Acknowledging complexity in the impacts of sexual victimisation trauma

ACSSA Issues No. 16 – February 2014

Acknowledging trauma from the policy perspective

The body of evidence (outlined above) that links trauma to human service use, has implications for policy. It is difficult to ignore the benefits of more effective, recovery-oriented service design for people with multiple needs. As the pathway between sexual victimisation and complex trauma becomes clear, it is important that this link is acknowledged and incorporated and into health and service designs. Policy reform around service design and delivery can play an important role in creating a cultural shift to a better understanding of complex trauma, and in facilitating the connectedness of services as discussed. This requires the implementation of systems of care that are person-centred and can provide the holistic overview necessary to deal with the social and health aspects of complex trauma in order to enable recovery. There is a need to create partnerships between services in different fields, such as mental health, substance abuse, relationship services, and those less directly involved in health such as employment and housing (Treloar & Holt, 2008).

The risk of not acknowledging the manifestation of trauma in various aspects of people's lives is the failure to engage those who need assistance, which may result in less successful treatments. There can also be the need for repeated service use for the same issues, which can be inefficient, expensive, and can negatively impact on the wellbeing of clients (Domino, Morrisey, Chung, Huntington, & Larson, 2005). Research around drug treatment clients, for example, indicates clients are significantly more likely to remain in treatment if other life issues are also addressed (Treloar & Holt, 2008). Review and analysis of appropriate human service policies for victim/survivors of complex trauma is a task beyond the scope of this paper, however, there are some important points for consideration when conceptualising service use for people suffering because of a history of trauma.

Policy development has the ability to impact on service provision by creating shared understanding of trauma for individual service providers. It can help shift health care focus from a medical, diagnostic approach, to a person-centred, recovery emphasis. Ideally, a trauma-informed approach to policy would operate to ensure awareness and collective understanding of complex trauma and help create a philosophy common to service providers to enable person-centred solutions. By creating policies that emphasise a culture of interagency collaboration, the impetus to approach the problem of trauma collectively is highlighted.

Structure of services

For people experiencing complex trauma, the need for organisational and structural factors to be appropriate is important. For example, social situations such as homelessness and poverty, where higher levels of trauma are common, can generate serious barriers to accessing services. Service engagement can be limited by transport, lack of trust of bureaucratic entities, and organisational cultures that are incompatible with particular aspects of people's lives, such as homelessness or parenting. Policy can impact and help to overcome problems with these structural factors by considering the infrastructure and barriers to access that may impede collaborative service use (Rosengard et al., 2007).

A key feature in the design of trauma-informed services is the need to ensure consumer empowerment. By policy development that directs a consumer-empowered approach in service settings, this important element can become a key goal of service delivery.

Accessibility and knowledge of services

For a range of reasons, service users may not be aware of all the services they are able to use and factors around entitlement to use. Service systems may be complex and difficult to navigate for people with particular problems. One suggestion of overcoming this is to ensure cross-promotion of other services within GP offices or across services (Rosengard et al., 2007).

One suggestion in the literature is to emphasise outreach services to ensure that those in need of a particular service have more opportunity to find out about and utilise the appropriate care (Rosengard et al., 2007).

Policy directives can motivate development of appropriate service availability and relevance by driving an understanding of optimum service delivery and relevance.

Joined-up/integrated/single point entry for services

The literature emphasises the need for flexibility and case-specific approaches to people suffering from complex cases of trauma (Briere & Jordan, 2004). Aspects of human service policy that may be effective for encouraging engagement and successful service use may include the ability for services to collaborate in a variety of ways and policy can ensure that information and resource sharing between services is maximised by facilitating connections between them. It can do this by directing and shaping structural connections and inter-service communications.

Measuring outcomes

For people with complex trauma and a range of needs, the issue of how to measure outcomes will be difficult. This will require considering what constitutes success and effectiveness and how to measure the cost of people's multiple engagements with services. This is an expansive question and beyond the scope of this paper. The trauma literature indicates that a very clear conceptual framework will be important in order to acknowledge the experiences of sexually victimised people and their resulting trauma and an understanding that the needs may be varied and that engagement and recovery may be difficult for a variety of reasons. Policy should consider the adoption of evaluation techniques that can most appropriately measure outcomes and service use by providing a more contextual and complete picture that includes consumer feedback and satisfaction aspects (Wall, 2013). In program evaluation aimed at considering effectiveness of treatments and programs, it should be acknowledged that a recovery trajectory wouldn't necessarily reflect clear, linear improvement but that functioning can drop before increasing once recovery commences.