Reaching consensus on the principles of trauma‐informed care in early intervention psychosis services: A Delphi study

Abstract

Aim The current study sought to conceptualize and reach consensus on the principles of trauma‐informed care in early intervention psychosis services. Methods A three‐phase Delphi method was employed in this study. Experts included researchers, service providers and Experts by Experience in the area of early intervention in psychosis. In the initial qualitative phase, an expert panel (n = 57) shared their views on the constituents of trauma‐informed care in early intervention psychosis services. Thematic analysis led to the generation of statement items. The expert panel was asked to rate the extent to which each statement item was an essential principle of trauma‐informed care, leading to consensus of endorsed principles. Results Qualitative analysis of the first phase data led to the identification of 185 distinct statements which were compiled into an online questionnaire for the panel to rate in Phase 2. The Phase 2 questionnaire was completed by 42 experts, with the endorsement of seven principles. In Phase 3, the panel were invited to re‐rate 24 statements. This phase was completed by 39 panel members, with the acceptance of a further nine principles. Consensus was achieved resulting in the endorsement of 16 essential principles of trauma‐informed care. Conclusions The study offers novel understanding of the conceptualisation of trauma‐informed care in early intervention services and suggests principles which are widely agreed by experts in the field. The recommendations may inform the adoption of consistently delivered trauma‐informed care in early interventions in psychosis and facilitate the evaluation and development of services.

Trauma and Psychosis: A Qualitative Study Exploring the Perspectives of People with Psychosis

“…In the context of trauma in psychosis, this would not only mean reducing the psychotic symptoms, but also trying to understand these symptoms as potential reactions to traumatic life experiences, and therefore bene t from general support consistent with trauma-informed care as well as, in some cases, trauma-focused therapy. Trauma-informed care in psychosis, based on knowledge and understanding of how trauma affects people's lives, have widely agreed on principles [49]. Trauma-focused therapy has shown promising results [50], with no evidence that it could lead to re-victimization or the exacerbation of PTSD or psychotic symptoms [51].…”

Research watch: trauma-informed mental health care and avoiding exclusion of people with a psychosis diagnosis from trauma therapies

“…Mitchell et al (2020) point to growing evidence that traumatic experiences in childhood may be a direct cause of psychosis, or at least some of the experiences that are thought of as psychosis. Early intervention services for psychosis aim to support people quickly when they are identified as having a first episode of psychosis, say Mitchell et al (2020).…”

“…Mitchell et al (2020) point to growing evidence that traumatic experiences in childhood may be a direct cause of psychosis, or at least some of the experiences that are thought of as psychosis. Early intervention services for psychosis aim to support people quickly when they are identified as having a first episode of psychosis, say Mitchell et al (2020). Although treatment outcomes seem to be better in these services than others, Mitchell et al (2020) point out that people who have experienced childhood trauma have poorer outcomes than those who have not.…”

“…There has been increasing recognition of the role of traumatic experiences in the backgrounds of people who receive a mental health diagnosis (Isobel et al , 2020), including psychosis (Mitchell et al , 2020). There have been calls for mental health services to take this into account by offering trauma-informed care (Peach et al , 2020; Sweeney et al , 2016).…”

“…Isobel et al (2020) asked mental health service users and carers in Australia to suggest ideas for trauma-informed care. Mitchell et al (2020) surveyed clinicians and service users (mainly in the UK) and asked them to rate the importance of certain practices representing trauma-informed care in early intervention services for psychosis. Bloomfield et al (2020) looked for research evidence about what sort of therapies are helpful for trauma in people who have been given a psychosis diagnosis.…”