Can training improve staff skills with complex trauma?
| Date | 02 July 2019 |
| Published date | 02 July 2019 |
| Pages | 112-123 |
| DOI | https://doi.org/10.1108/MHRJ-10-2018-0032 |
| Author | Paula Robinson,Emma Griffith,Chris Gillmore |
| Subject Matter | Health & social care,Mental health |
Can training improve staff skills with
complex trauma?
Paula Robinson, Emma Griffith and Chris Gillmore
Abstract
Purpose –Studies show that experiences of repeated or complex trauma are very common in patients
with severe mental health problems. Unfortunately, many professionals do not routinely ask about abuse,
due to concerns about how to ask and respond. There i s also a need for frontline staff to be trained
in trauma-informed ca re. The purpose of this paper is to id entify the needs of inpatient staff and developed
a tailor-made training package.
Design/methodology/approach –A training programme was developed from focus-group
discussion and delivered to the team. Questionnaires were administered pre-, post-training and at
three-month follow-up, to assess changes in knowledge, confidence and worries in the assessment and
treatment of complex trauma.
Findings –There was an increase in self-reported staff confidence (p ¼0.001) and knowledge (p ¼0.028)
about working with complextrauma andtheir worries decreased ( p ¼0.026) between pre- and post-training.
Practical implications –In order to sustain the benefits of training for longer, recommendations were made
to the service for on-going training, supervision and evaluation.
Originality/value –Given the recent interest in complex trauma within the literature (Diagnostic and
Statistical Manual of Mental Disorders –Fifth Version (DSM-V); International Statistical Classification of
Diseases –11th Version (ICD-11)), the piloting and development of complex trauma training packages is
timely. To the author’s knowledge, this is the first published account of complex trauma training for inpatient
staff. This paper offers clinical and research implications to services who may want to develop as
trauma-informed services within the NHS.
Keywords Staff training, Complex trauma, Service improvement, Programme evaluation, Complex PTSD
Paper type Research paper
Complex trauma or com plex posttraumat ic stress disorde r (CPTSD) was propose d by
Herman (1992) to describe a syndrome of prolonged and repeated trauma. It came into
being when some forms of trauma were found to be much more pervasive and
complex (Herman, 1 992). Childhood ab use that occurs over a n extended time per iod is
one such example (Courtois, 2004). Complex trauma suggests clusters of symptoms
relating to affect regulation, consciousness, self-perception, perception of the
perpetrator, relations with others and systems of meaning (Cloitre et al., 2011; Herman,
1992; Resick et al., 2012).
While there is growing attention to the concept of complex trauma, mixed views precluded
the development of a diagnosis in DSM-V (American Psychiatric Association, 2013). On
one hand, experts in th e field argue for the i nclusion of a distin ct subtype of PTSD th at
more adequately captures the above cluster of symptoms, with such recognition seen
as being the precursor needed for the development of research (Herman, 2012). On
the other hand, the d earth of new resear ch into the validity of complex trauma s ince
DSM-IV has led to con clusions that the re was insufficie nt evidence for com plex trauma
to be included as a subty pe in DSM-V (Resick et al., 2012). In comparison, ICD-11
(World Health Org anization, 2015) in cludes complex t rauma as a separate diagnosi s,
due to an emphasis on different diagnostic criteria and as a less conservative approach
has been taken than DSM-V’s requirement for a large burden of scientific proof
(Friedman, 2014).
Received 12 October 2018
Revised 3 March 2019
15 April 2019
Accepted 17 April 2019
Paula Robinson andEmma
Griffith are both basedat the
Department of Psychology, The
University of Bath, Bath,UK.
Chris Gillmore is based at The
Therapies Service, Bath NHS
House, Avon and Wiltshire
Mental Health Partnership NHS
Trust, Bristol, UK.
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VOL. 24 NO. 2 2019, pp. 112-123, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-10-2018-0032
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