The Trauma-Informed Care Supportive Climate Scale for Forensic Services: Development and preliminary validation.

Abstract

OBJECTIVE: Increasingly, secure hospitals (psychiatric hospitals with locked wards) are looking to incorporate trauma-informed approaches into their work or believe that they are already doing so. However, there are currently no psychometrically valid scales available to measure the extent to which people admitted to secure hospitals experience them as trauma-informed. This study aimed to develop and validate the Trauma-Informed Care Supportive Climate Scale for Forensic Services (Forensic TICSCale). METHOD: A preliminary 22-item scale was generated from data derived from focus groups with patients in a low-secure service. (Secure psychiatric facilities in the United Kingdom are categorized by three levels of security: low, medium, and high, depending on how much restriction is required to manage risks to self and others. The term "secure" is often used interchangeably with "forensic" to denote that many patients are there as a result of contact with the criminal justice system.) The items were refined by expert review, and a 22-item pilot scale was formed. The scale was administered to 80 patients residing in low- and medium-secure hospitals across England. Measures of helping alliance and restrictiveness were also administered as indicators of convergent validity. The dimensionality of the scale was assessed using principal component analysis. Internal consistency and test-retest reliability were also assessed. RESULTS: Principal component analysis revealed a unidimensional structure. Three items were removed due to low factor loadings. Thus, the final Forensic TICSCale comprised 19 items. The Forensic TICSCale significantly positively correlated with helping alliance and significantly negatively correlated with restrictiveness. Internal consistency of the Forensic TICSCale was very good, and test-retest reliability was strong. CONCLUSIONS: Further research is required to strengthen the psychometric properties of the Forensic TICSCale; however, it offers a promising first step toward developing a robust measure of trauma-informed care-supportive climates in secure services. (PsycInfo Database Record (c) 2026 APA, all rights reserved).