Trauma-informed care in a homeless women's shelter: a mixed method evaluation

Trauma-informed care (TIC) benefits to service users and providers are increasingly acknowledged across various health and social care settings. TIC can potentially increase service user engagement, prolong shelter placements, and lessen staff vicarious trauma and burnout. However, studies documenting staff experiences and/or the implementation of TIC are scarce. This limitation has prompted calls for more grounded and applied research into trauma-informed practice, tracking implementation in practice, staff perceptions, barriers, and organisational change. This study aims to address this gap and is an ecological, mixed-methods evaluation of the efficacy of TIC training in a female-only homeless shelter. Quantitative data included 132 incident reports during the first yearly quarters pre- and post-training, hypothesising post-training reductions in incident numbers and severity. Using expansive thematic analysis, semi-structured interviews with six shelter staff (n = 6) explored employee views of TIC relative to trauma understanding, incident management, and integration in practice. Findings revealed a marginal increase in incident numbers and a statistically significant reduction in incident severity post-TIC with a 50% reduction in calls to emergency medical services (EMS). Participant accounts of working practice pre- and post-TIC uncovered increased trauma understanding, increased confidence and competence, healing relationships, and enhanced self-care. Findings are discussed with reference to Substance Abuse and Mental Health Services Administration (SAMHSA)’s (2014) trauma-informed framework and Yatchmenoff et al’s. (2017) core questions in evaluating TIC. While these results are significant as one of the first evaluations of TIC training in Ireland, limitations and implications for future research and practice are considered.