Background People facing multiple disadvantage have often experienced extensive trauma. Changing Futures Bristol was part of a national programme to improve outcomes for people who face multiple disadvantage, such as combinations of homelessness, substance misuse, mental ill-health, domestic violence and abuse or contact with the criminal justice system. Aims were to understand how services could be improved, with more trauma-informed approaches at individual, service and system levels. An in-depth mixed method evaluation of Changing Futures Bristol examined how trauma-informed approaches were implemented and linked across services supporting people experiencing multiple disadvantage. Methods The study followed a participatory action research approach, involving research conducted in collaboration with people who have experienced multiple disadvantage, and staff partners. Collaborators actively contributed to securing funding, research design, data analysis, and write-up. A staff survey was conducted using existing measures and some tailored questions, to assess perceptions of trauma-informed approaches, equality, diversity and inclusion, and co-production. One hundred and seventeen staff responded, with 30 staff completing the survey again after one year to track any changes. Twenty-three staff members were interviewed. Qualitative data were analysed thematically, guided by trauma-informed principles and implementation domains. Results Movement toward more trauma-informed approaches was detected, although these changes were not found to be statistically significant after one year. Barriers included short-term funding and commissioning cycles and difficulties in staff retention, due to short-term contracts, vicarious trauma, stress and pressures of the job. Managers had to hold contradicting drivers to deliver targets and manage finances whilst creating space for relational support and trauma-informed practice. To create psychological safety, staff needed to feel trust and transparency. 73% of staff reported lived experience of at least one domain of multiple disadvantage or trauma. Support for staff is needed at all levels of the organisation. Conclusions A long-term, collaborative, and trauma-informed approach is needed at all levels, including leaders, managers, policymakers, and central government. Government and public service reforms that focus on cross-sector collaboration and devolution of power will support trauma-informed practices. Stable, long-term funding and planning will help create a motivated, skilled workforce that can build on existing good practice.

Cross-sector collaboration and long-term stable funding are key to making services more trauma-informed for people facing multiple disadvantage, according to a new study. The evaluation was conducted ...

More than 250,000 older adults live in English care homes, yet staff often lack clear guidance on how to develop the care plans that shape residents’ daily lives. Training is frequently described as “...

Many autistic people experience poor mental health. The results of past research into treatments for mental health problems might not apply to autistic people. For example, medication for mental healt...

Children growing up in British cities face barriers to safe, playable spaces as financial constraints, policy misalignment and housing pressures cause planners to prioritise property over parks, accor...

About the event Endometriosis affects around 1 in 10 women and those assigned female at birth. It can cause severe pain, heavy periods, fatigue, and difficulties with fertility, yet it often takes yea...

A new study is investigating whether FAST MRI, a new type of scan, can help detect small but aggressive breast cancers earlier. Now open to patients, the

Our projections show the substantial detrimental impacts that cuts to PEPFAR funding could have. Mitigation measures, including funding through alternative international donors or domestic government ...

Background Drug-related deaths have substantially increased over the past decade in the UK, particularly in Scotland. Co-use of opioids and benzodiazepines (prescribed and/or illicit) is contributing to rising mortality. This study identified motivations in people’s co-use with the aim of informing prescribing and harm reduction interventions to address drug-related deaths. Methods We interviewed 48 people who co-use opioids and benzodiazepines and/or z-drugs (zopiclone and zolpidem) in Glasgow (n = 28), Teesside (n = 10) and Bristol (n = 10). Most participants self-identified as male (n = 37, 77%), white (n = 45, 94%) and had a mean age of 43 years (range: 25–61 years). The majority reported at least one overdose experience, and poor mental health including trauma. Interviews were semi-structured, conducted by an academic and/or peer researcher, and analysed using reflexive thematic analysis. Results Participants’ motivations for co-using mapped onto two interlinked meta-themes: (1) Functional motivations included co-using to augment drug effects, self-medicate or help to generate income. (2) Experiential motivations described participants’ desires to achieve a ‘buzz’ (feeling energised), ‘glow’ (feeling comforted), ‘oblivion’ (escaping trauma and adversity), and ‘gouching’ (physical and mental sensations of ebbing in and out of glow and oblivion). Functional and experiential motivations were dynamic, interrelated and often co-occurred. Conclusions The importance of assessing motivations to co-use should be routinely recognised as part of harm reduction and medication assisted treatments to reduce mortality risk.

NHS hospitals are facing a shortage of nurses at a time when patients’ needs for care are increasing. To help address this, a new role called the Nursing Associate (NA) has been introduced. NAs work a...

Providing care for people living with dementia at home can be challenging. Stress, burnout, and frequent staff changes among care workers affects the quality of care. Research shows that matching care...

Colorectal cancer (CRC) screening is one of the main causes of death in high-income countries. In Japan, cancer screening programmes are delivered by different insurers, and these programmes are based mainly on communities and workplaces. Although several surveys have suggested participation rates are higher in workplace-based programmes, the experiences and views of participants and non-participants are poorly understood. We conducted a secondary qualitative analysis of transcripts from interviews with people who shared their experiences and/or views of employer-based CRC screenings. By using a qualitative database called DIPEx-Japan, we purposely selected participants who had been on social insurance which indicated they were eligible for workplace-based cancer screening. We excluded (i) individuals with a history of inflammatory colorectal diseases; (ii) individuals who stated that they had been exclusively on National Health Insurance; and (iii) individuals who did not mention workplace-based screening. We conducted a thematic analysis for the selected interviews. We selected 24 cases for analysis. The participants were encouraged to attend workplace-based CRC screening alongside other annual legislated health check-ups or by offering financial assistance to attend comprehensive general health check-ups in hospitals that also include screening by default. Two interviewees who had not attended workplace-based screening said that it was not provided as a mandatory option. The participants often lacked the information required to make an informed choice regarding their participation in workplace-based screening. Several interviewees who had not attended further examinations explained that they were not informed of the necessity or purpose of the screening. Follow-up strategies varied across employers. However, there was an indication that interviewees who had an established relationship with healthcare professionals expressed their willingness to take up further examinations if needed and continued to participate in screening after their retirement. Workplace-based cancer screening programmes may improve uptake of cancer screening because of their mandatory arrangements. However, better communication is needed to explain the risks and benefits of screening which will support their decisions to take up further examinations or encourage continuous participation in screening.

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About the event Endometriosis affects around 1 in 10 women and those assigned female at birth. It can cause severe pain, heavy periods, fatigue, and difficulties with fertility, yet it often takes yea...

Nursing Associates (NAs) are a relatively new role in healthcare. Introduced in 2016, they work at Band 4 – between Healthcare Support Workers and Registered Nurses. After 2 years of training, NAs can...

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The UK Equality Act 2010 mandates equal access to healthcare for people with disabilities. For those with disabilities who have also been diagnosed wi…

This annual event is to thank our patient and public contributors for working with health researchers and clinicians to help improve health and access to healthcare for everyone across the West of Eng...