Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Health Expect. 2023 Oct;26(5):1895-1914. doi: 10.1111/hex.13795. Epub 2023 Jul 10.
Health, 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.
Bridging 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.
Co-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.
Co-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.
Bridging 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.
健康、社会关怀、慈善和司法部门越来越认识到需要提供以创伤为中心的服务，这些服务旨在识别创伤迹象、提供适当的康复途径，并确保服务能够赋能于人，而不是再次造成创伤。以创伤知情服务为基础的是与经历过创伤的人合作。共同生产原则由于强调生活经历以及旨在解决权力失衡和促进公平，可以为这种合作提供一个有用的框架。本文旨在审查以创伤为中心和共同生产原则，以考虑它们在多大程度上重叠，并探讨如何调整共同生产方法以支持经历过创伤的人。
“弥合差距”是一个由经历过复杂创伤的女性、一家支持她们的慈善机构、初级保健临床医生和健康研究人员组成的合作项目，旨在改善创伤知情的初级保健服务。我们使用共同生产原则，旨在确保经历过创伤的女性在整个项目中都是主要决策者。通过反思性笔记（n=19）、会议观察（n=3）、参与项目的人员访谈（n=9）以及关于我们经验的反思性小组讨论，我们分享了学习、成功和失败。数据分析遵循框架方法，使用以创伤为中心的原则。
与经历过创伤的人合作时，共同生产过程可能需要进行调整。我们强调需要密切的伙伴关系、权力动态的灵活性和透明度，特别注意那些不太容易看到的权力方面。分享经验可能会重新引发创伤。进行共同生产工作的人需要了解创伤以及这可能如何影响个人的心理安全感。长期资金对于使项目有足够的时间建立信任并取得切实成果至关重要。
共同生产原则在开发以创伤为中心的服务时非常适用。需要更多地考虑人们是否以及如何分享生活经历、需要安全空间、诚实和谦逊、赋权和安全之间的困难动态、以及界限是否以及何时模糊可能会有所帮助。我们的发现适用于政策制定、资金和服务提供，以使共同生产过程更加以创伤为中心。
“弥合差距”是由一群经历过复杂创伤的女性发起的，包括成瘾、无家可归、心理健康问题、性剥削、家庭和性暴力以及贫困，与一位为这一人群提供医疗保健的全科医生（GP）以及一家名为 One25 的慈善机构的一名支持人员合作，该慈善机构支持布里斯托尔最边缘化的女性之一，帮助她们康复和茁壮成长。更多的全科医生和医疗保健研究人员加入了该组织，他们每两周聚会一次，为期 4 年，旨在改善创伤知情的初级保健服务。该组织使用共同生产原则共同合作，我们旨在确保经历过创伤的女性在我们的合作过程中成为主要决策者。本文是我们学习成果的总结，内容包括小组成员的讨论、观察和访谈。
