Trauma Recovery Model

TRM-triangle

Introduction

The TRM was developed by Dr Tricia Skuse and Jonny Matthew and built on their work with young people serving sentences at Hillside Secure Children’s Home, or who were subject to secure accommodation orders. It draws on: theories about child development and attachment; neurological impairment and the impact of maltreatment and behavioural conditions; the mental health of young people in the youth justice system; and interventions, effective practice and treatment attrition (Skuse & Matthew, 2015).

There is a core of young people with high rates of reoffending and that these young people often have complex needs (e.g. previous or current contact with social services and/or mental health services; special educational need). It recommends that steps are taken to ensure that youth justice services are able to meet the needs of this group of young people.

  • 48 per cent had witnessed family violence
  • 55 per cent had been abused or neglected
  • 62 per cent had difficulty coming to terms with trauma
  • 79 per cent had social services involvement
  • 81 per cent were without qualifications
  • 95 per cent had substance misuse issues.

The specific needs of this cohort of young people are further supported by other statistics and research. For instance, an examination of mental health services in the youth justice system in England (Berlowitz, 2011) indicated that young people often have emotional and low-level mental health issues, which stem from early trauma and adversity. This adds to the complexity of their immediate needs. These issues fall outside the threshold for specialist Child and Adolescent Mental Health services (CAMHS), because these young people do not have a diagnosable disorder (Nacro Cymru, 2009).

Trauma Recovery Model

Level 1. The first (foundation) level is based on the idea of ‘redeemability’ i.e. young people can be supported to have better lives and better outcomes.

Level 2. The second level of the model follows Maslow’s hierarchy of needs (Maslow, 1943) which posits that healthy psychological growth can only occur where basic physiological and safety needs have been met. As a result, the second level of the model is the need for support to focus on helping to establish structure and routine in everyday life, e.g. safe accommodation, regular meals, regular bedtimes, personal hygiene, educational routine, consistent boundaries and expectations of behaviour (Skuse & Matthew, 2015).

Level 3. Once these basic needs are starting to be met, the TRM states that young people are more likely to be ready for, and open to, developing trusting relationships with appropriate adults. As a result, the third level of the TRM focuses on staff working with young people to build constructive relationships.

Level 4. The fourth level of the TRM proposes that once strong working relationships are developed, young people are able to start to engage with and disclose current or historical trauma. Skuse and Matthew (2015) write:

‘Over time—sometimes a very protracted period—this yields opportunities to talk in more depth, to discuss pertinent issues that arise and to revisit difficult life experiences. It is not until young people have successfully negotiated the first two layers of the model [first three layers in Figure 3] that they feel safe enough, perhaps for the first time, to begin to think about and articulate what has happened to them in the past. The sorts of disclosures that typically emerge include complex bereavement, abuse, neglect, maltreatment, exploitation, incest and domestic violence.’ (p22)

This enables staff to work sensitively and/or to refer to specialist therapeutic interventions where necessary to help the young person work through traumatic experiences and losses.

Level 5. Skuse and Matthew (2015) argue that until young people have completed the first four stages of the TRM they are not able to fully understand their current situation, their behaviour or to address the impact or implications of their offences. As a result, it is only at stage 5 that staff can start working with young people on topics such as consequential thinking skills, empathy, and restorative approaches.

Level 6. By the penultimate layer of the TRM young people have developed an ‘increased sense of self-belief and a greater acceptance of their abilities and potential’ (Skuse & Matthew, 2015, p23). Nevertheless, they argue that young people still ‘require a significant amount of support in the form of guided goal setting, support into education and a scaffolded approach to structuring free time and community living in order to maximise the chances of sustained success’ (p23).

Level 7. The final phase of the TRM recognises that over time these young people can achieve self-determination, and live healthy, independent lives in the community with low or no levels of additional support.

Evidence

Unpublished evidence from the YJB on the use of the TRM in secure children’s home settings showed the following.

  • Assessments were more likely to take a longer-term view of the child’s needs and their likely ‘journey’ over time.
  • There was greater understanding across practitioners of how children’s needs were connected to their level of development and a greater recognition of the need for greater use of proactive preventative action to address these needs (rather than reactive, crisis responses).
  • There was increased focus on the underlying needs of the child, and not just their presenting behaviour.
  • There was improved understanding of the importance of staff taking a consistent approach to meeting the child’s needs.
  • It helped to provide a common framework which was used by a range of agencies and professionals working with a child.
  • It provided a framework against which progress or regression was gauged.

Formulations

  • Personal history – a timeline of a child’s life. This was designed to ensure that all practitioners would have a good understanding of the young person’s difficulties and their personal development. Key events in the child’s life would be included to help understand the key factors which contributed to the child’s problems.
  • Pattern of offending behaviour over time
  • The clinical psychologist would then summarise the discussion into an initial case formulation, i.e. a ‘story’ of the young person’s journey so far, why the problems existed and how these may link with the young person’s developmental process and influence current behaviours.
  • This would then be applied to the TRM and a set of recommendations for intervention and support developed. These would be tailored to the developmental needs of the child and ‘sequenced’ (in line with the TRM) for the best engagement and greatest impact.
  • Information, recommendations written into case formulation report and act as the basis for the intervention plan.

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