Paddy McNally is a consultant clinical psychologist who has spent most of his career focusing on applying trauma-informed care principles to those supporting people with learning disabilities. He has published "A Framework for the Implementation of trauma-informed care in Residential and Supported Living Services for Adults with a Learning Disability", which is freely available online.

In today's conversation, we talk specifically about the moments of 'stuck-ness' - when the relationships between a person and the team serving them appear to be stuck in circular interactions. This can feel very frustrating to everyone, and lead to feelings of hopeless.

Paddy explains how we can understand these moments as being enactments of past trauma being played out unconsciously in the relationships and interactions - or even the organisation or system - around a person. However, once noticed, even a small change in the interaction can bring some relief to everyone.

The conversation emphasizes the need for organizational support and reflective practices to create a safe and effective care environment. Ultimately, the significance of human connection in the healing process is paramount.

Chapters

00:00Introductions

02:24Understanding Trauma-Informed Care Principles

05:21The Impact of Trauma on Care Relationships

08:11Enactments in Care Teams

10:58Breaking the Cycle of Trauma in Care

13:34The Role of Staff Reflection and Support

16:18Creating Safe Spaces for Staff

19:03The Importance of Organizational Support

21:43Navigating Crisis in Care Settings

24:24The Path to Recovery for Care Teams

27:03Conclusion: The Human Experience in Care

In the final episode in this series, Bev and Jen discuss the complexities of implementing trauma-informed practices in settings supporting people with severe learning disabilities.

They draw on their own experiences to break down the challenges, and why 'off-the-peg' trauma-informed models can fall short when it comes to non-speaking individuals. They go on to discuss what sorts of engagements and tools they utilise to build spaces that help those with little or no spoken communication feel seen, heard and safe-enough to begin to process their experiences and overwhelming emotions.

This final conversation draws to a close this series focused on the challenges and possibilities for creating spaces that allow those with severe learning disabilities to heal from traumatic experiences.

In this conversation, Bev and Jen explore the emotional and psychological costs associated with care work, particularly in direct care settings. They discuss the challenges of managing vicarious trauma, the importance of support systems, and the need for self-care among care workers. The dialogue emphasizes the significance of creating a supportive environment that acknowledges the emotional toll of the work and promotes recovery and regulation for both staff and those they care for.

We discuss the place for boundaries inside trauma-informed practice, particularly in educational settings - that 'no' is both a trauma-informed word and a kind word in the right context. They discuss the importance of understanding trauma in students, the necessity of boundaries, and the balance between compassion and discipline. The dialogue emphasizes the role of relationships in healing and the need for a nuanced approach to care that recognizes both the costs and benefits of emotional investment in vulnerable individuals.

Jen and Bev explore the principles of empowerment, choice and voice in the context of trauma-informed care with people with severe learning disabilities. They delve into the significance of balancing spontaneity and routine, the emotional growth that comes from navigating disappointment, and the necessity of creating safe spaces for healing. The discussion also touches on family dynamics, fairness, and the importance of boundaries in fostering empowerment and understanding.

This conversation explores the dynamics of trust, transparency, and community in care settings, emphasizing the importance of emotional honesty and resilience.

Bev and Jen discuss their personal experiences and insights into how relationships and organizational culture impact the well-being of young people, particularly those with learning disabilities.

They highlight the need for a shift towards more open communication and the establishment of boundaries to create safer environments for both caregivers and those they support.

In this conversation, Bev and Jen delve into the principles of collaboration and mutuality, particularly in the context of trauma-informed care.

They explore how collaboration can dismantle power structures, the importance of respecting a person's autonomy, and the transformative experiences that arise from mutual trust and understanding.

Through personal anecdotes and professional insights, they highlight the challenges and rewards of fostering genuine connections that prioritize emotional safety and internal change.

In this conversation, Bev and Jen focus on safety – one of the core principles of trauma-informed care.

They start with some thoughts about how quickly psychological safety can get shaken, and then drill down into the role of relationships in creating safe, supportive environments particular in setting supporting people with severe learning disabilities.

They also touch on the complexities of dependency versus attachment in care settings and the need to value relationships over mere resources in caregiving.

In this conversation, Jen and Beverley discuss the challenges faced by young people with learning disabilities dealing with trauma and the importance of understanding their stories, when these can be found.

Discussing Bev’s Churchill Fellowship visits to the UK, Jen asks about the cultural differences in trauma-informed care between the UK and the USA, highlighting the role of therapy and the need for organizational change to embed trauma-informed principles. They explore the importance of choice and empowerment in care settings and the ongoing journey towards effective trauma-informed practices.

In this conversation, Bev and Jen use a discussion about the pandemic as a springboard into thinking about the different experiences of trauma, and the way we can recover.

They talk through understanding trauma as a bodily experience and the necessity of creating safe environments for recovery.

Applying this to examples of different ways of understanding presentations of young people with learning disabilities they have supported, they begin to think about the need for trauma-informed care and the complexities involved in helping individuals adapt from a state of fear to one of safety and trust.