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Peer support work is increasingly recognised as an adjunct support across various systems of health and social care, and is a core principle in trauma-informed care. Those accessing a wide range of human and social services may have experienced prior trauma. As such, trauma-informed care is a universal organisational model that seeks to realise, recognise and respond to trauma, while limiting possible re-traumatisation when individuals are engaging with systems of care. Peer support can play an integral role in supporting those who have experienced prior traumas. However, trauma does not exist in isolation and the wider environment influences, moderates and contributes to how an individual experiences and heals from trauma. Peers can play an important role helping to alleviate some of the environmental influences by helping to build the capacity of those that use health and social care services.

Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The provision of support is key in alleviating distress and improving work functioning. This paper aims to incite clarity on whether staff in DD services are more likely to access trauma support. The prevailing needs and outcomes for this population are also explored.

Data was extracted retrospectively from a database held by an internal trauma support service (TSS) for staff working in a secure psychiatric hospital. Overall, 278 permanent clinical staff accessed the TSS between 2018 and 2020, 102 (36.7%) of whom worked in an adult DD forensic inpatient service.

Staff working in DD services were over-represented in referrals to the TSS with a greater number of referrals per bed in DD services than in non-DD services (0.94 vs 0.33). DD staff were comparatively more likely to access support for non-physical, psychologically traumatic experiences. Psychological needs and outcomes following support were comparable between staff across services.

The findings highlight the more frequent need for trauma support of staff in forensic inpatient DD settings. Embedding a culture of safety and openness, and establishing appropriate and responsive models of staff support reflect key priorities for inpatient DD health-care providers, for the universal benefit of the organisation, workforce and service users.

This study offers novel insight into levels of access to support for staff working with people with DDs.

In the previous chapters, I set out a conceptual model of trauma-informed servant leadership and discussed servant leadership supervision for working with burnout, compassion fatigue and secondary trauma in employees within trauma related health and social care settings. In this chapter, I further extend servant leadership to the peer support principle in trauma-informed approaches (Substance Abuse and Mental Health Services Administration, 2014). The first part of this chapter will examine peer support work (PSW) and report on the outcomes associated with it. Then, servant leadership will be discussed and used to operationalise the principle of peer support as set out in trauma-informed approaches. A servant leadership peer support approach is put forward with a theoretical basis. This theoretical model has been slightly changed from the previous servant leadership approaches discussed, in order to represent the PSW role more accurately. However, as discussed previously, it is not the characteristics of the Servant leadership (SL) model that define the approach, rather the philosophy and desire to serve first. In the last section of this chapter, Martha Griffin brings the characteristics of this model to life using her vast experience and discusses some of the potential challenges faced by peers in training and practice.

Peer support has gained increasing attention within the mental health literature, including the trauma informed approaches research where peer support is a key principle. The purpose of this paper is to outline a servant leadership model of trauma peer support.

A targeted literature search that incorporated systematic reviews, meta-analyses and randomised control trials in the areas of servant leadership, peer support and trauma informed approaches were sourced.

Servant leadership can be used to provide a theoretical model of trauma peer support. All three constructs share the idea of empowerment as a core principle. An ideographic model of servant leadership trauma peer support is put forward based on eight characteristics from the extant literature.

As with all conceptual papers, a lack of empirical data means the findings need to be investigated using primary data. Future research may wish to use this theoretical model to test effectiveness in equivalence studies.

A theoretical model of trauma informed peer support based on servant leadership theory, with a clear guide to its utilisation.

This is a novel approach, a new addition to the literature.

Exposure to high-trauma work has been associated with negative outcomes for individuals and organisations. Support for these employees can buffer and protect against mental health problems. Frontline managers (FLMs) are well placed to provide for employee support needs but are often not effective in doing so. The purpose of this paper is to identify and understand barriers to provision of four different types of social support as identified by House (1981) by FLMs to employees in a high-trauma workplace.

This qualitative study investigates three Australian ambulance service organisations, including 72 interviews.

Nine barriers to support are identified that can obstruct the provision of optimum employee support. These relate to the FLM themselves, the workplace context and employee-centric factors.

This paper is a single industry case study; further complexity may exist in other high-trauma industries. Future research should consult policy makers to develop strategies to address the barriers to FLM support.

FLMs are critical support persons as they are well placed to provide many employee support needs. Emotional support is the foundation for facilitating all other types of support to employees but results here indicate it is often lacking for workers in high-trauma workplaces for a range of individual and organisational barriers that operate in isolation and combined.

This paper juxtaposes House’s (1981) support framework with study findings to provide a model of the barriers to optimal employee support. This model contributes to a reconceptualisation of the relationship between employee and direct manager that is particularly pertinent for high-trauma contexts.

Mental health services have changed significantly in the past few decades. Currently, our services are transforming from one that was biomedically led to one that encompasses a recovery orientation. Additionally, a new field of study as it related to mental health care is emerging that of trauma-informed care. In this chapter, we explore briefly what we mean by the terms trauma and trauma-informed care. This is followed by a critical examination of how co-production and servant leadership can work together to support individuals through their trauma towards recovery and well-being. From which, we suggest that peer support workers are suitable candidates to co-produce trauma-informed services as they embody the connecting principles of choice and empowerment needed for all three concepts to converge and work together to enhance recovery and well-being. While I focus on using co-production in the mental health space in this chapter, the principles and practices can equally apply to other health and social care services.

This paper advances what is known about emotional experiences and challenges when researching work-caused trauma in organisations and illustrates learning for researchers of work-related trauma. Viewing vulnerability as strength could be conceived as an oxymoron. The paper explains how vulnerability can lead to strength for researchers/participants and focuses on researcher reflexivity in relation to one interview with a woman leader in a small-scale qualitative study.

The research protocols of the qualitative study are outlined: pre-interview briefings, participant journaling and semi-structured interviews. Researcher reflexivity, following Hibbert's (2021) four levels of reflexive practice (embodied, emotional, rational and relational), is applied to an interview with a woman leader.

The paper illustrates how research design and recognising vulnerability as strength facilitates considerable relational work and emotional experiences. Researcher reflexivity conveys impact of work-caused trauma on participants and researchers. The paper advances understandings of vulnerability as strength in practice, emotional experiences and challenges of work-caused trauma research.

In this paper, a single case of researcher reflexivity is considered.

There are practical implications for researcher relationships with participants; demonstrating emotional awareness; responding to traumatic stories, participant distress and impact on the researcher; issues of vicarious/secondary traumatic stress; having safe psychological systems; scaffolding a process which recognises vulnerability as strength and becoming personally and methodologically vulnerable; risk of embodied and emotional impact; commitment to reflexivity and levels of reflexive practice.

There is lack of researcher reflexive accounts of practice when studying trauma. Few scholars suggest ways to support researchers in challenging and difficult research. There is silence in research exploring leaders' experiences of work-caused trauma. This paper provides a reflexive account in practice from a unique study of women leaders' experiences of work-caused trauma.

The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

The purpose of this paper is to describe an American healthcare organization's experience creating the first multi-facility trauma system managed by a private, nonprofit organization.

A leadership structure was established to initiate the first steps of system development, followed by needs assessments that identified key components essential to creating the interconnected system. The key components were applied as a result of evidence-based system development. After system implementation, early benefits were explored.

Data collection and research, prehospital support, system-wide quality improvement, rural outreach, communication, and system evaluation were identified as key components essential to creating an interconnected trauma system. The system currently connects 12 trauma centers throughout the state of Colorado while working within the parameters of an established statewide system. Early benefits included improved designation review results, the utilization of system-wide best practice protocols, a rich trauma registry, and closer relations with rural, out-of-network facilities.

This study describes the process undertaken to implement a unique medical system that provides regionalized care and complements an existing statewide trauma system. The authors hope their experience may serve as a roadmap for healthcare professionals wishing to develop an integrated, patient-centered model of care.

The development of this multi-facility trauma system within a private, not-for-profit healthcare organization is the first of its kind.

From the authors’ personal and professional experiences, they have observed that autistic women are uniquely at risk of interpersonal trauma. Given the tendency for autistic women to be overlooked in research and practice, this study aims to rectify this by exploring the relevant literature and including the voices of autistic women throughout this paper.

This study completed a literature review of quantitative and qualitative data relating to exposure to interpersonal trauma in autistic women. This study also reviewed relevant discursive evidence available on in memoirs and reports. This study also included dialogue between us as authors from an auto/“Autie”-ethnographic position.

Both clinical literature and discursive evidence support the idea that autistic women are uniquely at risk of interpersonal trauma, in particular, sexual victimisation. Explanatory factors are considered. Studies exploring rates of post-traumatic stress disorder (PTSD) were less consistent. Further evidence is required to better understand how autistic women experience and express PTSD and to inform assessment and treatment modifications.

To the best of the authors’ knowledge, this is the first paper to integrate clinical literature and discursive evidence on the topic of interpersonal trauma in autistic women. It provides useful insights into the experiences of autistic women in this space, directions for urgently needed future research and modifications to clinical practice.