ will be adopted to ensure continuous learning and the translation of knowledge into action with the aim of ensuring that the direction of the framework remains appropriate. A monitoring and evaluation framework will be developed by the Ministry of Health in consultation with NSW Health stakeholders and other agencies to support this process.