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Trauma impacts people's coping mechanisms with their ability to function posing risks to their capacity to manage and respond appropriately to stressors, and to recover. Trauma informed care recognises the needs of survivors by focusing on system-wide design and support during recovery, minimising the risk of re-traumatisation, and maximising choice and empowerment for new adaptations and post-traumatic growth. The principles of TIC are currently not being fully utilised in burns practice, including for severe burns, with the nature, extent and impacts of trauma not being fully understood or acknowledged. Those who sustain a burn injury have an increased risk for developing psychosocial issues that can extend to the family unit, and people with pre-existing mental disorders are more likely to sustain a burns injury, experiencing extended hospitalisation and rehabilitation and being less likely to adhere to burns care. With the application of trauma-informed care within the burns setting, along with an understanding and acknowledging the link between trauma, burns injuries and mental health, health care professionals can minimise potential negative psychological impacts. Investing resources is now essential to effectively address the "trauma deficit" in the area of burns recovery., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)

Trauma-informed care (TIC) is a model for the relationship of care between service users and service providers that recognises the importance of trauma, past and present, on that person's experiences, vulnerabilities and recovery. Burn injuries are a complex area of healthcare where trauma and the mental health disorders associated with trauma can both precede and proceed a burns injury with complications for recovery. Incorporating a model of TIC in the assessment and treatment of burns patients will proactively work to mitigate and arrest trauma responses, mental disorders and their sequelae in this population. With reference to the existing TIC knowledge base, we propose development of a model for the TIC of burns patients divided into three stages; before, during and after initial engagement with the patient. In the before stage, TIC will require clinical-level change, organisational integration, training and time. In the during stage, five elements are identified; creating safety, screening, collaborative inclusion of the patient in the intervention and recovery planning process, psychoeducation of the patient and supporters, and the use of peer-led services. In the after stage, patients need to be proactively supported through outreach and follow-up. Implementation of a trauma-informed model of care for burns injury patients provides significant opportunities to burns services and benefits towards their patients' recovery., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Research into recovery and adjustment after burn injury has indicated a link between psychopathological symptoms including traumatic stress, distress, depression and anxiety, and worse psychosocial and physical outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, and symptoms can be ongoing in certain patients for extensive periods, leading to a need for early screening in burns patients for psychological vulnerabilities. One potential factor influencing recovery from the psychological impact of burn injury is adult attachment style, specifically secure and insecure attachment, as this describes how an individual organizes their stress regulation. This cross-sectional study measured: (a) attachment style (via the Relationship Questionnaire [RQ]): (b) negative psychological symptoms (via the Depression Anxiety and Stress Scale [DASS]); and, (c) post-traumatic symptoms (via the Davidson Trauma Scale [DTS]) in a cohort of burns patients (n = 104, 51 analysed) in a severe burns unit in Australia during the acute phase of their recovery. Secure attachment style was inversely related to psychopathological symptoms. Secure participants scored significantly lower scores on the DASS (M = 17.63, SD = 17.07) compared to self-rated insecure participants [(M = 42.38, SD = 34.69), p < .01] and on the DTS (M = 14.22, SD = 15.42) compared to insecure participants [(M = 40.54, SD = 35.72), p < .01]. Similar results were found in analyses controlling for covariates of gender, age and burn severity as potential confounders. This research suggests attachment style may play an important role in psychosocial recovery from severe burn injury., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)