September 24, 2019

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By Dr. Sinead Mitchell

Childhood trauma is significantly correlated with psychosis, but no agreed-upon principles exist for trauma-informed care in early intervention psychosis services. A team from Queens University, Belfast, hopes to change this and are looking for your help. Sinéad Mitchell explains how developing this consensus will help ensure consistent and effective early psychosis care for young people who have experienced trauma.

Findings from the literature point to a significant and predictive relationship between trauma and psychotic experiences. This relationship is integral to understanding the impact of trauma, identifying those at risk of developing psychosis, and informing treatment decisions.

The Adverse Childhood Experience (ACE) study established an indisputable link between childhood exposure to traumatic experiences such as physical and sexual abuse, neglect, and domestic violence, and adverse health outcomes in adulthood. Childhood trauma has been found to be significantly related to psychotic experiences, substantially increases the risk of psychosis, and is described as a causal factor for command hallucinations and voice hearing.

A recent systematic review found an association between increased trauma and greater symptom severity and poorer functional outcome among individuals with an ‘at-risk’ mental state for psychosis. Felitti et al. (1998) highlighted that secondary prevention of the effects of ACEs requires the recognition of their occurrence and an understanding of the behavioural coping strategies that are adopted to reduce the emotional impact of these experiences.

Given the prevalence of trauma experienced by individuals with psychosis, psychosis and posttraumatic stress disorder are highly comorbid. Trauma-focused treatment has been rated as a first-line treatment for individuals presenting with current attenuated or residual psychotic symptoms, and those with a history of single and multiple traumas. Early intervention psychosis teams have demonstrated a reduction in relapse rates, risk of suicide, number of hospital admissions, crisis contacts, and symptoms, while improving employment and education outcomes, social functioning and quality of life among service users.

Trauma-informed care has been described as a holistic approach to preventing re-traumatisation and understanding service users’ needs, including those with multiple, intersecting psychosocial stressors such as poverty, mental illness and trauma.

While access to early intervention services has been shown to enhance longer-term outcomes for individuals living with psychosis, no current consensus exists of how trauma-informed care should be practised within these services. Research in this area is thus warranted.

Using the Delphi method, our study, ‘Trauma-informed care in early intervention psychosis services’, is an opportunity to:

·       consolidate knowledge surrounding the principles of trauma-informed care in early intervention psychosis services

·       offer consistency of care

·       guide future research and service developments

·       facilitate evaluation of the efficacy of trauma-informed care within early intervention psychosis services.


Share your experiences of trauma-informed care in early intervention services

Our study welcomes perspectives from anyone with experience within early intervention psychosis services. Those who register to join the online participant panel will take part in three brief online phases Phase 1 will ask for your views of what trauma-informed care is, or should be in early intervention services. In Phase 2 you will be asked to rate a series of statements which have been derived from the Phase 1 data. In Phase 3 you will be asked to rate a final list of statements to reach consensus among the online panel.

Phase 1 of the study is open now.  You can share your views and thoughts about what you feel is important to consider regarding trauma-informed care in early intervention services here.


More information about the study can be found at: