Trauma-informed co-production: Collaborating and combining expertise to improve access to primary care with women with complex needs

Helen R McGeown, Lucy C Potter, Tracey J Stone, Julie Swede, Helen A Cramer, Bridging Gaps group, Jeremy Horwood, Maria Carvalho, Florrie Connell, Gene S Feder, Michelle C Farr*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)

Abstract

Introduction
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 re-traumatise. 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.

Methods
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.

Results
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 re-trigger 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 establishment of trust and delivery of tangible results.

Conclusions
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.
Original languageEnglish
Pages (from-to)1895-1914
Number of pages20
JournalHealth Expectations
Volume26
Issue number5
DOIs
Publication statusPublished - 10 Jul 2023

Bibliographical note

Funding Information:
Many thanks to all the women with lived experience of trauma who have been part of this group through its development. Many thanks to all the members of the Anon charity who supported this project through its development and gave their time to enable this project to happen. We would like to thank Lesley Wye for all her time and efforts to initiate and support the development of Bridging Gaps. Many thanks to the GP trainees who joined us as part of their placements for their enthusiasm and willingness to get involved. Thanks to all the general practices that we have engaged with, and the work they have done to improve access to trauma‐informed primary care. Bridging Gaps has been funded through the Q Exchange by the Health Foundation and NHS England and NHS Improvement and the National Institute for Health and Care Research (NIHR) Research Capability Funding through the NHS Bristol, North Somerset and South Gloucestershire CCG. It has also been funded by the Coproduction Collective (formerly UCL Centre for Coproduction in Health Research) as part of the 2019/20 Phase 2 Pilot Projects and by the NIHR School for Primary Care Research with support from NIHR Applied Research Collaboration (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.

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