Applying trauma-informed care within children’s homes : an exploration of experiences, psychological formulation and implications for practice

Toolis, Amy and Kara, Buket (2025) Applying trauma-informed care within children’s homes : an exploration of experiences, psychological formulation and implications for practice. PhD thesis, Lancaster University.

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Abstract

This thesis includes a qualitative exploration of applying trauma-informed care (TIC) within children’s residential homes and consists of three sections, a systematic literature review (SLR), an empirical study and a critical appraisal of the overall thesis. The SLR explored how TIC is implemented into children’s residential homes (settings that provide care for children under local authority responsibility). A meta-ethnography approach was used to identify, analyse and synthesise qualitative studies, producing new insights into TIC. A synthesis of 11 papers produced seven third-order constructs within two overarching themes. The first theme highlighted three key factors influencing TIC implementation: utilising a TIC model/framework, practical barriers and cultural/organisational barriers. The second theme identified outcomes of effective TIC; including increased trauma awareness, relational safety, development of staff values and empowerment for young people. Implications for clinical psychology and the need for a theoretically driven TIC model are discussed, alongside recommendations for future research. The empirical study explored the lived experiences of how residential staff in secure children’s homes (settings with additional security for children who pose a risk to themselves or others) interpreted and used psychological formulation within their practice. It also considered whether psychological formulation impacted staff’s working relationships with colleagues and YP, and identified what role formulation has for future TIC practice and policy. Nine participants were interviewed, and data were analysed using interpretative phenomenological analysis. Five themes emerged: ‘Enhancing trauma-informed and holistic understandings’, ‘Promoting collaboration through multi-disciplinary team working’, ‘Strengthening connection and empowerment’, ‘Creating safety’ and ‘Flexibility, adaptation and implementation’. The findings highlighted the critical role of psychological formulation in enhancing TIC, with implications for clinical psychology, practice, policy and future research discussed. The critical appraisal identified the strengths, limitations, clinical implications, personal reflections, and recommendations for future research of both chapters.