Service User Research Enterprise, Population Health Research Institute, St George's University of London, London, UK.
Population Health Research Institute, St George's University of London, London, UK.
Health Expect. 2022 Dec;25(6):2818-2827. doi: 10.1111/hex.13585. Epub 2022 Sep 1.
Psychological therapy assessments are a key point at which a person is accepted into a service or referred on. There is evidence of service users experiencing harm, dropping out of services and potentially experiencing poor outcomes because of inadequate assessment practices. Approaches to assessment tend to be developed by individual services, with a lack of research identifying what makes a good assessment.
This survivor-led study, based in England, aimed to generate guidelines for conducting trauma-informed psychological therapy assessments. The study was guided by a Service User Advisory Group and a Clinician Advisory Group. The study was conducted in three key stages: (i) identifying, modelling and drafting guideline content (ii) modified Delphi study and (iii) guideline finalization. Stage 1 was informed by literature reviews, qualitative research, data workshops with Advisory Groups and an expert consultation. Fifty-nine people with relevant experiences then participated in a single-stage modified Delphi (Stage 2). The guidelines were finalized through an analysis of Delphi open comments and a final expert consultation (Stage 3).
The guidelines evolved through each stage of the process, and all items were deemed important by >90% of Delphi participants. The final trauma-informed guidelines contain eight principles, including 'focus on relationships', 'from systems to people' and 'healing environments'.
Experiential knowledge was key in generating the guidelines and conceptualizing content, with a consequent focus on areas, such as recognizing power differentials, understanding oppression as trauma and the relational aspects of assessments. Future research should focus on guideline implementation and investigate whether this impacts service user dropout, engagement with therapy, and outcomes.
This study is an example of survivor research, with several authors, including the study lead, identifying as survivors. We consider the ways in which our identities as survivor researchers impacted the study findings.
心理治疗评估是一个人被服务机构接纳或转介的关键点。有证据表明，由于评估实践不足，服务使用者受到伤害、退出服务，并可能导致不良后果。评估方法往往由个别服务机构制定，缺乏研究确定良好评估的标准。
本项基于英格兰的以幸存者为主体的研究旨在为创伤知情心理治疗评估制定指南。该研究由服务使用者咨询小组和临床咨询小组指导。该研究分三个关键阶段进行：（一）确定、模拟和起草指南内容；（二）改良德尔菲研究；（三）指南定稿。第一阶段的工作依据是文献综述、定性研究、与咨询小组的数据研讨会和专家咨询。然后，59 名具有相关经验的人员参加了单阶段改良德尔菲研究（第二阶段）。通过对德尔菲开放意见的分析和最后一次专家咨询（第三阶段），对指南进行了定稿。
指南在整个过程的每个阶段都有所发展，德尔菲研究参与者中>90%的人认为所有条目都很重要。最终的创伤知情指南包含八项原则，包括“关注关系”、“从系统到个人”和“疗愈环境”。
经验知识是制定指南和概念化内容的关键，因此特别关注诸如识别权力差异、将压迫视为创伤以及评估的关系方面等领域。未来的研究应集中在指南的实施上，并调查这是否会影响服务使用者的脱落率、对治疗的参与度和结果。
本研究是幸存者研究的一个例子，包括研究负责人在内的几位作者都认为自己是幸存者。我们考虑了作为幸存者研究人员的身份如何影响研究结果。
