Introduction

Following the publication of Inclusion’s Trauma Informed Practice Guidance, our services are committed to embed the principles. In this article, Suzanne Dooley discusses how the No Wrong Door service has been developed to now be considered as the leaders of trauma informed care within the mental health transformation programme.

The original No Wrong Door model

The original No Wrong Door (NWD) model was based on a trauma-informed approach model, which our team in the south-east have developed so that the service is now considered to be leaders of trauma-informed care within the mental health transformation programme.

The south-east NWD team has been in place since March 2023 and as it was a new service with the team joining gradually, it allowed for scope to really look at how we can improve our practice so that we are more trauma-informed.

For the first 12 months of the project, we held a referrals meeting on a Monday where we discussed every client referred and currently open to the service, it allowed us space to ask “What are the barriers for that service user to attend our service, and what are the barriers that could/is prevent/preventing them from being able to fully engage in their treatment pathway”. Then, we would create an individual plan for each service user, exploring these potential barriers and adjusting our approach accordingly. This gave us space to look at our practices and embed a trauma-informed approach.

Our referrals are now so high we are unable to do this for every case during our referral meeting, but with the approach embedded within the team, 3 weekly caseload reviews being completed with staff, we can continue to explore those important questions of the barriers preventing service users from accessing and engaging in treatment.

This trauma-informed approach has been extended to staff as well as clients. Looking at what barriers might complicate a piece of work, exploring reasons why something hasn’t gone to plan instead of making assumptions. This approach has led the staff to feel more positive and supported within the team, which reflected in their approach to clients. We now have developed a trauma-informed methodology for the Inclusion No Wrong Door Service, and continue to promote this way of working across the No Wrong Door Service in Hampshire.

Trauma-informed working has helped our service offer a more supported journey for clients, recognising their individual recovery pathways. This could include acknowledging the fear a client might have of coming into our services, and therefore offering to meet them out of service and create a plan for them. The model helps to explain a client’s treatment journey fully with them, instead of assuming they already know why certain things are happening as part of their pathway. It could be completing a joint assessment with another service so the client doesn’t have to repeat their story twice, which can sometimes be triggering and traumatic for the client.

This approach has allowed our clients to engage more with their treatment pathway and also empowering them to take ownership of their pathway.

A lot of services are working towards a trauma-informed way, therefore sharing news of different trauma-informed approaches helps services recognise that. It also reminds services of the importance of practices they may have forgotten, such as offering clients the choice of face-to-face appointments, phone or digital appointments. Explaining the assessment process so it’s done with the client not done to.