Abstract
Individuals who commit criminal offenses are rarely viewed with empathy. They are typically perceived through a punitive lens, a perspective which fails to consider factors that contribute to their offending behavior (Gueta et al., 2021). The reality is that many individuals who commit crimes are themselves victims of trauma in childhood, adulthood, or both (Baker et al., 2021; Ford et al., 2013; Levenson & Willis, 2019). An extensive body of research shows that the majority of men and women in prison have experienced trauma (e.g., Levenson et al., 2016; Miller & Najavits, 2012; Wolff & Shi, 2012). Australian research indicates 70.1% of women and 64.9% of men in prison have experienced some form of potentially traumatic event, predominantly in the form of witnessing, experiencing, or being threatened with violence, or physical, sexual, or emotional abuse (Justice Health & Forensic Mental Health Network, 2017).
The Burden of Crime
As of March 2023, there were 41,833 people in custody in Australia, an increase of 11,510 in the last decade (Australian Bureau of Statistics [ABS], 2013, 2023). A significant proportion of these people are recidivist: of the people released from Australian prisons during 2019 to 2020, 51.5% returned to corrective services within 2 years (Australian Government Productivity Commission, 2021). In the 2019 to 2020 financial year, the Australian government spent $5.2 billion on prisons, with recidivism accounting for more than half of those costs (Australian Government Productivity Commission, 2021). Given these numbers, it is understandable that rehabilitation to reduce the risk of reoffending is one of the five guiding principles for the Corrections system in Australia (Corrective Services Administrators’ Council, 2018), and that focus has increasingly turned to programs and services that support effective rehabilitation.
The current approach to rehabilitation in Victorian prisons is underpinned by the Risk-Needs-Responsivity (RNR) model, which identifies criminogenic risk factors and aims to target these through rehabilitative approaches (Bonta & Andrews, 2017; Corrections Victoria, 2017). While the efficacy of this model is empirically well-supported (see Andrews & Bonta, 2010), researchers have argued that consistently high recidivism rates have given impetus to calls for the need to better understand factors that contribute to successful rehabilitation (Day, 2020). In line with the RNR model, one of the factors that may affect responsivity to treatment is trauma. There is strong evidence that prior trauma exposure is linked to criminal recidivism (Dalsklev et al., 2021; Maschi et al., 2019; Sadeh & McNiel, 2015) and that failing to address the impacts of trauma can contribute to the development of criminal behavior. An Australian study by Honorato et al. (2016) found that a lack of support, or treatment, for trauma experiences increased the chances of engaging in violent offending in a high-security prison cohort. Given these findings, and the increasing evidence of links between trauma and rehabilitative treatment outcomes (Kustrin, 2021; Te Hiwi, 2021), exploration of appropriate and effective treatments for people in prison who have experienced trauma is an important avenue for further research.
Trauma and Criminal Conduct
Trauma describes the emotional, psychological, and physiological consequences that can result from an experience of threat, violence, and/or neglect (Thomas, 2019). The lasting and cumulative effects of trauma are well documented and include posttraumatic stress disorder (PTSD; Welfare & Hollin, 2015), disturbances in emotion regulation and interpersonal skills (Vitopoulos et al., 2019), poor decision making, impulsivity, aggression, and addictive behaviors (Baglivio & Epps, 2016; Ekinci & Kandemir, 2015; Ford et al., 2013; Stinson et al., 2016). Disturbances in brain function, social skill development, and behavior regulation from trauma can lead to antisocial and criminal behaviors. Criminal behavior can also develop through learned patterns, especially when individuals are exposed to others who display antisocial behavior or hold criminal beliefs and attitudes (e.g., normalization of sexual or physical violence; Fritzon et al., 2020). Baumle (2018) describes this as the “trauma to prison pipeline” (p. 695). Levenson et al. (2016) found that in a sample of 679 men who had committed sexual offenses, more than 84% had experienced at least one Adverse Childhood Experience (ACE; a measure of exposure to childhood traumatic events), and nearly half had experienced four or more ACEs. Higher ACEs were positively correlated with more violent, aggressive, and sexually deviant crimes, and with a higher risk of reoffending.
When individuals come into contact with the criminal justice system, their experiences during offending, arrest, judicial proceedings, and time in prison can bring their own trauma (Gueta et al., 2021; Mossiere & Marche, 2021). Threat of harm, witnessing, perpetrating, or experiencing violence in prison, memories of offending, loss of personal relationships, being separated from one’s children, and experiencing solitary confinement are among the potential traumas experienced by people in prison (DeVeaux, 2013; Hagan et al., 2018; Haney, 2006; Levenson & Willis, 2019; Petrillo, 2021). Research from New Zealand demonstrated that individuals’ trauma can negatively impact their progress in, and completion of, offense-specific treatment while in prison. Te Hiwi (2021) examined a high-risk, violent offending sample of 423 and found that higher exposure to trauma in childhood was linked to poorer engagement in, and completion of, rehabilitative treatment programs. Kustrin (2021) also explored the relationship between childhood trauma and progress in offense-specific treatment in a violent offending sample of 417. Findings indicated that greater childhood maltreatment reduced treatment progress and completion. Following release from prison, a history of trauma can present a significant barrier to successful reintegration into the community and increase risk of substance abuse and mental health difficulties (Doherty et al., 2014; Spjeldnes & Goodkind, 2009).
Treating Trauma in Forensic Settings
A number of recent papers have advocated for the need to recognize the role of trauma in incarceration and rehabilitation of people who commit crimes (e.g., Gueta et al., 2021; Levenson & Willis, 2019; Matheson et al., 2015; Willmot & Jones, 2022). Research into the use of trauma-informed approaches with forensic populations has begun to emerge in the last decade. However, it has largely focused on trauma-specific interventions, rather than trauma-informed care (TIC) as an approach that can be integrated into other services (i.e., how services are provided, rather than specific interventions). Research investigating the integration of TIC with existing treatment approaches in forensic populations is sparse and has delivered mixed results, indicating that further research is needed. Auty et al. (2022) examined the implementation of a TIC training program for prison officers in the United Kingdom and found no change in the custodial care experiences of women in prison as a result of the training. Specific challenges to successfully embedding TIC into prison systems were identified. These included punitive organizational culture, staff attitudes about the importance of TIC, and a lack of ongoing support for staff to implement TIC. Vaswani and Paul (2019) examined the implementation of TIC with young people in custody in Scotland. They found that prison staff supported TIC and that TIC training resulted in a small shift in organizational culture and practice. However, challenges to using a trauma-informed approach were identified. These included inadequate resources and limited support for staff to deliver TIC, and the prison environment and culture. A 2018 study by Mann examined the perspectives of 93 professionals working in forensic settings in the United States. Professionals identified a number of challenges they encounter when working with people in prison who have PTSD, including low treatment compliance, low motivation, and high rates of re-traumatization (repeated exposure to trauma triggers) in prison. They perceived the use of TIC to be useful to improve treatment of PTSD, but identified a number of systemic challenges, including lack of funding and resources, inadequately trained clinicians, and large caseloads impeding successful delivery of TIC in forensic services. More research is needed to better understand the potential benefits and limitations of integrating TIC with existing rehabilitation approaches and recommendations for doing so effectively.
The Current Study
This study aims to contribute to the limited literature in this area by exploring clinicians’ perspectives on the utility of TIC in offense-specific treatment with offending populations in Australia. Three research questions were posed:
In what ways, if any, is TIC seen as being important and/or useful in a forensic setting?
What are clinicians' views on the ways that TIC is currently being used in forensic settings in Victoria, Australia?
From a clinician's perspective, what factors facilitate or impede the use of TIC in Australian forensic settings?
Exploration of these questions will provide the first known insights into the clinical perspectives on the challenges and benefits of TIC in offense-specific assessment and intervention services in Australia. This information may be useful to reform existing programs and services to address the needs of those within the justice system and reduce rates of recidivism and crime in Australia. The results may also offer insights into clinical perceptions of improved TIC for offense-specific services in countries beyond Australia.
Method
Researcher Descriptions
This study represents a collaboration between Monash University and Corrections Victoria, the Department of Justice and Community Safety (DJCS), Victoria, Australia. The research team was comprised of two researchers from Monash University and one researcher from the DJCS. All researchers are registered psychologists. Reflexivity was achieved through collaboration between the three authors who have expertise in two different fields of psychology: Forensic Psychology and Educational and Developmental Psychology. The first author has a background in working with people exposed to trauma, the second author has extensive experience working and researching in the field of trauma, and the third author has extensive experience working and researching in the area of forensic treatment. All three authors worked together to identify and finalize the themes and subthemes from the thematic analysis (see the Design and Analysis section for more details).
Participants
The participants for this study were recruited from a pool of clinicians working in a business unit within Corrections Victoria, which specializes in forensic assessment and intervention services. The organization provides rehabilitation-focused services for people within the criminal justice system who have been convicted of violent, sexual, alcohol, and drug-related offenses (hereafter referred to as service users). Clinicians who work within Corrections Victoria are qualified in various disciplines, including psychology, social work, occupational therapy, and mental health nursing. They work in prisons or other correctional facilities or community correctional settings, providing assessment or intervention services, or both. Prison- and correctional-based work involves the provision of services to people in prison, on community-based orders, or in other settings under the jurisdiction of Corrections Victoria, such as those on post-sentence-imposed orders. Community-based work involves the provision of services to individuals living in the community who are attending rehabilitation programs under a court-imposed order as an alternative to imprisonment or as a condition of their release from prison on parole (State Government of Victoria, 2022). The role of a clinician involves undertaking assessments, facilitating interventions, making treatment recommendations, and preparing treatment plans, reports, and risk assessments for stakeholders such as community corrections and parole boards (Victorian State Government Department of Justice and Community Safety, 2023). Assessments are completed predominantly on an individual basis, while interventions are predominantly group-based, as is aligned with the broader evidence-base.
Eight clinicians participated in this study, seven of whom identified as women and one who identified as a man (
Materials
Interviews were guided using a semi-structured interview schedule developed by the authors. The interview schedule was informed by schedules previously developed by the second author (e.g., Berger et al., 2022; Davies & Berger, 2019), and by recent evidence specific to use of TIC in corrections settings. The interview questions were open-ended, with follow-up prompts given to elicit additional information or clarification, as required. The questions aimed to capture information across the following areas: (a) perceived prevalence and types of trauma experiences among service users and their perceived impact on recidivism and treatment outcomes (e.g., Based on your experience, how prevalent would you say a history of trauma is among service users?); (b) what TIC means to clinicians and whether and how they apply it in their work with service users (e.g., Can you give me examples of how you apply trauma-informed practice in your work with service users, if at all, and what guides your decisions in these examples?); (c) what TIC policies/processes/tools are available or required by clinicians to support service users (e.g., Can you describe any trauma-informed policies, frameworks, or programs that are available to inform your work with service users, if any?); (d) what TIC professional development/training is available or needed to support clinicians’ work with service users (e.g., What trauma-informed professional development or training is needed to inform your work with service users, such as the content, format, and mode of delivery, if any?); and (e) clinicians’ recommendations for ways in which the delivery of TIC can be improved or better supported (e.g., Can you describe any other policies/frameworks/programs/structures that need to be considered/are not congruent when implementing a trauma-informed policy or program? If any?).
Procedure
Ethical approval for this study was obtained from the Monash University Human Research Ethics Committee (Project Approval Number 31410), and from the Corrections Victoria Research Committee. DCJS staff distributed information about the study via email to all clinical staff working in assessment and treatment services within Corrections Victoria. To obtain as many participants as possible, across a 7-month period an initial email and five reminder emails were sent to all 175 clinical staff in the service requesting their participation in the study. An explanatory statement and consent form were attached to the emails. Clinicians were asked to return the signed consent form with their contact details to the DCJS service staff, who then emailed the completed consent forms to the first author. This process was necessary for ethical reasons so that the researchers would not have access to participant information prior to them consenting to participate. The first author then contacted the participants directly via email to arrange interviews. This process ensured that DCJS staff were not aware of staff who had agreed (or not) to participate in an interview. Interviews lasted between 31 and 67 min (
Design and Analysis
A constructivist qualitative methodology was employed for this study due to the limited literature exploring clinical perspectives on the use of TIC in forensic settings. A constructivist approach is highly suited to exploratory research which seeks to understand how participants construct knowledge on unfamiliar topics (Savin-Baden, & Howell Major, 2013). The interview transcripts were analyzed using constructionist thematic analysis (TA). The analysis was conducted in several stages in line with Braun and Clarke’s (2006) phases of TA. First, each transcript was read and re-read by the first author and initial codes were generated by identifying features of the data systematically across the data set and labeling them with a succinct descriptor. Once the data were coded, the first author organized the codes into potential themes and developed a thematic map. The first author consulted with the second author regarding the thematic map and further refined the themes based on this consultation process, combining similar codes into themes and subthemes. The transcripts were then analyzed and coded by an independent researcher who was not involved in data collection or initial data analysis. This consultation process revealed that both researchers had identified the same themes across the data. Six final themes with subthemes were identified using this process. After analysis of eight transcripts, it was determined through consensus between the researchers that data saturation had been reached.
Results
For the first research question the TA identified one main theme, while three main themes were identified for each of the second and third research questions (with the corresponding subthemes included alongside each main theme; see Table 1). Quotes are included to illustrate the themes and subthemes, with participants’ names replaced with pseudonyms to preserve their anonymity.
Themes and Subthemes of Clinicians’ Perceptions of Trauma-Informed Care (TIC) in Forensic Settings in Victoria
RQ1. In What Ways, If Any, Is TIC Seen as Being Important and/or Useful in a Forensic Setting?
Perceived Need for TIC
All participants reported the view that there is a need for TIC based on their experiences working with service users. One of the reasons they shared was the high rate of trauma among service users. All eight participants reported that while they were unaware of official trauma rates among service users, they believed them to be very high, as evidenced by a clinician’s comment, “I’ve never seen someone in those groups. . . who hasn’t had a really traumatic background.” Another justification given in favor of TIC was the perceived link between trauma and offending. Five participants reported a belief that offending behavior is intrinsically linked to the trauma service users have experienced, and that to address the behavior, the trauma needs to be addressed. One clinician observed that
when you’re looking at people who are very, very traumatized . . . you couldn’t extract the person from the trauma. Because it’s like completely shaped them . . . you can’t even see them . . . So to say that, what he did had nothing to do with what he’s been through, I think you couldn’t because you couldn’t even see him.
Half of the participants opined that trauma is linked to recidivism while the rest were unsure.
RQ2. In What Ways Is TIC Currently Being Used in Forensic Settings in Victoria, Australia?
TIC and Assessment
Five participants reported undertaking assessments with service users in their roles. All reported using TIC in their assessment work. Laura stated, “Don’t disregard the trauma that they’ve had, because . . . it paints a really good picture on . . . what’s brought them to now.” Specific techniques participants described included using a sensitive and responsive approach when exploring trauma in assessment interviews, and incorporating breaks or ending sessions early if service users become overwhelmed. Participants reported that they perceived TIC to be useful in creating a safe space for service users to share their stories, and to elicit necessary information about the service users’ backgrounds to support the assessment process. However, two participants reported a perception that the assessment context can sometimes impede TIC. Jane reported that she perceived that the need to prioritize the collection of the information to assess a service user’s risk of reoffending can mean that there is less room for TIC. She stated,
In a forensic setting, sometimes as clinicians, we have to push a little bit more to get that, um, information that we need to do . . . assessments and scoring . . .compared to . . . other settings . . . clinicians have to push a little bit more.
Laura described her perception that limited time during assessments can prevent clinicians from gathering information about service users’ trauma histories.
TIC and Intervention
Working at the Service User’s Pace
Five participants described that working with service users at their own pace during intervention sessions forms an important part of TIC. The participants described adjusting the pace with which they address trauma depending on the preparedness of the service user to acknowledge past trauma and its role in their offending. Margaret reported,
If someone’s resistant to . . . understanding that they’ve got trauma . . . or hearing what’s got to be said around the trauma . . . that slows it down. Doesn’t mean you stop, but it slows it down.
What Happened to You?
Four participants reported a perception that viewing service users, and helping them to view themselves, through a lens of “what happened to you?” rather than ‘what’s wrong with you?’ is another important part of TIC. Mary observed, “Through trauma-informed practice . . . I think that it's a . . . wonderful thing that they finally started seeing it as complex trauma, rather than just a deficit of the person.” Participants described viewing service user behaviors such as drug and alcohol use, or non-compliant behavior, through a trauma-informed lens. They reported their view that this can be helpful in understanding what might be going on for the service user and how to work with them. Participants reported feeling that this perspective was needed to gain insight into how a service user’s trauma was impacting their thoughts, feelings, and behaviors because, as Kim stated, “These guys are really clever in the way that they protect themselves from the world.”
Effects of TIC on Treatment Engagement and Outcomes
Six participants referred to ways in which, from their perspectives, service users’ trauma histories may negatively impact on their treatment engagement and outcomes. They reported a view that some service users have difficulty addressing their trauma or understanding the connection between their trauma and past offending. They described how, in treatment sessions, they perceived that service users can respond aggressively, have difficulty regulating their emotions and behavior, or refuse to discuss certain topics. Participants reported a view that this can impede service users’ treatment progress or result in withdrawal from treatment programs. Participants described a perceived link between trauma and entrenched maladaptive coping strategies, beliefs, and cognitions that they felt could be difficult to shift in treatment. Participants reported a view that TIC can help service users to understand the link between their experiences of trauma and offending behaviors and can create a safe and respectful therapeutic space for them to engage in treatment.
Responsivity to Triggers
Five participants noted the importance of being responsive to service users’ distress and dysregulation through TIC. They reported a view that trauma-related triggers can impact service users’ ability to engage in treatment. Katie stated, “If they’ve talked about some of that trauma . . . and they’re feeling triggered, it might mean that I have to finish the assessment for that day, and I might have to come back to it at another time.” Participants described navigating carefully around triggering topics and attending closely to service users’ verbal and non-verbal reactions. Participants who delivered group interventions mentioned a view that it can be challenging to minimize individual triggers in a group setting. John observed,
If a service user is talking about . . . their offending against someone, and that parallels someone else’s experience from when they have been offended against, making sure that we just check in with that person . . . to make sure that they’re not triggered . . . because they’re victim and perpetrator.
RQ3. What Factors Facilitate or Impede the Use of TIC in Australian Forensic Settings?
Facilitating and Impeding Factors
Access to Information About Service Users’ Trauma
All participants described numerous ways in which they have access to information about service users’ past trauma experiences, including self-disclosure, reports written during the assessment process, documentation from the judicial process, and prior psychiatric reports or diagnoses of PTSD. How participants described that they use this information to inform their work with service users varied between participants. Two participants explicitly described using the information to formulate an understanding of service users’ presenting difficulties. Kim commented, “In that [the assessment interview] they ask about their childhood, and so that becomes part of the case formulation . . . that predisposing aspect of it.” Two participants reported using the information to determine whether referrals for additional trauma support were needed. All clinicians described using the information to respond in a trauma-informed way in their work with service users.
Space for Clinicians to Confer About TIC
Six participants reported discussing TIC with colleagues. Some reported that these discussions occurred formally during team and supervisory meetings, or during discussion of service user cases in clinical workshops. Others described that discussions of trauma were brought up on an ad hoc basis during pre- intervention planning or post-intervention debriefing sessions with colleagues. Katie commented, “So in debriefing, or it could come up in, you know, pre-briefing, like, you know, so and so might react this way because there’s a bit of a background of such and such.” Some clinicians reported the perception that conversations featuring TIC occur regularly, while others reported a perception that TIC only comes up occasionally. Participants described perceived benefits to discussing TIC with colleagues, including learning new trauma-informed practices, guided decision-making for working with service users exposed to trauma, and helping clinicians manage their own vicarious trauma resulting from exposure to service users’ trauma. John observed, “Being on the other side of that kind of conversation is nice because you kind of become aware of what you take into the conversations we have with service users.”
The Challenges of Mandated Care
Four participants reported that it is not compulsory for service users to participate in assessment and intervention but that non-participation was reported to impact on their eligibility for parole or community order completion. Katie stated, “I guess it’s voluntary, they agree to come into treatment, but really, you know, usually they’re applying for parole . . . that’s also an external factor.” The participants described a perceived tension between delivering TIC and the requirements of the correctional agenda. One participant reported that it was her view that during risk assessments there was sometimes a need to “push” service users to disclose details of their trauma histories to appropriately assess their level of risk, due to the link between trauma experiences and beliefs underpinning offending for some service users. It should be noted that the service policy and direction is that clinical staff need not push service users to disclose details of trauma should the information not be freely given. Participants reported that they believed that if a service user did not want to talk about their offense due to related trauma, this may be viewed unfavorably by the parole board. Further, despite the service direction that service user non-disclosure does not require challenging, Emma commented,
If he’s saying . . . I don’t want to talk about my offence, it causes me trauma, then if I was a normal therapist in a normal environment, then we wouldn’t. But that’s my job, so . . . and that’s why he’s there. So that would become a little bit difficult.
Three of the participants described how they use TIC to manage non-disclosure by collaborating with service users about the best way to disclose their trauma history to meet parole or community order completion requirements.
“Trauma Is Everywhere But It’s Not Really the Focus.”
Five participants reported that they perceived a limited scope in their role to address service users’ past trauma. They reported that their primary role is to reduce the risk of reoffending. John described, “Treating their trauma is not within the scope of that process.” The participants reported feeling reluctant or guilty about asking service users to share their trauma histories during assessment or intervention because the remit of the service is to assess and provide intervention for offense-specific risks. Laura reported,
They tell you this really personal information about . . . say sexual abuse. And . . . there’s not enough time to explore it and . . . I personally feel really guilty. Re-triggering that. And then going, that’s all the time allocated.
It is noted that this response is not aligned with the clinical direction given in the service, which emphasizes the importance of trauma-informed practice and maintaining the therapeutic alliance in intervention and assessment. Five participants reported the view that there is scope to refer service users to other services to receive trauma-specific support. However, there was significant variation in the support options individual clinicians believed were available to service users, ranging from psychiatric support, alerting the service user’s case manager, or encouraging the service user to seek support in the future. Three clinicians described perceived barriers to service users accessing additional trauma support, including service users’ reluctance or lack of financial resources to engage in trauma therapy in circumstances where a free service is unavailable to them.
Availability of Trauma-Informed Tools and Training
Participants differed in their perspectives on the extent to which the assessment and intervention frameworks, tools, and training opportunities are conducive to the provision of TIC. A perceived lack of trauma-informed tools was reported by four participants as being an impediment to the provision of TIC. Emma commented, “In terms of trauma-informed practices that inform our . . . group interventions, or our assessments or our screenings, I am not aware of any.” The group format of treatment interventions was mentioned by three participants as presenting specific challenges. One challenge reported was the perceived need to carefully manage service users’ disclosures of trauma in ways that allow them to share safely without re-traumatizing others in the group. Mary stated, “How do you find the balance where everybody is safe in that space to speak . . . while making it safe for everybody?”
Conversely, half of the participants reported the perception that trauma-informed tools and techniques are incorporated to some extent through the programs and approaches they use with service users. Participants reported a perception that many of these practices are not explicitly labeled as trauma-informed and often form part of other treatment frameworks such as Cognitive Behavioral Therapy approaches. Participants reported using these approaches in trauma-informed ways. John stated,
I feel like in the sex offender treatment space it’s . . . maybe not formalized, but pretty woven in.” Jane commented, “I’d like to believe that all the programs that we run . . . at least draw on . . . some of the principles from the trauma informed care.
Five participants expressed a desire for more explicitly defined trauma-informed tools and techniques to guide provision of TIC with service users, despite such information being included in the induction program for new staff. Kim commented, “The explicit links aren’t made to us around which . . . techniques align with trauma-informed therapy.” Katie stated, “I would like it to be really clear about . . . trauma-informed frameworks or something that we should be following.”
There were also differences in the level of TIC training that participants reported receiving. Three clinicians described having received formal trauma-informed training as part of their induction or professional development. Five participants could not recall or did not describe receiving trauma-informed training. Kim commented, “With particular violence programs, there isn’t an element, like there’s not a section in the training that talks about trauma and how it can, um, pop up.” Five participants stated that they would like to have access to more TIC training. Four participants reported that they had acquired trauma-informed skills and experience over the course of their careers.
Discussion
This study aimed to explore the perspectives of clinicians working with people in the criminal justice system who have experienced trauma to better understand the challenges of using TIC in forensic intervention services. The results of this study indicate that clinicians report incorporating TIC into their clinical practice within the criminal justice system, and that they perceive doing so to be useful.
Consistent with prior research, clinicians reported the perspective that a history of trauma is extremely common among service users, and they reported that this presents specific challenges for clinicians when engaging service users (Levenson et al., 2016). Clinicians described a view that service users with trauma histories may avoid certain topics, have difficulty understanding the connection between their trauma and past offending, and have emotion regulation difficulties. It was also reported that these challenges can impede their responsiveness to treatment, although it must be noted that these were clinicians' views only without the presence of more objective data. Furthermore, due to a lack of descriptive detail in clinicians’ self-reported perspectives, it is not clear on the foundation on which these claims were made. This may speak to either different understandings, or misunderstandings, of appropriate ways to respond to, and explore trauma in offense-specific assessment and intervention. Nevertheless, some prior research has indicated that adverse/traumatic childhood experiences may have a negative impact on service users’ engagement in and completion of rehabilitative treatment programs in a violent offending cohort (Kustrin, 2021). Thus, current results highlight the possibility that trauma may impact on service user engagement or responsiveness to treatment; however, this would need further interrogation using quantitative data to substantiate.
This study identified that from a clinical perspective, there are existing systemic elements that reportedly support the delivery of TIC as an approach when delivering assessments and interventions. These included enabling clinicians to confer with colleagues about TIC, and to have access to information about service users’ trauma experiences. This is consistent with the Power Threat Meaning Framework, which emphasizes the profound impacts that trauma can have on individuals (Johnstone & Boyle, 2018). The results indicate that clinicians perceive that they are readily able to gather information about service users’ trauma histories, and that this information is being considered as part of current assessment and treatment processes. Clinicians reported that this helps them to formulate an understanding of service users’ presenting difficulties in the context of their past experiences, and to determine whether referrals for additional trauma support are warranted. This is in line with utilization of TIC as an approach, rather than an intervention.
To the authors’ knowledge, this is the first study to report on clinicians’ perceptions of integrating TIC into existing treatment approaches with service users who have experienced trauma by considering and addressing the impacts of trauma when delivering offense-specific intervention to this cohort. The results indicate that clinicians in a forensic setting perceive using a trauma-informed approach to be beneficial in their work with the people they work with. These findings imply that it may be useful for other jurisdictions to implement a TIC approach into forensic rehabilitation services. However, as noted previously, further research, particularly cross-jurisdictional research, is warranted.
The findings also highlight clinical perspectives that there may be systemic opportunities to better facilitate the integration of TIC into existing intervention services. The provision of professional development to increase clinicians’ competence was one such area highlighted by clinicians. Four clinicians indicated that they felt competent to deliver TIC as a result of training they have received and their own previous professional experience. However, five clinicians perceived a need for more trauma-informed professional development to be made available to them. It is notable that five participants in the current study reported being unable to recall having access to trauma-informed training opportunities in their current role, despite such training being included in the service’s internal induction program for new staff. However, there was also significant variation in reported support options available to service users, ranging from psychiatric support, alerting the service user’s case manager, or encouraging the service user to seek support. It should be noted that these disclosures were in conflict with existing processes to refer service users to specialized services designed to address mental health difficulties such as those relating to trauma, elsewhere within the justice system. Further, some participant responses implied that TIC is a specific intervention rather than a universal approach that is applied across settings and organizations, indicating a possible lack of clarity among clinicians regarding what TIC is. This suggests that, from a clinician's perspective, TIC training or resources in the system may need to be more accessible, or that staff may benefit from being encouraged to ensure attendance at scheduled training opportunities. From a clinician's perspective, this may include the active pursuit of internal TIC training opportunities and regular connection with trauma-specific mental health services in the system. The findings may also suggest that forensic workplaces should implement practices to track, and encourage, staff attendance at TIC trainings, or should otherwise reinforce workplace policies requiring TIC to be incorporated into treatment protocols.
These results demonstrate that clinicians perceive adequate training to be integral to the successful implementation of TIC within a forensic system to improve staff knowledge of and confidence in using TIC. This finding adds to Mann’s (2018) study, in which mental health staff suggested increased staff training in trauma-informed practices may improve treatment outcomes in service users with trauma. However, research into the effectiveness of TIC training for forensic clinicians is scarce. Large sample, quantitative studies are needed to verify the long-term efficacy of TIC training for clinicians in terms of reducing offense-specific risk and improving mental health outcomes for service users in forensic settings.
Another area of challenge participants identified perceiving was the limited availability of clear, structured, trauma-focused resources to support the integration of TIC into existing treatment approaches. Half of the participants reported the perception that trauma-informed approaches are incorporated to some extent through offense-specific programs. However, five participants expressed a desire for resources that link TIC with offense-specific treatment more explicitly. Proponents of TIC have attempted to address the issue of resourcing and role-scope limitations when suggesting approaches for implementing TIC in forensic settings (e.g., Miller & Najavits, 2012). However, much of the focus in this area is around the implementation of trauma-specific interventions rather than integrating TIC with existing rehabilitation approaches. Levenson (2014) described specific strategies that clinicians can use to deliver treatment programs in ways that recognize the prevalence and impact of trauma on behavior across the lifespan. The current findings show that clinicians are implementing some of these strategies in their rehabilitation work with service users. For example, Levenson recommended incorporating opportunities to model and rehearse healthy interactions within the therapeutic environment when delivering offense-specific treatment. This purportedly teaches service users’ more successful strategies for relating to others and meeting emotional needs in non-victimizing ways (Levenson, 2014). The current findings align with this recommendation: clinicians reported using the therapeutic relationship to model and teach respectful, positive relational skills. This aligns with a specific focus in existing offense-specific interventions in Victoria, on modeling and rehearsing healthy boundaries and respectful interaction patterns within the group setting. However, while clinicians described using TIC to navigate the specific challenges that exist when delivering group interventions to service users, they also identified a perception that it can be difficult to minimize individual triggers in a group setting. These findings imply that while TIC can support the delivery of group-based interventions, balancing TIC and the dynamics of group therapy can present unique challenges for clinicians. Such challenges were also identified by Levenson (2014). More research on this balance is needed to better understand how TIC can be utilized effectively in group settings and the practical implications on treatment efficacy within forensic intervention services.
Taken together, these findings extend upon existing recommendations and findings within the literature, suggesting that clinicians report that TIC is being implemented in Victorian correctional settings. However, some clinicians reported a perception that there were tensions between the implementation of TIC and the correctional agenda. Given that consideration and management of trauma is an explicit part of clinical guidance given within offense-specific services in Corrections Victoria (2017, 2021), future studies may be required to explore whether this view is systemic or limited to the small number of participants in the current study. Nevertheless, this study provides important insights into clinical perspectives of the use of TIC in forensic settings. The findings suggest that clinicians believe TIC can be delivered within the framework of current Victorian correctional policy. However, the efficacy of integrating TIC into existing treatment approaches to support the broader correctional goal of reducing recidivism remains an understudied area. More large-sample, quantitative studies are needed to better understand the long-term impacts of such an approach in terms of improving service user rehabilitation and mental health outcomes.
Limitations and Directions for Future Research
While this study offers some unique insights into the perspectives of clinicians working with TIC in Victoria, the results should be considered in the context of several important limitations. First, the sample size of eight clinicians used for this study is small, and the sample was drawn from clinicians working within the forensic system of one Australian state. This may limit the generalizability of the research findings, as the participants sampled may not accurately reflect the characteristics of the broader clinician population. There are important jurisdictional and legislative differences between the states and territories in Australia in terms of their approaches to forensic assessment and treatment, and remit over this. As such, it is unclear to what extent findings from Victoria may apply to other jurisdictions. Mandates and guidelines for rehabilitative programs are legislated at a state-based level, and the type, intensity, and theoretical underpinnings of rehabilitation programs differ from state to state (Heseltine et al., 2011; O’Sullivan, 2014). Future research could replicate this study with a sample of clinicians in other areas of Australia and internationally.
Second, the study sampled across both community- and prison-based forensic settings, and a range of clinician experiences and backgrounds. However, Corrections Victoria and DJCS ethical requirements of participant anonymity did not allow data on participants’ specific workplace setting or professional background to be captured. It would be valuable for future research to collect such data to understand unique differences in participants’ perceptions of TIC in forensic services. This may enhance understanding of how TIC can be implemented most effectively in different settings and the variables that moderate how clinicians understand and use TIC. To capture differences between clinicians of different characteristics and backgrounds, future research could use survey data to explore their perceptions and experiences of delivering TIC to service users. There may also be gender differences in how clinicians understand and use TIC, which may have biased some perspectives shared by participants. It would be valuable for future research to collect quantitative data with a sample of men and women clinicians to understand any gender differences in how they understand and apply TIC in their work.
Third, comments about the impact of trauma on treatment engagement and outcomes came from clinicians’ perspectives only, and no conclusions about recidivism can be made on the basis of these data. Further, the clinical opinions reported on in the current study were not cross-checked with policies, procedures, or broader statistics provided by the offense-specific rehabilitation service or the correctional system more broadly. Further study and support from quantitative data would be needed to clarify whether or not trauma may have any impact on the efficacy of offense-specific treatment, in terms of recidivism.
Fourth, it is possible that the clinicians who volunteered to participate in this study were motivated to do so because of their own interest in or awareness of TIC, or potential existing views of strengths or limitations of the use of TIC within the correctional setting. Therefore, the perspectives of participants may not be representative of the broader population of clinicians working in the forensic system. This limitation could be overcome in future research by surveying clinician perspectives relating to TIC alongside non-trauma-related topics to attract participation by clinicians with a broader range of interest areas.
Further, this research focused only on clinicians’ perspectives on TIC. It is important that future research explores the perspectives of service users regarding their experiences of TIC in offense-specific intervention and assessment services. This may reveal important differences between the experiences of providers and service users in terms of TIC delivery and its impact on offense-specific rehabilitation.
Finally, the results of this and previous studies indicate that clinicians perceive high rates of trauma among service users. However, the current study did not explore rates of vicarious trauma or burnout in staff. Exploration into the prevalence and impact of vicarious trauma and burnout among clinicians in forensic services, and how organizations can support staff wellbeing to enhance TIC, are important areas for future research.
Conclusion
This study examined the perspectives of forensic clinicians on the integration of TIC into offense-specific clinical practices. Results indicate that forensic clinicians perceive implementing TIC in their work with service users as useful. Aspects of the forensic system that are currently perceived to support TIC were identified, including enabling clinicians to access information about service users’ trauma histories and providing them opportunities to confer with colleagues about TIC, as well as formalized training opportunities on integrating TIC into clinical work for all staff. Perceived opportunities to adjust current practices were also identified, including correcting misconceptions about the implementation of TIC in correctional settings, and making clear to some clinical staff how TIC is explicitly connected with existing offense-specific intervention and assessment work. These results suggest that from a clinician perspective, rehabilitation efforts in forensic settings benefit from incorporating trauma-informed approaches, and this may make treatment more accessible for those who have experienced trauma across Australian correctional systems.
