Changing Futures: Improving mental health and wellbeing through trauma-informed support for people with multiple disadvantage

Project aims

We evaluated the work of Changing Futures Bristol. Changing Futures aimed to work with organisations and people with lived experience to:

• Improve the way that services work, so people can access the support they need more easily
• Inform new services, government programmes and policy
• Help staff provide fair, accessible long-term services
• Promote equality and diversity, and include people with lived experience in designing services

We carried out a participatory evaluation, working alongside people with lived experience and staff, to evaluate their work.

This project was funded by the NIHR Three Research Schools Mental Health Practice Evaluation Scheme.

What we did

We explored how trauma-informed approaches were being put into practice and what helped or got in the way.

We analysed how an organisation, Independent Futures (IF), enabled people with lived experience of multiple disadvantage to get involved in changing services and systems to better meet people’s needs.

We analysed surveys from clients who were experiencing multiple disadvantage and were supported by the programme to understand what difference the support made.

We conducted:

• a survey with 117 staff (with 30 repeating it a year later)
• interviews with 23 staff and 16 lived experience representatives
• an analysis of routinely collected survey data from 26 clients. Clients answered these surveys at several timepoints so that any improvements in their wellbeing and outcomes could be measured
• a documentary analysis of internal evaluation reports

What we found and what this means

Long-term commitment, stable funding, and cross-sector collaboration are needed to embed trauma-informed practice across services.

Implementing trauma-informed practices

We saw some movement towards more trauma-informed ways of working, but the changes were not statistically significant after a year.

Enablers to this were support and resources for cross sector-collaboration, open decision-making, transparent management styles, opportunities to share learning, training and reflective practice for all staff including managers. Barriers included short-term funding, insecure contracts, and pressures on staff.

Many staff had their own experiences of trauma, and this often motivated people to do their best for clients. Working with clients who are experiencing high levels of trauma can be stressful, especially where there are gaps in service provision (e.g. lack of mental health support).  Managers also faced a tough balancing act between meeting financial and performance targets and creating space for supportive, relational approaches. So, it is important that the right support is provided for all staff.

The findings from the first staff survey are available in detail here (PDF). Full details are available in our article published in BMC Health Services Research.

Working with people with lived experience of multiple disadvantage

Independent Futures (IF) was an organisation of people with lived experience of multiple disadvantage that supported Changing Futures Bristol work. We found that it modelled trauma-informed practice and helped influence systems change in some areas. Their trauma-informed approach facilitated personal growth, improved confidence and some work skills for IF lived experience members, who contributed to 65 different workstreams. However, embedding this involvement into wider services and systems can be challenging. Staff survey comments highlighted obstacles related to resources, time, and hierarchical cultures. Everyone needs to adopt and commit to trauma-informed principles to make lived experience involvement work. This requires flexibility, openness and willingness, making sure principles like trust, transparency, empowerment, choice and safety inform people’s everyday actions.

Supporting clients experiencing multiple disadvantage through My Team Around Me

My Team Around Me is a model that provides person-centred, trauma-informed support, co-ordinating services around a client. We analysed the impacts of implementing MTAM approaches on clients’ outcomes and explored what skills and resources are needed to embed MTAM across different services. We are currently writing this data up and will provide further details shortly.

What next?

We are exploring the sustainability of these ways of working, collaborating with Changing Futures Bristol in their continuing work. Our findings will help organisations identify gaps and opportunities to work towards trauma-informed practice. This will benefit both staff and service users by reducing and preventing trauma when they interact with organisations.

Changing how organisations do things takes time and effort. However, evidence shows trauma-informed organisations are more likely to be effective in their service delivery. Their staff are also more likely to enjoy their jobs while being productive.

How we use your data

We are using data that was routinely collected from the Ministry of Housing, Communities and Local Government (MHCLG) national evaluation dataset of the Changing Futures programme, which collected information on clients of Changing Futures at three-monthly intervals, to analyse whether the programme was effective at supporting clients who’ve experienced multiple disadvantage.

We are inviting staff involved in Changing Futures Bristol and some of its partner organisations to take part in a staff survey and interviews. To know more about how we use your data for the study, please see the privacy notice (PDF). If you do not want your data to be included in the study, you can request for your information to be removed from the databases we will be using.

What are your rights?

The data is held solely for research purposes. You have a right to be informed about the study, its use of the data, and how long we will hold the data for. Information about this will be provided in participant information sheets that we will provide to potential participants to invite them to take part in the study. For further information please also see our data privacy notice (PDF).