Introduction
Following the publication of Inclusion’s Trauma-Informed Practice Guidance, services are working to embed these principles in everyday practice. This is a case study from our STaRS drug and alcohol service in Staffordshire. It follows JO, a 22-year-old female with a history of alcohol and opiate dependency. JO had never been into mainstream services prior to her appointment. JO had recently fled a domestic abuse relationship in North Yorkshire and has started sofa surfing with friends within the Stafford borough district.
Pre-Appointment: Laying the Foundations for Safety
Before meeting JO, preparation was prioritised to reduce the likelihood of her needing to repeat distressing information. As JO had only previously completed an assessment over the phone with the assessment and engagement team, all available notes were reviewed in advance. This ensured the appointment could focus on building rapport rather than revisiting unnecessary details.
The environment was also considered carefully. A suitable room was booked to ensure privacy, comfort, and a calm setting for the key working session.
JO arrived five minutes late and appeared out of breath, as though she had rushed to attend. On entering the room, she was greeted warmly and reassured that it was a pleasure to meet her, with the intention of helping her feel as comfortable as possible. Mindful of the “hypothetical bag pack”, the unseen experiences and emotional weight she may be carrying, she was asked how her journey had been and offered a drink of water, which she accepted. She was also encouraged to take a moment to sit and catch her breath.
Once JO appeared more settled, she was gently asked, “Are you okay if we go through things now?”, ensuring she remained in control of the pace and direction of the session.
Creating a Safe and Supportive Environment
Once seated in the room, it was noted that JO was shielding her eyes from the glare of the sun. She was offered the option to change seats or close the blinds, while ensuring that all policies and safety procedures remained in place. Small adjustments such as these can have a significant impact on a person’s comfort and sense of control.
At the start of the appointment, JO was informed that at any point she could choose to stop or leave the session without needing to explain why. This is a core trauma-informed principle – ensuring that individuals feel in control of their engagement and are not pressured to continue if they feel unsafe or overwhelmed.
Recognising and Responding to Anxiety
During the session, JO appeared visibly anxious, with shaking hands and sweaty palms. This was gently acknowledged, and she confirmed that she was feeling nervous. Rather than assuming what might help, she was asked what usually supports her in these moments. JO shared that she had not previously used any calming techniques.
Box breathing was introduced as a simple and accessible grounding strategy. She was guided through the technique, and time was taken to practise it together. Once she felt more settled, she agreed to continue with the session.
This approach reflects the importance of pacing, co-regulation, and offering practical tools that individuals can use beyond the appointment.
Supporting Trauma Disclosure
While discussing her history of substance use, JO became visibly upset. It was recognised that this topic may have triggered a deeper emotional response. Instead of asking “what’s wrong with you?”, the approach remained trauma-informed: “what happened to you?”
JO disclosed that she had been raped at the age of 13 by her father’s best friend. She was thanked for her courage in sharing such a painful experience, and her disclosure was met with empathy and without judgement.
It was acknowledged that, while support could continue within the service, there may be limitations in providing specialist trauma intervention. As a result, appropriate services in the area with expertise in this field were discussed. JO agreed to a referral to a Sexual Assault Referral Centre (SARC).
Reassurance was provided that she would not be left to navigate this alone. Ongoing support was offered, including the option to attend appointments with her if that would help her feel more comfortable. This reinforces continuity of care and reduces the risk of re-traumatisation through fragmented services.
Ending the Session with Choice and Clarity
At the end of the appointment, JO was asked if there was anyone she would like contacted for additional support. She was also provided with relevant contact numbers to ensure she had access to help outside of scheduled sessions.
Clear information was given about the flexibility of future support. JO was informed that, depending on her preference, appointments could take place either in the community or within the service setting. She was also asked about her preferred location, times, and frequency of appointments – ensuring that her voice remained central in planning her care.
Allowing Time for Decompression
Following the appointment, and with vicarious trauma in mind, time was set aside for a 10–15 minute period of decompression. This included contacting a manager for a debrief to reflect on the session and ensure safe, supported practice.
Once this time had been taken, a follow-up message was sent to JO to maintain connection and provide reassurance:
“Hi JO, Its June from Stars, it was lovely to meet you today. Thank you for attending and engaging so well, I am looking forward to working with you. Please see the details of your next appointment below”
This approach supports both practitioner wellbeing and continuity of care, reinforcing trust, consistency, and ongoing support beyond the session.